Comparison of anesthesia technique on outcomes of endovascular repair of abdominal aortic aneurysms: a five-year review of monitored anesthesia care with local anesthesia vs. general or regional anesthesia.

AIM

This retrospective study compares outcomes according to anesthesia technique of a consecutive series of 48 endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) performed by one vascular surgeon at a single institution over a five-year period.

METHODS

Demographic, pre-procedure, procedure-related, recovery room, surgical unit, and hospital outcome variables were extracted and compared between patients receiving general or regional anesthesia and those receiving monitored anesthesia care (MAC) with local anesthesia.

RESULTS

Eighteen (37.5%) patients received general or regional anesthesia and 30 (62.5%) patients received MAC with local anesthesia. No statistically significant differences in demographics or pre-procedure variables were calculated between study groups. Conversion to open repair was not required, no intraoperative complications occurred, and conversion from MAC with local anesthesia to general anesthesia was not required. The only significant differences calculated were in length of anesthesia (P=0.001, power 0.962) and time to ambulation (P=0.004, power 0.871), with significantly lower median times in the MAC and local anesthesia groups. Other than one (2.1%) patient in the MAC with local anesthesia group whose death was related to history of severe coronary disease, no other acute medical complications occurred.

CONCLUSION

The results of this study suggest that use of MAC with local anesthesia during EVAR of AAAs is comparable to general and regional anesthesia in terms of safety and efficacy. Furthermore, MAC with local anesthesia confers additional outcome benefits versus general and regional anesthesia, as it is less invasive, offers greater hemodynamic stability, and enables better communication with the patient.