ANAESTHESIA FOR LOWER LIMB REVASCULARISATION

Abstract

I owcr limb revascularisation is done for critical limb ischaemia due to proven arterial occlusive disease and for acute limb ischaemia which occurs due to thromboembolism, trauma, and percutaneous vascular interventions. I <>wer limb revascularisation surgery is classified as high risk under American College of ( ardiology and American Heart Association guidelines on pre operative assessment. Therefore pre operative cardiac risk assessment and institution of appropriate risk icducing measures are important. Aims of anaesthesia are to maintain haemodynamic stability, normothermia, meticulous I n noperative fluid management and postoperative pain control. The anaesthetic technique per se has no bearing on the outcome as the quality of the anaesthetic. Ainlc limb ischaemia is an emergency to prevent limb loss. Patients are often i l l ; and •OUgh the same cardiac considerations apply extensive pre operative evaluation is not iJMiisible due to time constraints. Embolectomy would be performed under local piesthesia with the anaesthetist monitoring the patient. When more invasive surgery is ttinned general anaesthesia is preferred as patients would be receiving therapeutic doses Mliinlicoagulants. in both situations monitoring and management for reperfusion injuries is required.