Abstract
Background : The purpose of this study was to examine the relationship of epidural anesthesia with coagulation status and surgery outcome following lower extremity revascularization. Methods : Twenty patients with arteriosclerosis obliterance (ASO) scheduled for lower extremity vas- cular reconstruction were randomized to receive either general anesthesia or combined general-epidural anesthesia. An additional 20 randomly selected patients without atherosclerotic vascular disease under- going lower abdominal or lower extrernity surgery served as controls for coagulation status. In the group with general anesthesia, anesthesia was induced by administration of pentothal sodium and succiny- Icholine and maintained with NzO-Oz, isoflurane and vecuronium. In the group with combined anesthesia, epidural anesthesia was performed at the level of Lz. or L3-4 epidural space using 2% lidocaine, followed by general anesthesia same as general group. Postoperative pain control was followed by on-demand oral or intravenous narcotics in the general group and followed by epidural 0.125% bupivacaine and morphine in the combined group. The coagulation status was monitored using thrombelastography (TEG) and standard coagulation tests. Results : The ASO patients were hypercoagulable compared to the control patients before operation and on the first postoperative day. The hypercoagulability was attenuated postoperatively in the combined group. In the ASO-general group, postoperative MA, a and TEG index were 69.5 ± 6.1 mm, 53.3 ± 7.5。and 1.18 ± 1.29 respectively, but in the ASO-combined anesthesia group, they were 58.0 ± 6.2 mm, 38.0 ± 4.0 ' and -0.38 ± 1.20 respectively (P < 0.05). The rates of postoperative compli- cations did not significantly differ between the two groups. Conchusions : In patients with arteriosclerosis oblitetance undergoing arterial reconstructive surgery, thrombelastographic evidence of increased platelet-fibrinogen interaction is associated with early postoperative thrombotic events, and epiduvl anesthesia is associated with beneficial effects on coagulation status. (Korean J Anesthesiol 2000; 38: 409 ~ 419)
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