Anaesthesia for Lower Limb Amputation. A Comparison of Spinal Analgesia and General Anaesthesia in the Elderly

Mann, Roger A.; Bisset, W.I.K.

doi:10.1097/00132586-198408000-00053

Cited by 10 publications

(18 citation statements)

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“…Although the effect of anaesthesia on postoperative mortality has been studied [3], it has not been fully evaluated in patients undergoing MLEA. The only comparative study by Mann et al found no difference in the rates of mortality and morbidity between general anaesthesia and spinal anaesthesia [10]. However, they only studied 60 patients.…”

Section: Discussionmentioning

confidence: 96%

Effect of anaesthetic technique on mortality following major lower extremity amputation: a propensity score‐matched observational study

Khan

Qianyi²,

Liu

et al. 2013

Anaesthesia

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SummaryWe investigated whether the type of anaesthesia affects mortality and length of stay after non-traumatic major lower extremity amputations. A total of 1365 eligible patients who were operated on between 2002 and 2010 were included in the final analysis. Propensity score matching was used to produce 475 matched pairs of patients undergoing operation with either general or regional anaesthesia. We found that 30-day mortality was significantly greater in the general anaesthesia group compared with the regional anaesthesia group, with an odds ratio (95% CI) of 1.5 (1.0-2.3) in the total matched population and 4.2 (1.3-13.4) in a high-risk subgroup. The median (IQR [range]) length of postoperative hospital stay was significantly less in the patients of the high-risk subgroup who had general anaesthesia at 15 (7-21 [1-101]) days compared with 25 days (10-37 [0-78]) for those who had regional anaesthesia (p = 0.027). The results of our study suggest that 30-day mortality is significantly higher in patients undergoing major lower extremity amputations under general anaesthesia compared with regional anaesthesia. The choice of an appropriate anaesthetic technique is usually made by the anaesthesiologist after taking into account the patient's medical condition, operative factors, surgical requirements, skills of the anaesthesiologist and the preferences of the patient. Many of these decisions are based on previous experience and expert opinion. The fact that the anaesthetic technique can have repercussions beyond the traditional peri-operative period is only now being realised [1]. This new realisation has made intra-operative anaesthetic choice even more complex, requiring a more robust level of evidence to guide decision making than just expert opinion alone.The effect of anaesthetic technique on postoperative mortality has been studied in the past in various types of surgery [2,3], but the heterogeneity of the surgical population makes generalisations about the effect of anaesthesia on mortality inappropriate.Patients undergoing non-traumatic major lower extremity amputation (MLEA) are known to have a large number of comorbidities and an associated 30-day mortality ranging between 8% and 32% [4][5][6][7][8]. Cardiovascular complications make up the most common cause of postoperative mortality among these patients [7,9]. Although there is some evidence indicating that 612 Anaesthesia

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Section: Discussionmentioning

confidence: 96%

Effect of anaesthetic technique on mortality following major lower extremity amputation: a propensity score‐matched observational study

Khan

Qianyi²,

Liu

et al. 2013

Anaesthesia

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“…In fact, only 1 study used the NSQIP database to study outcomes in this surgical population, but it has several methodological limitations as described below. 10,21,22 In general, there is a paucity of evidence-based recommendations over which choice of anesthesia is best in this high-risk population. Chery et al conducted a retrospective review consisting of 463 patients who underwent LEAs, both BKAs and AKAs, at a single center over a 10-year span.…”

Section: Discussionmentioning

confidence: 99%

The Use of Regional or Neuraxial Anesthesia for Below-Knee Amputations May Reduce the Need for Perioperative Blood Transfusions

Malik

Brovman

Urman

2018

Regional Anesthesia and Pain Medicine

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“…Fifteen of these were subsequently excl uded. 13,14,17,19,20,21,24,26,28,[31][32][33]36,40,43 The reasons for their exclusion can be seen in Figure 1. Thus, 17 articles with the potential to answer our research question were identified.…”

Section: Study Selectionmentioning

confidence: 99%

Neuraxial anesthesia for orthopedic surgery: systematic review and meta-analysis of randomized clinical trials

2013

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CONTEXT AND OBJECTIVE: Taking the outcome of mortality into consideration, there is controversy about the beneficial effects of neuraxial anesthesia for orthopedic surgery. SciELO, EMBASE (1974 to November 2012 and reference lists of the studies included. Only randomized controlled trials were included. RESULTS: Out of 5,032 titles and abstracts, 17 studies were included. There were no statistically significant differences in mortality (risk difference, RD: -0.01; 95% confidence interval, CI: -0.04 to 0.01; n = 1903), stroke (RD: 0.02; 95% CI: -0.04 to 0.08; n = 259), myocardial infarction (RD: -0.01; 95% CI: -0.04 to 0.02; n = 291), length of hospitalization (mean difference, -0.05; 95% CI: -0.69 to 0.58; n = 870), postoperative cognitive dysfunction (RD: 0.00; 95% CI: -0.04 to 0.05; n = 479) or pneumonia (odds ratio, 0.61; 95% CI: 0.25 to 1.49; n = 167). CONCLUSION: So far, the evidence available from the studies included is insufficient to prove that neuraxial anesthesia is more effective and safer than general anesthesia for orthopedic surgery. However, this systematic review does not rule out clinically important differences with regard to mortality, stroke, myocardial infarction, length of hospitalization, postoperative cognitive dysfunction or pneumonia. CONCLUSÃO: Até o momento, as evidências são insuficientes nos estudos incluídos para provar que AN é mais efetiva e segura do que AG para cirurgias ortopédicas. Esta revisão sistemática não descartou diferenças clínicas importantes para mortalidade, acidente vascular encefálico, infarto miocárdico, tempo de internação, disfunção cognitiva pós-operatória e pneumonia. RESUMO IMSc. Professor,

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Anaesthesia for Lower Limb Amputation. A Comparison of Spinal Analgesia and General Anaesthesia in the Elderly

Cited by 10 publications

References 0 publications

Effect of anaesthetic technique on mortality following major lower extremity amputation: a propensity score‐matched observational study

Effect of anaesthetic technique on mortality following major lower extremity amputation: a propensity score‐matched observational study

The Use of Regional or Neuraxial Anesthesia for Below-Knee Amputations May Reduce the Need for Perioperative Blood Transfusions

Neuraxial anesthesia for orthopedic surgery: systematic review and meta-analysis of randomized clinical trials

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