PERIOPERATIVE ISCHEMIA IN AORTIC-SURGERY - COMBINED EPIDURAL GENERAL ANESTHESIA AND EPIDURAL ANALGESIA VS GENERAL-ANESTHESIA AND IV ANALGESIA/

Purpose: The goal of this randomized study was to determine whether co mbined general and epidural anaesthesia with postoperative epidural an algesia compared with general anaesthesia and postoperative intravenou s analgesia, reduced the incidence of perioperative myocardial ischaem ia in patients undergoing elective aortic surgery. Method: Patients we re randomly assigned to one of two groups. One group (EPI, n = 48) rec eived combined general and epidural anaesthesia and postoperative epid ural analgesia for 48 hrs. The other group (GA, n = 51) received gener al anaesthesia followed by postoperative intravenous analgesia. Anaest hetic goals were to maintain haemodynamic stability (+/-20% of preoper ative values), and a stroke volume >1 ml . kg(-1). A Holter monitor wa s attached to each patient the day before surgery. Leads 11, V-2, and V-5 were monitored. Myocardial ischaemia was defined as ST segment dep ression >1 mm measured at 80 millisec beyond the J point or an elevati on of 2 mm 60 millisec beyond the J point which lasted >60 sec. An eve nt that lasted >60 sec but returned to the baseline for >60 sec and th en recurred was counted as two separate events. The Holter tapes were reviewed by a cardiologist blind to the patient's group. Results: Ther e were no demographic differences between the two groups. Myocardial i schaemia was common; it occurred in 55% of patients. In hospital, preo perative ischaemia was uncommon (GA = 3, EPI = 8). Intraoperative isch aemia was common (GA = 18, EPI = 25). Mesenteric traction produced the largest number of ischaemic (GA = 11, EPI = 11) events. Postoperative ischaemia was most common on the day of surgery Termination of epidur al analgesia produced a burst of ischaemia (60 events in 9 patients) C onclusion: Combined general and epidural anaesthesia and postoperative epidural analgesia do not reduce the incidence of myocardial ischaemi a or morbidity compared with general anaesthesia and postoperative int ravenous analgesia.