Less Invasive Anesthetic Methods Better for Endovascular Aneurysm Repair

Fewer complications, and reduced length of stay and cost, reported as benefits

WINSTON-SALEM, N.C. – Thursday, Oct. 27, 2011 – Researchers have identified a safer, more cost effective way to provide anesthesia for patients undergoing endovascular repair of an abdominal aortic aneurysm.

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.

EVAR 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.

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,” said study co-author Matthew S. Edwards, BA, MS, MD, a professor of vascular and endovascular surgery and public health sciences at Wake Forest Baptist.

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).

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.