This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Brustia, P. Articles by Cumino, A. Search for Related Content PubMed PubMed Citation Articles by Brustia, P. Articles by Cumino, A. Related Collections Related Article

Fast-track approach in abdominal aortic surgery: left subcostal incision with blended anesthesia

^a Department of Vascular Surgery, ‘Maggiore della Carità’ Hospital, Corso Mazzini, 18-28100-Novara, Italy
^b Department of Anesthesiology and Intensive Care, ‘Maggiore della Carit’ Hospital, Novara, Italy

*Corresponding author. Tel.: +(39) 03213733741/3356623835; fax: +(39) 03213733741.

E-mail address: brustiapiero{at}tiscali.it (P. Brustia).

Objective: The introduction of fast-tracking multidisciplinary programs allows good results in postoperative outcome in many surgical specialties. We evaluated a multimodal clinical program (based on mininvasive surgery, epidural anesthesia and early mobilization and feeding) in abdominal aortic surgery. Methods: Between June 2000 and October 2005, 323 unselected patients were treated for atherosclerotic aorto-iliac occlusive disease (aorto-femoral bypass) and aortic or aorto-iliac aneurysm (aorto-aortic graft or aorto-iliac bifurcated graft). The infusion of bupivacaine 0.5% through an epidural catheter at T6-T7 interspace allowed sensory block between T4-S3. A light general anesthesia was performed using sevoflurane by a laryngeal mask in spontaneous breathing; no nasogastric tube was used. The patients were placed in dorsal decubitus; a transperitoneal access was performed with a left subcostal incision parallel to the condro-costal edge and spread from the linea alba to the edge of the rectus muscle. The bowel was maintained inside the abdominal cavity and manipulated with care. Standard surgical instrumentation was used. No drains were placed. Patients were transferred to the surgical ward at the end of surgery; they were early mobilized and enforced to drink and to eat. Analgesia was achieved with a continuous epidural infusion of bupivacaine 0.25% supplemented by oral ibuprofen on request. Results: We observed a mortality rate of 2.5% and a low postoperative morbidity: 1.4% of cardiac complications, 3.7% of transient creatinine increase, and no pulmonary complications. All patients ambulated a mean of 536 m (95% CI: 81.4) on the day of surgery and 2544 m (95% CI: 208.9) the day after. They consumed an oral diet, 36.2% of their daily caloric requirement on the same day of surgery and 1583 Kcal (95% CI: 105.2) the day after (77% of daily caloric requirement). Median hospital stay was three days (range 2–21). All patients were discharged home. Conclusions: Our experience suggested that hospital stay and morbidity after abdominal aortic surgery can be decreased by performing a mininvasive surgical approach, thoracic epidural anesthesia-analgesia and an aggressive postoperative nursing on the ward. Therefore, this multidisciplinary program can be proposed to all patients undergoing aortic surgery without prior selection, major technological investments and long-term surveillance.

Key Words: Aortic aneurysm; Abdominal surgical procedures; Minimally invasive; Perioperative care; Postoperative complications; Anesthesia; Epidural

Related Article

ICVTS on-line discussion A

Narcis Hudorovic
Interactive CardioVascular and Thoracic Surgery 2007 6: 64-65. [Full Text] [PDF]

This article has been cited by other articles:

				N. Hudorovic ICVTS on-line discussion A Interactive CardioVascular and Thoracic Surgery, February 1, 2007; 6(1): 64 - 65. [Full Text] [PDF]