Case Presentation by Sameer Dhalla, MD, NYU Chief Resident
Although common sense may dictate that the increased hemodynamic shifts of general anesthesia would lead to a greater incidence of perioperative cardiac complications, controlled trials and meta-analyses have generally not supported this theory. A study randomizing 100 patients scheduled for elective vascular reconstruction of the lower extremities to either epidural or general anesthesia showed no difference in cardiac outcomes out to six months. This was mirrored in similar studies evaluating 229 patients undergoing elective abdominal aortic aneurysm repair and 186 patients undergoing elective carotid artery surgery, all randomized to local or general anesthesia. A large meta-analysis of 24,716 patients who underwent carotid endarterectomy also showed no difference in cardiovascular complications based on anesthesia type.
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