Hormonal stress response and hemodynamic stability in patients undergoing endovascular vs. conventional abdominal aortic aneurysm repair.

ABSTRAC T Background and Aims: To investigate the effect of two different surgical techniques with different anesthetic modes on intraoperative and postoperative hormonal stress response, hemodynamic stability ,fluid loading and renal functio ni np atients scheduled for elective infrarenal abdominal aortic aneurysm (AAA) repair. Materials and Methods: Forty consecutiv ep atients scheduled for elective infrarenal AAA repai rw ere allocated without randomizing into two groups: an endovascular (EVAR, n=20) and ac onventional (CAR, n=20) aneurysm repair group according to aneurysm morphology as determined by preoperative computed tomograph ya nd angiography .T he EVAR group were operated under spinal anesthesia and the CAR group using general anesthesia with epidural blockade. Results: Patients undergoing CAR showed lower intraoperative mea na rterial pressure and significantly higher plasma norepinephrine before aortic cross-clamping and signifi cantly higher lactate after aortic declampin ga nd postoperatively than patient si nt he EVAR group. Postoperatively ,v asopressin and serum cortisol were also significantly higher in the CAR group. Fluid loading and estimated blood loss were mor ee xcessive in the CAR group. Conclusions: Stress response was lower and hemodynamic stability and lower body perfusion superior and renal function also better maintained in patients undergoing EVAR under spinal anesthesia as compared to those undergoing CAR using general anesthesia with epidural blockade.