Safety of Local Anesthesia Combined with Monitored Intravenous Sedation for American Society of Anesthesiologists 3 and 4 Patients Undergoing Lower Limb–preservation Procedures

published online 05 February 2010.

Abstract

The aim of this retrospective study is to evaluate the prognostic value of American Society of Anesthesiologists (ASA) classification with regard to perioperative variables of cardiac complications, pulmonary complications, and mortality in patients undergoing limb salvage procedures with monitored intravenous sedation and foot and ankle blocks. None of the ASA 3 or 4 patients experienced any pulmonary or cardiac complication; no patient required invasive monitoring or postoperative cardiac care unit admission. We suggest that the performance of peripheral foot and ankle blocks with monitored intravenous sedation appears to be a safe and useful option for ASA 3 and 4 patients undergoing limb-preservation surgery.

Level of Clinical Evidence: 2

Keywords: bupivacaine, diabetic foot infection, limb salvage, nerve block, physical status, surgical complication

1 Associate Professor, Department of Anesthesiology, Yale University, New Haven, CT

2 Resident CA3, Department of Anesthesiology, Yale University, New Haven, CT

3 Associate Professor of Anesthesia and Critical Care, Government Medical College & Hospital, Chandigarh, India

4 Professor, Department of Anesthesiology, Yale University, New Haven, CT

5 Volunteer, Department of Anesthesiology, Yale University, New Haven, CT

6 Yale College, Yale University, New Haven, CT

7 Assistant Professor, Department of Podiatry and Orthopedics, Yale University, New Haven, CT

Address correspondence to: Nalini Vadivelu, MD, Associate Professor, Department of Anesthesiology, Yale University, New Haven, CT 06520.

Financial Disclosure: None reported.

Conflict of Interest: None reported.

PII: S1067-2516(09)00421-9

doi:10.1053/j.jfas.2009.09.006

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