• André P Schmidt, Daiane Silvello, FilhoClovis T BevilacquaCTBServiço de Anestesia e Medicina Perioperatória, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil., Deborah Bergmann, Luiz Eduardo C Ferreira, Marcos F Nolasco, Tales D Pires, Walter C Braga, and Cristiano F Andrade.
• Serviço de Anestesia e Medicina Perioperatória, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde (ICBS), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Serviço de Anestesia, Santa Casa de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil; Serviço de Anestesia, Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brazil; Programa de Pós-graduação em Ciências Pneumológicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Programa de Pós-graduação em Ciências Cirúrgicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Programa de Pós-Graduação em Anestesiologia, Ciências Cirúrgicas e Medicina Perioperatória, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil. Electronic address: apschmidt@hcpa.edu.br.
• J. Cardiothorac. Vasc. Anesth. 2024 Dec 21.

ObjectivesPostoperative 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.DesignThis study was designed as a prospective, randomized controlled clinical trial with 2 parallel arms.SettingTwo tertiary teaching hospitals.ParticipantsWe enrolled 128 adult patients with American Society of Anesthesiologists status II to IV who were scheduled to undergo elective lower extremity arterial bypass surgery.InterventionsPatients were assigned randomly to receive either general anesthesia or spinal anesthesia.Measurements And Main ResultsThe 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).ConclusionsIn 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.Copyright © 2024 Elsevier Inc. All rights reserved.

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