Anaesthesia for infrainguinal vascular surgery

Vascular patients are at increased risk of complications both related to their co-morbidity and the nature of the surgery. The focus of this article is on the anaesthetic management of patients presenting for infrainguinal arterial reconstructive surgery, including the factors influencing both overall outcome and outcome of the vascular graft. Pan vascular disease should be assumed in all patients presenting for infrainguinal vascular surgery. Preoperative assessment entails risk stratification, preoperative optimization and decisions regarding antiplatelet therapy. Individual anaesthetic techniques are chosen according to risk/benefit analysis of each patient. Proven benefits of continuous regional anaesthesia techniques are analgesia and extension of anaesthetic blockade in case of re-exploration. Postoperative care should be an extension of intra-operative management including meticulous pain relief, maintenance of normothermia and adequate circulating intravascular volume.