Cardiovascular and catecholamine responses during endovascular and conventional abdominal aortic aneurysm repair.

Abstract

To compare changes in plasma catecholamines, acid-base status and cardiovascular dynamics in patients undergoing endovascular or conventional infrarenal abdominal aortic aneurysm (AAA) repair under standard general anaesthesia. Prospective cohort study. 30 patients scheduled for elective infrarenal AAA repair. Plasma epinephrine and norepinephrine concentrations, acid-base status and cardiovascular measurement were compared before surgery, and 5 min after aortic clamping and clamp release (conventional group) or occlusion and release (endovascular group) in patients undergoing endovascular (n = 15) or conventional AAA repair (n = 15). Arterial pH (p < 0.005) and base deficit (p < 0.05) increased, and plasma bicarbonate decreased (p < 0.005) during aortic cross-clamping in the conventional group. pH decreased further (p < 0.005), and base deficit and pCO2 increased (both p < 0.005) after clamp release. These changes were significantly greater than during endovascular repair, in whom within-group changes were not statistically significant. Values were similar in the two groups 30 min after reperfusion. Plasma epinephrine concentrations increased during conventional surgery (p < 0.05) and were greater than in the endovascular group (p < 0.05). Plasma norepinephrine concentrations increased during surgery in both groups but the changes were not statistically significant. Plasma catecholamine concentrations, changes in cardiovascular variables and acid-base status were increased during conventional compared with endovascular AAA repair.