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

Objectives: 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. Design: prospective cohort study. Materials: 30 patients scheduled for elective infrarenal AAA repair. Methods: 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). Results: 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 pCO(2) 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 bur the changes were not statistically significant. Conclusions: plasma catecholamine concentrations, changes in cardiovascular variables and acid-base status were increased during conventional compared with endovascular AAA repair.