Open Abdominal Aortic Aneurysm (AAA) repair is a high-risk surgical procedure accompanied by intense endocrine and metabolic responses to surgical stress, with subsequent activation of the inflammatory cascade, cytokine and acute-phase protein release, and bone marrow activation. There is a proven correlation of surgical stress, which patients undergoing open AAA repair are subjected to, with patient outcome, morbidity/mortality, intensive care unit stay and overall length of stay. Modern general anesthetic techniques have been revised and rely on perioperative multimodal anesthetic and analgesic strategies for improved overall patient outcome. Based on this context of a multimodal anesthetic technique and having taken into consideration the international "opioid-crisis" epidemic, an Opioid Free Anesthesia-Analgesia (OFA-A) strategy started to emerge. It is based on the administration of a variety of anesthetic/analgesic agents with different mechanisms of action, including immunomodulating and anti-inflammatory effects. Our basic hypothesis is that the implementation of a perioperative multimodal OFA-A strategy, involving the administration of pregabalin, ketamine, dexmedetomidine, lidocaine, dexamethasone, dexketoprofen, paracetamol and magnesium sulphate, will lead to attenuation of surgical stress response compared to a conventional Opioid-Based Anesthesia-Analgesia (OBA-A) strategy. Furthermore, the anticipated attenuation of the inflammatory response, is pressumed to be associated with equal or improved analgesia, compared to a perioperative OBA-A technique.
Age range
40 Years – 85 Years
Sex
ALL
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Surgical Stress Response - IL-6 - Preoperatively
Timeframe: 1) Preoperatively (as a baseline)
Surgical Stress Response - IL-6 - 15 minutes after aortic cross-clamp
Timeframe: 2) 15 minutes after aortic cross-clamping
Surgical Stress Response - IL-6 - 60 minutes after aortic cross-clamp
Timeframe: 3) 60 minutes after aortic cross-clamp release
Surgical Stress Response - IL-6 - 24 hours after aortic cross-clamp release
Timeframe: 4) 24 hours after aortic cross-clamp release
Surgical Stress Response - IL-8 - Preoperatively
Timeframe: 1) Preoperatively (as a baseline)
Surgical Stress Response - IL-8 - 15 minutes after aortic cross-clamp
Timeframe: 2) 15 minutes after aortic cross-clamping
Surgical Stress Response - IL-8 - 60 minutes after aortic cross-clamp
Timeframe: 3) 60 minutes after aortic cross-clamp release
Surgical Stress Response - IL-8 - 24 hours after aortic cross-clamp release
Timeframe: 4) 24 hours after aortic cross-clamp release
Surgical Stress Response - IL-10 - Preoperatively
Timeframe: 1) Preoperatively (as a baseline)
Surgical Stress Response - IL-10 - 15 minutes after aortic cross-clamp
Timeframe: 2) 15 minutes after aortic cross-clamping
Surgical Stress Response - IL-10 - 60 minutes after aortic cross-clamp
Timeframe: 3) 60 minutes after aortic cross-clamp release
Surgical Stress Response - IL-10 - 24 hours after aortic cross-clamp release
Timeframe: 4) 24 hours after aortic cross-clamp release
Surgical Stress Response - Copeptin - Preoperatively
Timeframe: 1) Preoperatively (as a baseline)
Surgical Stress Response - Copeptin - 15 minutes after aortic cross-clamp
Timeframe: 2) 15 minutes after aortic cross-clamping
Surgical Stress Response - Copeptin - 60 minutes after aortic cross-clamp
Timeframe: 3) 60 minutes after aortic cross-clamp release
Surgical Stress Response - Copeptin - 24 hours after aortic cross-clamp release
Timeframe: 4) 24 hours after aortic cross-clamp release
Surgical Stress Response - TNF-a - Preoperatively
Timeframe: 1) Preoperatively (as a baseline)
Surgical Stress Response - TNF-a - 15 minutes after aortic cross-clamp
Timeframe: 2) 15 minutes after aortic cross-clamping
Surgical Stress Response - TNF-a - 60 minutes after aortic cross-clamp
Timeframe: 3) 60 minutes after aortic cross-clamp release
Surgical Stress Response - TNF-a - 24 hours after aortic cross-clamp release
Timeframe: 4) 24 hours after aortic cross-clamp release
Surgical Stress Response - Cortisol - Preoperatively
Timeframe: 1) Preoperatively (as a baseline)
Surgical Stress Response - Cortisol - 15 minutes after aortic cross-clamp
Timeframe: 2) 15 minutes after aortic cross-clamping
Surgical Stress Response - Cortisol - 60 minutes after aortic cross-clamp
Timeframe: 3) 60 minutes after aortic cross-clamp release
Surgical Stress Response - Cortisol - 24 hours after aortic cross-clamp release
Timeframe: 4) 24 hours after aortic cross-clamp release
Surgical Stress Response - CRP - Preoperatively
Timeframe: 1) Preoperatively (as a baseline)
Surgical Stress Response - CRP - 15 minutes after aortic cross-clamp
Timeframe: 2) 15 minutes after aortic cross-clamping
Surgical Stress Response - CRP - 60 minutes after aortic cross-clamp
Timeframe: 3) 60 minutes after aortic cross-clamp release
Surgical Stress Response - CRP - 24 hours after aortic cross-clamp release
Timeframe: 4) 24 hours after aortic cross-clamp release
Surgical Stress Response - WBC - Preoperatively
Timeframe: 1) Preoperatively (as a baseline)
Surgical Stress Response - WBC - 15 minutes after aortic cross-clamp
Timeframe: 2) 15 minutes after aortic cross-clamping
Surgical Stress Response - WBC - 60 minutes after aortic cross-clamp
Timeframe: 3) 60 minutes after aortic cross-clamp release
Surgical Stress Response - WBC - 24 hours after aortic cross-clamp release
Timeframe: 4) 24 hours after aortic cross-clamp release
Haemodynamic Stability - Tachycardia
Timeframe: From anesthesia induction, until the end of surgery (end of placement of last suture/surgical clip on patient), assessed up to 8 hours
Haemodynamic Stability - Bradycardia
Timeframe: From anesthesia induction, until the end of surgery (end of placement of last suture/surgical clip on patient), assessed up to 8 hours
Haemodynamic Stability - Hypotension SBP
Timeframe: Baseline: 5 minutes prior to anaesthesia induction. Intraoperative Hypotension: From anesthesia induction, until the end of surgery (end of placement of last suture/surgical clip on patient), assessed up to 8 hours
Haemodynamic Stability - Hypotension MBP
Timeframe: Baseline: 5 minutes prior to anaesthesia induction. Intraoperative Hypotension: From anesthesia induction, until the end of surgery (end of placement of last suture/surgical clip on patient), assessed up to 8 hours
Haemodynamic Stability - Hypertension
Timeframe: Baseline: 5 minutes prior to anaesthesia induction. Intraoperative Hypotension: From anesthesia induction, until the end of surgery (end of placement of last suture/surgical clip on patient), assessed up to 8 hours
Haemodynamic Stability - Fluid requirements - Crystalloids - Intraoperatively
Timeframe: From anesthesia induction, until the end of surgery (end of placement of last suture/surgical clip on patient), assessed up to 8 hours
Haemodynamic Stability - Fluid requirements - Crystalloids - 24 hours postoperatively
Timeframe: From the end of surgery (end of placement of last suture/surgical clip on patient) until 24 hours postoperatively
Haemodynamic Stability - Fluid requirements - Colloids - Intraoperatively
Timeframe: From anesthesia induction, until the end of surgery (end of placement of last suture/surgical clip on patient), assessed up to 8 hours
Haemodynamic Stability - Fluid requirements - Colloids - 24 hours postoperatively
Timeframe: From the end of surgery (end of placement of last suture/surgical clip on patient) until 24 hours postoperatively
Haemodynamic Stability - Fluid requirements - Concentrated RBCs - Intraoperatively
Timeframe: From anesthesia induction, until the end of surgery (end of placement of last suture/surgical clip on patient), assessed up to 8 hours
Haemodynamic Stability - Fluid requirements - Concentrated RBCs - 24 hours postoperatively
Timeframe: From the end of surgery (end of placement of last suture/surgical clip on patient) until 24 hours postoperatively
Haemodynamic Stability - Fluid requirements - Plasma - Intraoperatively
Timeframe: From anesthesia induction, until the end of surgery (end of placement of last suture/surgical clip on patient), assessed up to 8 hours
Haemodynamic Stability - Fluid requirements - Plasma - 24 hours postoperatively
Timeframe: From the end of surgery (end of placement of last suture/surgical clip on patient) until 24 hours postoperatively
Haemodynamic Stability - Fluid requirements - Platelets - Intraoperatively
Timeframe: From anesthesia induction, until the end of surgery (end of placement of last suture/surgical clip on patient), assessed up to 8 hours
Haemodynamic Stability - Fluid requirements - Platelets - 24 hours postoperatively
Timeframe: From the end of surgery (end of placement of last suture/surgical clip on patient) until 24 hours postoperatively
Haemodynamic Stability - Blood Loss - Intraoperatively
Timeframe: From anesthesia induction, until the end of surgery (end of placement of last suture/surgical clip on patient), assessed up to 8 hours
Haemodynamic Stability - Blood Loss - 24 hours postoperatively
Timeframe: From the end of surgery (end of placement of last suture/surgical clip on patient) until 24 hours postoperatively
Haemodynamic Stability - Fluid Balance - Intraoperatively
Timeframe: From anesthesia induction, until the end of surgery (end of placement of last suture/surgical clip on patient), assessed up to 8 hours
Haemodynamic Stability - Fluid Balance - 24 hours postoperatively
Timeframe: From the end of surgery (end of placement of last suture/surgical clip on patient) until 24 hours postoperatively
Haemodynamic Stability - Vasoactive Requirements - Adrenaline - Intraoperatively
Timeframe: From anesthesia induction, until the end of surgery (end of placement of last suture/surgical clip on patient), assessed up to 8 hours
Haemodynamic Stability - Vasoactive Requirements - Adrenaline - 24 hours postoperatively
Timeframe: From the end of surgery (end of placement of last suture/surgical clip on patient) until 24 hours postoperatively
Haemodynamic Stability - Vasoactive Requirements - Noradrenaline - Intraoperatively
Timeframe: From anesthesia induction, until the end of surgery (end of placement of last suture/surgical clip on patient), assessed up to 8 hours
Haemodynamic Stability - Vasoactive Requirements - Noradrenaline - 24 hours postoperatively
Timeframe: From the end of surgery (end of placement of last suture/surgical clip on patient) until 24 hours postoperatively
Haemodynamic Stability - Vasoactive Requirements - Ephedrine - Intraoperatively
Timeframe: From anesthesia induction, until the end of surgery (end of placement of last suture/surgical clip on patient), assessed up to 8 hours
Haemodynamic Stability - Vasoactive Requirements - Ephedrine - 24 hours postoperatively
Timeframe: From the end of surgery (end of placement of last suture/surgical clip on patient) until 24 hours postoperatively
Haemodynamic Stability - Vasoactive Requirements - Phenylephrine - Intraoperatively
Timeframe: From anesthesia induction, until the end of surgery (end of placement of last suture/surgical clip on patient), assessed up to 8 hours
Haemodynamic Stability - Vasoactive Requirements - Phenylephrine - 24 hours postoperatively
Timeframe: From the end of surgery (end of placement of last suture/surgical clip on patient) until 24 hours postoperatively
Haemodynamic Stability - Vasoactive Requirements - Dobutamine - Intraoperatively
Timeframe: From anesthesia induction, until the end of surgery (end of placement of last suture/surgical clip on patient), assessed up to 8 hours
Haemodynamic Stability - Vasoactive Requirements - Dobutamine - 24 hours postoperatively
Timeframe: From the end of surgery (end of placement of last suture/surgical clip on patient) until 24 hours postoperatively
Haemodynamic Stability - Vasoactive Requirements - Dopamine - Intraoperatively
Timeframe: From anesthesia induction, until the end of surgery (end of placement of last suture/surgical clip on patient), assessed up to 8 hours
Haemodynamic Stability - Vasoactive Requirements - Dopamine - 24 hours postoperatively
Timeframe: From the end of surgery (end of placement of last suture/surgical clip on patient) until 24 hours postoperatively
Haemodynamic Stability - Vasoactive Requirements - Nitroglycerine - Intraoperatively
Timeframe: From anesthesia induction, until the end of surgery (end of placement of last suture/surgical clip on patient), assessed up to 8 hours
Haemodynamic Stability - Vasoactive Requirements - Nitroglycerine - 24 hours postoperatively
Timeframe: From the end of surgery (end of placement of last suture/surgical clip on patient) until 24 hours postoperatively