A comparative study of voice outcomes and complication rates in patients undergoing injection laryngoplasty performed under local versus general anaesthesia: an Adelaide voice specialist's experience

2017 ◽  
Vol 131 (S1) ◽  
pp. S41-S46 ◽  
Author(s):  
D Chandran ◽  
C Woods ◽  
S Ullah ◽  
E Ooi ◽  
T Athanasiadis
Keyword(s):  
General Anaesthesia ◽  
Local Anaesthesia ◽  
Voice Handicap Index ◽  
Complication Rates ◽  
Post Injection ◽  
Injection Laryngoplasty ◽  
Patient Demographics ◽  
Management Algorithm ◽  
Significant Difference ◽  
General Anaesthesia Group

AbstractObjective:To compare clinical outcomes and complication rates in patients undergoing injection laryngoplasty performed under local versus general anaesthesia.Methods:A retrospective review was conducted of patients who underwent injection laryngoplasty performed by a single laryngologist in a tertiary Australian laryngology centre, between February 2013 and December 2014. Patient demographics, anaesthetic modality and complications were recorded. Voice Handicap Index 10 and the Grade, Breathiness, Roughness, Asthenia, Strain scale were evaluated.Results:Thirty-four laryngoplasties were performed under general anaesthesia and 41 under local anaesthesia, with mean patient ages of 59.5 and 68.8 years, respectively. Voice Handicap Index 10 scores were significantly improved post-injection (p< 0.001), with no significant difference between general anaesthesia and local anaesthesia (p> 0.05). All aspects of the Grade, Breathiness, Roughness, Asthenia, Strain scale showed significant improvement post-injection, except asthenia. There were seven (9.3 per cent) minor complications (five in the general anaesthesia group, two in the local anaesthesia group), all managed conservatively.Conclusion:Injection laryngoplasties performed under general anaesthesia and local anaesthesia offer similar voice outcomes, with comparable complication rates. Hence, development of a management algorithm for injection laryngoplasties performed under local anaesthesia is recommended.

Local anaesthesia and conscious sedation for cochlear implantation: experience with 20 patients

2015 ◽  
Vol 130 (2) ◽  
pp. 151-156 ◽  
Author(s):  
B Pateron ◽  
D Bakhos ◽  
A LeLouarn ◽  
P Bordure ◽  
A Bozorg Grayeli ◽  
...  
Keyword(s):  
General Anaesthesia ◽  
Cochlear Implantation ◽  
Local Anaesthesia ◽  
Conscious Sedation ◽  
Symptomatic Treatment ◽  
Good Alternative ◽  
Profound Hearing Loss ◽  
Significant Difference ◽  
Surgical Duration ◽  
General Anaesthesia Group

AbstractObjective:Cochlear implantation is mostly performed under general anaesthesia. This study aimed to evaluate cochlear implantation performed under local anaesthesia and sedation.Method:Twenty patients had a cochlear implant fitted under combined local anaesthesia (local anaesthesia group) and 41 patients had one fitted under general anaesthesia (general anaesthesia group) for bilateral profound hearing loss, from 2011 to 2014. Surgical duration, period of post-operative hospitalisation and early post-operative symptoms were compared. In the local anaesthesia group, operative symptoms reported during the surgery and by questionnaire were analysed.Results:Mean surgical duration was significantly shorter in the local anaesthesia group: 87 versus 122 minutes (p< 0.001). No significant difference was observed between the local anaesthesia and general anaesthesia groups regarding mean post-operative hospitalisation and early post-operative symptoms. Under local anaesthesia, patients had no particular symptoms in 60 per cent of cases. The remaining patients in this group experienced vertigo (10 per cent), pain (20 per cent) and pain-related movement (10 per cent) during the intervention. These symptoms can be controlled with symptomatic treatment.Conclusion:Combined local anaesthesia for cochlear implantation is a good alternative to general anaesthesia for co-operating patients.

Baerveldt shunt surgery versus combined Baerveldt shunt and phacoemulsification: a prospective comparative study

2017 ◽  
Vol 102 (9) ◽  
pp. 1248-1253 ◽  
Author(s):  
Mohamad El Wardani ◽  
Ciara Bergin ◽  
Kenza Bradly ◽  
Eamon Sharkawi
Keyword(s):  
Complication Rates ◽  
Failure Rates ◽  
Shunt Surgery ◽  
Patient Demographics ◽  
Aqueous Shunt ◽  
Included Patient ◽  
Significant Difference ◽  
Negative Effect ◽  
Prospective Comparative Study ◽  
Baerveldt Tube

AimTo examine the efficacy and safety of Baerveldt tube (BT) implantation compared with combined phacoemulsification and Baerveldt tube (PBT) implantation in patients with refractory glaucoma.MethodsSeventy-six eyes of 76 patients were enrolled, 38 pseudophakic eyes underwent BT implantation alone and 38 phakic eyes underwent the BT implantation combined with phacoemulsification. Groups were matched for preoperative intraocular pressure (IOP) and number of glaucoma medications. Preoperative and postoperative measures recorded included patient demographics, visual acuity (VA), IOP, number of antiglaucoma medications and all complications. Patients were followed up for a minimum of 36 months. Failure was defined as: inadequate IOP control (IOP≤5 mm Hg/>21 mm Hg/<20% reduction from baseline, reoperation for glaucoma, loss of light perception vision, or removal of the implant).ResultsThere was a significant difference in failure rates between groups at 36 months (PBT 37% vs BT 15%, P=0.02). There was no significant difference for PBT versus BT in preoperative baseline ocular characteristics. At 36 months: median IOP=14 mm Hg vs 12 mm Hg, P=0.04; mean number of antiglaucomatous medications=1.7 vs 1.3, P=0.61; median VA=0.8 vs 0.7, P=0.44. Postoperative complication rates were similar in both groups (n=5 vs 5; 13% vs 13%).ConclusionsFailure rates were significantly greater in the PBT group at 3 years. Median IOP was also significantly higher in the PBT group. These results suggest that combining phacoemulsification with aqueous shunt surgery may have a negative effect on long-term shunt bleb survival.

scholarly journals Impact of economic crisis on indications for general versus local anaesthesia in head and neck surgery: a single centre analysis

2014 ◽  
Vol 3 (6) ◽  
pp. 92
Author(s):  
Tatjana Goranovic ◽  
Boris Simunjak ◽  
Dinko Tonkovic ◽  
Miran Martinac
Keyword(s):  
Cost Saving ◽  
Head And Neck ◽  
General Anaesthesia ◽  
Local Anaesthesia ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Significant Difference ◽  
Before And After ◽  
Saving Measure ◽  
The Impact

Objective: To analyze the impact of the hospital board’s cost saving measure on physicians’ decision to indicate head and neck surgery according to the type of anaesthesia (general versus local). Methods: Design: a retrospective analysis of medical charts on head and neck surgery and anaesthesia covering 2011-2012. Setting: department of otorhinolaryngology and head and neck surgery, university hospital, Croatia. Participants: patients undergoing head and neck surgery. Intervention(s): reduction of departmental financial fund for general anaesthesia for 10%. Main Outcome Measure(s): an overall of number of head and neck surgeries performed in general versus local anaesthesia before and after the implementation of the intervention measure. Results: There were a total of 984 head and neck surgeries in general anaesthesia in 2011 and 861 in 2012. There were a total of 460 head and neck surgeries in local anaesthesia in 2011 and 528 in 2012. The performance of head and neck surgeries in general anaesthesia was significantly reduced in a year after the implementation of the intervention (p = .01) There was no statistical significant difference in the performance of head and neck surgeries in local anaesthesia before and after the intervention. Conclusions: The reduction of departmental fund for general anaesthesia as a cost saving method resulted only in reducing the total performance of surgeries in general anaesthesia without any switch to performing surgeries in local anaesthesia. It seems that the hospital board’s cost saving measure did not have any impact on physicians’ decisions to indicate more surgeries in local anaesthesia. 

Cost analysis of injection laryngoplasty performed under local anaesthesia versus general anaesthesia: an Australian perspective

2017 ◽  
Vol 132 (2) ◽  
pp. 168-172 ◽  
Author(s):  
D Chandran ◽  
C M Woods ◽  
M Schar ◽  
N Ma ◽  
E H Ooi ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Cost Analysis ◽  
General Anaesthesia ◽  
Local Anaesthesia ◽  
Cost Savings ◽  
Operating Theatre ◽  
Injection Laryngoplasty ◽  
Procedure Time ◽  
The Mean ◽  
American Society

AbstractObjective:To conduct a cost analysis of injection laryngoplasty performed in the operating theatre under local anaesthesia and general anaesthesia.Methods:The retrospective study included patients who had undergone injection laryngoplasty as day cases between July 2013 and March 2016. Cost data were obtained, along with patient demographics, anaesthetic details, type of injectant, American Society of Anesthesiologists score, length of stay, total operating theatre time and surgeon procedure time.Results:A total of 20 cases (general anaesthesia = 6, local anaesthesia = 14) were included in the cost analysis. The mean total cost under general anaesthesia (AU$2865.96 ± 756.29) was significantly higher than that under local anaesthesia (AU$1731.61 ± 290.29) (p < 0.001). The mean operating theatre time, surgeon procedure time and length of stay were all significantly lower under local anaesthesia compared to general anaesthesia. Time variables such as operating theatre time and length of stay were the most significant predictors of the total costs.Conclusion:Procedures performed under local anaesthesia in the operating theatre are associated with shorter operating theatre time and length of stay in the hospital, and provide significant cost savings. Further savings could be achieved if local anaesthesia procedures were performed in the office setting.

Awake versus asleep deep brain stimulation for Parkinson’s disease: a critical comparison and meta-analysis

2017 ◽  
Vol 89 (7) ◽  
pp. 687-691 ◽  
Author(s):  
Allen L Ho ◽  
Rohaid Ali ◽  
Ian D Connolly ◽  
Jaimie M Henderson ◽  
Rohit Dhall ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Side Effects ◽  
General Anaesthesia ◽  
Brain Stimulation ◽  
Meta Analysis ◽  
Complication Rates ◽  
Significant Difference ◽  
Deep Brain

ObjectiveNo definitive comparative studies of the efficacy of ‘awake’ deep brain stimulation (DBS) for Parkinson’s disease (PD) under local or general anaesthesia exist, and there remains significant debate within the field regarding differences in outcomes between these two techniques.MethodsWe conducted a literature review and meta-analysis of all published DBS for PD studies (n=2563) on PubMed from January 2004 to November 2015. Inclusion criteria included patient number >15, report of precision and/or clinical outcomes data, and at least 6 months of follow-up. There were 145 studies, 16 of which were under general anaesthesia. Data were pooled using an inverse-variance weighted, random effects meta-analytic model for observational data.ResultsThere was no significant difference in mean target error between local and general anaesthesia, but there was a significantly less mean number of DBS lead passes with general anaesthesia (p=0.006). There were also significant decreases in DBS complications, with fewer intracerebral haemorrhages and infections with general anaesthesia (p<0.001). There were no significant differences in Unified Parkinson’s Disease Rating Scale (UPDRS) Section II scores off medication, UPDRS III scores off and on medication or levodopa equivalent doses between the two techniques. Awake DBS cohorts had a significantly greater decrease in treatment-related side effects as measured by the UPDRS IV off medication score (78.4% awake vs 59.7% asleep, p=0.022).ConclusionsOur meta-analysis demonstrates that while DBS under general anaesthesia may lead to lower complication rates overall, awake DBS may lead to less treatment-induced side effects. Nevertheless, there were no significant differences in clinical motor outcomes between the two techniques. Thus, DBS under general anaesthesia can be considered at experienced centres in patients who are not candidates for traditional awake DBS or prefer the asleep alternative.

scholarly journals Our experience of 200 cases of thyroid surgery under local anaesthesia versus general anaesthesia

2017 ◽  
Vol 3 (3) ◽  
pp. 683
Author(s):  
Sambhaji G. Chintale ◽  
Vilas R. Kirdak ◽  
Sonali P. Jatale ◽  
Kaleem Shaikh
Keyword(s):  
Length Of Stay ◽  
General Anaesthesia ◽  
Thyroid Surgery ◽  
Local Anaesthesia ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Work Load ◽  
Lesion Size ◽  
Safe Alternative ◽  
General Anaesthesia Group

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Local Anaesthesia is now being accepted universally as a safe alternative to general anaesthesia for thyroid surgery. This study was carried out to compare the outcomes of patients undergoing thyroid surgery under local and general anaesthesia. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">200 patients who underwent thyroid surgery for benign and malignant diseases under local and general anaesthesia from March 2014 to march 2017 were analysed. Patient characteristics analysed were age, sex, pathology lesion size, operating time, length of stay, cost and post-operative complications.  </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Mean lesion sizes were 4.5 cms and 6.5 cms in local and general anaesthesia group respectively. Mean operating time was 50, 5 minutes and 75.5 minutes in local anaesthesia and general anaesthesia group respectively. Mean cost incurred was Rs. 2500 in local anaesthesia and Rs. 5500 in general anaesthesia group. Mean length of hospital stay was 40, 25 hours and 75.06 hours in local anaesthesia and general anaesthesia group respectively. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Local anaesthesia is a safe alternative to general anaesthesia for patients undergoing thyroid surgery. Use of local anaesthesiahas resulted in a decreased length of stay, cost and means operating time, hence useful in a setup with limited anaesthesia time and increased work load.</span></p>

scholarly journals Supratentorial and Infratentorial Approaches to Pineal Surgery: A Database Analysis

2018 ◽  
Vol 80 (04) ◽  
pp. 364-370
Author(s):  
David M. Rosenberg ◽  
Brett W. Geever ◽  
Akash S. Patel ◽  
Anisse N. Chaker ◽  
Abhiraj D. Bhimani ◽  
...  
Keyword(s):  
Pineal Gland ◽  
Clinical Decision Making ◽  
Tumor Resection ◽  
Postoperative Outcomes ◽  
Complication Rates ◽  
Database Analysis ◽  
Improvement Program ◽  
Multicenter Studies ◽  
Patient Demographics ◽  
Significant Difference

Objectives Neoplasms involving the pineal gland are rare. When they do occur, tumor resection is anatomically challenging and is traditionally addressed by either a supratentorial or an infratentorial approach. To date, no large, multicenter studies have been performed that systematically analyze outcomes comparing these two approaches. This study aimed to evaluate outcomes for patients undergoing pineal neoplasm resection, comparing supratentorial and infratentorial approaches. Design Retrospective database review. Setting Multi-institutional database. Participants From 2005 to 2016, 60 patients were identified, with 13 undergoing a supratentorial approach and 47 undergoing an infratentorial approach. Main Outcome Measures Patient demographics, comorbidities, and 30-day postoperative outcomes were investigated using the American College of Surgeons National Surgical Quality Improvement Program database. Demographics, readmission, reoperation, and complication rates were analyzed and compared with previous studies. Results Patient demographics were similar between these two groups. The overall complication rates for the supratentorial and infratentorial approaches were 30.8 and 17%, respectively, and the difference was not statistically significant. The most common medical complications encountered were respiratory and hematological. Conclusion As the first multi-institutional database analysis of approaches to the pineal gland, this study provides an analysis of patient demographics, comorbidities, and postoperative complications. After controlling for preoperative risk factors and demographic characteristics, no statistically significant differences in postoperative outcomes were found between infratentorial and supratentorial approaches. The mean readmission, reoperation, and complication rates were found to be 2.1, 8.3, and 20%, respectively. The lack of significant difference between approaches suggests that clinical decision-making should depend upon anatomical considerations and physician preference, although the complications illustrated here may provide some preoperative guidance.

Role of anaesthesia in endoscopic and external dacryocystorhinostomy: A meta-analysis of 3282 cases

2021 ◽  
pp. 112067212110356
Author(s):  
Alessandro Vinciguerra ◽  
Alessandro Nonis ◽  
Antonio Giordano Resti ◽  
Mohammad Javed Ali ◽  
Mario Bussi ◽  
...  
Keyword(s):  
General Anaesthesia ◽  
Local Anaesthesia ◽  
Meta Analysis ◽  
Primary Treatment ◽  
Success Rates ◽  
Significant Difference ◽  
Full Text Review ◽  
External Dacryocystorhinostomy ◽  
Type Of Anaesthesia

Distal acquired lacrimal obstruction is a common adulthood pathology whose primary treatment is represented by EXT-DCR and END-DCR. When considering their influencing factors, the role of the type of anaesthesia applied during these surgeries has a major role. The aim of this study is to systematically analyse the influence of general and local/regional anaesthesia on the final success rates of EXT-DCR and END-DCR. Primary EXT-DCR and END-DCR articles published later than 2000 with at least 50 single clinician procedures were selected. Exclusion criteria included acute dacryocystitis, tumours, studies focussing on revision surgeries, surgeries with adjunctive procedures, not clearly demarcated surgeons, mixed cohort study of acquired and congenital disorders. This systematic review was conducted in accordance with MOOSE guidelines; where feasible, a meta-analysis of the collected results was conducted. As a result, 11,445 articles were selected of which 2741 were examined after screening, and 16 included after full text review (0.6% of the initial papers). Among all papers included, the number of EXT-DCR was not enough to provide a solid analysis of the effect of anaesthesia; conversely, a significant difference of success rate was noted between local anaesthesia + sedation (85.1%, IC 77.8%–90.4%), and general anaesthesia (90.8%, IC 88.8%–92.4%) in END-DCR ( p = 0.048). In conclusion, END-DCR performed with general anaesthesia should be considered as the solution of choice; however, local anaesthesia, eventually associated with a sedation, can be used as an alternative in selected cases. No meaningful conclusions could be drawn for EXT-DCR, due to the lack of data.

scholarly journals Role of minimally invasive glaucoma surgery in the management of chronic open-angle glaucoma

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ojasvi Sharma ◽  
Didar Abdulla ◽  
Anthony King ◽  
Monali Chakrabarti ◽  
Tarun Sharma
Keyword(s):  
Success Rate ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Case Series ◽  
Glaucoma Surgery ◽  
Complication Rates ◽  
Open Angle ◽  
Patient Demographics ◽  
Significant Difference ◽  
Advanced Glaucoma

AbstractTo compare the safety and efficacy of phacoemulsification combined with ab-interno trabeculectomy (Trabectome) and phacoemulsification combined with I-Stent inject in patients with medically uncontrolled primary open-angle glaucoma (POAG). A retrospective comparative case series. 70 eyes of 66 patients completed 2 years follow up after these treatments performed in 2017–2018. 35 eyes of 33 patients underwent combined Phaco-Trabectome (PT); and 35 eyes of 33 patients underwent combined Phaco-I-Stent inject (Pi). Patient demographics and preoperative characteristics are comparable. A 20% drop in IOP was achieved in 27 eyes (77.14%) in PT group and 28 eyes (80%) in Pi group (p = 0.77). Success rate (target IOP achieved and maintained for 2 years) in advance glaucoma was 25% in PT group and 30.7% in Pi group (p = 0.90). In mild to moderate glaucoma, success rate was 85.71% in PT group and 90% in Pi group (p = 0.67). There was no significant difference between two groups with regards to mean reduction in glaucoma medications and complication rates. Trabectome and I-Stent combined with phacoemulsification are equally efficacious and safe for treating patients with medically uncontrolled mild and moderate primary open-angle glaucoma (POAG). However, they are not an effective treatment for patients with advanced glaucoma.

scholarly journals The impact of the Covid-19 pandemic on care of women with ectopic pregnancy in a tertiary London hospital

2021 ◽  
Vol 13 (4) ◽  
pp. 395-398
Author(s):  
J.E. Gaughran ◽  
D.M. Geddes-Barton ◽  
T Cliff ◽  
F Bailey ◽  
C Ovadia ◽  
...  
Keyword(s):  
Complication Rates ◽  
Telephone Triage ◽  
Management Options ◽  
Triage System ◽  
Patient Demographics ◽  
Significant Difference ◽  
Diagnosis Rate ◽  
Ectopic Pregnancies ◽  
Operative Findings ◽  
The Impact

Background: In response to the COVID-19 pandemic, a central London tertiary referral hospital’s nurse-led Early Pregnancy & Acute Gynaecology Unit (EPAGU) suspended its walk-in service in favour of a telephone triage system with scheduled appointments. Objective: To assess if the pandemic and this adaptation to clinical services had an impact on the presentation, management and complication rate of ectopic pregnancies. Materials and Methods: A retrospective review was performed of ectopic pregnancies diagnosed in the EPAGU between 5th of March 2020 – 15th of July 2020 (pandemic) and 5th of March 2019 – 15th of July 2019 (pre-pandemic). Main outcome measures: Ultrasound findings, patient demographics, serum hCG concentrations, operative findings and complications. Results: There was a 36% reduction in attendances to the unit during the pandemic. Allowing for this, there was no significant difference in the diagnosis rate between the two periods. There was no significant difference in the gestation at diagnosis, serum hCG concentration or volume of mass at presentation. There was also no significant difference in rate of surgical intervention or complications including rupture of fallopian tube, haemoperitoneum or need for blood transfusion. Conclusion: This study suggests this is a safe means of caring for women with ectopic pregnancies which does not limit management options nor lead to higher complication rates. What is new: Other EPAGUs may choose to adopt a telephone triage system with reassurance of its safety.

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