Spinal with AAA

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I did a AAA the other week with a spinal-general and was wondering how common this practice is. Obviously, the benefit of the spinal is for pain control post-op, but if so, would an epideral not be just as good (ie. post-op dosing)?

From my perspective, the hemodynamics seemed rather smooth. Little increase in SVR with crossclamping. In fact, if my memory serves, the patient required three bags of Neo for the four hour case.

What are all your thoughts on the pros and cons of this technique?

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while i can understand the benefit of depressed peripheral resistance at time of aortic cross clamp - i think the duration of a spinal is a major drawback and doesn't have the advantages of an epidural... and you can obtain the same results with an epidural... in fact almost all of my AAA (unless they are ruptured thoracos that are too unstable to place an epidural) get epidurals, and i run the epidural throughout the case, paralyze the patient and use literally minimal volatile.... it makes for a great wake-up and these patients never have pain (or rarely do)... which definitely makes their hemodynamics much smoother upon awakening!

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A side off your original topic, but curious. I currently had a patient about 25 days out of a AAA with an epidural that the end of all resulted in paraplegia and on to renal failure currently on dialysis. Testing is indicating no 'found' reason for this occurring (ex nothing on mri etc) . She actually was doing preop testing for a hip replacement. They are currently under the impression of a preexisting condition..?? Do you have any experiences with this or similar?? Expectations are that she will not improve. Interested in your point of view, not the potential blame issue. I have hear the doc's discussion on this with the family and under the impression of all involved that there is no 'found proofable' explanation other than the obvious risk already involved.

Lisa (who gladly gave birth to 5 without pain intervention for her own personal fears):stone

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