Anaesthetic management of patients undergoing infrainguinal vascular surgery

Anaesthetic techniques for infrainguinal vascular surgery aim at minimizing overall morbidity–mortality rates in a patient population with a high likelihood of coexisting disease. Regional anaesthesia can reduce post-operative thrombotic events, minimize cardiac morbidity and maintain effective post-operative analgesia. However, general anaesthesia is sometimes necessary owing to contraindications to regional anaesthesia as an alternative with similar overall morbidity–mortality according to some studies. Peripheral nerve blocks are utilized in special situations with minimal interference with cardiovascular function. Questions answered in this survey include the following. Does present knowledge show that the choice of anaesthetic technique has an impact on major outcome variables? What impact do side-effects of regional anaesthesia have on outcome variables? Is anti-coagulation therapy acceptable during vascular procedures when utilizing regional anaesthesia? Future investigations must focus on several treatment modalities in randomized trials to find optimal cost-effectiveness for peri-operative anaesthetic management in patients with a high risk for cardiovascular morbidity.