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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
ORIGINAL ARTICLES ANESTHESIOLOGY
Minerva Anestesiologica 2001 June;67(6):441-6
Fast track in abdominal aortic surgery
Renghi A., Gramaglia L., Ciarlo M. *, Cerioli S. *, Albani A.
Ospedale degli Infermi - Biella
*Ospedale Regionale - Aosta
Background. The aim of this work is to evaluate the efficacy of a new perioperative approach to improve the outcome and to reduce hospitalisation after abdominal aortic surgery.
Methods. Experimental design: observational study on patients operated from October 1996 to October 1997 (Group 1996), and from November 1997 to November 1998 (group 1998). Centre: Anaesthesiology Department of Regional Hospital. Patients: historical group: 56 patients surgically treated with abdominal aortic bypass in 1996. Case control group: 58 patients surgically treated with abdominal aortic bypass in 1998. Intervention: group 1996: maintenance of anaesthesia with forane and fentanyl; postoperative infusion of mepivacaine 1% through lumbar epidural catheter. Group 1998: preoperative anaesthesia through thoracic (T 4) epidural catheter with infusion of bupivacaine 0.5%; maintenance of anaesthesia with propofol, fentanyl and infusion of bupivacaine 0.125%; postoperative infusion of bupivacaine 0.125%, early rehabilitation care (early removal of nasogastric tube and urinary catheter, early deambulation, feeding and physiotherapy). Evaluation: analgesia efficacy, day of deambulation, day of removal of the urinary catheter and the nasogastric tube, day of bowel canalization, day of discharge, major complications.
Result. In group 1998 analgesia was better. Furthermore a significant improvement consisted in the earlier removal of the nasogastric tube and the urinary catheter, earlier return of the gastrointestinal function and earlier deambulation. The length of stay is significantly reduced. In group 1998 we have less complications.
Conclusions. Total intra-venous anaesthesia associated with a thoracic epidural anaesthesia, connected with early rehabilitation may improve the outcome and reduce the length of stay in patients submitted to abdominal aortic surgery.