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document
[ Aortofemoral bifurcation bypass . Effect of the anesthesia procedure ( NLA , thoracic continuous catheter peridural anesthesia ) on circulation , respiration and metabolism . Homeostasis and oxygen transport ] . 50 patients were investigated during induction of anaesthesia and infrarenal aortic bypass surgery . 26 were operated on under neuroleptanaesthesia ( NA group ) and 24 under continuous epidural combined with a light general anaesthesia ( epidural group ) . Blood losses were replaced with 5 per cent human albumin , red cell concentrates , and fresh frozen plasma . Ringer lactate solution was used to replace the functional extracellular fluid volume . During induction and maintenance of anaesthesia body temperature fell ( NA group from 36.7 to 35.3 degrees C ; epidural group from 36.7 to 34.9 degrees C ) but no statistically significant difference could be found between the groups , in spite of better surface perfusion of the lower part of the body in the epidural group . The increase of plasma glucose concentration was lower in the epidural group as compared to the NA group . Stress mediated hypokalaemia was of the same degree in both groups , the median values of the plasma potassium concentrations being in the lower reference range ( 3.5-3.7 mmol X 1 ( -1 ] , although large amounts of red cell concentrates were given . During clamping of the aorta a moderate compensated acidosis developed in both groups . Declamping caused a more marked increase of paCO2 and a greater fall of pH in the NA group as compared to the epidural group . Induction of anaesthesia was followed by a fall in oxygen uptake ( NA group from 221 to 163 ml X min-1 ; epidural group from 230 to 189 ml X min-1 ) which appears to be delayed in the epidural group , with a short lasting statistically significant difference between the groups after eventration of the gut ( NA group : 162 ml X min-1 less than epidural group 184 ml X min-1 ) . Later on , oxygen uptake was equal in both groups , with no further changes due to clamping or declamping of the aorta . At the end of the operation , when nitrous oxide had been turned of , the oxygen uptake increased considerably in several patients , despite continuing artificial ventilation and intravenous hypnotics and analgesics having been given . Eventration and exterioration of the gut caused the most marked changes in haemodynamics and oxygen transport with significant differences between the groups . Immediately after eventration there was a sudden fall in paO2 in both groups ( NA group from 99 to 83 mm Hg ; epidural group from 96 to 84 mm Hg ) and an increase of the calculated intrapulmonary right-to-left-shunt ( NA group from 7 to 21 % ; epidural group from 10 to 19 % ) . ( ABSTRACT TRUNCATED AT 400 WORDS )
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Intervention_Surgical
Aortofemoral bifurcation bypass
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Intervention_Physical
NLA , thoracic continuous catheter peridural anesthesia
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Intervention_Surgical
infrarenal aortic bypass surgery
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Intervention_Physical
neuroleptanaesthesia ( NA group )
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Intervention_Physical
continuous epidural combined with a light general anaesthesia ( epidural group )
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Intervention_Pharmacological
Ringer lactate solution
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Outcome_Physical
surface perfusion
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Outcome_Physical
plasma glucose concentration
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Outcome_Physical
Stress mediated hypokalaemia
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Outcome_Physical
median values of the plasma potassium concentrations
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Outcome_Physical
moderate compensated acidosis
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Outcome_Physical
marked increase of paCO2
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Outcome_Physical
greater fall of pH
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Outcome_Physical
fall in oxygen uptake
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Outcome_Physical
oxygen uptake
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Outcome_Physical
oxygen uptake
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Participant_Sample-size
50
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Participant_Condition
anaesthesia
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Participant_Condition
infrarenal aortic bypass surgery
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Participant_Sample-size
26
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Participant_Condition
neuroleptanaesthesia
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Participant_Sample-size
24
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Participant_Condition
light general anaesthesia