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Continuing Education in Anaesthesia, Critical Care & Pain 2005 5(3):89-92; doi:10.1093/bjaceaccp/mki024
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Continuing Education in Anaesthesia, Critical Care & Pain | Volume 5 Number 3 2005 © The Board of Management and Trustees of the British Journal of Anaesthesia [2005]. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org

Anaesthesia for lower limb revascularization

Gail Tovey, MB ChB FRCA, Specialist Registrar in Anaesthesia
UHL NHS Trust, Leicester Royal Infirmary, Leicester, LE1 5WW

Jonathan P Thompson, BSc MD FRCA, Senior Lecturer/Honorary Consultant in Anaesthesia and Critical Care
University Department of Cardiovascular Sciences, Clinical Division of Anaesthesia Critical Care and Pain Management, UHL NHS Trust, Leicester Royal Infirmary, Leicester, LE1 5WW
Tel: 01162 585291, Fax: 01162 854487, E-mail: jt23@leicester.ac.uk (for correspondence)

The first 150 words of the full text of this article appear below.


Key points

Surgery for lower limb revascularization is associated with a high risk of cardiac morbidity and mortality.

Preoperative cardiac risk assessment is important and risk-reducing measures should be started appropriately.

Perioperative ß-blockade decreases perioperative cardiac complications in the highest risk patients.

The quality of anaesthetic practice rather than specific technique per se has the most important influence on patient outcome.

Acute limb ischaemia is an emergency that precludes prolonged preoperative cardiac evaluation.

 


   Critical limb ischaemia
 
Critical limb ischaemia (CLI) is defined as chronic ischaemic rest pain, ulcers or gangrene attributable to objectively proven arterial occlusive disease. Peripheral vascular disease (PVD) is a marker for severe multi-system atherosclerosis and patients with critical limb ischaemia presenting for lower limb revascularization present a significant challenge to the anaesthetist. They are usually elderly with a high prevalence of hypertension, diabetes mellitus, cerebrovascular and renal vascular disease, and smoking-related respiratory disease. Only 8% of patients with PVD . . . [Full Text of this Article]

Treatment strategies


   Preoperative assessment
 

   Preoperative management
 

   Perioperative management
 
Monitoring

General anaesthesia

Regional anaesthesia


   Postoperative management
 

   Acute limb ischaemia
 

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