Mehmet Ilker SIVACIGIL, Leyla SIVACIGIL, Lale YUCEYAR, Hulya EROLCAY
The Medical Bulletin of Haseki - 2026;64(2):92-100
Aim: Vascular surgery is among the surgical procedures associated with the highest cardiac morbidity and mortality because the surgical stress response is pronounced in individuals with cardiogenic risk factors. The aim of this study is to evaluate the effect of epidural anesthesia on the surgical stress response during major vascular surgery. Methods: Two groups (epidural group (EG), n=15; control group, n=15) were formed in the cardiovascular surgery operating room by prospective randomization. Hemodynamic fluctuations and visual analog scale (VAS) pain scores were monitored. The primary endpoint was defined as the change in N-terminal-proBNP (NT-proBNP) levels on postoperative day two compared with preoperative measurements. Troponin-I, changes in blood flow, pain scores, and sevoflurane use were secondary endpoints. Results: Sevoflurane consumption was lower in EG, whereas fluid volume was higher. >=11 tachycardia attacks were more frequent in CG, and >=11 decreases in mean arterial pressure were seen (33.3% vs. 0%; p=0.042). VAS was lower in favor of EG (Day-1: 4.33+/-0.98 vs. 5.27+/-0.70, p=0.011; Day-2: 1.67+/-1.13 vs. 2.13+/-0.64, p=0.041). No difference in NT-proBNP/troponin-I levels was observed between groups. Conclusion: In vascular surgery, epidural anesthesia can reduce hemodynamic fluctuations and early postoperative pain while limiting the rise in NT-proBNP . Biomarker findings are hypothesis-generating owing to methodological constraints and necessitate validation through studies with larger sample sizes.
