Local anesthesia for infrainguinal arterial reconstruction

Area of Science:

• Vascular Surgery
• Anesthesiology
• Cardiology

Background:

• Perioperative cardiac complications affect 4-6% of patients undergoing infrainguinal revascularization.
• High-risk patients with complex cardiac conditions face increased risks with general or regional anesthesia.
• Urgent limb salvage operations necessitate careful anesthetic considerations for vulnerable patients.

Purpose of the Study:

• To evaluate the feasibility and outcomes of using local anesthesia for infrainguinal revascularization.
• To assess the safety and efficacy of local anesthesia in high-risk surgical patients.
• To determine if local anesthesia is a viable alternative to general or regional anesthesia for limb salvage.

Main Methods:

• 86 infrainguinal reconstructions performed under local infiltration anesthesia (0.5% or 1.0% lidocaine).
• Intravenous sedation used as needed for patient comfort.
• Postoperative monitoring included continuous electrocardiography.

Main Results:

• Low rates of perioperative cardiac complications (2% myocardial infarctions).
• Two postoperative deaths (2.4%) occurred, one from stroke.
• General anesthesia conversion was required in 5% of cases due to agitation or extensive vein harvesting.

Conclusions:

• Infrainguinal limb salvage operations can be safely performed under local anesthesia.
• Local anesthesia offers theoretical and practical advantages for selected high-risk patients.
• Local anesthesia should be considered a valuable alternative to general or regional anesthesia.