INTRAOPERATIVE CARE
Regional versus General Anesthesia
Most evidence suggests little, if any difference in outcome between
regional and general anesthesia in the elderly (see Chapter
43
and Chapter 44
).
[137]
These results have been reported in many
types
of surgery, including major vascular procedures and orthopedics.[138]
[139]
[140]
[141]
[142]
However, specific effects of regional anesthesia
may provide some benefit. For one, regional anesthesia affects the coagulation system
by preventing postoperative inhibition of fibrinolysis.[143]
Deep vein thrombosis or pulmonary embolism may occur in 2.5% of patients after certain
high-risk procedures.[144]
Regional anesthesia
may decrease the incidence of deep vein thrombosis after total-hip arthroplasty.
[145]
However, these findings are controversial
because similar results have not been reported with total-knee replacement.[146]
In lower extremity revascularization, regional anesthesia is associated with a decreased
incidence of postoperative graft thrombosis when compared with general anesthesia.
[147]
Second, the hemodynamic effects of regional
anesthesia may be associated with decreased blood loss in pelvic and lower extremity
surgery.[148]
[149]
Third, regional anesthesia does not necessitate instrumentation of the airway and
may allow patients to maintain their own airway and level of pulmonary function.
Data suggest that the elderly are more susceptible to hypoxemic episodes in the
recovery room. Patients who undergo regional anesthesia may have a lower risk of
hypoxemia.[150]
However, it is unclear whether
fewer pulmonary complications occur with regional versus general anesthesia.
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