Our Summary

This research paper discusses the use of regional anesthesia for a high-risk patient needing surgery. The patient was a 65-year-old man with serious lung disease, high blood pressure, and vascular disease, who was scheduled for a specific type of artery bypass surgery in his leg. Because of his health issues, general anesthesia was considered risky. Instead, the doctors used a regional anesthesia technique involving a combination of two nerve blocks in his leg. This allowed the patient to be sedated but not fully unconscious during the surgery. The procedure went well, taking almost two hours, and the patient felt no pain. The patient was then able to be safely moved to the surgical ward. The authors suggest that this anesthesia technique is useful but often overlooked, and hope that this case will serve as a reminder of its value for patients who can’t safely have general anesthesia.

FAQs

  1. What is the femoral-popliteal bypass surgery?
  2. What is the regional anesthesia technique mentioned in the article and how does it work?
  3. Why is regional anesthesia considered a safer option for high-risk patients over general anesthesia?

Doctor’s Tip

One helpful tip a doctor might tell a patient about femoral-popliteal bypass is to follow post-operative care instructions carefully to ensure proper healing and prevent complications. This may include taking prescribed medications, keeping the incision site clean and dry, avoiding strenuous activities, and attending follow-up appointments with your healthcare provider. Additionally, maintaining a healthy lifestyle with regular exercise and a balanced diet can help improve blood flow and overall vascular health.

Suitable For

Patients who are typically recommended femoral-popliteal bypass surgery are those with peripheral artery disease in the femoral and popliteal arteries, which are the major arteries in the thigh and behind the knee, respectively. This condition can lead to decreased blood flow to the lower leg and foot, causing symptoms such as pain, numbness, and difficulty walking. Patients with severe symptoms that do not improve with conservative treatments such as medication and lifestyle changes may be candidates for femoral-popliteal bypass surgery.

Additionally, patients who have complications from peripheral artery disease, such as tissue damage or ulceration in the lower leg or foot, may also be recommended for femoral-popliteal bypass surgery. These complications can be serious and may require surgical intervention to improve blood flow and prevent further damage.

Furthermore, patients with peripheral artery disease who have not responded well to other treatments or who have a high risk of complications from their condition may also be candidates for femoral-popliteal bypass surgery. In some cases, this surgery may be recommended as a last resort to improve blood flow and prevent limb loss in patients with severe peripheral artery disease.

Overall, patients who are recommended femoral-popliteal bypass surgery are those with significant peripheral artery disease in the femoral and popliteal arteries, who have not responded well to other treatments, or who have complications that require surgical intervention. These patients may benefit from improved blood flow to the lower leg and foot, leading to reduced symptoms and improved quality of life.

Timeline

Before femoral-popliteal bypass surgery:

  • The patient is diagnosed with vascular disease in their leg
  • Doctors determine that surgery is necessary to improve blood flow to the leg
  • The patient undergoes pre-operative testing and evaluation to assess their overall health and readiness for surgery
  • Anesthesia options are discussed, taking into consideration the patient’s high-risk factors
  • Regional anesthesia using nerve blocks is chosen as the safest option for the patient

After femoral-popliteal bypass surgery:

  • The patient is sedated but conscious during the surgery, which lasts approximately two hours
  • The patient experiences no pain during the procedure
  • Once the surgery is complete, the patient is moved to the surgical ward for recovery
  • The patient’s leg will require time to heal and physical therapy to regain strength and function
  • Follow-up appointments will be scheduled to monitor the patient’s progress and ensure the success of the surgery.

What to Ask Your Doctor

  1. What is a femoral-popliteal bypass and why do I need it?
  2. What are the potential risks and complications associated with this surgery?
  3. Are there any alternative treatment options available for my condition?
  4. How long will the recovery process take and what can I expect during the recovery period?
  5. Will I need to make any lifestyle changes after the surgery to prevent future complications?
  6. How experienced are you in performing femoral-popliteal bypass surgeries?
  7. What is the success rate of this procedure in patients with similar health conditions?
  8. Will I need to undergo any additional tests or evaluations before the surgery?
  9. What type of anesthesia will be used for the surgery and why?
  10. What are the potential side effects or risks associated with the anesthesia technique being used for my surgery?

Reference

Authors: Selvi O, Bayserke O, Tulgar S. Journal: Cureus. 2018 Feb 2;10(2):e2140. doi: 10.7759/cureus.2140. PMID: 29632750