ANESTHESIA IN PERIPHERAL VASCULAR SURGERY

无论是区域麻醉还是全身麻醉 具有以下特征的患者的围手术期发病率较高： 心血管疾病通常是一个重要的临床问题 医学专家之间的争论。 没有设计良好的前景 已经对这一问题进行了研究， 目前依靠的证据是轶事，主观，或 间接证据 确定硬膜外麻醉（作为一个子集 局部麻醉）和全身麻醉的发生率相当， 术中和术后心肌缺血，我们提出了一个 200例接受下呼吸道感染的患者的随机临床试验 约翰霍普金斯医院的四肢血管移植手术 在四年的时间里。 本研究的具体目的是（1）比较 围手术期心肌缺血、梗死和死亡， 随机分配至硬膜外麻醉和全身麻醉的患者;（2） 确定缺血频繁发生的高危亚组， 无论麻醉方法如何;（3）进入和 描述实现预定目标的相对难度 两种技术之间的血流动力学目标。 同意 患者将回答标准化的病史问卷， 进行体检，如果合格， 随机接受硬膜外麻醉或全身麻醉。 在手术过程中，麻醉技术和 血流动力学管理将由方案规定。 心肌缺血和梗死将通过 评价当天开始的96小时霍尔特监测记录 术前和术后连续的CK-MB同工酶， 心电图均未显示麻醉剂类型。 血流动力学不稳定 将根据设盲的术中数据记录确定， 参数超出特定范围的发作， 控制干预。 多变量分析将用于开发模型， 缺血的发生，其特定目的是建立 麻醉类型是否是心脏病的独立预测因素 端点。

Whether regional anesthesia or general anesthesia is associated with a higher perioperative morbidity in patients with cardiovascular disease is an important clinical issue commonly debated among medical specialists. No well designed prospective studies examining this issue have been performed, and arguments currently rely on evidence which is anecdotal, subjective, or circumstantial. To determine if epidural anesthesia (as a subset of regional) and general anesthesia exhibit comparable rates of intra- and postoperative myocardial ischemia, we propose a randomized clinical trial of 200 patients undergoing lower extremity vascular graft surgery at the Johns Hopkins Hospital over a four year period. Specific aims of this study are (1) to compare rates of perioperative myocardial ischemia, infarction, and death, in patients randomized to epidural and general anesthesia; (2) to identify high-risk subgroups in whom ischemia occurs frequently, regardless of the anesthetic method; and (3) to access and characterize the relative difficulty of achieving predetermined hemodynamic goals between the two techniques. Consenting patients will answer a standardized medical history questionnaire, undergo a physical examination, and then, if qualified, be randomized to receive either epidural or general anesthesia. During surgery both the anesthetic technique and the hemodynamic management will be specified by protocol. Myocardial ischemia and infarction will be determined by evaluation of 96-hour Holter monitor recordings starting the day prior to surgery and serial, postoperative CK-MB isoenzymes and EKGs all masked as to anesthetic type. Hemodynamic instability will be determined from masked intraoperative data records as episodes of parameters beyond a specific range and as incidence of controlling interventions. Multivariate analysis will be used to develop models for the occurrence of ischemia with the specific purpose of establishing whether type of anesthesia is an independent predictor of cardiac endpoints.