• J Clin Anesth · Jun 2013

    Impact of anesthesia technique on the incidence of major complications after open aortic abdominal surgery: a cohort study.

    • Marc Licker, Ellenberger Christoph, Vanessa Cartier, Damiano Mugnai, Nicolas Murith, Afksendios Kalangos, Marc Aldenkortt, Tiziano Cassina, and John Diaper.
    • Department of Anesthesiology, Pharmacology and Intensive Care, Faculty of Medicine, University Hospital, CH-1211 Geneva, Switzerland. Marc-Joseph.Licker@hcuge.ch
    • J Clin Anesth. 2013 Jun 1;25(4):296-308.

    Study ObjectiveTo determine the risk factors of perioperative complications and the impact of intrathecal morphine (ITM) in major vascular surgery.DesignRetrospective analysis of a prospective cohort.SettingsOperating room, intensive care unit, and Postanesthesia Care Unit of a university hospital.MeasurementsData from 595 consecutive patients who underwent open abdominal aortic surgery between January 1997 and December 2011 were reviewed. Data were stratified into three groups based on the analgesia technique delivered: systemic analgesia (Goup SA), thoracic epidural analgesia (Group TEA), and intrathecal morphine (Group ITM). Preoperative patient characteristics, perioperative anesthetic and medical interventions, and major nonsurgical complications were recorded.Main ResultsPatients managed with ITM (n=248) and those given thoracic epidural analgesia (n=70) required lower doses of intravenous (IV) sufentanil intraoperatively and were extubated sooner than those who received systemic analgesia (n=270). Total inhospital mortality was 2.9%, and 24.4% of patients experienced at least one major complication during their hospital stay. Intrathecal morphine was associated with a lower risk of postoperative morbidity (OR 0.51, 95% CI 0.28 - 0.89), particularly pulmonary complications (OR 0.54, 95% CI 0.31 - 0.93) and renal dysfunction (OR 0.52, 95% CI 0.29 - 0.97). Other predictors of nonsurgical complications were ASA physical status 3 and 4 (OR 1.94, 95% CI 1.07 - 3.52), preoperative renal dysfunction (OR 1.61, 95% CI 1.01 - 2.58), prolonged surgical time (OR 1.78, 95% CI 1.16 - 2.78), and the need for blood transfusion (OR 1.77, 95% CI 1.05 - 2.99).ConclusionsThis single-center study showed a decreased risk of major nonsurgical complications in patients who received neuraxial analgesia after abdominal aortic surgery.Copyright © 2013 Elsevier Inc. All rights reserved.

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