THE POSTOPERATIVE EFFECTS OF ANESTHESIA P ROCEDURES

The perioperative morbidity and mortality is mainly influenced by the type and duration of surgery as well as the patient's preoperative sta te of health. Anesthesia per se, however, may also result in severe pe rioperative (patho)physiological changes,which may be both desired (e. g. analgesia, vasodilation in vascular surgery) or detrimental (e.g. h ypothermia,ventilatory depression) and which may differ depending on t he anesthetic technique used (e.g. general anesthesia vs. regional ane sthesia). Yet, all anesthestic techniques have in common, that their e ffects are not limited to the duration of the surgical intervention, b ut may expand far into the postoperative period. Therefore, many trial s have been performed in the past aiming to compare the impact of diff erent anesthetic techniques on the incidence of postoperative techniqu es, no significant advantage of one or the other technique has been id entified up to now with respect to postoperative mortality or severe m orbidity. This finding may be due to at least three factors. 1) Many s ide-effects related to anesthesia - due to close postoperative monitor ing - are detected and treated early in the postoperative phase (e.g. in the recovery room),thereby preventing serious complications. 2) Pos toperative mortality related exclusively to anesthesia probably is so few, that huge patient numbers would be required to demonstrate any si gnificant differences between different techniques. 3) Besides the fac tor 'anesthesia', may other factors contribute to the anesthesia relat ed morbidity and mortality (e.g. the factor 'anesthetist') which are h ardly quantified. The fact that clear advantages for a single techniqu e have not yet been demonstrated must not, however, result in anesthet ic 'nihilism'. Rather there may be good reasons in the individual pati ent (e.g. lack of a recovery room), to prefer a certain anesthetic tec hnique or drug over another, in order to lower the individual risk of anesthesia. Whether the use of a certain technique - e.g. spinal or ep idural anesthesia - may contribute to a reduction of specific postoper ative surgical complications (e.g. rate of reocclusion subsequent to p eripheral vascular surgery) is presently under investigation.