Con: regional anesthesia is not preferable to general anesthesia for the patient with heart disease

The debate over regional anesthesia and general anesthesia with respect to relative risk in different classes of patients will probably be interminable until studies addressing the issue begin to specify the treatment protocols more carefully and to control as many variables as possible. Patients with cardiovascular disease who undergo major surgery are special cases in which either form of anesthesia may be acceptable or preferable. The benefits of lesser regional procedures do not necessarily extend to major conduction blockade in these individuals. Appropriate monitoring and goal-directed control of physiologic variables throughout the entire perioperative period may be more important than the type of anesthesia. General anesthesia that is carefully prepared, monitored, and conducted cannot be ruled out in the seriously ill.