What
anesthetic techniques are used for endovascular graft insertions?
Different anesthetic techniques have been
described for aortic stent-graft placement including local anesthesia, regional
anesthesia, and general anesthesia. Since the early procedures often required
long surgical times, general anes-thesia was usually administered to improve
patient compli-ance. Increasing surgical experience and more sophisticated
devices allowed for regional anesthetics (including epidural, spinal, and
continuous spinal anesthetics) as well as local anesthetics supplemented by
sedation. Choice of anesthetic technique is dependent on the planned surgical
intervention and the patient’s comorbid conditions. Surgery for arterial stents
that require percutaneous placement of catheters through limited incisions may
be tolerated with local anes-thesia and sedation. The need for extensive
inguinal explo-ration and dissection or for the construction of a femoral
artery to femoral arterial conduit may favor either regional or general
anesthesia. If surgical dissection is extended into the retroperitoneum, a
higher level of regional anesthesia or gen-eral anesthesia will be necessary to
provide adequate anes-thesia. Many of these procedures may take a long time to
perform. If the patient is undergoing local anesthesia or regional anesthesia,
adequate intravenous sedation is neces-sary because of agitation secondary to
restlessness and pain from lying in one position for a prolonged period of
time.
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