Factors associated with the need for airway intervention immediately after extubation from general anesthesia

Background: Carpal tunnel release (CTR) can be performed with a variety of anesthesia techniques. General anesthesia is associated with higher risk profile and increased resource utilization, suggesting it should not be routinely used for CTR. The purpose of this study was to examine the patient factors associated with surgeons’ requests for general anesthesia for CTR and the frequency of routine use of general anesthesia by Veterans Health Administration (VHA) surgeons and facilities. Methods: National VHA data for fiscal years 2015 and 2017 were used to identify patients receiving CTR. Mixed-effects logistic regression was used to evaluate patient, procedure, and surgeon factors associated with requests by the surgeon for general anesthesia versus other anesthesia techniques. Results: In all, 18 145 patients underwent CTR performed by 780 surgeons in 113 VHA facilities. Overall, there were 2218 (12.2%) requests for general anesthesia. Although some patient (eg, older age, obesity), procedure (eg, open vs endoscopic), and surgeon (eg, higher volume) factors were associated with lower odds of requests for general anesthesia, there was substantial facility- and surgeon-level variability. The percentage of patients with general anesthesia requested ranged from 0% to 100% across surgeons. Three facilities and 28 surgeons who performed at least 5 CTRs requested general anesthesia for more than 75% of patients. Conclusions: Where CTR is performed and by whom appear to influence requests for general anesthesia more than patient factors in this study. Avoidance of routine use of general anesthesia for CTR should be considered in future clinical practice guidelines and quality measures.

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Adverse Events and Factors Associated with Potentially Avoidable Use of General Anesthesia in Cesarean Deliveries

Anesthesiology ◽

10.1097/aln.0000000000002629 ◽

2019 ◽

Vol 130 (6) ◽

pp. 912-922 ◽

Cited By ~ 20

Author(s):

Jean Guglielminotti ◽

Ruth Landau ◽

Guohua Li

Keyword(s):

Adverse Events ◽

General Anesthesia ◽

Cesarean Delivery ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Neuraxial Anesthesia ◽

General Anesthetics ◽

Factors Associated ◽

Increased Risk ◽

Anesthesia Complications

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Compared with neuraxial anesthesia, general anesthesia for cesarean delivery is associated with increased risk of maternal adverse events. Reducing avoidable general anesthetics for cesarean delivery may improve safety of obstetric anesthesia care. This study examined adverse events, trends, and factors associated with potentially avoidable general anesthetics for cesarean delivery. Methods This retrospective study analyzed cesarean delivery cases without a recorded indication for general anesthesia or contraindication to neuraxial anesthesia in New York State hospitals, 2003 to 2014. Adverse events included anesthesia complications (systemic, neuraxial-related, and drug-related), surgical site infection, venous thromboembolism, and the composite of death or cardiac arrest. Anesthesia complications were defined as severe if associated with death, organ failure, or prolonged hospital stay. Results During the study period, 466,014 cesarean deliveries without a recorded indication for general anesthesia or contraindication to neuraxial anesthesia were analyzed; 26,431 were completed with general anesthesia (5.7%). The proportion of avoidable general anesthetics decreased from 5.6% in 2003 to 2004 to 4.8% in 2013 to 2014 (14% reduction; P < 0.001). Avoidable general anesthetics were associated with significantly increased risk of anesthesia complications (adjusted odds ratio, 1.6; 95% CI, 1.4 to 1.9), severe complications (adjusted odds ratio, 2.9; 95% CI, 1.6 to 5.2), surgical site infection (adjusted odds ratio, 1.7; 95% CI, 1.5 to 2.1), and venous thromboembolism (adjusted odds ratio, 1.9; 95% CI, 1.3 to 3.0), but not of death or cardiac arrest. Labor neuraxial analgesia rate was one of the most actionable hospital-level factors associated with avoidable general anesthetics. Relative to hospitals with a rate greater than or equal to 75%, the adjusted odds ratio of avoidable general anesthetics increased to 1.3 (95% CI, 1.2 to 1.4), 1.6 (95% CI, 1.5 to 1.7), and 3.2 (95% CI, 3.0 to 3.5) as the rate decreased to 50 to 74.9%, 25 to 49.9%, and less than 25%, respectively. Conclusions Compared with neuraxial anesthesia, avoidable general anesthetics are associated with increased risk of adverse maternal outcomes.

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Adverse Events and Factors Associated With Potentially Avoidable Use of General Anesthesia in Cesarean Deliveries

Obstetric Anesthesia Digest ◽

10.1097/01.aoa.0000652752.42029.d2 ◽

2020 ◽

Vol 40 (1) ◽

pp. 2-4

Author(s):

J. Guglielminotti ◽

R. Landau ◽

G. Li

Keyword(s):

Adverse Events ◽

General Anesthesia ◽

Factors Associated ◽

Cesarean Deliveries

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Acute epiglottitis: analysis of factors associated with airway intervention

The Journal of Laryngology & Otology ◽

10.1258/002221505775010823 ◽

2005 ◽

Vol 119 (12) ◽

pp. 967-972 ◽

Cited By ~ 68

Author(s):

Hideaki Katori ◽

Mamoru Tsukuda

Keyword(s):

Diabetes Mellitus ◽

Seasonal Variation ◽

Endotracheal Intubation ◽

Retrospective Review ◽

Vocal Fold ◽

Clinical Course ◽

Acute Epiglottitis ◽

Airway Intervention ◽

Factors Associated ◽

Two Factors

We reviewed acute epiglottitis (AE) and identified factors associated with airway intervention. This report was a retrospective review of patients with AE and compared with factors associated with airway intervention. We reviewed 96 patients who were diagnosed with AE in our hospitals in Japan. Ninety-two (96 per cent) patients were adults, and no seasonal variation in the incidence of AE was encountered. Eight (8 per cent) patients had tracheostomy and endotracheal intubation had not been done. We found that symptoms of stridor and muffled voice, a rapid clinical course, and diabetes mellitus were the factors associated with airway intervention. Extremely severe swelling of the epiglottis such that only less than half of the posterior vocal fold (scope classification (SC): III) could be seen, and extension of the swelling to the arytenoids (SC: B) were the two factors that were strongly associated with airway intervention.

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Factors Associated with Mothers Selecting General Anesthesia for Lower Segment Caesarean Section

Journal of Psychosomatic Obstetrics & Gynecology ◽

10.3109/01674829509024465 ◽

1995 ◽

Vol 16 (3) ◽

pp. 167-170 ◽

Cited By ~ 5

Author(s):

A. Holdcroft ◽

A. M. Parshall ◽

M. G. Knowles ◽

K. E. Waite ◽

B. M. Morgan

Keyword(s):

Caesarean Section ◽

General Anesthesia ◽

Lower Segment ◽

Factors Associated ◽

Lower Segment Caesarean Section

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Magnitude and factors associated with surgical site infection among mothers underwent cesarean delivery in Nekemte town public hospitals, western Ethiopia

PLoS ONE ◽

10.1371/journal.pone.0250736 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0250736

Author(s):

Diriba Ayala ◽

Tadesse Tolossa ◽

Jote Markos ◽

Mekdes Tigistu Yilma

Keyword(s):

Surgical Site Infection ◽

General Anesthesia ◽

Cesarean Delivery ◽

Public Health Problem ◽

Public Hospitals ◽

Outcome Variable ◽

Site Infection ◽

Cross Sectional ◽

Factors Associated ◽

Prolonged Labor

Background Surgical site infection (SSI) is a serious public health problem due to its impacts on maternal morbidity and mortality and it can have a significant effect on quality of life for the patient. However, little has been studied regarding the magnitude and factors associated with SSI among women underwent cesarean delivery (CD) in study area. Therefore, the aim of this study was to assess the magnitude and factors associated with SSI among women underwent cesarean delivery in Nekemte Town Public Hospitals 2020. Methods An institution based cross-sectional study was conducted from January 1/2018 to January 1/2020. A simple random sampling technique was employed to select 401 patient cards from all records women underwent CD from January 1/2018 to January 1/2020. Epidata version 3.2 was used for data entry, and STATA version 14 was used for analysis. A logistic regression model was used to determine the association of independent variables with the outcome variable and adjusted odds ratios (AOR) with 95% confidence interval was used to estimate the strength of the association. Results Three hundred eight two (382) cards of women were selected for analysis making a response rate of 95.2%. The mean (±SD) age of the mothers was 25.9 (±4.8) years. The prevalence of SSIs was 8.9% (95% CI: 6.03, 11.76). Age > 35 years (AOR = 5.03, 95% CI:1.69, 14.95), pregnancy-induced hypertension (AOR = 5.63, 95%CI:1.88, 16.79), prolonged labor (AOR = 4.12, 95% CI:1.01, 32.19), receiving general anesthesia (AOR = 3.96 95% CI:1.02, 15.29), and post-operative hemoglobin less than 11 g/dl (AOR = 4.51 95% CI:1.84, 11.07) were significantly associated with the occurrence of SSI after cesarean delivery. Conclusions and recommendations The magnitude of post CD SSI in this study was comparable with the sphere standards of CDC guidelines for SSI after CD. Concerned bodies should give due attention the proper utilization of partograph to prevent prolonged labor, and provision of iron folate to increase the hemoglobin level of pregnant mothers in all health institution. In addition, we would recommend the use of spinal anesthesia over general anesthesia.

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Anesthetic management of a pregnant broodmare with gastrointestinal colic

Vlaams Diergeneeskundig Tijdschrift ◽

10.21825/vdt.v90i1.17769 ◽

2021 ◽

Vol 90 (1) ◽

pp. 29-36

Author(s):

L. Miller ◽

M. Gozalo-Marcilla ◽

P.J. Pollock ◽

A. Panti

Keyword(s):

Risk Factors ◽

Case Report ◽

General Anesthesia ◽

Early Pregnancy ◽

Anesthetic Management ◽

Surgical Correction ◽

Factors Associated ◽

Anesthetic Risk ◽

Negative Outcome

Gastrointestinal colic in mares during early pregnancy may require general anesthesia for surgical correction. There is a scarcity of literature identifying anesthetic risk factors associated with negative outcome in the pregnant mare. In this case report, a seven-year-old Thoroughbred broodmare, presenting for the investigation and treatment of colic in the fifth month of pregnancy, underwent surgery for the correction of right dorsal displacement of the large colon. Intraoperatively, interventions for maternal hypoxemia and hypotension were necessary. The mare recovered well from general anesthesia and was discharged from the hospital eleven days postoperatively. In this case report, the successful anesthetic management of a pregnant broodmare is described, and all aspects that may improve the outcome for both mare and fetus are considered, with emphasis on the prevention of cardiovascular and respiratory disturbances.

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