Pancreaticoduodenectomy under epidural anesthesia without endotracheal intubation for the elderly

To evaluate the efficacy of a single application of epidural anesthesia without endotracheal intubation for pancreaticoduodenectomy (PD), the data on 30 patients who underwent PD were analyzed for their operative morbidity and mortality. These patients were classified into two groups according to the type of anesthesia performed: 15 received epidural anesthesia alone (Group I) and 15, general anesthesia under endotracheal intubation (Group II). The clinical characteristics of the patients in both groups were comparable at the time of operation, except that Group I included a significantly larger proportion of elderly patients than Group II (p < 0.05). Postoperative pulmonary complications (PPCs) occurred in 5 (33.3%) of the Group II patients, especially in elderly patients who underwent lengthy operations, whereas no such complications occurred in the Group I patients (p < 0.05), even in elderly patients with a long operating time. The curability of the malignant tumors and the incidences of other complications were not significantly different between the two groups. These findings suggest that a single application of epidural anesthesia is effective in preventing PPCs when performing a time-consuming PD, especially in elderly patients.