Anaesthesia for lower limb revascularization

Tovey, Gail; Thompson, Jonathan P.

doi:10.1093/bjaceaccp/mki024

Cited by 8 publications

(4 citation statements)

References 12 publications

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“…The presence of an anaesthetist has several additional benefits. 6 The anaesthetist also ensures an additional physiological review of the patient which is beneficial especially for those with multiple co-morbidities. Even if it is decided to perform the procedure under local anaesthetic, it is advantageous to have the anaesthetist present to monitor the patient as they will be high risk especially during the reperfusion phase because of the associated hyperkalaemia, myocardial depression, arrhythmias, myoglobinaemia, and acute renal failure.…”

Section: Discussionmentioning

confidence: 99%

Update Experience of Surgery for Acute Limb Ischaemia in a District General Hospital – Are We Getting Any Better?

Morris‐Stiff

D'souza

Raman

et al. 2009

annals

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INTRODUCTION The aims of this study were to audit results of a 10-year experience of surgery for acute limb ischaemia (ALI) in terms of limb salvage and mortality rates, and to compare results with a historical published series from our unit. PATIENTS AND METHODS All emergency operations performed during the period 1993-2003 were identified from theatre registers and patient notes reviewed to determine indications for, and outcome of, surgery. Data were compared to a similar cohort who underwent surgery from 1980 to 1990. RESULTS There was a 33% increase in workload from 87 to 116 patients between the two time periods. The number of patients with idiopathic ALI reduced (24% versus 4%; P < 0.05), and there were fewer smokers (71% versus 39%; P < 0.05) and a greater number of claudicants (17% versus 35%; P < 0.05) in those treated from 1993-2003. Latterly, more patients underwent pre-operative heparinisation (33% versus 80%; P < 0.05), received prophylactic antibiotics (14% versus 63%; P < 0.05), and had anaesthetic presence in theatre (46% versus 88%; P < 0.05). There was also a reduction in local anaesthetic procedures (80% versus 41%; P < 0.05). Despite increased pre-operative (15% versus 47%; P < 0.05) and on-table imaging (0% versus 16%; P < 0.05) technical success did not improve. Whilst complication rates were identical at 62%, there were fewer cardiovascular complications in the recent cohort. The 30-day mortality rate for embolectomy fell from 45% to 33%. Multivariate analysis revealed age > 70 years, prolonged symptom duration, ASA score ≥ III, lack of prophylactic antibiotics, absence of an anaesthetist, and operations performed under local anaesthetic to be associated with increased risk of mortality. Factors adversely affecting limb salvage included prolonged duration from symptom onset to operation, and a history of claudication or smoking. CONCLUSIONS Despite improvements in pre-and peri-operative management, arterial embolectomy/thrombectomy remains a procedure with a high morbidity and mortality. Further attempts to improve outcome must be directed at early diagnosis and referral as delay from symptom onset to surgery is a major determinant of outcome.

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Section: Discussionmentioning

confidence: 99%

Update Experience of Surgery for Acute Limb Ischaemia in a District General Hospital – Are We Getting Any Better?

Morris‐Stiff

D'souza

Raman

et al. 2009

annals

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“…General anesthetic agents are known to cause severe cardiovascular instability, therefore employing GA in this case would jeopardize myocardial perfusion. Amyloid deposition in the coronary vessels, due to preexisting CA, was placing an extra burden [ 9 ]. However, one should note that these conditions are only relative contraindications of GA, thus we would be forced to proceed with it despite the high risk if no other reasonable alternatives were available.…”

Section: Discussionmentioning

confidence: 99%

“…This infiltration causes restrictive cardiomyopathy. The left ventricle cannot dilate appropriately and stops being preload dependent, leaving a fast heart rate as the sole mechanism for preserving cardiac output [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Applying the Suprainguinal Approach of Fascia Iliaca Compartment Block for Surgical Anesthesia in a Patient Undergoing Emergency Femoral Thrombectomy: A Case Report

Soulioti,

Antonopoulos,

Manikis

et al. 2023

Cureus

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We present the first documented case of achieving surgical anesthesia for a vascular surgery using the suprainguinal approach of the fascia iliaca compartment block (SFICB), in a patient with severe comorbidities from the cardiovascular system. More specifically, a male elderly patient with a history of cardiac amyloidosis, severe aortic stenosis, and coronary artery disease, was in need of emergent thrombectomy due to acute lower limb ischemia. During the evaluation of this patient, general and neuraxial anesthesia were both considered. However, the former would expose him to the risk of myocardial ischemia and other complications due to cardiovascular instability caused by the general anesthetic agents while the latter was absolutely contraindicated due to recent clopidogrel use and the specific pathophysiology changes induced by cardiac amyloidosis. Thus, a peripheral nerve block was deemed to be the best option in this case. SFICB, despite being challenging, could offer adequate analgesic results so it was the anesthetic technique of choice. The surgery was completed and the patient recovered appropriately. The aim of this report is to discuss the specific anesthetic considerations of this case, highlight the ability of SFICB to achieve surgical anesthesia in vascular surgeries, and increase familiarity with the procedure.

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“…Surgery for lower limb revascularization is associated with a high risk of cardiac morbidity and mortality. [ 1 ] Here, we present a case of successful anesthesia management of ALI in a patient with a recent myocardial infarction (MI) who underwent femoral thrombectomy under fascia iliaca block (FIB).…”

Section: Introductionmentioning

confidence: 99%

Fascia Iliaca block as the sole anesthesia technique in a patient with recent myocardial infarction for emergency femoral thrombectomy

et al. 2015

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Anaesthesia for lower limb revascularization

Cited by 8 publications

References 12 publications

Update Experience of Surgery for Acute Limb Ischaemia in a District General Hospital – Are We Getting Any Better?

Update Experience of Surgery for Acute Limb Ischaemia in a District General Hospital – Are We Getting Any Better?

Applying the Suprainguinal Approach of Fascia Iliaca Compartment Block for Surgical Anesthesia in a Patient Undergoing Emergency Femoral Thrombectomy: A Case Report

Fascia Iliaca block as the sole anesthesia technique in a patient with recent myocardial infarction for emergency femoral thrombectomy

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