Use of epidural anesthesia and spontaneous ventilation during transabdominal colon and rectal procedures in selected high-risk patient groups

PURPOSE: Patients with cardiopulmonary compromise who require transabdominal colon and rectal procedures are at increased risk for postoperative cardiac and pulmonary complications and prolonged hospital stays. Because epidural anesthesia has been shown to minimize reductions in functional residual capacity and consequently improve pulmonary function, we sought to determine its impact on patients undergoing colon and rectal procedures who were at high risk for postoperative cardiopulmonary morbidity. METHODS: We prospectively studied 31 patients undergoing colon and rectal procedures in whom epidural anesthesia with spontaneous ventilation were used. The criteria for entry included histories of respiratory insufficiency, atherosclerotic heart disease, and extremes of age. Patients who received general endotracheal anesthesia were excluded from consideration. Cardiac and pulmonary morbidity, mortality, and length of stay were analyzed. The data obtained were compared with those of a similar group of 50 patients who during the same time interval had undergone transabdominal colon and rectal operations with general anesthesia in the absence of epidural anesthesia. RESULTS: There were 19 males and 12 females in the epidural study group. Mean age was 71 (range, 35-92) years. There were no cases of pulmonary morbidity. Cardiac morbidity was 6 percent (2/31), with a mortality rate of 3 percent (1/31). Average length of postoperative hospital stay was 10.5 (range, 7-19) days. There were 29 males and 21 females with a mean age of 67 (range, 51- 92) years in the general anesthesia group. Pulmonary morbidity was 18 percent (9/50). Incidence of cardiac complications was 4 percent (2/50). There were no mortalities. Average length of stay in the general anesthesia group was 13.6 (range, 6-24) days. CONCLUSION: Use of epidural anesthesia with spontaneous ventilation in elective transabdominal colon and rectal procedures may decrease the incidence of pulmonary complications and length of postoperative hospital stay in a select group of high-risk patients.