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Local anesthesia for endovascular abdominal aortic aneurysm repair
E L G Verhoeven1, C S Cinà, I F J Tielliu
1Department of Surgery, University Medical Center, McMaster University. e.l.g.verhoeven@chir.umcg.nl
Journal of Vascular Surgery
|September 21, 2005
Summary
Local anesthesia (LA) is a feasible and safe anesthetic strategy for endovascular aneurysm repair (EVAR), reducing complications and recovery times compared to regional (RA) or general anesthesia (GA). This approach prioritizes LA for EVAR, reserving other methods for specific indications.
Area of Science:
- Vascular Surgery
- Anesthesiology
- Patient Outcomes
Background:
- Endovascular aneurysm repair (EVAR) is a common treatment for abdominal aortic aneurysms (AAA).
- Anesthetic strategies for EVAR typically involve general anesthesia (GA) or regional anesthesia (RA).
- The safety and efficacy of prioritizing local anesthesia (LA) for EVAR require further investigation.
Purpose of the Study:
- To evaluate a unified anesthetic strategy for EVAR using predominantly local anesthesia (LA).
- To compare outcomes between LA, regional anesthesia (RA), and general anesthesia (GA) in EVAR patients.
- To assess the feasibility and tolerability of a LA-first approach for EVAR.
Main Methods:
- Prospective continuous cohort study of 239 patients undergoing elective EVAR between 1998 and 2003.
- Patients were stratified into three groups based on anesthetic strategy: LA, RA, or GA.
- Primary outcomes included all-cause mortality, cardiac morbidity, respiratory complications, and renal failure; secondary outcomes assessed conversion rates, analgesic use, and time-related recovery metrics.
Main Results:
- LA was associated with significantly lower complication rates compared to GA (P < .001).
- Patients receiving LA experienced shorter operating times, intensive care unit stays, hospitalizations, and faster ambulation and oral intake resumption.
- Conversion to GA was required in only two LA patients (1.2%), and 13% needed additional sedation/analgesia.
Conclusions:
- A preferential LA strategy for EVAR, reserving RA or GA for specific indications, is feasible and well-tolerated.
- This approach demonstrates potential for improved patient recovery and reduced complications in EVAR procedures.
- LA-based anesthesia offers a safe and effective alternative for a significant proportion of EVAR patients.