Featured Research

from universities, journals, and other organizations

Less invasive anesthetic methods better for endovascular aneurysm repair

Date:
December 27, 2011
Source:
Wake Forest Baptist Medical Center
Summary:
Researchers have identified a safer, more cost effective way to provide anesthesia for patients undergoing endovascular repair of an abdominal aortic aneurysm -- a common, often asymptomatic condition that, if not found and treated, can be deadly.

Researchers have identified a safer, more cost effective way to provide anesthesia for patients undergoing endovascular repair of an abdominal aortic aneurysm -- a common, often asymptomatic condition that, if not found and treated, can be deadly.

A new study done by investigators at Wake Forest Baptist Medical Center found that using less invasive spinal, epidural and local/monitored anesthesia care (MAC) is better than general anesthesia for elective endovascular repair of infrarenal abdominal aortic aneurysms (EVAR).

Details of the research appear in the November issue of the Journal of Vascular Surgery, the official publication of the Society for Vascular Surgery.

Aortic aneurysms are abnormal bulges, or "ballooning" in the walls of the aorta, the body's largest artery. Roughly the diameter of a garden hose, this artery brings oxygen-rich blood from the heart to the rest of the body. It extends from the heart down through the chest and abdominal region, where it divides into a blood vessel that supplies each leg. Although an aneurysm can develop anywhere along the aorta, most occur in the section running through the abdomen (abdominal aneurysms). An infrarenal abdominal aortic aneurysm is one that occurs in the belly, below the kidney arteries.

Occasionally an aneurysm may occur because of an area of weakness within the artery wall. An aortic aneurysm is serious because it may rupture, causing life-threatening internal bleeding. The risk of an aneurysm rupturing increases as the aneurysm gets larger. Each year, approximately 15,000 Americans die of a ruptured aortic aneurysm, however the condition is usually asymptomatic until the point of rupture. As such, most aortic aneurysms are unexpectedly identified while a patient is having a computed tomography (CT) scan or ultrasound done for another condition. Men over the age of 65 with a history of ever smoking can have an ultrasound done to specifically screen for aneurysms as part of a "Welcome-to-Medicare" visit with their physician. When detected in time, an aortic aneurysm can usually be repaired with surgery.

Infrarenal abdominal aortic aneurysms make up about 95 percent or more of abdominal aortic aneurysms and, while they occur in both sexes, they are most prevalent in men older than 60, affecting about 3 percent of this population, explained study co-author Matthew S. Edwards, B.A., M.S., M.D., a professor of vascular and endovascular surgery and public health sciences at Wake Forest Baptist.

"That's a lot of people," Edwards said. "If aortic aneurysms aren't repaired, they can burst and 80 to 90 percent of people who have a ruptured aortic aneurysm die. It's necessary for those who are suitable candidates for surgery to have their aneurysms repaired."

EVAR has completely revolutionized the care of aneurysms, allowing doctors to do repairs through two small incisions in the groin, Edwards said. It is currently the most common procedure for repairing aortic aneurysms in the United States. Historic trends have led to general anesthesia being the most common mode of anesthesia used for this procedure, but it is sometimes associated with the development of pneumonia, the need for a breathing tube and other pulmonary complications, he explained.

Other anesthetic techniques can also be used, such as local anesthesia, local anesthesia plus sedation (called "monitored" or "MAC"), spinal anesthesia and epidural anesthesia. According to this study, these other methods result in a shortened hospital stay and fewer pulmonary complications.

"In our study, general anesthesia was associated with increased postoperative length of stay (LOS) and increased complications involving the lungs when compared to the other anesthetic methods," Edwards said.

The researchers collected data on 6,009 patients who had elective EVAR performed between 2005 to 2008 at one of 221 North American hospitals. General anesthesia was used in 4,868 of the cases, while 419 patients had spinal anesthesia during their procedure; 331 had epidural anesthesia; and 391 had local/MAC. Emergency cases and patients who had other procedures being done at the same time that required general anesthesia were excluded from the study.

The team then reviewed the data to evaluate rates of mortality, morbidity and length of stay (LOS), or how long the patient remained in the hospital after the procedure.

The researchers found that general anesthesia was associated with an increase in pulmonary complications when compared to spinal and local/MAC anesthesia. Use of general anesthesia also was associated with a 10 percent increase in LOS for general when compared to spinal anesthesia, and a 20 percent increase when compared to general versus local/MAC anesthesia. Trends toward increased pulmonary complications and LOS were not observed for general versus epidural anesthesia. No significant association between anesthesia type and mortality was observed.

"Our study data suggest that increasing the use of less invasive anesthetic techniques, when appropriate, may limit postoperative complications in EVAR patients," Edwards said.


Story Source:

The above story is based on materials provided by Wake Forest Baptist Medical Center. Note: Materials may be edited for content and length.


Journal Reference:

  1. Matthew S. Edwards, Jeanette S. Andrews, Angela F. Edwards, Racheed J. Ghanami, Matthew A. Corriere, Philip P. Goodney, Christopher J. Godshall, Kimberley J. Hansen. Results of endovascular aortic aneurysm repair with general, regional, and local/monitored anesthesia care in the American College of Surgeons National Surgical Quality Improvement Program database. Journal of Vascular Surgery, 2011; 54 (5): 1273 DOI: 10.1016/j.jvs.2011.04.054

Cite This Page:

Wake Forest Baptist Medical Center. "Less invasive anesthetic methods better for endovascular aneurysm repair." ScienceDaily. ScienceDaily, 27 December 2011. <www.sciencedaily.com/releases/2011/10/111027125151.htm>.
Wake Forest Baptist Medical Center. (2011, December 27). Less invasive anesthetic methods better for endovascular aneurysm repair. ScienceDaily. Retrieved July 30, 2014 from www.sciencedaily.com/releases/2011/10/111027125151.htm
Wake Forest Baptist Medical Center. "Less invasive anesthetic methods better for endovascular aneurysm repair." ScienceDaily. www.sciencedaily.com/releases/2011/10/111027125151.htm (accessed July 30, 2014).

Share This




More Health & Medicine News

Wednesday, July 30, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Health Insurers' Profits Slide

Health Insurers' Profits Slide

Reuters - Business Video Online (July 30, 2014) Obamacare-related costs were said to be behind the profit plunge at Wellpoint and Humana, but Wellpoint sees the new exchanges boosting its earnings for the full year. Fred Katayama reports. Video provided by Reuters
Powered by NewsLook.com
Concern Grows Over Worsening Ebola Crisis

Concern Grows Over Worsening Ebola Crisis

AFP (July 30, 2014) Pan-African airline ASKY has suspended all flights to and from the capitals of Liberia and Sierra Leone amid the worsening Ebola health crisis, which has so far caused 672 deaths in Guinea, Liberia and Sierra Leone. Duration: 00:43 Video provided by AFP
Powered by NewsLook.com
At Least 20 Chikungunya Cases in New Jersey

At Least 20 Chikungunya Cases in New Jersey

AP (July 30, 2014) At least 20 New Jersey residents have tested positive for chikungunya, a mosquito-borne virus that has spread through the Caribbean. (July 30) Video provided by AP
Powered by NewsLook.com
Generics Eat Into Pfizer's Sales

Generics Eat Into Pfizer's Sales

Reuters - Business Video Online (July 29, 2014) Pfizer, the world's largest drug maker, cut full-year revenue forecasts because generics could cut into sales of its anti-arthritis drug, Celebrex. Fred Katayama reports. Video provided by Reuters
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins