Department of Anaesthesia, Southmead Hospital, Bristol, UK.
Clinical Trials and Evaluation Unit, Bristol Medical School, University of Bristol, Bristol, UK.
Br J Surg. 2019 Jan;106(1):74-81. doi: 10.1002/bjs.10973. Epub 2018 Aug 23.
Case series and a post hoc subgroup analysis of a large randomized trial have suggested a potential benefit in treating ruptured abdominal aortic aneurysms (rAAAs) using endovascular aneurysm repair (EVAR) with local anaesthesia (LA) rather than general anaesthesia (GA). The uptake and outcomes of LA in clinical practice remain unknown.
The UK National Vascular Registry was interrogated for patients presenting with rAAA managed with EVAR under different modes of anaesthesia between 1 January 2014 and 31 December 2016. The primary outcome was in-hospital mortality. Secondary outcomes included: the number of centres performing EVAR under LA; the proportion of patients receiving this technique; duration of hospital stay; and postoperative complications.
Some 3101 patients with rAAA were treated in 72 hospitals during the study: 2306 underwent on open procedure and 795 had EVAR (LA, 319; GA, 435; regional anaesthesia, 41). Overall, 56 of 72 hospitals (78 per cent) offered LA for EVAR of rAAA. Baseline characteristics and morphology were similar across the three EVAR subgroups. Patients who had surgery under LA had a lower in-hospital mortality rate than patients who received GA (59 of 319 (18·5 per cent) versus 122 of 435 (28·0 per cent)), and this was unchanged after adjustment for factors known to influence survival (adjusted hazard ratio 0·62, 95 per cent c.i. 0·45 to 0·85; P = 0·003). Median hospital stay and postoperative morbidity from other complications were similar.
The use of LA for EVAR of rAAA has been adopted widely in the UK. Mortality rates appear lower than in patients undergoing EVAR with GA.
病例系列和一项大型随机试验的事后亚组分析表明，在局部麻醉（LA）下而非全身麻醉（GA）下使用血管内腹主动脉瘤修复（EVAR）治疗破裂的腹主动脉瘤（rAAA）可能具有潜在益处。LA 在临床实践中的应用情况和结果尚不清楚。
在 2014 年 1 月 1 日至 2016 年 12 月 31 日期间，通过英国国家血管登记处调查了接受不同麻醉方式治疗的 rAAA 患者接受 EVAR 治疗的情况。主要结局是住院死亡率。次要结局包括：在 LA 下进行 EVAR 的中心数量；接受该技术的患者比例；住院时间；和术后并发症。
在研究期间，72 家医院共治疗了 3101 例 rAAA 患者：2306 例接受开放手术，795 例接受 EVAR（LA，319；GA，435；区域麻醉，41）。总体而言，72 家医院中有 56 家（78%）提供 LA 用于治疗 rAAA 的 EVAR。三个 EVAR 亚组的基线特征和形态相似。在 LA 下接受手术的患者的住院死亡率低于接受 GA 的患者（319 例中的 59 例（18.5%）与 435 例中的 122 例（28.0%）），并且在调整已知影响生存的因素后仍然如此（调整后的危险比 0.62，95%置信区间 0.45 至 0.85；P=0.003）。中位住院时间和其他并发症的术后发病率相似。
LA 在英国已广泛用于 rAAA 的 EVAR。死亡率似乎低于接受 GA 下 EVAR 的患者。
