Первая международная удаленная научно-практическая конференция

"Сердечно-сосудистая хирургия и ангиология - 2003"

First International Scientific Teleconference

"Cardiovascular Surgery and Angiology - 2003"

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B.Minchev, D.Markov, D.Maximov, T.Zachariev, G.Tzarianski, Al.Tschirkov

COPD PATIENTS UNDERGOING ELECTIVE TRANSPERITONEAL ABDOMINAL AORTIC REPAIR: ADVANTAGES OF EPIDURAL ANALGESIA.  A SEVEN-YEAR EXPERIENCE

Division of vascular surgery, University hospital “St. Ekaterina”

Sofia, Bulgaria.

Summary: Introduction: The purpose of this study was to examine the advantages of epidural analgesia in patients with chronic obstructive pulmonary disease (COPD), underwent elective transperitoneal aneurysmorraphy. These patients are more likely to develop pulmonary morbidity following major abdominal surgery.

Methods: During a 7-year period all patients who have been diagnosed with COPD undergoing elective abdominal aortic aneurysm (AAA) repair (n=119) in “St. Ekaterina” hospital are reviewed. Inclusion criteria were an FEV1/FVC ratio <75% and/or PaCO2 >45mmHg. Clinical outcomes were compared between those who received epidural analgesia (epidural group) and those patients in whom pain management was via patient controlled analgesia (PCA) or intravenous opioids (control group). Primary endpoints measured were pulmonary complications, duration of intubation, ICU stay, and hospital days.

Results: Strict inclusion criteria were met by 119 patients. We divided patients into two groups - 78 patients in the epidural group and 41 patients in the control group. When comparing the epidural vs. control group the mean AAA size was 6.50.8cm vs. 6.21.5cm, FEV1 was 57.523.8% vs. 49.811.6%, and the mean FEV1/FVC ratio was 53.011.6% vs. 50.95.8%, respectively. The overall hospital stay remained similar between the two groups. The epidural group had a significantly lower incidence of postoperative ventilator dependency and ICU stay (p<0.05), as well as a decreased bend for pulmonary complications when compared to the control group. The relative risk of developing a pulmonary complication in the absence of epidural analgesia was 2.3.

Conclusions: Epidural analgesia should be considered in all COPD patients undergoing elective transperitoneal AAA repair. It is a beneficial in patients with COPD undergoing AAA repair by reducing both the postoperative ventilator duration and ICU stay.

Keywords: abdominal aortic aneurysm, chronic pulmonary obstructive disease, epidural analgesia.

Minchev B., Markov D., Maximov D. et al.  COPD PATIENTS UNDERGOING ELECTIVE TRANSPERITONEAL ABDOMINAL AORTIC REPAIR: ADVANTAGES OF EPIDURAL ANALGESIA. A SEVEN-YEAR EXPERIENCE // The First International Scientific Teleconference "Cardiovascular Surgery and Angiology - 2003", The book of Conference.- SPb, 2003.- P.