EFFECTS OF ANESTHETIC TECHNIQUE ON MYOCARDIAL WALL-MOTION ABNORMALITIES DURING ABDOMINAL AORTIC-SURGERY

Objective: To assess the impact of regional supplemented general anest hesia (RSGEN) on regional myocardial function during abdominal aortic surgery (AAS). Design: Prospective randomized study. Setting: Single a cademic medical center. Participants: Seventy-three patients scheduled for infrarenal aortic aneursymectomy. Interventions: Patients receive d standardized intraoperative anesthetic management consisting of eith er general anesthesia (GA; n = 37) or general anesthesia supplemented by epidural anesthesia (RSGEN; n = 36). Measurements and Main Results: Hemodynamic measurements and transesophageal echocardiograms (TEE) we re obtained at eight intraoperative times. The electrocardiogram (EGG) was continuously recorded using Holter monitoring. Of the 56 patients with interpretable TEE recordings, 8 of 30 (27%) GA patients and 7 of 26 (27%) RSGEN patients developed new segmental wall motion abnormali ties (SWMAs). There was no treatment effect on either the incidence (p = 0.23) or the intensity (p = 0.34) of SWMAs, Cross-clamping of the a orta was associated with the onset of new SWMAs (odds ratio, 8.2; 95% CI, 1.1 to 64; p = 0.04), Among the 63 patients with interpretable Hol ter recordings, 9 of 34 (26%) GA patients and 9 of 29 (31%) RSGEN pati ents exhibited intraoperative ischemia, There was no treatment effect on the incidence (p = 0.22) or intensity (p = 0.67) of ECG ischemia. C onclusion: Despite providing modest hemodynamic depression, RSGEN did not reduce the incidence or intensity of either regional myocardial dy sfunction or ECG ischemia. New SWMAs were temporally associated with c rossclamping of the aorta and tended to resolve with unclamping. Copyr ight (C) 1997 by W.B. Saunders Company.