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• W2060007001 abstract "Over the last decade medical care has been driven by two dominant forces: pressures to reduce use of medical resources and improvements in quality of patient care. Improvements in patient outcome and reduced use of resources have been suggested to result from using regional techniques as compared with general anesthesia alone for high-risk patients undergoing significant operative procedures. Other proposed advantages of regional anesthesia techniques include decrease in the neuroendocrine “stress” response, improved postoperative pulmonary function, reduced thrombotic complications, and reduced perioperative cardiac morbidity. Patients with cardiac disease undergoing noncardiac surgery represent a significant management challenge to the anesthesiologist. Unlike patients presenting for cardiac surgery, these patients frequently do not have extensive work-ups directed at the cardiovascular system, have not been as aggressively medically managed, and are not expected, based upon their surgical procedure, to need cardiac monitoring or intervention after surgery. Outcome research comparing regional with general anesthesia over the last decade has been focused primarily on the high-risk patient undergoing noncardiac vascular surgery. Vascular surgery patients have been shown to be at higher risk of perioperative cardiac morbidity than patients having other types of surgery, 9 and patients with peripheral vascular disease have a higher rate of mortality overall than those without it. 5 Patients who are at high risk for cardiovascular morbidity can be expected to have an increased rate of morbidity regardless of their anesthetic. Thus, trials performed upon a relatively small number of patients can have a large enough number of adverse outcomes to establish whether one type of anesthetic is more dangerous than another. Options for regional anesthesia for patients with cardiovascular disease include use of subarachnoid or epidural local anesthetics or narcotics, regional anesthesia for carotid artery endarterectomy, use of interscalene or axillary block for placement of fistulas in the arm for renal dialysis, and intercostal blockade as an adjunct for upper abdominal surgery. Several recent prospective clinical trials have examined the use of epidural or spinal anesthesia either as an adjunct or as the sole anesthetic for procedures, including thoracic surgery, aortic surgery, and lower extremity vascular surgery. Non-neuraxial regional anesthesia has not been studied with the same intensity. It does not involve as great a physiologic trespass because it does not cause sympathectomy, which may be accompanied by hypotension. It is also appropriate for less major surgery, such as eye surgery or arteriovenous fistula formation, for patients with renal failure. Even though patients having these procedures often have cardiac disease, these surgical procedures are not associated with high rates of perioperative cardiovascular complications. Therefore, this article focuses upon neuraxial anesthesia rather than upon other types of regional anesthesia." @default.
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• W2060007001 date "1997-03-01" @default.
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• W2060007001 title "REGIONAL VERSUS GENERAL ANESTHESIA" @default.
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• W2060007001 doi "https://doi.org/10.1016/s0889-8537(05)70315-1" @default.
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