In some centers, regional anesthesia is the prime choice for patients undergoing vascular surgery. This is because the sympathetic tone of the blood vessels is blocked by regional anesthesia, which maintains good perfusion at the site of operation as well as in distal tissues.
Surgical procedures that can be performed with regional anesthesia alone are carotid endarterectomy, vascular surgery of the upper extremities (e.g., arterial surgery, Gore-Tex graft), aortogram, aortoiliac bypass graft, iliofemoral bypass graft, and vein stripping. Patients undergoing surgical procedures under regional anesthesia can receive supplemental light general anesthesia. This is provided for the following reasons:
1. Oxygenation is improved if the level of regional anesthesia is high (e.g., T4 and above).
2. The patient is spared the discomfort and pain of lying in one position during long procedures.
3. The risk of oversedation is reduced during long procedures.
4. Relaxation is provided for very anxious and nervous patients who cannot stay still or remain calm during the procedure.
The combined technique is indicated for patients with aortic aneurysms, splenorenal shunts, portocaval shunts (in patients with splenorenal or portocaval shunts, however, liver failure may be so marked that coagulation abnormalities constitute a relative contraindication to regional anesthesia), vascular tumor of the hepatic artery, or any prolonged abdominal procedure for vascular surgery.
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