[General or locoregional anesthesia: which to choose for a patient at risk?]

HIGH RISK SITUATIONS: The risk of surgery is higher in certain situations (subjects over 70 years of age, underlying disease states). Procedures lasting more than 3 hours or performed in emergency situations also increase the risk. The question is often raised as to which type of anesthesia, general or locoregional, is the most appropriate to lower the risk of complications in such situations. ANESTHESIA-DEPENDENT EFFECTS: Respiratory complications during or after surgery are more frequent if general anesthesia is used. Cardiovascular complications are not influenced by the type of anesthesia. Local-regional anesthesia can lower the risk of post-operative venous thrombosis and the development of thrombus formation secondary to vascular surgery. It also eliminates the neuroendocrine response to surgical stress. MODEST EFFECT: Only a few precise parameters can differentiate risk between general and locoregional anesthesia. However, the type of anesthesia has little effect on overall morbidity or mortality, which depend more on the general status of the patient and the surgical procedure performed.