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Rivista di Angiologia

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2002 September;21(3):218-21

lingua: Inglese

Combined spinal and epidural anesthesia for abdominal aortic aneurysm surgery in patients with severe chronic pulmonary obstructive disease

Flores J. A., Nishibe T., Koyama M., Imai T., Kudo F., Miyazaki K., Yasuda K.

Depart­ment of Car­di­o­vas­cu­lar Sur­gery, Hok­kai­do Uni­ver­sity ­School of Med­i­cine, Sap­po­ro, Japan


Back­ground. The pres­ence of chron­ic obstruc­tive pul­mo­nary dis­ease (COPD) ­should not be con­sid­ered a con­tra­in­di­ca­tion to oper­a­tion but ­should rath­er iden­ti­fy those ­patients that ­require spe­cial pre­op­er­a­tive and post­op­er­a­tive pul­mo­nary care. The pur­pose of this paper is to ­report our expe­ri­ence in the use of com­bined spi­nal and epi­du­ral anes­the­sia (CSEA) for open AAA ­repair in such ­patients.
Meth­ods. From April 1997 to Novem­ber 1998, three ­patients with ­severe COPD under­went elec­tive open infra­ren­al AAA ­repair under CSEA. All the ­patients sat­is­fied one or more of the fol­low­ing cri­te­ria: a room air PaO2 ≤60 mmHg, PaCO2 ≥45 mmHg, FEV1 ≤50% of pre­dict­ed, and/or FVC ≤75% of pre­dict­ed, and one of them was on home oxy­gen pre­op­er­a­tive­ly. Pre­op­er­a­tive prep­ar­a­tion of the ­patients con­sist­ed of breath­ing exer­cis­es with incen­tive espi­rom­e­try, elim­i­na­tion of under­lay­ing pul­mo­nary infec­tions and usage of bron­chod­i­la­tor ther­a­py.
­Results. All the ­patients tol­er­at­ed sur­gery safe­ly. None of them devel­oped post­op­er­a­tive com­pli­ca­tions, includ­ing pneu­mo­nia and other res­pir­a­to­ry con­di­tions. No sig­nif­i­cant chang­es in room air arte­ri­al blood gas or pul­mo­nary func­tion was rec­og­nized ­before and after sur­gery.
Con­clu­sions. CSE anes­the­sia is a ­viable anes­thet­ic ­option for con­ven­tion­al AAA sur­gery in ­patients with ­severe COPD since it can pre­serve spon­ta­ne­ous breath­ing and pro­vide addi­tion­al res­pir­a­to­ry ben­e­fits over gen­er­al anes­the­sia.

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