27-Aug-88 3:00 PM CST

Below-Knee Physiologic Cryoanesthesia In The Critically Ill Patient

Journal of Vascular Surgery

Author: M.R. Brinker, MD, Gregory A. Timberlake, MD, James M. Goff, BSE, Janet C. Rice, PhD, and Morris D. Kerstein, MD

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Controversy has surrounded the role of local hvpothennia as a preoperative treatment in amputations of the lower extremity. Although several investigators have shown that ctyoamputation with a tourniquet significantly decreases the risk of postoperative morbidity and death in the seriously ill patient, the procedure has not gained widespread popularity. Much of the resistance to the technique stems from improper association of amputation under cryoanesthesia with local cooling as a surgical anesthetic.

This report is an analysis or9l patients who underwent below-knee (BK) amputation at Charity
Hospital of Louisiana at New Orleans (CHNO) between 1980 and 1985. The study was undertaken to determine the effectiveness of amputation under cryoanesthesia in decreasing postopcrath'c morbidity and death in BK amputations. To our knowledge, a well-controlled study of this type has not been published in the literature.

PATIENTS AND METHODS

A series of 154 BK amputations performed by Tulane University School of Medicine housestaff at CHNO between 1980 and 1985 was reviewed. The data were obtained through a rruospecth'e review of the medical records. To be included in the study, patient charts had to contain indication for surgical amputation, associated risk factors of vascular disease, physical findings (proximal extent of disease, Doppler studies, and x-ray films of the affected limb), surgical procedure performed, and postoperative complications. Unreconstructable vascular disease
was defined clinically after review of Doppler studies, angiograms, and the patients' clinical and psychosocial status. A total of 104 patient charts met these strict criteria, of which 13 were eliminated because the primary indication for BK amputation was major trauma. The remaining 91 patients for whom the...

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