Objective:

To compare the effects of “general” and “general+epidural” anaesthesia techniques on ischemia-reperfusion-injury in patients undergoing surgical revascularization due to aortailiac occlusive disease, by comparing plasma malondialdehyde (MDA), ischemic modified albumin (IMA) levels, ankle/brachial-index (ABI) measurements.

Methods:

Sixty patients (ASA I-III) were enrolled. Forty patients undergoing surgical revascularization were divided into two groups randomly: “general anaesthesia” (Group G, n=20) [induced with tiyopental sodyum (3-5 mg kg-1), fentanyl (1 mcg kg-1), muscle relaxation with with cisatracurium (0.15 mg kg-1), maintained with sevoflurane (2-3%), nitrous oxideoxygen mixture (40-60%)] and “general+epidural anaesthesia” (Group GE, n=20) [lomber epidural performed before anaesthesia induction (0.5% levobupivacaine, 20 mL). Peri-operative analgesia established with infusion of epidural levobupivacaine (0.125%, 10 mL h-1)]. Control group (Group K) was consisted of twenty patients undergoing varicosectomy. For plasma MDA, IMA measurements in groups G and GE, blood was taken pre-induction (t1), immediately before removal of the aortic clamp (t2), 1h (t3), 2h after clamp removal (t4), 6h (t5), 24h (t6) postoperatively. In Group K, blood was taken pre-induction (t1), 60min (t2), 120min (t3), 180min after commencement surgery (t4), at 6h (t5), 24h postoperatively (t6). Preoperative, post-operative ABIs were measured.

Results:

Serum levels of MDA and IMA were higher than the control values up to the 6th postoperative measurement, in both groups. But these levels decreased to initial levels within 24h in both groups. Comparing groups G and GE, plasma MDA, IMA levels were significantly lower between t2-t4 and t2-t5 in Group GE. No difference was determined between Group G and GE in terms of ABI values, though postoperative values in both groups were high.

Conclusion:

The combination of epidural anaesthesia and general anesthesia may decrease the ischemia-reperfusion injury in aortailiac occlusive disease patients undergoing aorto-femoral bypass surgery under aortic clamping.

Keywords: Arterial occlusive diseases, epidural anaesthesia, ischemiareperfusion injury, malondialdehyde, ischemic modified albumin