Original Research| Volume 49, ISSUE 2, P152-154, March 2010

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

Published:February 05, 2010DOI:


      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.

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        • Jacqueline R.
        • Malviya S.
        • Burke C.
        • Reynolds P.
        An assessment of interrater reliability of the ASA physical status classification in pediatric surgical patients.
        Paediatr Anaesth. 2006; 16: 928-931
        • Wolters U.
        • Wolf T.
        • Stutzer H.
        • Schroder T.
        ASA classification and perioperative variables as predictors of postoperative outcome.
        Br J Anaesth. 1996; 77: 217-222
        • Feigal D.
        • Blaisdell F.
        The estimation of surgical risk.
        Med Clin North Am. 1979; 63: 1131-1143
        • Cohen M.
        • Duncan P.
        Physical status score and trends in anesthetic complications.
        J Clin Epidemiol. 1988; 41: 83-90
        • Tiret L.
        • Hatton F.
        • Desmonts J.
        • Vourc'h G.
        Prediction of outcome of anaesthesia in patients over 40 years: a multifactorial risk index.
        Stat Med. 1988; 7 (947-554)
        • Reilley T.E.
        • Gerhardt M.A.
        Anesthesia for foot and ankle surgery.
        Clin Podiatr Med Surg. 2002; 19 (vii): 125-147
        • Chelly J.E.
        • Delaunay L.
        • Williams B.
        • Borghi B.
        Outpatient lower extremity infusions.
        Best Pract Res Clin Anaesthesiol. 2002; 16: 311-320
        • Ptaszek A.J.
        • Morris S.G.
        • Brodsky J.W.
        Midfoot field block anesthesia with monitored intravenous sedation in forefoot surgery.
        Foot Ankle Int. 1999; 20: 583-586
        • Michel J.P.
        • Klopfenstein C.
        • Hoffmeyer P.
        • Stern R.
        • Grab B.
        Hip fracture surgery: is the pre-operative American Society of Anesthesiologists (ASA) score a predictor of functional outcome?.
        Aging Clin Exp Res. 2002; 14: 389-394
        • Breslow M.J.
        • Parker S.D.
        • Frank S.M.
        • Norris E.J.
        • Yates H.
        • Raff H.
        • Rock P.
        • Christopherson R.
        • Rosenfeld B.A.
        • Beattie C.
        Determinants of catecholamine and cortisol responses to lower extremity revascularization. The PIRAT Study Group.
        Anesthesiology. 1993; 79: 1202-1209
        • Bode R.J.
        • Lewis K.
        • Zarich S.
        • Pierce E.
        • Roberts M.
        • Kowalchuk G.
        • Satwicz P.
        • Gibbons G.
        • Hunter J.
        • Espanola C.
        Cardiac outcome after peripheral vascular surgery. Comparison of general and regional anesthesia.
        Anesthesiology. 1996; 84: 3-113
        • Christopherson R.
        • Beattie C.
        • Frank S.
        • Norris E.
        • Meinert C.
        • Gottlieb S.
        • Yates H.
        • Rock P.
        • Parker S.
        • Perler B.
        Perioperative morbidity in patients randomized to epidural or general anesthesia for lower extremity vascular surgery. Perioperative Ischemia Randomized Anesthesia Trial Study Group.
        Anesthesiology. 1993; 79: 422-434