THE EFFECT OF ANAESTHESIA TECHNIQUE ON PERIOPERATIVE OUTCOME FOLLOWING VASCULAR REPAIR SURGERY ASSOCIATED WITH POLYTRAUMA

Robinson et al. investigated the vascular effects of propofol and demonstrated that its peripheral vasodilatory action is largely mediated through suppression of sympathetic vasoconstrictor nerve activity(22). This mechanism results in a reduction of vascular tone and subsequent vasodilatation. In the context of vascular injury, such pharmacological properties of propofol may be advantageous in mitigating elevated vascular tone and supporting adequate postoperative blood flow(22).

Volatile anaesthetics allow rapid titration and can be advantageous during phases of physiological instability commonly encountered in polytrauma (23). Studies have also found that inhalation anaesthetics cause vascular dilatation, too, more so by sevoflurane compared to isoflurane (24). This could be again beneficial in managing vascular injury where tone is increased. This will help to enhance blood flow.

However, evidence specifically analysing anaesthesia type in orthopedic vascular trauma is scarce. Evidence specific to orthopedic–vascular trauma remains limited; hence, anaesthetic strategies are typically individualized based on patient physiology, anticipated blood loss, injury severity, and the staged nature of damage-control surgery.

Kampman et al. conducted a large multinational meta-analysis involving over 51,000 patients, found no significant differences in all-cause mortality, myocardial infarction, stroke, or major postoperative complications between TIVA and inhalational anaesthesia (25).

Choi et al., in a randomised trial conducted in an orthopaedic arthroplasty centre, reported no significant differences between TIVA and volatile anaesthesia in postoperative pain scores or opioid requirements in patients undergoing total shoulder arthroplasty (26).

Yin et al., in an arthroscopy-focused orthopaedic centre, concluded that both TIVA and sevoflurane provided acceptable operative field visibility and comparable surgical quality during shoulder arthroscopy (27).