The Effect of Lumbar Epidural and General Anesthesia on Plasma Catecholamines and Hemodynamics During Abdominal Aortic Aneurysm Repair

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Abstract
Twenty-four patients undergoing abdominal aortic aneurysm (AAA) repair were studied to compare the effects of lumbar epidural anesthesia (LEA) and general anesthesia (GA) on plasma catecholamine levels and hemodynamics before and during infra renal aortic cross-clamping. Patients received either a high dose of opioid anesthetic (GA group, n = 12), or lumbar epidural anesthesia to T4 sensory level with a light general anesthetic (LEA group, n = 12). Systemic vascular resistance (SVR) and norepinephrine (NE) and epinephrine (E) levels were measured before anesthetic induction (before epidural activation in the LEA group, and before general anesthesia induction in the GA group), 15 min before cross-clamping, and 1,5, and 10 min after cross-clamping. There was a large (P < 0.05) increase in NE and E in the GA group by 15 min before aortic cross-clamping, but NE and E levels in the LEA group did not increase. The GA group had significantly higher levels of NE and E than the LEA group 15 min before cross-clamping and also after clamping. NE levels in the LEA group increased after cross-clamping, and NE levels in the GA group remained constant. E levels remained stable in both groups after cross-clamping. After clamping, SVR increased in both groups, but the increase occurred after 1 min in the GA group and took 5 min to become significant in the LEA group. There was no significant correlation between changes in NE or E and changes in SVR in either group. This study shows that epidural anesthesia to T4 prevents NE and E increases in response to abdominal surgery. E does not increase in response to clamping, and NE increases only in the LEA group. Catecholamine level changes were not reflected in SVR differences between groups. SVR seems to be more dependent on mechanical changes from the cross-clamping than to changes in catecholamine levels.

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