Anaesthesia for lower limb amputation. A comparison of spinal analgesia and general anaesthesia in the elderly

Amputation of the lower limb for vascular disease has a high morbidity and mortality. A comparative study in 60 patients was carried out between spinal analgesia with sedation and general anaesthesia with controlled ventilation which maintained end expiratory carbon dioxide 4-4.5 k Pa. The spinal technique had advantages over general anaesthesia during surgery and in the first 24 hours, but no long term benefits. Meticulous pre-operative preparation, intra-operative care and careful postoperative management, including monitoring of end expiratory carbon dioxide tension, appeared to be major factors contributing towards the low morbidity and mortality.