Key messages
- we did not find any randomized controlled trials to help answer our question
- there is a need for high-quality evidence to compare the benefits and harms of general anesthesia compared to loco-regional anesthesia in people undergoing endovascular repair of an aortic aneurysm
What is an aortic aneurysm?
When the diameter of arteries or veins grows beyond a certain size, they are known as aneurysms. Aneurysms that continue to grow beyond a certain size are at risk of bursting. The aorta is the largest artery in the body, and people with a burst aortic aneurysm are at a high risk of experiencing severe complications, such as death.
How are aortic aneurysms treated?
In order to treat, or repair, an aortic aneurysm, the surgeon could cut into the person's chest and abdomen to expose the aneurysm, and replace it with a synthetic material, known as a graft. This is called open aortic aneurysm repair. Another option is for the surgeon to use an x-ray (or similar technology) to guide them as they insert the graft through small cuts in the person's arteries, and avoid the need for a big surgical cut. This is known as endovascular aortic aneurysm repair.
People who undergo an endovascular aortic aneurysm repair can have a general anesthetic, during which they are placed in a temporary coma and depend on a machine to breathe (commonly called put to sleep). The advantages for this anesthetic approach are that the anesthetist can control the person's airway, and the surgeon knows that the person won't move during the delicate phases of the surgery. However, there is also a risk of low blood pressure, blood clots, and breathing problems during or after surgery. Alternatively, people can receive medicines to control the pain and anxiety of surgery without going to sleep. This is known as loco-regional anesthesia. The advantage of this approach is that the person avoids the risks of general anesthesia. However, loco-regional anesthesia requires that the person fully co-operates during the surgery and lies still, and being awake during the surgery may cause them significant discomfort.
What did we want to find out?
We wanted to find out if there were any benefits or harms of general anesthesia compared to loco-regional anesthesia for people who are having an endovascular repair of an aortic aneurysm.
What did we do?
We searched for all randomized studies that compared the use of general anesthesia to loco-regional anesthesia use in people who needed an endovascular repair of an aortic aneurysm. In randomized controlled trials, the treatments people receive are decided at random, and these give the most reliable evidence about treatment effects.
What did we find?
We did not find any randomized controlled trials that met the inclusion criteria for our review. As such, it is not possible to draw conclusions about the benefits or harms of general anesthesia compared with loco-regional anesthesia for endovascular treatment of aortic aneurysms. This means there is a need for randomized controlled trials to provide evidence of any benefits or harms to help guide decision-making.
How up-to-date is this evidence?
This evidence is current to 11 March 2022.
We did not identify any randomized controlled trials that compared general versus loco-regional anesthesia for endovascular aortic aneurysm repair. There is currently insufficient high-quality evidence to determine the benefits or harms of either anesthetic approach during endovascular aortic aneurysm repair. Well-designed prospective randomized trials with relevant clinical outcomes are needed to adequately address this.
Aortic aneurysms occur when the aorta, the body's largest artery, grows in size, and can occur in the thoracic or abdominal aorta. The approaches to repair aortic aneurysms include directly exposing the aorta and replacing the diseased segment via open repair, or endovascular repair. Endovascular repair uses fluoroscopic-guidance to access the aorta and deliver a device to exclude the aneurysmal aortic segment without requiring a large surgical incision. Endovascular repair can be performed under a general anesthetic, during which the unconscious patient is paralyzed and reliant on an anesthetic machine to maintain the airway and provide oxygen to the lungs, or a loco-regional anesethetic, for which medications are administered to provide the person with sufficient sedation and pain control without requiring a general anesthetic. While people undergoing general anesthesia are more likely to remain still during surgery and have a well-controlled airway in the event of unanticipated complications, loco-regional anesthesia is associated with fewer postoperative complications in some studies. It remains unclear which anesthetic technique is associated with better outcomes following the endovascular repair of aortic aneurysms.
To evaluate the benefits and harms of general anesthesia compared to loco-regional anesthesia for endovascular aortic aneurysm repair.
We used standard, extensive Cochrane search methods. The latest search was 11 March 2022.
We searched for all randomized controlled trials that assessed the effects of general anesthesia compared to loco-regional anesthesia for endovascular aortic aneurysm repairs.
We used standard Cochrane methods. Our primary outcomes were: all-cause mortality, length of hospital stay, length of intensive care unit stay. Our secondary outcomes were: incidence of endoleaks, requirement for re-intervention, incidence of myocardial infarction, quality of life, incidence of respiratory complications, incidence of pulmonary embolism, incidence of deep vein thrombosis, and length of procedure. We planned to use GRADE methodology to assess the certainty of evidence for each outcome.
We found no studies, published or ongoing, that met our inclusion criteria.