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We present a case of pseudohypotension in a patient with undiagnosed left subclavian artery stenosis who underwent emergency surgery. The patient was misdiagnosed as being hypotensive intra-operatively because the blood pressure was measured non-invasively on the affected arm. He was thought to have local anaesthetic systemic toxicity and subjected to the inconvenience, cost and possible adverse effects of inappropriate treatment. This case highlights the fact that vascular surgical patients may have subclavian artery stenosis which is usually asymptomatic. Pseudohypotension can be avoided if blood pressure is measured in both arms in patients with peripheral vascular disease.

Background and Aims: Lower extremity amputation (LEA) is a commonly performed surgery and is associated with significant mortality and morbidity. This review compares the impact of anaesthetic technique on 30-day mortality and other perioperative outcomes in patients undergoing LEA. Methods: A systematic search of databases including PubMed, Embase, Scopus and Cochrane Central Register of Controlled Trials, from January 2010 to March 2021, was performed. Studies were eligible if they compared 30-day mortality following either general anaesthesia (GA) or regional anaesthesia (RA), in adult patients undergoing LEA. Results: Ten retrospective observational studies were identified. Four of these studies utilised a propensity-score matching technique. Based on these four studies, RA when compared to GA, is not associated with a reduction in the 30-day mortality (Odds ratio 0.83, 95% confidence interval (CI): 0.65, 1.05, I 2 20%, P = 0.12). Also there is a very low level of evidence that RA may result in a decrease in the hospital length-of-stay and intensive care unit admissions of patients undergoing LEA. Conclusion: RA does not decrease the 30-day postoperative mortality in patients undergoing LEA when compared to GA.

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