Effects of Neuraxial or General Anesthesia on the Incidence of Postoperative Pulmonary Complications in Patients Undergoing Peripheral Vascular Surgery: A Randomized Controlled Trial

Objectives: Postoperative complications after major surgery, especially in vascular procedures, are associated with a significant increase in costs and mortality. Postoperative pulmonary complications (PPCs) have a notable impact on morbidity and mortality. The primary aim of this present study was to evaluate the effects of spinal anesthesia compared with general anesthesia on the incidence of PPCs in patients undergoing lower extremity bypass surgery.

Design: This study was designed as a prospective, randomized controlled clinical trial with 2 parallel arms.

Setting: Two tertiary teaching hospitals.

Participants: We enrolled 128 adult patients with American Society of Anesthesiologists status II to IV who were scheduled to undergo elective lower extremity arterial bypass surgery.

Interventions: Patients were assigned randomly to receive either general anesthesia or spinal anesthesia.

Measurements and main results: The primary outcome was the incidence of PPCs and secondary end points included hemodynamic and blood gas analysis perioperatively. A total of 128 patients were included in the study, with 123 patients completing the study protocol. Approximately 26.7% of patients who received general anesthesia experienced PPC, compared with 12.7% of those who received spinal anesthesia (p = 0.051). Patients who underwent spinal anesthesia had a lower incidence of hypotension and required fewer intraoperative vasoactive drugs (p < 0.001).

Conclusions: In this study, spinal anesthesia did not significantly reduce the incidence of PPCs in patients undergoing peripheral vascular surgery compared with general anesthesia. Neuraxial anesthesia may reduce the incidence of hypotension and the need for hemodynamic pharmacological support in patients undergoing peripheral arterial surgery, although further dedicated studies are required to validate these findings.