• 1

    Alvi R, Jones S, Burrows D, et al: The safety of topical anaesthetic and analgesic agents in a gel when used to provide pain relief at split skin donor sites. Burns 24: 54, 1998.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2

    Beausang E, Orr D, Shah M, et al: Subcutaneous adrenaline infiltration in paediatric burn surgery. Br J Plast Surg 52: 480, 1999.

  • 3

    Cuignet O, Pirson J, Boughrouph J, et al: The efficacy of continuous fascia iliaca compartment block for pain management in burn patients undergoing skin grafting procedures. Anesth Analg 98: 1077, 2004.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Jacqueline R, Malviya S, Burke C, et al: An assessment of interrater reliability of the ASA physical status classification in pediatric surgical patients. Paediatr Anaesth 16: 928, 2006.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Cullen DJ, Apolone G, Greenfield S, et al: ASA Physical Status and age predict morbidity after three surgical procedures. Ann Surg 220: 3, 1994.

  • 6

    Mak PH, Campbell RC, Irwin MG; American Society of Anesthesiologists: The ASA Physical Status Classification: inter-observer consistency. Anaesth Intensive Care 30: 633, 2002.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Wolters U, Wolf T, Stutzer H, et al: ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth 77: 217, 1996.

  • 8

    Vadivelu N, Gesquire M, Mitra S, et al: Safety of local anesthesia combined with monitored intravenous sedation for American Society of Anesthesiologists 3 and 4 patients undergoing lower limb–preservation procedures. J Foot Ankle Surg 49: 152, 2010.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Reilley TE, Gerhardt MA: Anesthesia for foot and ankle surgery. Clin Podiatr Med Surg 19: 125, 2002.

  • 10

    Haynes SR, Lawler PG: An assessment of the consistency of ASA physical status classification allocation. Anaesthesia 50: 195, 1995.

  • 11

    Owens WD, Felts JA, Spitznagel EL Jr: ASA physical status classifications: a study of consistency of ratings. Anesthesiology 49: 239, 1978.

  • 12

    Ranta S, Hynynen M, Tammisto T: A survey of the ASA physical status classification: significant variation in allocation among Finnish anaesthesiologists. Acta Anaesthesiol Scand 41: 629, 1997.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Derrington MC, Smith G: A review of studies of anaesthetic risk, morbidity and mortality. Br J Anaesth 59: 815, 1987.

  • 14

    Arvidsson S, Ouchterlony J, Sjostedt L, et al: Predicting postoperative adverse events: clinical efficiency of four general classification systems: the project perioperative risk. Acta Anaesthesiol Scand 40: 783, 1996.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Cohen MM, Duncan PG: Physical status score and trends in anesthetic complications. J Clin Epidemiol 41: 83, 1988.

  • 16

    Lee A, Lum ME: Measuring anaesthetic outcomes. Anaesth Intensive Care 24: 685, 1996.

  • 17

    Lee A, Lum ME, O'Regan WJ, et al: Early postoperative emergencies requiring an intensive care team intervention: the role of ASA physical status and after-hours surgery. Anaesthesia 53: 529, 1998.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Leung JM, Dzankic S: Relative importance of preoperative health status versus intraoperative factors in predicting postoperative adverse outcomes in geriatric surgical patients. J Am Geriatr Soc 49: 1080, 2001.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Menke H, Klein A, John KD, et al: Predictive value of ASA classification for the assessment of the perioperative risk. Int Surg 78: 266, 1993.

  • 20

    Klotz HP, Candinas D, Platz A, et al: Preoperative risk assessment in elective general surgery. Br J Surg 83: 1788, 1996.

  • 21

    Breslow MJ, Parker SD, Frank SM, et al: Determinants of catecholamine and cortisol responses to lower extremity revascularization: the PIRAT Study Group. Anesthesiology 79: 1202, 1993.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22

    Tiret L, Hatton F, Desmonts JM, et al: Prediction of outcome of anaesthesia in patients over 40 years: a multifactorial risk index. Stat Med 7: 947, 1988.

  • 23

    Hadzic A, Arliss J, Kerimoglu B, et al: A comparison of infraclavicular nerve block versus general anesthesia for hand and wrist day-case surgeries. Anesthesiology 101: 127, 2004.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Hadzic A, Karaca PE, Hobeika P, et al: Peripheral nerve blocks result in superior recovery profile compared with general anesthesia in outpatient knee arthroscopy. Anesth Analg 100: 976, 2005.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Hadzic A, Williams BA, Karaca PE, et al: For outpatient rotator cuff surgery, nerve block anesthesia provides superior same-day recovery over general anesthesia. Anesthesiology 102: 1001, 2005.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Klein SM, Evans H, Nielsen KC, et al: Peripheral nerve block techniques for ambulatory surgery. Anesth Analg 101: 1663, 2005.

  • 27

    Liu SS, Strodtbeck WM, Richman JM, et al: A comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials. Anesth Analg 101: 1634, 2005.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Bhattacharya SD, Vaslef SN, Pappas TN, et al: Locoregional versus general anesthesia for open inguinal herniorrhaphy: a National Surgical Quality Improvement Program analysis. Am Surg 78: 798, 2012.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Bitar G, Mullis W, Jacobs W, et al: Safety and efficacy of office-based surgery with monitored anesthesia care/sedation in 4778 consecutive plastic surgery procedures. Plast Reconstr Surg 111: 150, 2003.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    De Virgilio C, Romero L, Donayre C, et al: Endovascular abdominal aortic aneurysm repair with general versus local anesthesia: a comparison of cardiopulmonary morbidity and mortality rates. J Vasc Surg 36: 988, 2002.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Franz R, Hartman J, Wright M: Comparison of anesthesia technique on outcomes of endovascular repair of abdominal aortic aneurysms: a five-year review of monitored anesthesia care with local anesthesia vs. general or regional anesthesia. J Cardiovasc Surg 52: 567, 2011.

    • Search Google Scholar
    • Export Citation
  • 32

    Okhunov Z, Juncal S, Ordon M, et al: Comparison of outcomes in patients undergoing percutaneous renal cryoablation with sedation vs general anesthesia. Urology 85: 130, 2015.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Segal JL, Owens G, Silva WA, et al: A randomized trial of local anesthesia with intravenous sedation vs general anesthesia for the vaginal correction of pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 18: 807, 2007.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Bhananker SM, Posner KL, Cheney FW, et al: Injury and liability associated with monitored anesthesia care: a closed claims analysis. Anesthesiology 104: 228, 2006.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Tesniere A, Servin F: Intravenous techniques in ambulatory anesthesia. Anesthesiol Clin North America 21: 273, 2003.

  • 36

    Vu MM, Galiano RD, Souza JM, et al: A multi-institutional, propensity-score-matched comparison of post-operative outcomes between general anesthesia and monitored anesthesia care with intravenous sedation in umbilical hernia repair. Hernia 20: 517, 2016.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Verhoeven EL, Cina CS, Tielliu IF, et al: Local anesthesia for endovascular abdominal aortic aneurysm repair. J Vasc Surg 42: 402, 2005.

  • 38

    Wardrop P, Nishikawa H: Lateral cutaneous nerve of the thigh blockade as primary anaesthesia for harvesting skin grafts. Br J Plast Surg 48: 597, 1995.

Safety of Deep Sedation in Patients Undergoing Full-Thickness Skin Graft Harvesting and Skin Graft Reconstruction for Limb Salvage

An Outcome Analysis

View More View Less
  • 1 Stony Brook University School of Medicine, Stony Brook, NY. Dr. Kai is now with the Department of Internal Medicine, NYU-Winthrop Hospital, Mineola, NY.
  • | 2 Department of Anesthesiology, Yale School of Medicine, New Haven, CT.
  • | 3 Yale School of Public Health, New Haven, CT.
  • | 4 Department of Surgery, Orthopedics, and Rehabilitation, Yale School of Medicine, New Haven, CT.
Restricted access

Background:

Studies on obtaining donor skin graft using intravenous sedation for patients undergoing major foot surgeries in the same operating room visit have not previously been reported. The objective of this retrospective study is to demonstrate that intravenous sedation in this setting is both adequate and safe in patients undergoing skin graft reconstruction of the lower extremities in which donor skin graft is harvested from the same patient in one operating room visit.

Methods:

Medical records of 79 patients who underwent skin graft reconstruction of the lower extremities by one surgeon at the Yale New Haven Health System between November 1, 2008, and July 31, 2014, were reviewed. The patients' demographic characteristics, American Society of Anesthesiologists class, comorbid conditions, intraoperative analgesic administration, estimated blood loss, total operating room time, total postanesthesia care unit time, and postoperative complications within the first 72 hours were reviewed.

Results:

This study found minimal blood loss and no postoperative complications, defined as any pulmonary or cardiac events, bleeding, admission to the intensive care unit, or requirement for invasive monitoring, in patients who underwent major foot surgery in conjunction with full-thickness skin graft.

Conclusions:

We propose that given the short duration and peripheral nature of the procedures, patients can safely undergo skin graft donor harvesting and skin graft reconstruction procedures with intravenous sedation regardless of American Society of Anesthesiologists class in one operating room visit.

Corresponding author: Alice M. Kai, MD, Department of Internal Medicine, NYU-Winthrop Hospital, Mineola, NY. (E-mail: alice.kai@nyulangone.org)