Neuraxial Anesthesia and Postoperative Mortality and Morbidity

2018 ◽  
pp. 225-229
Keyword(s):  
Systematic Review ◽  
Postoperative Complications ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Postoperative Morbidity ◽  
Postoperative Mortality ◽  
Mortality And Morbidity ◽  
Neuraxial Blockade ◽  
Study Results ◽  
Wide Range

This case focuses on the effects of neuraxial blockade on postoperative mortality and morbidity by asking the question: What are the effects of neuraxial blockade with epidural or spinal anesthesia on postoperative morbidity and mortality? This systematic review examined all trials with randomization to intraoperative neuraxial blockade (with epidural or spinal anesthesia) or no neuraxial blockade for which data were available before January 1, 1997. The study included 9,559 patients over 141 included trials. Study results demonstrated that neuraxial blockade reduces morbidity and postoperative complications in a wide range of patients, independent of surgery type, choice of neuraxial technique, or use of general anesthesia.

scholarly journals Spinal anesthesia in awake surgical procedures of the lumbar spine: a systematic review and meta-analysis of 3709 patients

2021 ◽  
Vol 51 (6) ◽  
pp. E7
Author(s):  
Roberto J. Perez-Roman ◽  
Vaidya Govindarajan ◽  
Jean-Paul Bryant ◽  
Michael Y. Wang
Keyword(s):  
Systematic Review ◽  
Postoperative Complications ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Patient Outcomes ◽  
Spine Surgery ◽  
Interbody Fusion ◽  
Operative Time ◽  
Meta Analysis ◽  
Awake Surgery

OBJECTIVE Awake surgery has previously been found to improve patient outcomes postoperatively in a variety of procedures. Recently, multiple groups have investigated the utility of this modality for use in spine surgery. However, few current meta-analyses exist comparing patient outcomes in awake spinal anesthesia with those in general anesthesia. Therefore, the authors sought to present an updated systematic review and meta-analysis investigating the utility of spinal anesthesia relative to general anesthesia in lumbar procedures. METHODS Following a comprehensive literature search of the PubMed and Cochrane databases, 14 clinical studies were included in our final qualitative and quantitative analyses. Of these studies, 5 investigated spinal anesthesia in lumbar discectomy, 4 discussed lumbar laminectomy, and 2 examined interbody fusion procedures. One study investigated combined lumbar decompression and fusion or decompression alone. Two studies investigated patients who underwent discectomy and laminectomy, and 1 study investigated a series of patients who underwent transforaminal lumbar interbody fusion, posterolateral fusion, or decompression. Odds ratios, mean differences (MDs), and 95% confidence intervals were calculated where appropriate. RESULTS A meta-analysis of the total anesthesia time showed that time was significantly less in patients who received spinal anesthesia for both lumbar discectomies (MD −26.53, 95% CI −38.16 to −14.89; p = 0.00001) and lumbar laminectomies (MD −11.21, 95% CI −19.66 to −2.75; p = 0.009). Additionally, the operative time was significantly shorter in patients who underwent spinal anesthesia (MD −14.94, 95% CI −20.43 to −9.45; p < 0.00001). Similarly, when analyzing overall postoperative complication rates, patients who received spinal anesthesia were significantly less likely to experience postoperative complications (OR 0.29, 95% CI 0.16–0.53; p < 0.0001). Furthermore, patients who received spinal anesthesia had significantly lower postoperative pain scores (MD −2.80, 95% CI −4.55 to −1.06; p = 0.002). An identical trend was seen when patients were stratified by lumbar procedures. Patients who received spinal anesthesia were significantly less likely to require postoperative analgesia (OR 0.06, 95% CI 0.02–0.25; p < 0.0001) and had a significantly shorter hospital length of stay (MD −0.16, 95% CI −0.29 to −0.03; p = 0.02) and intraoperative blood loss (MD −52.36, 95% CI −81.55 to −23.17; p = 0.0004). Finally, the analysis showed that spinal anesthesia cost significantly less than general anesthesia (MD −226.14, 95% CI −324.73 to −127.55; p < 0.00001). CONCLUSIONS This review has demonstrated the varying benefits of spinal anesthesia in awake spine surgery relative to general anesthesia in patients who underwent various lumbar procedures. The analysis has shown that spinal anesthesia may offer some benefits when compared with general anesthesia, including reduction in the duration of anesthesia, operative time, total cost, and postoperative complications. Large prospective trials will elucidate the true role of this modality in spine surgery.

Outcomes After Receipt of Neuraxial or Regional Anesthesia Instead of General Anesthesia for Lower Limb Revascularization Surgery: Protocol for a Systematic Review and Meta-Analysis (Preprint)

2021 ◽  
Author(s):  
Derek Roberts ◽  
Hannah Dreksler ◽  
Sudhir K. Nagpal ◽  
Allen Li ◽  
Jeanna Parsons Leigh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Outcomes ◽  
Hospital Stay ◽  
General Anesthesia ◽  
Regional Anesthesia ◽  
Lower Limb ◽  
Meta Analysis ◽  
Study Results ◽  
Multicenter Randomized Controlled Trial ◽  
Revascularization Surgery

BACKGROUND Patients undergoing lower limb revascularization surgery for peripheral artery disease (PAD) have a high-risk of perioperative morbidity and mortality and often have long hospital stays. Use of neuraxial or regional anesthesia instead of general anesthesia may represent one approach to improving outcomes and reducing resource use among these patients. OBJECTIVE To conduct a systematic review and meta-analysis to determine whether receipt of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery for PAD results in improved health outcomes and costs and a shorter length of hospitalization. METHODS We will search electronic bibliographic databases (MEDLINE, EMBASE, and the seven databases in Evidence-Based Medicine Reviews), review articles identified during the search, and included article bibliographies. We will include randomized and non-randomized studies comparing use of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery for PAD. Two investigators will independently evaluate risk of bias. The primary outcome will be short-term mortality (in-hospital or 30-day). Secondary outcomes will include longer-term mortality; major adverse cardiovascular, pulmonary, and renal events; delirium; deep vein thrombosis or pulmonary embolism; major adverse limb events; neuraxial or regional anesthesia-related complications; graft-related outcomes; length of operation and hospital stay; costs; and patient-reported or functional outcomes. We will calculate summary odds ratios and standardized mean differences using random-effects models. Heterogeneity will be explored using stratified meta-analyses and meta-regression. We will assess for publication bias using Begg’s and Egger’s tests and use the trim-and-fill method to estimate the potential influence of this bias on summary estimates. Finally, we will use Grading of Recommendations, Assessment, Development, and Evaluation methodology to make an overall rating of the quality of evidence in our effect estimates. RESULTS The protocol was registered in PROSPERO, the international register of systematic reviews. CONCLUSIONS This study will synthesize existing evidence regarding whether receipt of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery for PAD results in improved health outcomes, graft patency, and costs, and a shorter length of hospital stay. Study results will be used to inform practice and future research, including creation of a pilot and then multicenter randomized controlled trial. CLINICALTRIAL PROSPERO CRD42021237060.

Effects of Perioperative Dexmedetomidine on Postoperative Mortality and Morbidity: A Systematic Review and Meta-analysis

2019 ◽  
Vol 41 (1) ◽  
pp. 138-154.e4 ◽  
Author(s):  
Ke Peng ◽  
Fu-hai Ji ◽  
Hua-yue Liu ◽  
Juan Zhang ◽  
Qing-cai Chen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
Mortality And Morbidity

30-Day Postoperative Morbidity of Emergency Surgery for Obstructive Right- and Left-Sided Colon Cancer in Obese Patients: A Multicenter Cohort Study of the French Surgical Association

2019 ◽  
Vol 37 (2) ◽  
pp. 111-118
Author(s):  
Laurent Genser ◽  
Gilles Manceau ◽  
Diane Mege ◽  
Valérie Bridoux ◽  
Zaher Lakkis ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Emergency Surgery ◽  
Postoperative Morbidity ◽  
Postoperative Mortality ◽  
Hemodynamic Instability ◽  
Normal Weight ◽  
Obese Patients ◽  
Multicenter Cohort Study ◽  
Mortality And Morbidity ◽  
Cardiovascular Comorbidity

Background: Emergency surgery impairs postoperative outcomes in colorectal cancer patients. No study has assessed the relationship between obesity and postoperative results in this setting. Objective: To compare the results of emergency surgery for obstructive colon cancer (OCC) in an obese patient population with those in overweight and normal weight patient groups. Methods: From 2000 to 2015, patients undergoing emergency surgery for OCC in French surgical centers members of the French National Surgical Association were included. Three groups were defined: normal weight (body mass index [BMI] < 25.0 kg/m2), overweight (BMI 25.0–29.9 kg/m2), and obese (BMI ≥30.0 kg/m2). Results: Of 1,241 patients, 329 (26.5%) were overweight and 143 (11.5%) were obese. Obese patients had significantly higher American society of anesthesiologists score, more cardiovascular comorbidity and more hemodynamic instability at presentation. Overall postoperative mortality and morbidity were 8 and 51%, respectively, with no difference between the 3 groups. For obese patients with left-sided OCC, stoma-related complications were significantly increased (8 vs. 5 vs. 15%, p = 0.02). Conclusion: Compared with lower BMI patients, obese patients with OCC had a more severe presentation at admission but similar surgical management. Obesity did not increase 30-day postoperative morbidity except stoma-related complications for those with left-sided OCC.

Providing Anesthesia Care in Resource-limited Settings

2016 ◽  
Vol 124 (3) ◽  
pp. 561-569 ◽  
Author(s):  
Promise Ariyo ◽  
Miguel Trelles ◽  
Rahmatullah Helmand ◽  
Yama Amir ◽  
Ghulam Haidar Hassani ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Surgical Care ◽  
Resource Limited Settings ◽  
Perioperative Mortality ◽  
Patient Demographics ◽  
Resource Limited ◽  
Anesthesia Providers ◽  
Wide Range ◽  
Surgical Duration

Abstract Background Anesthesia is integral to improving surgical care in low-resource settings. Anesthesia providers who work in these areas should be familiar with the particularities associated with providing care in these settings, including the types and outcomes of commonly performed anesthetic procedures. Methods The authors conducted a retrospective analysis of anesthetic procedures performed at Médecins Sans Frontières facilities from July 2008 to June 2014. The authors collected data on patient demographics, procedural characteristics, and patient outcome. The factors associated with perioperative mortality were analyzed. Results Over the 6-yr period, 75,536 anesthetics were provided to adult patients. The most common anesthesia techniques were spinal anesthesia (45.56%) and general anesthesia without intubation (33.85%). Overall perioperative mortality was 0.25%. Emergent procedures (0.41%; adjusted odds ratio [AOR], 15.86; 95% CI, 2.14 to 115.58), specialized surgeries (2.74%; AOR, 3.82; 95% CI, 1.27 to 11.47), and surgical duration more than 6 h (9.76%; AOR, 4.02; 95% CI, 1.09 to 14.88) were associated with higher odds of mortality than elective surgeries, minor surgeries, and surgical duration less than 1 h, respectively. Compared with general anesthesia with intubation, spinal anesthesia, regional anesthesia, and general anesthesia without intubation were associated with lower perioperative mortality rates of 0.04% (AOR, 0.10; 95% CI, 0.05 to 0.18), 0.06% (AOR, 0.26; 95% CI, 0.08 to 0.92), and 0.14% (AOR, 0.29; 95% CI, 0.18 to 0.45), respectively. Conclusions A wide range of anesthetics can be carried out safely in resource-limited settings. Providers need to be aware of the potential risks and the outcomes associated with anesthesia administration in these settings.

Impact of the Type of Anesthesia on Outcome after Elective Endovascular Aortic Aneurysm Repair: Literature Review

Vascular ◽  
2008 ◽  
Vol 16 (6) ◽  
pp. 340-345 ◽  
Author(s):  
Umar Sadat ◽  
David G. Cooper ◽  
Jonathan H. Gillard ◽  
Stewart R. Walsh ◽  
Paul D. Hayes
Keyword(s):  
Hospital Stay ◽  
General Anesthesia ◽  
Endovascular Aneurysm Repair ◽  
Postoperative Mortality ◽  
Postoperative Outcomes ◽  
Mortality And Morbidity ◽  
Icu Stay ◽  
Locoregional Anesthesia ◽  
Aneurysm Repair ◽  
The Impact

The type of anesthesia used during aneurysm repair affects postoperative outcomes for the patient. Although endovascular aneurysm repair (EVAR) appears to improve surgical outcomes, by convention, general anesthesia remains predominantly used. The aim of this study was to compare the impact of the type of anesthesia (ie, locoregional versus general anesthesia) on the outcomes following EVAR. A literature search was carried out using the PubMed search engine to find relevant published articles that compared locoregional and general anesthesia in patients undergoing EVAR. The review of the selected studies showed that although patients in the locoregional group were less medically fit compared with those in the general anesthesia group, there was a reduction in the cardiovascular support required during and after the surgery, postoperative hospital stay, intensive care unit (ICU) stay, and postoperative mortality and morbidity. Although there is no level 1 evidence for or against locoregional anesthesia in EVAR, conventionally, EVAR has been performed under general anesthesia. But this is rooted in tradition rather than evidence. This review suggests that locoregional anesthesia can improve postoperative outcomes following EVAR by reducing hospital stay, ICU stay, mortality, and morbidity, although other factors may also have some influence.

scholarly journals PERBANDINGAN NYERI YANG TERJADI 24 JAM PASCA OPERASI PADA PENDERITA YANG DIBERIKAN ANESTESIA UMUM DAN ANESTESIA SPINAL

e-CliniC ◽  
2015 ◽  
Vol 3 (3) ◽  
Author(s):  
Fiska M. Muhammad ◽  
Lucky Kumaat ◽  
Iddo Posangi
Keyword(s):  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Emotional Experience ◽  
P Value ◽  
Inhalation Anesthesia ◽  
Vas Score ◽  
Post Operative Pain ◽  
Wide Range ◽  
Significant Difference ◽  
Anesthesia Spinal

Abstract: Pain can be described as an unpleasant sensory and emotional experience associated with tissue damage which has already occured or potentially will be occurred. General anesthesia is oftenly perfomed on a wide range of surgical procedures. There are two techniques of general anesthesia: inhalation anesthesia and intravenous anesthesia. Spinal anesthesia is one of the simplest and most reliable of regional anesthesia technique. This study aimed to compare the pain between general anesthesia and spinal anesthesia 24 hours post operative. This was an analytical prospective study. Samples were 24 patients consisting of 12 patients with general anesthesia and 12 patients with spinal anesthesia. The inclusion criteria were patients aged 20-60 years old, duration of operation 1-4 hours, and the operations were caesarean section and hysterectomy. The pain assessment used VAS score as well as blood pressure, pulse, and respiration. Data were statistically analyzed by using the Mann-Whitney test and showed a p-value 0.876. Conclusion: There was no significant difference in 24-hour-post-operative pain using VAS score among patients with general anesthesia and with spinal anesthesia.Keywords: VAS scores, general anesthesia, spinal anesthesia.Abstrak: Nyeri dapat digambarkan sebagai suatu pengalaman sensorik dan emosional yang tidak menyenangkan yang berkaitan dengan kerusakan jaringan yang sudah atau berpotensi terjadi. Anestesia umum sering dilalukan pada berbagai macam prosedur pembedahan dan terbagi atas anestesia inhalasi dan anestesia intravena. Anestesia spinal merupakan salah satu anestesia yang paling sederhana dan paling dapat diandalkan dari tehnik anestesia regional. Penelitian ini bertujuan untuk mengetahui perbandingan nyeri pada pemberian anestesia umum dan anestesia spinal 24 jam pasca operasi. Penelitian ini menggunakan metode analitik prospektif. Terdapat 24 sampel yang terbagi atas 12 penggunaan anestesia umum dan 12 penggunaan anestesia spinal, dengan kriteria rentang umur pasien 20-60 tahun, lama operasi 1-4 jam serta jenis pembedahan seksio sesarea dan histerektomi. Penilaian nyeri menggunakan skor VAS serta tekanan darah, nadi dan respirasi. Data diolah dengan menggunakan program SPSS versi 20. Hasil uji statistik Mann-Whitney mendapatkan nilai p= 0,876 yang menunjukkan tidak terdapat perbedaan bermakna dari skor VAS. 24 jam pasca operasi dengan anestesia umum dan anestesia spinal. Simpulan: Tidak terdapat perbedaan bermakna nyeri 24 jam pasca operaasi dinilai dengan skor VAS pada pemberian anestesia umum dan anestesia spinal.Kata kunci: Skor VAS, anestesia general, anestesia spinal

scholarly journals Outcomes After Receipt of Neuraxial or Regional Anesthesia Instead of General Anesthesia for Lower Limb Revascularization Surgery: Protocol for a Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Derek J. Roberts ◽  
Hannah Dreksler ◽  
Sudhir K. Nagpal ◽  
Allen Li ◽  
Jeanna Parsons Leigh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Outcomes ◽  
Hospital Stay ◽  
General Anesthesia ◽  
Regional Anesthesia ◽  
Lower Limb ◽  
Meta Analysis ◽  
Study Results ◽  
Multicenter Randomized Controlled Trial ◽  
Revascularization Surgery

Abstract Background: Patients undergoing lower limb revascularization surgery have a high-risk of perioperative morbidity and mortality and often have long hospital stays. Use of neuraxial or regional anesthesia instead of general anesthesia may represent one approach to improving outcomes and reducing resource use among these patients. We propose to conduct a systematic review and meta-analysis to determine whether receipt of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery results in improved health outcomes and costs and a shorter length of hospitalization. Methods: We will search electronic bibliographic databases (MEDLINE, EMBASE, and the seven databases in Evidence-Based Medicine Reviews), review articles identified during the search, and included article bibliographies. We will include randomized and non-randomized studies comparing use of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery. Two investigators will independently evaluate risk of bias. The primary outcome will be short-term mortality (in-hospital or 30-day). Secondary outcomes will include longer-term mortality; major adverse cardiovascular, pulmonary, and renal events; delirium; deep vein thrombosis or pulmonary embolism; major adverse limb events; neuraxial or regional anesthesia-related complications; graft-related outcomes; length of operation and hospital stay; costs; and patient-reported or functional outcomes. We will calculate summary odds ratios and standardized mean differences using random-effects models. Heterogeneity will be explored using stratified meta-analyses and meta-regression. We will assess for publication bias using Begg’s and Egger’s tests and use the trim-and-fill method to estimate the potential influence of this bias on summary estimates. Finally, we will use Grading of Recommendations, Assessment, Development, and Evaluation methodology to make an overall rating of the quality of evidence in our effect estimates.Discussion: This study will synthesize existing evidence regarding whether receipt of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery results in improved health outcomes, graft patency, and costs, and a shorter length of hospital stay. Study results will be used to inform practice and future research, including creation of a pilot and then multicenter randomized controlled trial. Systematic Review Registration: Submitted to PROSPERO February 12, 2020.

scholarly journals The Outcome of Complex Hepato-Pancreato-Biliary Surgery for Elderly Patients: A Propensity Score Matching Analysis

2018 ◽  
Vol 36 (4) ◽  
pp. 323-330 ◽  
Author(s):  
Kosei Takagi ◽  
Yuzo Umeda ◽  
Ryuichi Yoshida ◽  
Daisuke Nobuoka ◽  
Takashi Kuise ◽  
...  
Keyword(s):  
Risk Factors ◽  
Propensity Score ◽  
Elderly Patients ◽  
Propensity Score Matching ◽  
Postoperative Morbidity ◽  
Postoperative Mortality ◽  
Elderly Group ◽  
Postoperative Outcomes ◽  
Mortality And Morbidity ◽  
Propensity Score Matching Analysis

Background/Aims: Postoperative mortality and morbidity rates after hepato-pancreato-biliary (HPB) surgery remain high, and the number of elderly patients requiring such surgery has been increasing. This study aimed to investigate postoperative outcomes of complex HPB surgery for elderly patients. Methods: We retrospectively reviewed perioperative data of 721 patients who underwent complex HPB surgery between 2010 and 2015. The patients were divided into 2 groups: elderly (≥75 years) and non-elderly (< 75 years). Surgical outcomes of both groups were compared after propensity score-matching analysis. Subsequently, risk factors for serious postoperative morbidity were identified by multivariate analysis. Results: Before matching, the elderly group (n = 170) had more comorbidities, such as cardiovascular and renal disease, than the non-elderly group (n = 551). Matching yielded elderly (n = 170) and non-elderly groups (n = 170) with similar preoperative backgrounds. The mortality and morbidity rates did not differ significantly between the groups. In multivariate analyses, operative time (OR 1.79; p = 0.005) and blood loss (OR 1.66; p = 0.03) were identified as independent risk factors for serious postoperative morbidity, whereas older age did not have a predictive impact (OR 1.16; p = 0.52). Conclusions: Although elderly ­patients had more comorbidities and higher incidences of postoperative mortality and several complications before matching, their postoperative outcomes were equivalent to those of non-elderly patients after matching.

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