Phill Vainer, B.S. Medical Student, KCU Class of 2024
Anesthesia Before Vascular Surgery: Things to Know
As with any surgery, a major consideration for patients is whether their bodies can handle anesthesia safely. With vascular surgery, this is just the same. When anesthesiologists evaluate a patient before vascular surgery, the two most important factors they consider are what type of vascular surgery the patient is getting and what other diseases the patient may already have.
Every surgical procedure a vascular surgeon performs requires a unique approach from anesthesia to help guide the patient through a safe and pain-free surgery. Depending on the procedure, an anesthesiologist will have a specifically tailored approach to how they administer and manage anesthesia from the beginning and till the end of the surgery. They will also have a plan for how they limit post surgical pain and nausea. Common procedures related to vascular surgery include procedures to treat peripheral artery disease, aneurysmal disease, and thromboembolic disease.
Likewise, common diseases such as chronic kidney disease, heart disease, and chronic obstructive pulmonary disease also significantly influence how an anesthesiologist plans a procedure. In the next portion of this article, I will talk about how those common diseases can affect the delivery of anesthesia.
Chronic Kidney Disease:
Very common in Vascular Surgery is to perform procedures endovascularly, which means the entire surgery is performed inside of arteries and veins and does not require making any large incisions into the
body. However, doing this involves using "contrast dyes," which allows the surgeons to see exactly where in the body they are working without having to cut open the skin! The problem, however, is that patients with chronic kidney disease do not handle these "contrast dyes" very well and risk having their kidneys injured.
Fortunately, anesthesiologists can avoid exposing a person with chronic kidney disease to kidney injury from contrast dyes by carefully hydrating the patient with intravenous fluids. Specific hydration protocols exist to significantly reduce the risk of kidney injury, so patients with kidney disease can feel assured that they'll safely tolerate the contrast dyes used in endovascular procedures.
Patients undergoing vascular surgery commonly have underlying issues with their hearts. In preparing for anesthesia, an anesthesiologist will evaluate each patient's heart condition carefully to ensure that they are safe for surgery. Patients with heart disease will likely receive an EKG, echocardiogram, and coronary angiography before surgery to ensure they will be safe. After a patient undergoes these tests, an anesthesiologist will review the results and either clear a patient for surgery or decide to cancel the surgery. As a patient, if you have a heart condition and were cleared for surgery, feel assured that lots of time was spent making sure your heart is strong enough to handle the procedure.
Chronic Obstructive Pulmonary Disease:
Often patients in need of vascular surgery have a long history of tobacco use. Chronic tobacco use causes significant damage to many organ systems in our body, including our lungs and arteries. For this reason, many patients undergoing vascular surgery also happen to have COPD. An anesthesiologist's most important consideration before caring for a patient during their procedure is that they have stopped smoking for at least 8 weeks. These eight weeks of smoking cessation will decrease the risk of experiencing many surgical complications. Some of these surgical complications include heart attack and limb loss.
Post-Operative Anesthetic and Pain Management:
Your level of pain and recovery from vascular surgery will depend on the complexity of your procedure. Sometimes, you will have to spend some time in the intensive care unit for close monitoring, and other times you'll feel good enough to go home in a few hours. Depending on your surgery, your vascular surgeon and anesthesiologist will inform you of what to expect regarding recovery and pain. Fortunately, with the use of special nerve-blocking medications and long-acting painkillers, the pain and recovery from vascular surgery is often very mild.