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General versus epidural anesthesia for femoral-popliteal bypass surgery

1990; Elsevier BV; Volume: 2; Issue: 2 Linguagem: Inglês

10.1016/0952-8180(90)90056-9

1873-4529

Michael C. Damask, Charles Weissman, George Todd,

Anesthesia and Neurotoxicity Research

This study examines whether epidural anesthesia is more effective than general anesthesia using an inhalation agent in controlling cardiovascular responses during femoral-papliteal bypass surgery. Nineteen patients were randomized into two groups: general anesthesia (n = 10) and epidural anesthesia (n = 9). The patients who underwent general anesthesia received sodium pentothal and succinylcholine for induction of anesthesia and 60% N2O, 40% O2, and 1% to 1.5% isofurane for maintenance. Fifteen minutes before extubation, the patients received morphine sulfate 0.05 mglkg intravenously (IV). The group that underwent epidural anesthesia received anesthesia to T-10 (through a catheter placed in the L4–5 interspace using 3% 2-chloroprocaine). Thirty minutes after the last dose, 0.05 mg/kg IV was administered. Hemodynamic variables were recorded at selected intervals during the operation and for 60 minutes in the recovery room. In the general anesthesia group, mean arterial pressure (MAP) and rate pressure product (RPP) significantly decreased (p < 0.05) during the operation as compared with preoperative values. Following extubation and skin incision, 5 minutes after extubation, and after 60 minutes in the recovery room, MAP, heart rate (HR), and RPP were significantly greater (p < 0.05) as compared with intraoperative periods. In the epidural anesthesia group, there were clinically important decreases in MAP and RPP after reaching T-10 and skin incision. The general anesthesia patients showed higher MAP, HR, and RPP 5 minutes after extubation and after 60 minutes in the recovery room. Epidural anesthesia patients showed stable hemodynamic patterns throughout the study. This study demonstrates that epidural anesthesia allows for a more stable intraoperative and postoperative course as compared to the general anesthesia technique used, especially at the end of surgery and in the recovery room.