What anesthetic techniques are used for endovascular graft insertions?

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.