[The risk of general anesthesia in surgery of the veins of the lower limbs].
Venous surgery on the lower limbs does not involve specific problems for the anaesthetist. General anaesthetic is still indicated in particular cases, even though techniques of locoregional anaesthetic are being more and more widely used in venous surgery of the lower limbs. Certain authors have found that the indications for general anaesthetic are limited to the counterindications or failures of local anaesthetic; others give general anaesthetic a wider application when surgery is to be carried out on a patient in the ventral decubitus position. The aim of general anaesthetic for venous surgery of the lower limbs is simply to facilitate a purely functional surgery. In this context, injury or fatality directly connected with the anaesthetic seems unacceptable. However, the accident rate is far from being low, as various inquiries have revealed. In France, the inquiry set up by INSERM found that serious accident related wholly or partially to the anaesthetic occurs once in every 3,000 operations. Of course, the accident rate increases with age and depends on the previous pathological condition. But, quite apart from cardio-vascular accidents, which have multiple causes and usually involve high-risk patients, these studies show that respiratory accidents involve every type of patient, whatever their medical history. Moreover, the majority of such accidents could have been avoided had there been adequate monitoring to detect any anomaly before the occurrence of the accident. It is thus appropriate to recall the recommendations of the American Society of Anesthiologists for standard pre-operative monitoring: monitoring of ventilation (spirometry, capnometry, debrancher alarm), monitoring of oxygenation, circulation (continuous ECG and pulse assessment) and monitoring of temperature.(ABSTRACT TRUNCATED AT 250 WORDS)
Baron
J F
JF
Département d'Anesthésie-Réanimation, Hôpital Pitié-Salpêtrière, Paris, France.
D000059:Accidents; D000768:Anesthesia, General / Q000009:adverse effects*; D006801:Humans; D007866:Leg / Q000098:blood supply*; D012306:Risk; D014680:Veins / Q000601:surgery*
Risque de l'anesthésie générale pour chirurgie veineuse des membres inférieurs.