Lower Limb Blood Flow during Transurethral Resection of the Prostate under Spinal or General Anaesthesia

Abstract

Using venous occlusion impedance plethysmography, leg blood flow was measured in seventeen men undergoing transurethral prostatectomy under either amethocaine spinal anaesthesia (SAB) or nitrous oxide-halothane general anaesthesia (GA). Mean leg blood flow doubled (206% of preoperative control value) fol/owing induction of SAB, remained elevated throughout surgery (146% of control at the end of operation) and had returned to pre-operative levels (94%) by two hours postoperatively. Under GA, mean blood flow rose gradually during surgery to 136% of control by the end. However, mean blood flow was only 28% of control at one hour postoperatively, rising to 66% of control by two hours. Analysis of variance showed a significant difference in blood flow changes between the two groups (Greenhouse Geisser P= 0.005). The early postoperative fall in leg blood flow in the GA group might be important in the aetiology of postoperative deep vein thrombosis.

Changes of dorsalis pedis artery flow pattern after caudal block in children: observational study using a duplex sonography

“…It has been investigated that arterial blood pressure and cardiac output are shown to be well maintained with this technique (1,2). Rising in total blood flow of lower limbs from sympatholytic blocks in adults was demonstrated in several previous reports (3–5). However, little is known about the acute change in peripheral arterial flow patterns of sympathetically blocked lower limbs, particularly in anesthetized children.…”

Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised

“…The neuraxial blockade group had no general anaesthesia in 79 (56%) trials and the same general anaesthesia as the non-neuraxial blockade group in 37 (26%) trials. In 22 (15%) trials the neuraxial blockade group received a general anaesthesia different from that in the non-neuraxial blockade group; the systemic opioid varied in seven trials, 28 34 43 84 120 186 192 the use of inhalational anaesthetic varied in two trials, 71 140 the type of inhalational anaesthetic varied in two trials, 148 165 the induction drug varied in one trial,191 and more than one aspect varied in 10 trials. 42 76 80 81 97 151 161 168 169 189 For three (2%) trials details of the general anaesthesia method were unknown.…”

“…An overall reduction in mortality was still evident after we excluded studies for which the total number of patients originally randomised was not available (0.68, 0.51 to 0.91) 26 180; original authors could not be contacted (0.69, 0.53 to 0.90) 36 38 40 82 83 86 103 115 118 131 137-144 147 150 153 155 166 171 172 179 181 185 190 ; more than 5% of all patients were lost to follow up or excluded after randomisation (0.69, 0.51 to 0.91) 3 14 32 38 57 62 71 74 75 94 108 113 114 120 129 130 140 159 164 165 171 173 181 187 ; or more than 5% of the neuraxial blockade group were excluded after randomisation (0.68, 0.51 to 0.91). 28 32 57 75 94 113 120 129 130 140 159 164 165 171 173 The reduction in mortality was also evident after exclusion of two trials that were stopped before scheduled completion (0.70, 0.53 to 0.91) and exclusion of unpublished data (0.67, 0.51 to 0.88).…”

Hemodynamic alterations in the transferred tissue to lower extremities

“…2,7,8 Lower limb hemodynamic impairment associated with surgery and general anesthesia has been well documented. Foate et al 19 reported that the mean arterial leg blood flow in patients under general anesthesia was only 28% of the control at 1 hour after surgery. This compromised arterial inflow has been linked to a higher rate of early postoperative graft failure in infrainguinal arterial bypass surgery, whereas epidural anesthesia did not cause this adverse effect of general anesthesia.…”