European Journal of Cardiovascular Medicine

Anesthetic management in major vascular surgery poses unique challenges due to the complex interplay between anesthesia, patient comorbidities, and the physiological impacts of the surgical procedures. Hemodynamic stability is a critical concern during such surgeries as fluctuations can significantly affect patient outcomes. The choice of anesthetic agents is pivotal because of their varied effects on blood pressure, heart rate, and overall cardiovascular stability.^[1][2]

This study seeks to explore the hemodynamic impacts of different anesthetic agents used during major vascular surgeries. Vascular surgeries, such as aortic aneurysm repair or peripheral arterial surgeries, are known for their potential to cause significant hemodynamic disturbances due to surgical stress and blood loss. The anesthetic agents used in these surgeries play a crucial role in maintaining cardiovascular stability and ensuring adequate organ perfusion.^[3][4]

Literature highlights several anesthetic agents, including volatile anesthetics like isoflurane, sevoflurane, and desflurane, as well as intravenous agents like propofol and etomidate. Each agent has distinct pharmacological profiles influencing myocardial function, vascular resistance, and autonomic nervous system balance. Research indicates that the choice of anesthetic can affect intraoperative hemodynamic control, which in turn influences postoperative outcomes including the risk of myocardial ischemia, stroke, and renal failure.^[5][6]

Aim

To compare the impact of various anesthetic agents on hemodynamic stability during major vascular surgeries.

Objectives

1. To identify the anesthetic agents most commonly used in major vascular surgeries and their hemodynamic effects.
2. To evaluate the association between the choice of anesthetic agent and intraoperative hemodynamic stability.
3. To assess the influence of different anesthetic agents on postoperative recovery and complications.

Source of Data: Data was collected from patients undergoing major vascular surgeries at a tertiary care hospital.

Study Design: The study was designed as a cross-sectional observational study.

Study Location: The research was conducted at the General Surgery and Anesthesiology Departments of a large tertiary care center.

Study Duration: Data collection occurred from January 2024 to December 2024.

Sample Size: The study involved 200 patients selected based on inclusion and exclusion criteria.

Inclusion Criteria: Included were adults aged 18 and older who underwent elective major vascular surgeries under general anesthesia.

Exclusion Criteria: Excluded were patients with a history of chronic heart failure, severe arrhythmias, those who received emergency surgery, or had incomplete medical records.

Procedure and Methodology: Patients were monitored for hemodynamic parameters such as blood pressure, heart rate, and cardiac output using standard anesthetic monitoring equipment. The type of anesthetic agent used, the dosage, and administration technique were recorded.

Sample Processing: No specific sample processing was necessary as this study focused on observational clinical data.

Statistical Methods: Data were analyzed using SPSS software. Descriptive statistics were used to characterize the patient demographics and surgical details. Inferential statistics, including Chi-square and t-tests, were employed to compare hemodynamic parameters across different anesthetic agents.

Data Collection: Data were collected through patient medical records, intraoperative monitoring systems, and postoperative follow-up notes. All data were anonymized and secured to ensure patient confidentiality.

Table 1: Comparing the Impact of Various Anesthetic Agents on Hemodynamic Stability during Major Vascular Surgeries

Table 1 presents data on mean blood pressure and heart rate for four different anesthetic agents: Isoflurane, Sevoflurane, Propofol, and Etomidate. Blood pressure values ranged from 85 ± 9 mmHg with Propofol to 90 ± 8 mmHg with Sevoflurane, and heart rate varied minimally among agents, suggesting different impacts on hemodynamic stability. Statistical significance is indicated by P-values ranging from 0.032 to 0.050, showing significant variability in hemodynamic responses to these agents.

Table 2: Identifying the Anesthetic Agents Most Commonly Used in Major Vascular Surgeries and Their Hemodynamic Effects

Table 2 outlines the usage percentages and hemodynamic effects of the same agents. Propofol is the most commonly used at 30%, and all agents show similar hemodynamic effects (Mean BP around 85-90 mmHg). The P-values (ranging from 0.015 to 0.042) suggest statistically significant preferences in usage patterns among the agents, correlating with their respective hemodynamic impacts.

Table 3: Evaluating the Association between the Choice of Anesthetic Agent and Intraoperative Hemodynamic Stability

Table 3 demonstrates the stability percentages during surgery, with Propofol showing the highest stability at 95%. The confidence intervals and P-values provide statistical evidence of significant differences in the maintenance of intraoperative hemodynamic stability among the agents, reinforcing the importance of agent selection based on patient-specific factors and surgical conditions.

Table 4: Assessing the Influence of Different Anesthetic Agents on Postoperative Recovery and Complications

Table 4 details the complication rates and recovery times post-surgery. Propofol shows the lowest complication rate (8%) and shortest recovery time (44 ± 7 hours), suggesting it may be the most beneficial in terms of postoperative recovery. The data indicate statistically significant differences in recovery profiles among the anesthetics, as evidenced by the range of P-values from 0.021 to 0.049, which underscores the need for careful choice of anesthetic agent to optimize recovery and minimize complications.

Table 1: Comparing the Impact of Various Anesthetic Agents on Hemodynamic Stability During Major Vascular Surgeries This table highlights the differences in mean blood pressure and heart rate among four anesthetic agents. Studies like those by Boucher N et al. . . (2023)^[7] have shown that agents like Propofol and Isoflurane can maintain better hemodynamic stability due to their minimal impacts on heart rate variability and blood pressure. Our findings suggest similar trends where Isoflurane and Etomidate demonstrate relatively stable hemodynamic parameters. The statistical significance indicated by the P-values correlates well with findings from Andropoulos DB et al. . . (2015)^[8], which indicated that hemodynamic stability could vary significantly with different anesthetic choices in vascular surgeries.

Table 2: Identifying the Anesthetic Agents Most Commonly Used in Major Vascular Surgeries and Their Hemodynamic Effects Our results showing Propofol as the most frequently used agent align with global trends as reported by Fakhari S et al. . . (2018)^[9]. They noted that Propofol's popularity might stem from its favorable profile concerning hemodynamic effects. This study’s P-values indicate strong statistical support for its widespread use, corroborating with findings from Aghdaii N,et al. . . (2015)[10] who noted Propofol's superior hemodynamic management capabilities in their cohort of vascular surgery patients.

Table 3: Evaluating the Association Between the Choice of Anesthetic Agent and Intraoperative Hemodynamic Stability Data showing Propofol with the highest percentage of intraoperative stability is supported by research from Yang B et al. . . (2016)^[11], who found that Propofol consistently maintains better intraoperative hemodynamic stability compared to volatile agents. The statistically significant differences highlighted in our study add to the body of evidence that suggests careful selection of anesthetics can optimize patient stability during major surgeries.

Table 4: Assessing the Influence of Different Anesthetic Agents on Postoperative Recovery and Complications This table indicates that Propofol not only enhances intraoperative stability but also appears to facilitate faster recovery and fewer complications. This finding is in line with the research by Soliman R et al. . . (2016)^[12], which demonstrated that Propofol’s pharmacokinetic properties might contribute to improved postoperative outcomes. The statistical significance seen in our results supports this argument and emphasizes the importance of choosing anesthetic agents that aid quicker patient recovery.

The cross-sectional study provides significant insights into the differential impacts of anesthetic agents on perioperative hemodynamic stability. Our findings underscore the importance of selecting the appropriate anesthetic to enhance patient outcomes during and after major vascular surgeries.

The study highlights that Propofol, among the agents examined, tends to offer superior hemodynamic stability, characterized by lower variability in blood pressure and heart rate. It also facilitates better intraoperative management and is associated with a higher incidence of stable hemodynamic profiles. Furthermore, Propofol was observed to contribute to shorter recovery times and lower complication rates post-surgery, reinforcing its potential as a preferred agent in vascular surgical procedures.

Conversely, while Isoflurane, Sevoflurane, and Etomidate also maintain adequate hemodynamic parameters, they were associated with slightly higher rates of hemodynamic fluctuations and postoperative complications compared to Propofol. These differences, though statistically significant, remind us of the need for a tailored approach based on individual patient profiles and specific surgical scenarios.

In conclusion, this study validates the critical role of anesthetic selection in major vascular surgeries and supports the use of Propofol for enhancing hemodynamic stability and improving recovery outcomes. However, the choice of anesthetic should always be tailored to the individual characteristics of the patient and the specifics of the surgical procedure. Future studies should focus on longitudinal assessments to further elucidate the long-term impacts of anesthetic choice on patient morbidity and mortality in vascular surgery settings.

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