Cameron Cartier, DO
Journal of Cardiothoracic Anesthesia, Feb 2004
“Combined epidural and general anesthesia”
Are epidurals associated with better
patient outcome for infrarenal abdominal aortic surgery? This particular study was a randomized,
prospective study to test that hypothesis.
This study was carried out at New York Medical College, and randomly
selected patients undergoing infrarenal abdominal aortic surgery into two
groups: the first group received a combination of an epidural with “light”
general anesthesia, and the second group received general anesthesia
alone. Great care was taken to monitor
the hemodynamic status intra-operatively in both groups, as well as monitoring
closely how patients did post-operatively.
After the cross-clamping of the aorta, the cardiac index and pulmonary
capillary wedge pressures did not change significantly in the group that
received the epidural, whereas the patients who received general anesthesia
alone had a significant drop in cardiac index as well as an increase in
pulmonary capillary wedge pressure.
Post-operatively, the patients who received the epidural demonstrated
less incidence of ventilatory dependent respiratory failure, less vasodilatory
requirements, and shorter stays in the ICU.
Based on these findings, this article recommends the use of combined
epidural/general anesthesia for patients undergoing this particular
surgery. Possible limitations of this
study are that this study was only performed in one hospital, which leads to a
relatively small patient population
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