New Anesthetic Technique for Dacryocystorhinostomy: 218 Cases with Local-Anesthesia Ultrasonographic Guided and Blunt Cannula

Introduction: Transcatheter aortic valve implantation is a less invasive option for aortic valve replacement. The number of transcatheter aortic valve implantations under local anesthesia with sedation has been increasing as the team’s experience increases and less invasive accesses are used. The aim of this study is to describe the evolution of the anesthetic technique in patients undergoing transcatheter aortic valve implantation at our center over the years, as which was compared. Material and Methods: Retrospective study in 149 consecutive patients undergoing transcatheter aortic valve implantation in Hospital Santa Marta (January 2010 to December 2016). Data was collected from the periprocedural records of patients. Patients were stratified according to anesthetic technique. Results: From our patients’ sample, 57.0% were female, with median age 82 [58 - 95] years. Most patients underwent general anesthesia (68.5%). In the local anesthesia with sedation group there was a shorter duration of the procedure (120; [60 - 285] vs 155 [30 - 360]) and a lower number of patients requiring administration of vasopressors (61.8% vs 28.3%) – p < 0.05. There were no differences regarding length of hospital stay (9 [4 - 59] vs 10 [3 - 87]), periprocedural complications (66.0% vs 72.5%), readmission rate (4.3% vs 3.9%) or 30-days (2.1% vs 4.9%) and 1-year mortality (6.4% vs 7.8%) – p > 0.05. There was an increasing number of transcatheter aortic valve implantations performed under local anesthesia with sedation over the years.Discussion: The choice of anesthetic technique depends on the patient’s characteristics, experience and preference of the team.Conclusion: Local anesthesia with sedation seems to be associated with similar results as general anesthesia. The increase in the number of transcatheter aortic valve implantations under local anesthesia with sedation seems to follow the trend of lower invasiveness of the procedure.

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Patient Satisfaction with General versus Local Anesthesia during Carotid Endarterectomy

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0039-1688692 ◽

2019 ◽

Vol 80 (05) ◽

pp. 341-344

Author(s):

Jan Mracek ◽

Jakub Kletecka ◽

Irena Holeckova ◽

Jiri Dostal ◽

Jolana Mrackova ◽

...

Keyword(s):

Patient Satisfaction ◽

Carotid Endarterectomy ◽

Local Anesthesia ◽

Postoperative Nausea And Vomiting ◽

Anesthetic Technique ◽

Anesthetic Techniques ◽

Advantages And Disadvantages ◽

Future Preference ◽

Intraoperative Pain ◽

Optimal Approach

Background and Study Aims Both general and local anesthesia are used in our department for carotid endarterectomy (CEA). The decision as to which anesthetic technique to use during surgery is made individually. The aim of our study was to evaluate patient satisfaction and preference with the anesthesia type used. Material and Methods The satisfaction of a group of 205 patients with regard to anesthesia used and their future preferences were evaluated prospectively through a questionnaire. The reasons for dissatisfaction were assessed. Results CEA was performed under general anesthesia (GA) in 159 cases (77.6%) and under local anesthesia (LA) in 46 cases (22.4%). In the GA group, 148 patients (93.1%) were satisfied; 30 patients (65.2%) in the LA group were satisfied (p < 0.0001). The reason for dissatisfaction with GA were postoperative nausea and vomiting (7 patients), postoperative psychological alteration (3), and fear of GA (1). The reasons for dissatisfaction with LA were intraoperative pain (9 patients), intraoperative discomfort and stress (5), and intraoperative breathing problems (2). Of the GA group, 154 (96.9%) patients would prefer GA again, and of the LA group, 28 (60.9%) patients would prefer LA if operated on again (p < 0.0001). Overall, 172 patients (83.9%) would prefer GA in the future, and 33 patients (16.1%) would prefer LA. Conclusion Overall patient satisfaction with CEA performed under both GA and LA is high. Nevertheless, in the GA group, patient satisfaction and future preference were significantly higher. Both GA and LA have advantages and disadvantages for CEA. An optimal approach is to make use of both anesthetic techniques based on their individual indications and patient preference.

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Postoperative Clinical Outcomes of Thoracoscopic Surgery under Local Anesthesia in Patients with Primary Spontaneous Pneumothorax

Applied Sciences ◽

10.3390/app11041468 ◽

2021 ◽

Vol 11 (4) ◽

pp. 1468

Author(s):

Eunji Kim ◽

Chi-Seung Lee ◽

Jeong Su Cho ◽

Hoseok I ◽

Yeong Dae Kim ◽

...

Keyword(s):

Surgical Technique ◽

Clinical Outcomes ◽

Local Anesthesia ◽

Spontaneous Pneumothorax ◽

Thoracoscopic Surgery ◽

Wedge Resection ◽

Operation Time ◽

Postoperative Recurrence ◽

Primary Spontaneous Pneumothorax ◽

Anesthetic Technique

(1) Background: since the technologies of anesthesia and surgery were advanced, video-assisted thoracic surgery (VATS) under local anesthesia (LA) has been widely carried out and is considered a robust surgical technique to prevent the recurrence of pneumothorax in patients with recurrent primary spontaneous pneumothorax (PSP). In this study, postoperative clinical outcomes were compared to evaluate the feasibility and efficacy of VATS under LA compared with general anesthesia (GA) in patients with PSP. (2) Methods: 255 patients underwent wedge resection underwent VATS for PSP in our hospital from January 2014 to June 2019. Of them, 30 patients underwent the operation under LA and the others underwent the operation under GA. Except for the anesthesia method, the same surgical technique was adopted for all patients. All medical records were retrospectively reviewed. (3) Results: the total operation time and total hospital days were relatively shorter, post-chest tube drainage was significantly shorter (0.04), and visual analog scale (VAS) scores in the outpatient clinic were significantly lower in the LA group than in the GA group (p = 0.01). The incidence of postoperative recurrence after discharge in the LA group (3.3%) was also lower than in the GA group (18.67%) (p = 0.001). In the LA group, there were no cases of conversion to intubation. (4) Conclusions: our results showed relatively better clinical outcomes in VATS under LA with sedation than under GA in the treatment of PSP. Hence, LA with sedation can be considered as a robust anesthetic technique for VATS and as applicable in the surgical treatment of PSP.

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Indications for General versus Local Anesthesia during Carotid Endarterectomy

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0039-1678601 ◽

2019 ◽

Vol 80 (04) ◽

pp. 250-254

Author(s):

Jan Mracek ◽

Jakub Kletecka ◽

Jan Mork ◽

David Stepanek ◽

Jiri Dostal ◽

...

Keyword(s):

Carotid Endarterectomy ◽

Local Anesthesia ◽

Patient Preference ◽

Sleep Apnea Syndrome ◽

Anesthetic Technique ◽

Shunt Insertion ◽

Increased Risk ◽

Apnea Syndrome ◽

Optimal Approach ◽

Selection Of

Background and Study Aims Both general anesthesia (GA) and local anesthesia (LA) are used in our department for carotid endarterectomy. The decision of which anesthetic technique to use during surgery is made on an individual basis. The aim of our study was to analyze the reasons for using GA or LA. Material and Methods The reasons that led to the selection of either GA or LA were analyzed retrospectively in a group of 409 patients. Results GA was used in 304 patients (74%) and LA in 105 patients (26%). The reasons for a preference for GA were clopidogrel use (88 patients), patient preference (80), increased risk of shunt insertion (43), unfavorable anatomical conditions (41), surgeon preference (21), simultaneous carotid endarterectomy and cardiac surgery (18), emergent carotid endarterectomy (12), and sleep apnea syndrome (1). The reasons for selecting LA were internal comorbidities (46 patients), patient preference (39), unavailability of intraoperative electrophysiologic monitoring (15), and pacemaker (5). Conclusion GA is the dominant choice for carotid endarterectomy in our department because of its prevailing benefits and its preference among neurosurgeons and patients. However, in some subgroups of patients, LA is preferable. An optimal approach is therefore an individual indication for both anesthesia techniques.

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Anesthetic Techniques for Urological Surgeries in Benue State University Teaching Hospital (BSUTH), Makurdi, Nigeria

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2020.2.5.403 ◽

2020 ◽

Vol 2 (5) ◽

Author(s):

M. E. Efu ◽

E. I. Ogwuche ◽

B. A. Ojo ◽

B. A. Eke

Keyword(s):

Local Anesthesia ◽

Relevant Information ◽

Epidural Block ◽

University Teaching ◽

University Hospital ◽

Anesthetic Technique ◽

Anesthetic Techniques ◽

State University ◽

Female Ratio ◽

Urological Surgery

Background: Urological surgery entails operating on the urinary system. Like every other surgery, they require anesthesia for the elimination of surgical pain. The organ to be operated as well as surgical approach determines the choice of anaesthesia used. This may be in the form of regional (including neuroaxial anesthesia) or general or even local anesthesia. This study was conducted to ascertain the anesthetic techniques employed for urological surgeries in the Benue State University Hospital (BSUTH), Makurdi, Nigeria. Methodology: This was a three-year retrospective study carried out in BSUTH, Makurdi, Nigeria. A total of 125 case files of eligible patients were retrieved from the records department following approval of an application. Relevant information was extracted from the patients’ folders and transferred into a prepared proforma. The data collected were analyzed using SPSS version 25 using simple statistics. Results: The age group with the highest number is that between 61 and 70 years, recording 40 (32.0%). The mean age was 54.0±20.4 Males were a clear majority with 119 cases accounting for 95.2% while only 6 cases (4.8%) involved females. The male to female ratio was 19.8:1. Most of the patients belonged to ASA II which recorded 70 (56.0%). Of the total of 125 diagnoses made, cancer of the prostate (CaP) was the highest with 63 (50.4%). The most common surgical procedure was prostate biopsy which was undertaken 58 times accounting for 46.4% of the procedures. Caudal block was employed most with 59 (47.2%). This was followed by Local infiltration with 30 (24.0%). Eighty-eight patients had surgery on day case basis while 37 patients underwent surgery as in-patients representing 70.4% and 29.6% of the study group respectively. Conclusion: Urological procedures are mostly infra-umbilical and are thus quite amenable to either regional or local anesthesia. This study has shown that caudal epidural block is the anesthetic technique of choice in urological surgery in this centre. Local anesthesia and sub-arachnoid block are next in that order. GA is not often employed. LA and regional techniques involve fewer disturbances to the respiratory system, and these were the anaesthetic methods mostly employed as established in this study.

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Conhecimento de cirurgiões-dentistas sobre a anatomia da face aplicada à anestesia local: uma revisão sistematizada

ARCHIVES OF HEALTH INVESTIGATION ◽

10.21270/archi.v8i2.3163 ◽

2019 ◽

Vol 8 (2) ◽

Author(s):

Érick Tássio Barbosa Neves

Keyword(s):

Local Anesthesia ◽

Associated Factors ◽

Inferior Alveolar Nerve ◽

Family Health ◽

Anesthetic Technique ◽

Inferior Alveolar Nerve Block ◽

Porto Alegre ◽

New Approach ◽

Local Material ◽

Dent Assoc

Introdução: A Anatomia Humana é um componente curricular obrigatório na formação dos profissionais da saúde. Trata-se de uma disciplina básica que fornece subsídio para atividades de mais alta complexidade, como procedimentos clínicos e laboratoriais. Nesse sentido, o conhecimento da Anatomia nervosa da face se destaca como importante para a execução de uma anestesia local eficaz e segura em Odontologia. Objetivo: Avaliar a produção científica sobre o nivel de conhecimento dos cirurgiões-dentista sobre a Anatomia nervosa aplicada à anestesia local. Material e método: Trata-se de uma revisão integrativa sistematizada da literatura. Para este estudo foi realizada a busca de artigos em revistas indexadas nas bases de dados Lilacs, Scielo e Medline, utilizando como critérios de busca as seguintes palavras-chave: Anestesia Local, Conhecimento, Odontologia, Neuroanatomia e Clínica Odontológica, nos idiomas português, inglês e espanhol. Resultados: Permaneceram na amostra final do estudo, 05 artigos, após avaliação da responsividade aos objetivos do estudo. A abordagem do tema é ainda incipiente na literatura e não há estudos avaliando o conhecimento anatômico de cirurgiões-dentistas sobre a anestesia local. Conclusão: Sugere-se que sejam realizados novos estudos, preferencialmente com delineamento experimental, a fim de contribuir para a educação em saúde nesta área específica e reduzir as disparidades curriculares nos centros de ensino superior.Descritores: Anestesia Local; Conhecimento; Odontologia; Neuroanatomia; Clínicas Odontológicas.ReferênciasArruda RM, Sousa CRA. Aproveitamento teórico-prático da disciplina Anatomia Humana do curso de Fisioterapia. Rev bras educ med. 2014;38(1):65-71.Mouthé Filho A, Borges MAS, Figueiredo IPR, Villalobos MIOB, Taitison PF. Refletindo o ensino da Anatomia Humana. Enfermagem revista. 2016;19(2):169-75.Antoniazzi MCC, Carvalho PL, Koide CH. Importância do conhecimento da anatomia radiográfica para a interpretação de patologias ósseas. RGO Porto Alegre. 2008;56(2):195-99.Silva SREP, Andrade APRCB, Costa FP, Cunha RS, Politano GT, Pinheiro SL, Imparato JCP. Avaliação da técnica anestésica local utilizada por alunos de graduação em Odontologia. ConScientiae Saúde. 2010;9(3):469-75.Teixeira LMS, Reher P, Reher VGS. Anatomia aplicada à Odontologia. Rio de Janeiro. 2.ed. Guanabara Koogan; 2008.Lopes GB, Freitas JB. Parestesia dos nervos alveolar inferior após exodontia de terceiros molares. Arq Bras Odontol. 2013;9(2):35-40.Andrade YDN, Araujo EBJ, Souza LMA, Groppo FC. Análise das variações anatômicas do canal da mandíbula encontradas em radiografias panorâmicas. Rev odontol Unesp. 2015;44(1)31-6.Dodo CG, Sotto-Maior BS, Faot F, Del Bel Cury AA, Senna PM. Lesão do nervo alveolar inferior por implantes dentários: prevenção, diagnóstico e tratamento. Dental Press Implantol. 2015;9(4)57-66.Souza MT, Silva MD, Carvalho R. Revisão integrativa: o que é e como fazer. Einstein. 2010; 8(1):102-6.Bolanos DC, Wong LR, Guillén AJP. Comprendiendo y combatiendo el fracasso anestésico en Odontología. Revista ADM. 2015; 72(6):290-98.Vasconcelos BCE, Freitas KCM, Almeida RAC, Mauricio HA. A importância da técnica de aspiração prévia ao bloqueio anestésio do nervo alveolar inferior. Rev Cir Traumatol Buco-Maxilo-fac. 2007;7(1):29-36.Mattos ABT, Gleiser R, Primo LSSG. Complicações anestésicas em Odontopediatria. J bras odontopediatr odontol bebê. 1999;2(5):49-56.Palti DG, Almeida CM, Rodrigues AC, Andreo JC, Lima JEO. Anesthetic technique for inferior alveolar nerve block: a new approach. J Appl Oral Sci. 2011;19(1):11-15.Blanton PL, Jeske AH. The key to profound local anesthesia: neuroanatomy. J Am Dent Assoc. 2003;134(6):753-760.Cabral ED. Dental local anesthesia in family health units: use, pain and associated factors. Rev Dor. 2015;16(4):254-58.Pontanegra RSM, Camboim CCL, Freire JCP, Nóbrega MCT, Barreto JO, Santos JA, Dias-Ribeiro E. Análise do conhecimento de graduandos em Odontologia sobre o uso de anestésico local em pacientes com necessidades especiais. FOL - Faculdade de Odontologia de Lins/Unimep. 2017;27(1):5-14.Carvalho B, Fritzen EL, Parodes AG, Santos RB, Gedoz L. O emprego dos anestésicos locais em Odontologia: Revisão de Literatura. Rev bras odontol. 2013;70(2):178-81.Foreaux G, Sá MA, Schetino LPL, Guerra LB, Silva JH. O ensino-aprendizagem da anatomia humana: avaliação do desempenho dos alunos após a utilização de mapas conceituais como uma estratégia pedagógica. Ciênc Educ. 2018; 24(1):95-110.

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Interstitial high dose rate (HDR) brachytherapy under local anesthesia for early stage prostate cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.14639 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 14639-14639

Author(s):

D. White ◽

R. Mark ◽

P. J. Anderson ◽

T. Neumann ◽

M. Nair

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

Dose Rate ◽

Local Anesthesia ◽

High Dose Rate ◽

External Beam Radiation ◽

Anesthetic Technique ◽

High Dose ◽

Beam Radiation ◽

Spinal Anesthetic

14639 Background: Transrectal Ultrasound (TRUS) guided interstitial implant for prostate cancer using Low Dose Rate (LDR) and High Dose Rate (HDR) techniques has been reported with results comparing very favorably to external beam radiation therapy. TRUS interstitial implant of the prostate has been traditionally performed under general or spinal anesthetic in an operating room. We report our results with a technique performed under local anesthesia in a Department procedure room. Methods: Patients with T1 and T2 localized prostate cancer were judged to be candidates for TRUS guided interstitial implant. Results: Between 2002 and 2006, 248 TRUS guided prostate implants were performed under local anesthesia. Conscious sedation consisted of intravenous Morphine (12–22 mg) and Versed (6–14 mg), or intravenous Demerol (50–175 mg) and Versed (3–12 mg). Local anesthetic was given with a mixture of 1% Lidocaine, 0.25% Marcaine, 1:100,000 Epinephrine, and 4% Sodium Bicarbonate neutralizing solution (20–120 cc). Local anesthesia was given to a 5 × 5 cm perineal area to a depth of 10 cm under TRUS guidance. The implants were placed under mobile multi-plane prostate template (Radiation Therapy Products Prostate Template) guidance using from 3 to 4 planes, and 12 to 22 needles. Needle spacing was 1.0 cm. The implant procedure included sigmoidoscopy and cystoscopy. Median implant time was 45 minutes (range: 30 to 150 minutes). HDR treatment was given using the Nucletron afterloading system. The implant volume received 2,250 cGy in 3 fractions prescribed to the 100% Isodose line, given over 24 hours. Urethral dose points (12–16) were followed, and limited to ≤ 105% of the prescription dose. The procedure was well tolerated, with all patients having completed the procedure. One patient developed respiratory suppression, and required reversal with Narcan. He recovered uneventfully. Otherwise, there have been no acute complications to date. Conclusions: TRUS interstitial implant of the prostate under local anesthesia is feasible. Implant time and complications compare favorably to general or spinal anesthetic technique. No significant financial relationships to disclose.

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Anatomic Bases for Brachial Plexus Block of Capuching (Sapajus libidinosus)

Acta Scientiae Veterinariae ◽

10.22456/1679-9216.81291 ◽

2018 ◽

Vol 44 (1) ◽

pp. 6

Author(s):

Juliana Molina Martins ◽

Rômulo Freitas Francelino Dias ◽

Kath Freire De Vasconcelos ◽

Ediane Freitas Rocha ◽

José Rômulo Soares dos Santos ◽

...

Keyword(s):

Brachial Plexus ◽

Local Anesthesia ◽

Brachial Plexus Block ◽

Anesthetic Technique ◽

Hypodermic Needle ◽

Capuchin Monkeys ◽

Safe Distance ◽

Chemical Restraint ◽

Plexus Block ◽

Access Pathway

Background: In captivity, capuchin monkeys compete for space and rank. Fights can result in traumas, especially to the limbs, requiring interventions that are often outpatient. Local anesthesia as a tool in these procedures, as an aid to chemical restraint, is very relevant for small outpatient surgeries, or even for pain relief. Knowledge of peripheral nerve anatomy is essential to perform local anesthesia. Thus the objective of the present study was to determine, by anatomical studies of the brachial plexus region, the best access pathways for anesthetic blocking of the nerve.Materials, Methods & Results: Seven adult capuchin monkeys (Sapajus libidinosus) were used, weighing 2-3 kg, fixed and preserved in formaldehyde aqueous solution at 10%. In five of these animals the supraclavicular, infraclavicular and axillar regions were dissected to visualize the muscles, clavicle and bracchial plexus nerves. An analogical pachymeter was used to measure the depth of the plexus in relation to the cranial and caudal clavicle face and axillary fossa, comparing the length of two hypodermic needles (13x4.5 mm and 15x5 mm). Simulation of the anesthetic block was tested in two animals: before dissecting an acrylic varnish solution was injected using a syringe and 13x4.5 mm needle in the supraclavicular, infraclavicular regions and axillary fossa. To assess the positioning points of the syringe, dissection was performed and the varnish perfusion in the plexus was observed. For the anesthetic block in the supraclavicular region the dorsal median of the clavicle with a 95º deltoclavicular angle with the needle perpendicular to the skin was taken as point of reference. In the infraclavicular the reference point was the caudal face of the median clavicle with an 80º deltoclavicular angle. In the axillar region, with the limb at 90º, the syringe was positioned perpendicular to the axillar at the height of the mid portion of the thorax. The mean and standard deviation of the skin-brachial plexus distance for the supraclavicular, infraclavicular and axillar techniques were, respectively, 1.76 ± 0.1387 cm, 1.12 ± 0.239 cm and 1.59 ± 0.365 cm. These data showed the viability of executing the anesthesia technique by three access pathways. However, in the supraclavicular access pathway in the anesthetic simulation with the 13x4.5 mm hypodermic needle, the stain diffused to the plexus, showing, when compared with the 1.76 cm mean skin- plexus distance a safe distance to prevent the needle from perforating the nerve.Discussion: The techniques reported in the human literature for brachial plexus block presented a series of complications, with incomplete blocks and hemorrhages when the axillar access pathway was used and presented risk of pneumothorax in the supraclavicular. In the capuchin monkey the supraclavicular access pathway in anesthetic simulation with 13x4.5mm hypodermic needle showed a safe distance for the needle not to perforate the nerve, so that the use of this needle could be indicated in 2-3 kg animals. However, hypodermic needles are not recommended for use in this area because of the risk of perforating the subclavicular artery close to the plexus. As an alternative some anesthesiologists use the infraclavicular access pathway with atraumatic needles recommended for brachial plexus block, with relative success and fewer complications. Although the supraclavicular region showed the best depth in relation to the technique used here, anesthetic tests should be made to confirm the efficaciousness of executing the brachial plexus anesthetic technique in capuchin monkeys using atraumatic needles for nerve block.

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Tumescent Anesthesia in General Surgery

10.1093/med/9780190457006.003.0005 ◽

2018 ◽

Author(s):

Jacob Cole ◽

Victor Rivera ◽

Anthony Tucker

Keyword(s):

Local Anesthesia ◽

Local Anesthetic ◽

General Surgery ◽

Cosmetic Surgery ◽

Anesthetic Technique ◽

Tumescent Anesthesia ◽

Tumescent Solution ◽

Anesthesia Technique ◽

Solution Formulation

Tumescent anesthesia is a fairly novel anesthetic technique originating in dermatologic and cosmetic surgery. In the 30 years since this technique was first described, it has gradually gained wider acceptance as a viable anesthetic technique for a variety of procedures. This chapter discusses the development of the tumescent anesthesia technique including the benefits of tumescence over standard local anesthesia and the safety of the technique. Local anesthetic pharmacology and pharmacodynamics are reviewed along with the different additives that complement the tumescent solution formulation. Finally, this chapter reviews some of the more common procedures utilizing tumescent anesthesia.

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Utilization and Outcomes of Local Anesthesia and Peripheral Nerve Block for Hybrid Lower Extremity Revascularization

Journal of Endovascular Therapy ◽

10.1177/1526602819887382 ◽

2019 ◽

Vol 27 (1) ◽

pp. 94-101

Author(s):

Arash Fereydooni ◽

Tess O’Meara ◽

Wanda M. Popescu ◽

Alan Dardik ◽

Cassius Iyad Ochoa Chaar

Keyword(s):

Length Of Stay ◽

Lower Extremity ◽

Peripheral Nerve ◽

Local Anesthesia ◽

Peripheral Nerve Block ◽

Operating Time ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Anesthetic Technique ◽

Lower Extremity Revascularization

Purpose: To investigate the utilization of local anesthesia or peripheral nerve block with monitored anesthesia care (LPMAC) and its impact on the perioperative outcomes of hybrid lower extremity revascularization (LER) compared with general anesthesia (GA). Materials and Methods: A search of the ACS-NSQIP database between 2005 and 2017 identified 9430 patients who underwent hybrid LER for peripheral artery disease. Excluding 449 ineligible cases left 8981 hybrid LER patients for analysis. The patients were dichotomized based on the anesthetic technique: 8631 (96.1%) GA and 350 (3.9%) LPMAC. The GA patients were matched 3:1 based on propensity scores to patients in the LPMAC group based on gender, age, race, functional status, transfer status, chronic obstructive pulmonary disease (COPD), dialysis status, American Society of Anesthesiologists (ASA) class, emergent surgery, preoperative sepsis, indication, and type of open and endovascular procedure. Outcomes including complications, mortality, procedure time, and hospital length of stay were compared between the matched groups (801 GA vs 267 LPMAC). Results: Comparing the unmatched groups, those treated under LPMAC were older (72.7±9 vs 68±8.4 years, p<0.001) and had higher rates of COPD (24.3% vs 17%, p=0.001), dialysis dependence (8.1% vs 4.2%, p=0.002), preoperative sepsis (6.6% vs 4.2%, p=0.029), and ASA class ≥IV (29.1% vs 24.1%, p=0.036) than in the unmatched GA cohort. In the matched comparison, LPMAC was associated with lower overall morbidity (25.5% vs 32.3%, p=0.042) and shorter operating time (202.7±98 vs 217.7±102 minutes, p=0.034) compared with GA. The rate of myocardial infarction was lower (1.1% vs 2.4%) and ventilator use for >48 hours was less frequent (0.4% vs 2.6%) for LPMAC patients, though statistical significance was not reached. There was no difference in mortality or hospital length of stay. Conclusion: LPMAC is an infrequent anesthetic technique for hybrid LER and is primarily used for patients with a high burden of comorbidities. LPMAC is associated with reduced overall morbidity and operating time. Further studies are needed to identify which patients undergoing hybrid LER benefit most from LPMAC.

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