Effects of protective mechanical ventilation during general anesthesia in patients undergoing peripheral vascular surgery: A randomized controlled trial

Purpose Postoperative complications after major surgery, especially vascular procedures, are associated with a significant increase in costs and mortality. Previous studies evaluating general anesthesia versus regional or neuraxial anesthesia for infrainguinal bypass have produced conflicting results. The main aim of the present study is to review current evidence on the application of regional or general anesthesia in patients undergoing infrainguinal bypass surgery and its potential favorable effects on postoperative outcomes. Contents Patients undergoing vascular surgery often have multiple comorbidities, and it is important to outline both benefits and risks of regional anesthesia techniques. Neuraxial anesthesia in vascular surgery allows overall avoidance of general anesthesia and does provide short-term benefits beyond analgesia. Previous observational studies suggest that neuraxial anesthesia for lower limb revascularization may reduce morbidity and length of stay. However, evidence of long-term benefits is lacking in most procedures and further work is still warranted. Conclusions Neuraxial anesthesia is usually an effective anesthesia technique for infrainguinal bypass surgery. Elderly patients and those with underlying respiratory problems may display some benefit from neuraxial anesthesia. Further evaluation within institutions should be performed to identify which patients would most benefit from regional techniques. Notably, systemic antithrombotic and anticoagulation therapy is common among this population and may affect anesthetic choices.

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An optimal protective ventilation strategy in lung resection surgery: A prospective, single- center, 3-arm randomized controlled trial

Min

Yoon

Choe

et al. 2022

Preprint

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To establish an optimal strategy for one-lung ventilation (OLV), we compared 3 ventilation strategies for avoiding postoperative pulmonary complications (PPCs). Eighty-seven patients requiring OLV for elective thoracic surgery were enrolled and allocated to 3 groups according to ventilation strategies: VT of 4 ml kg-1 of predicted body weight (PBW) (n=29, low volume [LV] group); VT of 6 ml kg-1 of PBW (n=29, medium volume [MV] group); and VT of 8 ml kg-1 of PBW (n=29, high volume [HV] group). All groups were ventilated at PEEP of 5 cmH2O. The primary outcomes included the incidence of PPCs, defined as PaO2/FiO2<300 mmHg, and/or newly developed lung lesions, including infiltration and atelectasis, within 3 days postoperatively. The MV group showed the lowest incidence of PPCs among the LV, MV, and HV groups (12/26 [30.8%] vs 8/29 [20.5%] vs 19/27 [48.7%], P=0.006, respectively). The LV and MV groups revealed significantly higher PaO2/FiO2 ratio than the HV group 6 hours after surgery (P=0.024 and P=0.016, respectively). There were no differences in ventilator-induced lung lesions among the 3 groups. During OLV, protective ventilation at VT of 6 ml kg-1 with PEEP of 5 cmH2O may attain higher postoperative PaO2/FiO2 ratio and lower incidence of PPCs. Registry number of ClnicalTrials.gov: NCT03234621

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Effects of protective mechanical ventilation during general anesthesia in patients undergoing peripheral vascular surgery: A randomized controlled trial

Cited by 4 publications

References 5 publications

Effects of neuraxial or general anesthesia on the incidence of postoperative pulmonary complications in patients undergoing peripheral vascular surgery: a randomized controlled trial.

Effects of neuraxial or general anesthesia on the incidence of postoperative pulmonary complications in patients undergoing peripheral vascular surgery: a randomized controlled trial.

Anesthetic management for lower extremity vascular bypass procedures: The impact of general or regional anesthesia on clinical outcomes

An optimal protective ventilation strategy in lung resection surgery: A prospective, single- center, 3-arm randomized controlled trial

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