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.
