One-week postoperative patency of lower extremity in situ bypass graft comparing epidural and general anesthesia: retrospective study of 822 patients.

BACKGROUND: The purpose of this study was to determine whether anesthesia affects graft patency after lower extremity arterial in situ bypass surgery. METHODS: This investigation was a retrospective study using a national database on vascular surgical patients at a single medical institution. We assessed a total of 822 patients exposed to infrainguinal in situ bypass vascular surgery over the period of January 2000 to September 2010. RESULTS: All patients included in the study (age [mean ± SD] 70.8 ± 9.7 years) underwent infrainguinal in situ bypass (n = 885) for lower extremity revascularization under epidural (n = 386) or general (n = 499) anesthesia. Thirty-day mortality (3.4% for epidural anesthesia versus 4.4% general anesthesia; P = 0.414) and comorbidity were comparable in the 2 groups. Graft occlusion within 7 days after surgery was reported in 93 patients, with a similar incidence in the epidural (10.1%) and general (10.8%) anesthesia groups (P = 0.730). When examining a subgroup of patients (n = 242) exposed to surgery on smaller vessels (femorodistal in situ bypass procedures, n = 253), the incidence of graft occlusion was also similar in the 2 groups at 14.0% and 9.4%, respectively (P = 0.262). CONCLUSION: This retrospective study has shown that when graft patency is evaluated 7 days after surgery, anesthetic choice (epidural or general anesthesia) does not influence outcome.

Limited knowledge of lipid rescue therapy in local anaesthetic systemic toxicity.

INTRODUCTION: There is increasing evidence to support the use of intravenous lipid emulsion (ILE) in the management of local anaesthetic systemic toxicity (LAST) and non-local anaesthetic lipophilic-drug poisoning. This trend is supported by the Association of Anaesthetists of Great Britain and Ireland's latest guidelines on LAST treatment. Similar national guidelines have yet to be introduced in Denmark. The aim of the present study was to study the adoption of lipid rescue therapy in Denmark. MATERIAL AND METHODS: All Danish hospitals with an attending anaesthesiologist (no. 38) were contacted by phone. A total of 34 attending anaesthesiologists (AAs) participated in the systematic telephone survey. RESULTS: A total of 22 (65%) of the AAs were aware of use of ILE in the management of LAST. One (3%) had knowledge of ILE treatment for non-local anaesthetic-drug poisoning. Eight (24%) had access to local guidelines on lipid rescue therapy. The same eight AAs also knew where to find ILE. None of the hospitals lacking guidelines had taken an active stand against the treatment. CONCLUSION: Patients with toxic reactions who could potentially benefit from ILE will not be offered lipid rescue therapy in 26 of 34 hospitals (76%)--either because the AA is not aware of this treatment modality, or due to absence of either guidelines or ILE. To improve the availability of lipid rescue therapy, more hospitals need to develop emergency packs containing ILE and guidelines. Introduction of national guidelines on lipid rescue therapy would probably accelerate this process.