Key result
Propofol-based TIVA is not linked to increased perioperative MACE versus local anesthesia during angioplasty.
Why the study?
The risks of propofol-based total intravenous anesthesia compared to local anesthesia in patients undergoing percutaneous transluminal angioplasty in the lower extremity were not well defined.
Does propofol-based total intravenous anesthesia compared to local anesthesia increase perioperative complications in patients undergoing percutaneous transluminal angioplasty in the lower extremity?
Cohort (n=231)
No
Does propofol-based total intravenous anesthesia compared to local anesthesia increase perioperative complications in patients undergoing percutaneous transluminal angioplasty in the lower extremity?
Absolute Event Rate: 7.8% vs 3.9%
p-value: p=0.221
In patients undergoing lower extremity PTA, propofol-based TIVA is associated with a higher rate of minor perioperative complications compared to local anesthesia, though major adverse cardiac events do not significantly differ.
Propofol TIVA was not associated with increased major cardiac events in lower extremity angioplasty; leaves open questions on minor complications and requires randomized confirmation before practice change.
Objective: This study aimed to determine the risks of propofol-based total intravenous anesthesia (TIVA) compared to local anesthesia (LA) in patients undergoing percutaneous transluminal angioplasty (PTA) in a lower extremity. Material and Methods: A retrospective cohort study was conducted in 231 patients who underwent PTA in the lower extremity using either propofol-based TIVA or LA between January 2016 and September 2018. The outcomes of interest included perioperative major adverse cardiac events (MACE) and minor perioperative complications. Risk factors analysis was performed using a univariate logistic regression and backward stepwise multivariate logistic regression. Results: Although the rate of perioperative MACE was two times higher in the propofol-based TIVA group (7.8%) than the LA group (3.9%), no significant difference was found (p-value=0.221). The propofol-based TIVA group had a significantly higher incidence of all minor perioperative complications than the LA group (77.6% vs 13.6%, p value<0.001). Multivariate analysis found that low body mass index (BMI) and American Society of Anesthesiologists classification III were independent factors associated with perioperative MACE, while propofol-based TIVA, body weight (or BMI), hypertension, diabetes mellitus, previous coronary artery disease, and previous congestive hear failure were associated with perioperative minor complications. Conclusion: Based on this study, no significant differences in perioperative MACE were found using either TIVA or LA. However, TIVA produced a significantly higher incidence of perioperative minor complication than LA. Close intraoperative monitoring should be implemented when using propofol-based TIVA in patients undergoing PTA in the lower extremity.
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Wongwiwattananon et al. (2020) conducted a cohort in Peripheral artery disease (n=231). Propofol-based total intravenous anesthesia vs. Local anesthesia was evaluated on Perioperative major adverse cardiac events (MACE) (p=0.221). Propofol-based total intravenous anesthesia did not significantly increase perioperative major adverse cardiac events compared to local anesthesia (7.8% vs 3.9%) in patients undergoing angioplasty.
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