Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
J Endovasc Ther. 2021 Dec;28(6):837-843. doi: 10.1177/15266028211028207. Epub 2021 Jun 28.
Endovascular repair of thoracoabdominal aortic aneurysms carries a risk of spinal cord ischemia, the causes of which remain uncertain. We hypothesized that local anesthesia (LA) with conscious sedation could abrogate the potential suppressive cardiovascular effects of general anesthesia (GA) and facilitate intraoperative monitoring of neurological function. Here, we examine the feasibility of this technique during fenestrated (FEVAR) or branched endovascular aortic repair (BEVAR).
Consecutive patients undergoing FEVAR or BEVAR under LA and conscious sedation by a team at a single center were analyzed. Patients received conscious sedation using intravenous remifentanil and propofol infusions in conjunction with a local anesthetic agent. No patient had a prophylactic spinal drain inserted. Outcome measures included conversion to GA, need for vasopressors and/or spinal drainage, length of stay, complications, and patient survival.
A total of 44 patients underwent FEVAR or BEVAR under LA and conscious sedation. The cohort included thoracoabdominal aortic aneurysms (n=41) and pararenal aneurysms treated with endografts covering the supraceliac segment (n=3). Four patients (9%) required conversion to GA at a median operative duration of 198 minutes (range 97-495 minutes). Vasopressors were required intraoperatively in 3 of the cases that were converted to GA. No patient developed spinal cord ischemia and none had insertion of a spinal drain. The median hospital length of stay was 4 days (range 2-41 days). Postoperative delirium and hospital-acquired pneumonia was seen in 7% of patients. All patients survived to 30 days, with 95% alive at a median follow-up of 15 months (range 3-26 months).
LA and conscious sedation is a feasible anesthetic technique for the endovascular repair of thoracoabdominal aortic aneurysms.
胸主动脉腹主动脉瘤的血管内修复有脊髓缺血的风险，其原因尚不清楚。我们假设局部麻醉（LA）加镇静可以消除全身麻醉（GA）的潜在抑制心血管作用，并便于术中监测神经功能。在此，我们检查了该技术在开窗（FEVAR）或分支血管内主动脉修复（BEVAR）中的可行性。
分析了一个中心的一个团队在局部麻醉和镇静下进行的 FEVAR 或 BEVAR 的连续患者。患者接受静脉注射瑞芬太尼和异丙酚输注，同时使用局部麻醉剂进行镇静。没有患者预防性插入脊髓引流管。观察指标包括转为 GA、需要血管加压药和/或脊髓引流、住院时间、并发症和患者存活率。
共有 44 例患者在局部麻醉和镇静下接受 FEVAR 或 BEVAR。该队列包括胸主动脉腹主动脉瘤（n=41）和肾周动脉瘤，用覆盖腹腔干上段的内支架治疗（n=3）。4 例患者（9%）在中位手术时间 198 分钟（97-495 分钟）时需要转为 GA。3 例转为 GA 的病例术中需要使用血管加压药。没有患者发生脊髓缺血，也没有患者插入脊髓引流管。中位住院时间为 4 天（2-41 天）。术后谵妄和医院获得性肺炎发生率为 7%。所有患者均存活至 30 天，95%的患者在中位随访 15 个月（3-26 个月）时存活。
LA 和镇静是胸主动脉腹主动脉瘤血管内修复的一种可行的麻醉技术。
