Perioperative Outcomes of Thrombectomy Patients Using Venovenous Bypass and Suction Filtration With General Anesthesia

2020 ◽  
Author(s):  
Shu Y. Lu ◽  
Adam A. Dalia ◽  
Maximilian Lang ◽  
Michael G. Fitzsimons
Keyword(s):  
General Anesthesia ◽  
Perioperative Outcomes ◽  
Venovenous Bypass

scholarly journals Perioperative Comparative Effectiveness of Anesthetic Technique in Orthopedic Patients

2013 ◽  
Vol 118 (5) ◽  
pp. 1046-1058 ◽  
Author(s):  
Stavros G. Memtsoudis ◽  
Xuming Sun ◽  
Ya-Lin Chiu ◽  
Ottokar Stundner ◽  
Spencer S. Liu ◽  
...  
Keyword(s):  
Length Of Stay ◽  
General Anesthesia ◽  
Knee Arthroplasty ◽  
Joint Arthroplasty ◽  
Neuraxial Anesthesia ◽  
Perioperative Outcomes ◽  
Anesthetic Technique ◽  
Complication Risk ◽  
Comorbidity Burden ◽  
The Impact

Abstract Background The impact of anesthetic technique on perioperative outcomes remains controversial. We studied a large national sample of primary joint arthroplasty recipients and hypothesized that neuraxial anesthesia favorably influences perioperative outcomes. Methods Data from approximately 400 hospitals between 2006 and 2010 were accessed. Patients who underwent primary hip or knee arthroplasty were identified and subgrouped by anesthesia technique: general, neuraxial, and combined neuraxial–general. Demographics, postoperative complications, 30-day mortality, length of stay, and patient cost were analyzed and compared. Multivariable analyses were conducted to identify the independent impact of choice of anesthetic on outcomes. Results Of 528,495 entries of patients undergoing primary hip or knee arthroplasty, information on anesthesia type was available for 382,236 (71.4%) records. Eleven percent were performed under neuraxial, 14.2% under combined neuraxial–general, and 74.8% under general anesthesia. Average age and comorbidity burden differed modestly between groups. When neuraxial anesthesia was used, 30-day mortality was significantly lower (0.10, 0.10, and 0.18%; P < 0.001), as was the incidence of prolonged (>75th percentile) length of stay, increased cost, and in-hospital complications. In the multivariable regression, neuraxial anesthesia was associated with the most favorable complication risk profile. Thirty-day mortality remained significantly higher in the general compared with the neuraxial or neuraxial–general group for total knee arthroplasty (adjusted odds ratio [OR] of 1.83, 95% CI 1.08–3.1, P = 0.02; OR of 1.70, 95% CI 1.06–2.74, P = 0.02, respectively). Conclusions The utilization of neuraxial versus general anesthesia for primary joint arthroplasty is associated with superior perioperative outcomes. More research is needed to study potential mechanisms for these findings.

Improving Perioperative Outcomes for the Adult Patient With Obstructive Sleep Apnea After General Anesthesia

2013 ◽  
Vol 28 (3) ◽  
pp. e29
Author(s):  
Jill Setaro ◽  
Carole Capps ◽  
Edna Giffen ◽  
Amy Ferrara ◽  
Michelle Knipe ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
General Anesthesia ◽  
Adult Patient ◽  
Perioperative Outcomes ◽  
Obstructive Sleep

scholarly journals Comparative Efficacy of Neuraxial and General anesthesia for hip fracture surgery: A meta-analysis of randomized clinical trials

2019 ◽  
Author(s):  
Xinxun Zheng ◽  
Yuming Tang ◽  
Yuan Gao ◽  
Zhiheng Liu
Keyword(s):  
Hip Fracture ◽  
Blood Loss ◽  
General Anesthesia ◽  
Sample Size ◽  
Meta Analysis ◽  
Neuraxial Anesthesia ◽  
Perioperative Outcomes ◽  
Hip Fracture Surgery ◽  
Evidence Quality ◽  
Fracture Surgery

Abstract Background: The choice of anesthesia technique remains debatable in patients undergoing surgical repair of hip fracture. This meta-analysis was performed to compare the effect of neuraxial (epidural/spinal) versus general anesthesia on perioperative outcomes in patients undergoing hip fracture surgery. Methods: Medline, Cochrane Library, Science-Direct, and EMBASE databases were searched to identify eligible studies focused on the comparison between neuraxial and general anesthesia in hip fracture patients between January 2000 and May 2019. Perioperative outcomes were extracted for systemic analysis. The sensitivity analyses were performed by the leave-one-out approach. The evidence quality for each outcome was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: Nine randomized controlled trials (RCTs) including 1084 patients fulfilled our selection criteria. The results showed that there were no significant differences in the 30-day mortality, length of stay, and the prevalence of delirium, acute myocardial infarction, and pneumonia for neuraxial anesthesia compared to general anesthesia. There was a significant difference in terms of blood loss in favor of the neuraxial anesthesia. The evidence quality for each outcome evaluated by the GRADE system was low. Conclusions: In summary, our present study demonstrated that neuraxial anesthesia is significantly superior to general anesthesia regarding blood loss in patients undergoing hip fracture surgery. Due to small sample size and enormous inconsistency in the choice of outcome measures, more high-quality studies with large sample size are needed to to clarify this issue.

scholarly journals Comparative Efficacy of Neuraxial and General anesthesia for hip fracture surgery: A meta-analysis of randomized clinical trials

2020 ◽  
Author(s):  
Xinxun Zheng ◽  
Yuming Tang ◽  
Yuan Gao ◽  
Zhiheng Liu
Keyword(s):  
Hip Fracture ◽  
Blood Loss ◽  
General Anesthesia ◽  
Sample Size ◽  
Meta Analysis ◽  
Neuraxial Anesthesia ◽  
Perioperative Outcomes ◽  
Hip Fracture Surgery ◽  
Evidence Quality ◽  
Fracture Surgery

Abstract Background: The choice of anesthesia technique remains debatable in patients undergoing surgical repair of hip fracture. This meta-analysis was performed to compare the effect of neuraxial (epidural/spinal) versus general anesthesia on perioperative outcomes in patients undergoing hip fracture surgery.Methods: Medline, Cochrane Library, Science-Direct, and EMBASE databases were searched to identify eligible studies focused on the comparison between neuraxial and general anesthesia in hip fracture patients between January 2000 and May 2019. Perioperative outcomes were extracted for systemic analysis. The sensitivity analyses were performed by the leave-one-out approach. The evidence quality for each outcome was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.Results: Nine randomized controlled trials (RCTs) including 1084 patients fulfilled our selection criteria. The results showed that there were no significant differences in the 30-day mortality (OR = 1.34, 95% CI 0.56, 3.21; P = 0.51), length of stay (MD = -0.65, 95% CI -0.32, 0.02; P =0.06), and the prevalence of delirium (OR = 1.05, 95% CI 0.27, 4.00; P = 0.95), acute myocardial infarction (OR = 0.88, 95% CI 0.17, 4.65; P = 0.88), deep venous thrombosis (OR = 0.48, 95% CI 0.09, 2.72; P = 0.41), and pneumonia (OR = 1.04, 95% CI 0.23, 4.61; P = 0.96) for neuraxial anesthesia compared to general anesthesia. There was a significant difference in terms of blood loss in favor of the neuraxial anesthesia (MD = -137.8, 95% CI -241.49, -34.12; p = 0.009). The evidence quality for each outcome evaluated by the GRADE system was low.Conclusions: In summary, our present study demonstrated that neuraxial anesthesia is associated with a reduced blood loss in patients undergoing hip fracture surgery compared to general anesthesia. However, this result was underpowered. Due to small sample size and enormous inconsistency in the choice of outcome measures, more high-quality studies with large sample size are needed to clarify this issue

scholarly journals Comparative Efficacy of Neuraxial and General anesthesia for hip fracture surgery: A meta-analysis of randomized clinical trials

2020 ◽  
Author(s):  
Xinxun Zheng ◽  
Yuming Tang ◽  
Yuan Gao ◽  
Zhiheng Liu
Keyword(s):  
Hip Fracture ◽  
Blood Loss ◽  
General Anesthesia ◽  
Multiple Testing ◽  
Meta Analysis ◽  
Perioperative Outcomes ◽  
Bonferroni Correction ◽  
Hip Fracture Surgery ◽  
Evidence Quality ◽  
Fracture Surgery

Abstract Background: The choice of anesthesia technique remains debatable in patients undergoing surgical repair of hip fracture. This meta-analysis was performed to compare the effect of neuraxial (epidural/spinal) versus general anesthesia on perioperative outcomes in patients undergoing hip fracture surgery.Methods: Medline, Cochrane Library, Science-Direct, and EMBASE databases were searched to identify eligible studies focused on the comparison between neuraxial and general anesthesia in hip fracture patients between January 2000 and May 2019. Perioperative outcomes were extracted for systemic analysis. The sensitivity analyses were conducted using a Bonferroni correction and the leave-one-out method. The evidence quality for each outcome was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.Results: Nine randomized controlled trials (RCTs) including 1084 patients fulfilled our selection criteria. The outcomes for the meta-analysis showed that there were no significant differences in the 30-day mortality (OR = 1.34, 95% CI 0.56, 3.21; P = 0.51), length of stay (MD = -0.65, 95% CI -0.32, 0.02; P =0.06), and the prevalence of delirium (OR = 1.05, 95% CI 0.27, 4.00; P = 0.95), acute myocardial infarction (OR = 0.88, 95% CI 0.17, 4.65; P = 0.88), deep venous thrombosis (OR = 0.48, 95% CI 0.09, 2.72; P = 0.41), and pneumonia (OR = 1.04, 95% CI 0.23, 4.61; P = 0.96) for neuraxial anesthesia compared to general anesthesia, and there was a significant difference in blood loss between the two groups (MD = -137.8, 95% CI -241.49, -34.12; p = 0.009). However, after applying the Bonferroni correction for multiple testing, all the adjusted p-values were above the significant threshold of 0.05. The evidence quality for each outcome evaluated by the GRADE system was low.Conclusions: In summary, our present study demonstrated that there might be a difference in blood loss between patients receiving neuraxial and general anaesthesia, however, this analysis was not robust to adjustment for multiple testing and therefore at high risk for a type I error. Due to small sample size and enormous inconsistency in the choice of outcome measures, more high-quality studies with large sample size are needed to clarify this issue.

A prospective study on the comparison of general anesthesia and tea (thoracic epidural anesthesia) for perioperative outcomes in patients undergoing modified radical mastectomy

2021 ◽  
Vol 12 (1) ◽  
pp. 631-635
Author(s):  
Goutham V V N ◽  
Venkata Ganesh M ◽  
Lavanya P V S ◽  
Mrudula Vandana ◽  
Ravikanth S
Keyword(s):  
General Anesthesia ◽  
Respiratory Depression ◽  
Demographic Data ◽  
Radical Mastectomy ◽  
Breast Cancer Surgery ◽  
Perioperative Outcomes ◽  
Epidural Administration ◽  
Thoracic Epidural ◽  
Intraoperative Hypotension ◽  
A Prospective Study

The 2nd most common tumor among women is breast cancer. Surgery is usually done by general anesthesia (GA). TEA is one of the anesthetic procedures that can be performed using local anesthetic epidural administration. TEA may boost pain relief without the potential for respiratory muscle weakness and sedation. An epidural catheter was inserted in T4 to T5 for the T-group, with a 10-15 ml injection of 0.75% ropivacaine. Intermittent supplements of 5-10 ml 0.75% ropivacaine maintained anesthesia. General anesthesia was caused by fentanyl of 1-2 μg/kg, accompanied by propofol (1.5-2 mg/kg), with sevoflurane. We evaluated intraoperative hemodynamics, post-operative patient parameters like nausea and vomiting, shivering, respiratory depression. Overall patient satisfaction is compared between two groups.  The demographic data was similar in both groups. Intraoperative hypotension observed in 33.3% of group T patients and 16.6% of group G patients. 20% of the group T patients showed intraoperative bradycardia, whereas 6.66% of group G patients showed intraoperative bradycardia. Incidence of vomiting & nausea is 26.6% in group G, whereas in group T it is 6.66%. The incidence of post-operative shivering is equal in both groups. Post-operative respiratory depression is not observed in both groups. 86.6% of the group T patients are satisfied overall, whereas it is 60% in group G.

Opioid-Free Anesthesia in the Perioperative Setting—A Preliminary Retrospective Matched Cohort Study

2020 ◽  
Author(s):  
Austin Bell ◽  
Christopher Andrews ◽  
Krista B Highland ◽  
Angela Senese Forbes
Keyword(s):  
Cohort Study ◽  
General Anesthesia ◽  
Scale Score ◽  
Rating Scale ◽  
Perioperative Outcomes ◽  
Postanesthesia Care Unit ◽  
Pain Rating ◽  
Matched Cohort ◽  
Matched Cohort Study ◽  
Pain Rating Scale

ABSTRACT Introduction Anesthesiologists have long used multimodal analgesia for effective pain control. Opioid-sparing anesthetics are gaining popularity among practitioners in light of increasing concerns for both immediate opioid side effects and the long-term opioid misuse among susceptible patients. Currently, there is a critical gap in knowledge regarding outcomes after an opioid-free anesthetic (OFA) during general anesthesia. We hypothesized that an opioid-free general anesthetic will not be inferior to a traditional opioid anesthetic (OA) as measured by the perioperative outcomes of postanesthesia care unit (PACU) duration, 12-hour postoperative summed pain intensity (SPI12) scores, total morphine equivalent doses (MEDs) utilized in the 12-hour postoperative inpatient (MED12) and total MEDs utilized in the 90-day outpatient periods (MED90). Materials and Methods Patients were included if they were  ≥18 years old, met criteria for American Society of Anesthesiologists classification I-IV, received general endotracheal anesthesia from a single anesthesia provider for a surgical operation in 2016, did not receive intraoperative administration of opioids, and were recovered in the PACU. A total of 25 patients were included in the OFA group and 29 control patients in the OA group (n = 54). A retrospective chart review of intraoperative records, perioperative pain scores, and medication utilization (inpatient and outpatient) was performed to obtain the data for the analysis of the primary outcomes. Results In both OFA and OA groups, the continuous outcomes were not normally distributed. Subsequent bivariate tests of the indicated OA versus OFA age (d = 0.58), surgery duration (d = 0.24), and preoperative pain score (d = 0.51) warranted inclusion in the multinomial regression. Surgical duration was not significantly associated with the primary outcomes. However, the continuous variables of age and preoperative Defense and Veterans Pain Rating Scale score were associated with differences in primary outcomes. Every 1-year increase in the age was associated with a 5.06 increase in SPI12 and 5.73 mg increase in MED12. Every 1-point increase in the preoperative Defense and Veterans Pain Rating Scale score was associated with an 8.45 minutes increase in PACU duration, 11.25 increase in SPI12, 17.85 mg increase in MED12, and 20.83 mg increase in MED90. In regard to the primary outcomes, there was a lack of significant differences between the OFA and OA groups in all outcomes (PACU duration, mean SPI12, MED12, and MED90). Conclusions To our knowledge, this is the first matched cohort study directly comparing an OFA with a traditional anesthetic for general anesthesia in a wide range of surgical and clinical scenarios. There was no significant difference in SPI12 between the OFA group and OA group, suggesting that patients’ subjective pain was similar immediately after surgery whether or not they received intraoperative opioids. Concurrently, no “catch-up” effect was observed as the PACU duration; MED12 and MED90 were not different between the OFA and OA groups. However, there were many covariates identified in this study because of the small sample size or each group. Additional research is needed to explore if these findings can be extrapolated to a larger more heterogeneous population. Our preliminary work suggests that eliminating patient exposure to opioids in the intraoperative period does not have a deleterious effect on perioperative patient outcomes.

scholarly journals Perioperative Outcomes From the Prospective Multicenter Least Invasive Fast-Track EVAR (LIFE) Registry

2017 ◽  
Vol 25 (1) ◽  
pp. 6-13 ◽  
Author(s):  
Zvonimir Krajcer ◽  
Venkatesh G. Ramaiah ◽  
Esteban A. Henao ◽  
D. Chris Metzger ◽  
Wayne K. Nelson ◽  
...  
Keyword(s):  
Blood Loss ◽  
General Anesthesia ◽  
Resource Utilization ◽  
Stent Graft ◽  
Fast Track ◽  
Perioperative Outcomes ◽  
Procedure Time ◽  
Performance Goal ◽  
Oral Nutrition ◽  
Percutaneous Access

Purpose: To determine the feasibility, perioperative resource utilization, and safety of a fast-track endovascular aneurysm repair (EVAR) protocol in well-selected patients. Methods: Between October 2014 and May 2016, the LIFE (Least Invasive Fast-track EVAR) registry ( ClinicalTrials.gov identifier NCT02224794) enrolled 250 patients (mean age 73±8 years; 208 men) in a fast-track EVAR protocol comprised of bilateral percutaneous access using the 14-F Ovation stent-graft, no general anesthesia, no intensive care unit (ICU) admission, and next-day discharge. The primary endpoint was major adverse events (MAE) through 30 days. The target performance goal for the MAE endpoint was 10.4%. Results: Vascular access, stent-graft delivery, and stent-graft deployment success were 100%. A total of 216 (86%) patients completed all elements of the fast-track EVAR protocol. Completion of individual elements was 98% for general anesthesia avoidance, 97% for bilateral percutaneous access, 96% for ICU avoidance, and 92% for next-day discharge. Perioperative outcomes included mean procedure time of 88 minutes, median blood loss of 50 mL, early oral nutrition (median 6 hours), early mobilization (median 8 hours), and short hospitalization (median 26 hours). Fast-track EVAR completers had shorter procedure time (p<0.001), less blood loss (p=0.04), faster return to oral nutrition (p<0.001) and ambulation (p<0.01), and shorter hospital stay (p<0.001). With 241 (96%) of the 250 patients returning for the 30-day follow-up, the MAE incidence was 0.4% (90% CI 0.1% to 1.8%), significantly less than the 10.4% performance goal (p<0.001). No aneurysm rupture, conversion to surgery, or aneurysm-related secondary procedure was reported. There were no type III endoleaks and 1 (0.4%) type I endoleak. Iliac limb occlusion was identified in 2 (0.8%) patients. The 30-day hospital readmission rate was 1.6% overall. Conclusion: A fast-track EVAR protocol was feasible in well-selected patients and resulted in efficient perioperative resource utilization with excellent safety and effectiveness.

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