Expert: Dr Ian Jackson - please note UK based - 5/28/2008

Question
QUESTION: I would like to know the side effects of any general Spinal anaesthetic durgs used in a lower limb athroplasty and the possible complications of high bloodpressure with regards to both spinal and GA

ANSWER: Hi Diana
High blood pressure is not seen as a major issue for anaesthetists and the period around your operation these days. Recents analysis of over 40 studies on this topic has shown that blood pressures of up to 160/110 are not a problem and indeed there is little evidence that pressures above this are a major issue. However there is a huge body of evidence that the management of high blood pressure provides major health gains for people of all ages with a reduction in strokes (CVAs) and heart problems amongst other things.
GA vs spinal for lower limb arthroplasty. In the end there is little difference in outcomes so neither has any major long term advantage over the other. For the operation described I routinely encourage patients to have a spinal anaesthetic with minimal sedation rather than a GA.
Happy to answer a follow up question if this doesn't cover what you are looking for, but I hope it helps.
Kind regards
Dr Ian Jackson

---------- FOLLOW-UP ----------

QUESTION: If you were a mentally disabled patient would it be recommended to have GA rather than a spinal because of the patient being awake during surgery and not fully understanding what is going on? or this would still make no difference?

Answer
Diana
Depends on degree of disability. If lack of understanding a concern then would depend if I could encourage the patients to sit for me to put the spinal in. If they could then I would be happy to proceed and then make them have a gentle snooze while the operation was being performed. The sedation would mean they wouldn't be a problem during the operation. If they couldn't sit for the spinal then I would use a GA.