Indications for General versus Local Anesthesia during Carotid Endarterectomy

2019 ◽  
Vol 80 (04) ◽  
pp. 250-254
Author(s):  
Jan Mracek ◽  
Jakub Kletecka ◽  
Jan Mork ◽  
David Stepanek ◽  
Jiri Dostal ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Local Anesthesia ◽  
Patient Preference ◽  
Sleep Apnea Syndrome ◽  
Anesthetic Technique ◽  
Shunt Insertion ◽  
Increased Risk ◽  
Apnea Syndrome ◽  
Optimal Approach ◽  
Selection Of

Background and Study Aims Both general anesthesia (GA) and local anesthesia (LA) are used in our department for carotid endarterectomy. The decision of which anesthetic technique to use during surgery is made on an individual basis. The aim of our study was to analyze the reasons for using GA or LA. Material and Methods The reasons that led to the selection of either GA or LA were analyzed retrospectively in a group of 409 patients. Results GA was used in 304 patients (74%) and LA in 105 patients (26%). The reasons for a preference for GA were clopidogrel use (88 patients), patient preference (80), increased risk of shunt insertion (43), unfavorable anatomical conditions (41), surgeon preference (21), simultaneous carotid endarterectomy and cardiac surgery (18), emergent carotid endarterectomy (12), and sleep apnea syndrome (1). The reasons for selecting LA were internal comorbidities (46 patients), patient preference (39), unavailability of intraoperative electrophysiologic monitoring (15), and pacemaker (5). Conclusion GA is the dominant choice for carotid endarterectomy in our department because of its prevailing benefits and its preference among neurosurgeons and patients. However, in some subgroups of patients, LA is preferable. An optimal approach is therefore an individual indication for both anesthesia techniques.

scholarly journals Patient Satisfaction with General versus Local Anesthesia during Carotid Endarterectomy

2019 ◽  
Vol 80 (05) ◽  
pp. 341-344
Author(s):  
Jan Mracek ◽  
Jakub Kletecka ◽  
Irena Holeckova ◽  
Jiri Dostal ◽  
Jolana Mrackova ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Carotid Endarterectomy ◽  
Local Anesthesia ◽  
Postoperative Nausea And Vomiting ◽  
Anesthetic Technique ◽  
Anesthetic Techniques ◽  
Advantages And Disadvantages ◽  
Future Preference ◽  
Intraoperative Pain ◽  
Optimal Approach

Background and Study Aims Both general and local anesthesia are used in our department for carotid endarterectomy (CEA). The decision as to which anesthetic technique to use during surgery is made individually. The aim of our study was to evaluate patient satisfaction and preference with the anesthesia type used. Material and Methods The satisfaction of a group of 205 patients with regard to anesthesia used and their future preferences were evaluated prospectively through a questionnaire. The reasons for dissatisfaction were assessed. Results CEA was performed under general anesthesia (GA) in 159 cases (77.6%) and under local anesthesia (LA) in 46 cases (22.4%). In the GA group, 148 patients (93.1%) were satisfied; 30 patients (65.2%) in the LA group were satisfied (p < 0.0001). The reason for dissatisfaction with GA were postoperative nausea and vomiting (7 patients), postoperative psychological alteration (3), and fear of GA (1). The reasons for dissatisfaction with LA were intraoperative pain (9 patients), intraoperative discomfort and stress (5), and intraoperative breathing problems (2). Of the GA group, 154 (96.9%) patients would prefer GA again, and of the LA group, 28 (60.9%) patients would prefer LA if operated on again (p < 0.0001). Overall, 172 patients (83.9%) would prefer GA in the future, and 33 patients (16.1%) would prefer LA. Conclusion Overall patient satisfaction with CEA performed under both GA and LA is high. Nevertheless, in the GA group, patient satisfaction and future preference were significantly higher. Both GA and LA have advantages and disadvantages for CEA. An optimal approach is to make use of both anesthetic techniques based on their individual indications and patient preference.

scholarly journals Obesity-Hypoventilation Syndrome: Increased Risk of Death over Sleep Apnea Syndrome

PLoS ONE ◽  
2015 ◽  
Vol 10 (2) ◽  
pp. e0117808 ◽  
Author(s):  
Olalla Castro-Añón ◽  
Luis A. Pérez de Llano ◽  
Sandra De la Fuente Sánchez ◽  
Rafael Golpe ◽  
Lidia Méndez Marote ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Sleep Apnea Syndrome ◽  
Obesity Hypoventilation Syndrome ◽  
Risk Of Death ◽  
Increased Risk ◽  
Apnea Syndrome ◽  
Hypoventilation Syndrome ◽  
Obesity Hypoventilation

scholarly journals Risk for stroke and chronic kidney disease in patients with sleep apnea syndrome and heart failure with different ejection fractions

Pneumologia ◽  
2019 ◽  
Vol 68 (1) ◽  
pp. 15-20
Author(s):  
Carmen Ardelean ◽  
Daniel Lighezan ◽  
Raluca Morar ◽  
Sorin Pescariu ◽  
Stefan Mihăicuță
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Sleep Apnea Syndrome ◽  
Central Apnea ◽  
Obstructive Apnea ◽  
Tricuspid Insufficiency ◽  
Increased Risk ◽  
Apnea Syndrome ◽  
Group 2 ◽  
Group 1

Abstract Background Patients with sleep apnea syndrome (SAS) and heart failure (HF) have concomitant different comorbidities and increased risk of morbidity. Aim The aim of this study was to analyze differences between patients with SAS and heart failure with preserved ejection fraction (HFpEF; ejection fraction [EF]≥50%) – group 1 and those with SAS and heart failure with reduced ejection fraction (HFrEF; EF<50%) – group 2. Methods We evaluated 51 patients with SAS and HF in the sleep laboratory of Timisoara Victor Babes Hospital. We collected general data, sleep questionnaires, anthropometric measurements (neck circumference [NC], abdominal circumference [AC]), somnography for apnea–hypopnea index (AHI), oxygen desaturation index (ODI), echocardiographic data, comorbidities, and laboratory test. Results The study included 51 patients who were divided into two groups depending on EF, with the following characteristics: Group 1 (HFpEF): 26 patients, 19 males, seven females, age 61.54±9.1 years, body mass index (BMI) 37±6.4 kg/m2, NC 45.4±3.6 cm, AC 126.6±12.9 cm, AHI 48.3±22.6 events/hour, central apnea 5.6±11.4 events/hour, obstructive apnea 25.7±18.7 events/hour, ODI 41.2±21.2/hour and lowest SpO2 –72.1±14%. Group 2 (HFrEF): 25 patients, 18 males, seven females, age 63.6±8.8 years, BMI 37.9±7.5 kg/m2, NC 46±4.4 cm, AC 127.2±13.9 cm, AHI 46.4±21.7 events/hour, central apnea 4.6±8.3 events/hour, obstructive apnea 25.9±18.5 events/hour, ODI 44.8±27.1/hour and lowest SpO2 –70.6±12.1%. Differences between groups regarding anthropometric and somnographic measurements and lipidic profile were not statistically significant. Significant differences were observed regarding stroke (23% vs. 4%, p=0.04) in the group with HFpEF and regarding creatinine measurements (1.1±0.2 vs. 1.4±0.7, p=0.049), aortic insufficiency (11.5% vs. 36%, p=0.04) and tricuspid insufficiency (6.1% vs. 80%, p=0.01) in the group with HFrEF. Conclusions Patients with SAS and HFpEF have a higher risk of stroke. Patients with SAS and HFrEF have a significantly increased risk of developing a life-long chronic kidney disease and aortic and tricuspid insufficiency. These results may suggest pathogenic links between SAS and the mentioned comorbidities, and this may explain the higher mortality when this association is present.

Increased risk of cerebral white matter lesions in obstructive sleep apnea syndrome

2016 ◽  
Vol 15 (1) ◽  
pp. 49-55
Author(s):  
Rauf Oguzhan Kum ◽  
Deniz Baklaci ◽  
Muge Ozcan ◽  
Deniz Sozmen Ciliz ◽  
Yavuz Fuat Yilmaz ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
White Matter ◽  
Sleep Apnea Syndrome ◽  
White Matter Lesions ◽  
Cerebral White Matter ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Cerebral White Matter Lesions ◽  
Apnea Syndrome

scholarly journals A Novel Method for Recognition of Bioradiolocation Signal Breathing Patterns for Noncontact Screening of Sleep Apnea Syndrome

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Maksim Alekhin ◽  
Lesya Anishchenko ◽  
Alexander Tataraidze ◽  
Sergey Ivashov ◽  
Vladimir Parashin ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Learning Algorithm ◽  
Sleep Apnea Syndrome ◽  
Central Sleep Apnea ◽  
Breathing Patterns ◽  
Obstructive Sleep ◽  
Novel Method ◽  
Apnea Syndrome ◽  
Hidden Neurons ◽  
Selection Of

A novel method for recognition of breathing patterns of bioradiolocation signals breathing patterns (BSBP) in the task of noncontact screening of sleep apnea syndrome (SAS) is proposed and implemented on the base of wavelet transform (WT) and neural network (NNW) applications. Selection of the optimal parameters of WT includes determination of the proper level of wavelet decomposition and the best basis for feature extraction using modified entropy criterion. Selection of the optimal properties of NNW includes defining the best number of hidden neurons and learning algorithm for the chosen NNW topology. The effectiveness of the proposed approach is tested on clinically verified database of BRL signals corresponding to the three classes of breathing patterns: obstructive sleep apnea (OSA); central sleep apnea (CSA); normal calm sleeping (NCS) without sleep-disordered breathing (SDB) episodes.

Hematological Parameters as Predictors of Cardiovascular Disease in Obstructive Sleep Apnea Syndrome Patients

Angiology ◽  
2015 ◽  
Vol 67 (5) ◽  
pp. 461-470 ◽  
Author(s):  
Mustafa Saygin ◽  
Onder Ozturk ◽  
Mehmet Fehmi Ozguner ◽  
Ahmet Akkaya ◽  
Ercan Varol
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Obstructive Sleep Apnea Syndrome ◽  
Sleep Apnea Syndrome ◽  
Apnea Hypopnea Index ◽  
Distribution Width ◽  
Positive Correlation ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Apnea Syndrome

We investigated the role of the red cell distribution width (RDW) and other parameters including platelet (PLT) count, mean platelet volume (MPV), and platelet distribution width (PDW) in patients with obstructive sleep apnea syndrome (OSAS) having cardiovascular diseases (CVDs). Patients (n = 142) having sleep disorders and who applied for a night polysomnography were included in this study. For statistical analysis, chi-square test, bivarite correlation, and logistic and stepwise regression tests were used. A positive correlation between RDW MPV, RDW, and body mass index as well as PLT and apnea–hypopnea index were observed. A negative correlation between AHI and PDW ( P = .041) and a positive correlation between AHI and PLT ( P = .010) were found in the patients ≥40 years old with CVD. The RDW was higher in patients ≥40 years old who had CVD ( P = .016), and 19% of them had RDW >14%. The PDW (odds ratio = 6.02 [95% confidence interval = 1.3-28.2], P = .023) appeared to be associated with increased risk of hyperlipidemia in patients with severe OSAS. If these results are confirmed, RDW could be used with other markers, especially PLT and PDW, in prediction of CVD in patients with severe OSAS.

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