Types of anesthesia for different sacroiliac joint interventions

2021 ◽  
pp. 51-66
Author(s):  
Behnum A. Habibi ◽  
Mark N. Malinowski ◽  
Chong H. Kim
Keyword(s):  
Radiofrequency Ablation ◽  
Minimally Invasive ◽  
General Anesthesia ◽  
Sacroiliac Joint ◽  
Anesthetic Technique ◽  
Anesthetic Techniques ◽  
Anesthesia Care ◽  
History Of ◽  
History Of Anesthesia ◽  
Joint Injections

There are a variety of anesthetic techniques commonly used for sacroiliac joint (SIJ) procedures. For example, diagnostic SIJ injections do not necessitate anesthesia, while open SIJ fusions require general anesthesia. This chapter, targeted to practitioners performing SIJ procedures, covers the basic elements of these techniques. After a brief discussion of the history of anesthesia in relation to SIJ procedures, each common anesthetic technique is discussed, in order of increasing sedation. Local anesthesia is discussed for intraarticular joint injections, blocks of the nerves innervating the SIJ, and radiofrequency ablations of these same nerves. Monitored anesthesia care is discussed for procedures such as minimally invasive SIJ fusions and the Simplicity radiofrequency ablation technique. The use of neuraxial anesthesia, via either spinal or epidural blocks, is considered for lateral SIJ fusions. Finally, the use of general anesthesia for lateral and open fusions is reviewed.

scholarly journals Spinal versus general anesthesia for patients undergoing outpatient total knee arthroplasty: a national propensity matched analysis of early postoperative outcomes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mark C. Kendall ◽  
Alexander D. Cohen ◽  
Stephanie Principe-Marrero ◽  
Peter Sidhom ◽  
Patricia Apruzzese ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Adverse Events ◽  
General Anesthesia ◽  
Knee Arthroplasty ◽  
Anesthetic Management ◽  
Anesthetic Technique ◽  
Anesthetic Techniques ◽  
Short Term ◽  
Knee Replacements ◽  
Total Knee

Abstract Background A comparison of different anesthetic techniques to evaluate short term outcomes has yet to be performed for patients undergoing outpatient knee replacements. The aim of this investigation was to compare short term outcomes of spinal (SA) versus general anesthesia (GA) in patients undergoing outpatient total knee replacements. Methods The ACS NSQIP datasets were queried to extract patients who underwent primary, elective, unilateral total knee arthroplasty (TKA) between 2005 and 2018 performed as an outpatient procedure. The primary outcome was a composite score of serious adverse events (SAE). The primary independent variable was the type of anesthesia (e.g., general vs. spinal). Results A total of 353,970 patients who underwent TKA procedures were identified comprising of 6,339 primary, elective outpatient TKA procedures. Of these, 2,034 patients received GA and 3,540 received SA. A cohort of 1,962 patients who underwent outpatient TKA under GA were propensity matched for covariates with patients who underwent outpatient TKA under SA. SAE rates at 72 h after surgery were not greater in patients receiving GA compared to SA (0.92%, 0.66%, P = 0.369). In contrast, minor adverse events were greater in the GA group compared to SA (2.09%, 0.51%), P < 0.001. The rate of postoperative transfusion was greater in the patients receiving GA. Conclusions The type of anesthetic technique, general or spinal anesthesia does not alter short term SAEs, readmissions and failure to rescue in patients undergoing outpatient TKR surgery. Recognizing the benefits of SA tailored to the anesthetic management may maximize the clinical benefits in this patient population.

Anesthetic Choice for Functional Endoscopic Sinus Surgery

1992 ◽  
Vol 6 (1) ◽  
pp. 1-4 ◽  
Author(s):  
John A. Fornadley ◽  
Kevin S. Kennedy ◽  
Joseph F. Wilson ◽  
Peter T. Galantich ◽  
Gregg S. Parker
Keyword(s):  
General Anesthesia ◽  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Patient Comfort ◽  
Anesthetic Technique ◽  
Anesthetic Techniques ◽  
Local Infiltration ◽  
Local Technique ◽  
Local Anesthetic Injection

Controversy continues concerning the optimal anesthetic technique when completing endoscopic sinus surgery. To attempt to investigate the results using different anesthetic techniques, experience with endoscopic sinus surgery over 12 months (233 cases) was retrospectively reviewed. The use of local anesthetic injection with or without regional blocks (specifically ethmoid and greater palatine) was evaluated, as was the choice of general anesthesia versus local technique in a context of blood loss, patient comfort, and complications. Regional block technique appears to add morbidity for little additional benefit. Endoscopic sinus surgery may be performed safely in appropriately selected patients using either general anesthesia or local infiltration with sedation.

Anesthesia for Gastrointestinal Endoscopic Procedures

2018 ◽  
Author(s):  
Lori Kral Barton ◽  
Regina Y. Fragneto
Keyword(s):  
General Anesthesia ◽  
Patient Characteristics ◽  
The United States ◽  
Anesthetic Techniques ◽  
Anesthesia Care ◽  
Care Providers ◽  
Endoscopic Procedures ◽  
Endoscopic Techniques ◽  
Sole Agent ◽  
Geographic Regions

As the population ages, patients presenting for endoscopic procedures are more likely to have significant comorbidities. In addition, endoscopic procedures of increasing complexity are being performed. While there are significant differences among geographic regions in the United States, anesthesia care providers are providing sedation or general anesthesia for a greater proportion of procedures performed in the endoscopy suite. A variety of drugs and anesthetic techniques have been used successfully. Propofol remains the most commonly used drug when sedation is provided by an anesthesia professional, sometimes as a sole agent and sometimes in combination with other medications. Dexmedetomine and ketamine have also been used successfully. Patient characteristics and the specific needs of the endoscopist based on the procedure being performed will determine the most appropriate anesthetic regimen for each patient. For more complex endoscopic techniques, general anesthesia may be preferred, with some data indicating improved success of the procedure.

scholarly journals Endoscopic Radiofrequency Treatment of the Sacroiliac Joint Complex for Low Back Pain: A Prospective Study with a 2-Year Follow-Up

2019 ◽  
Vol 2 (22.2) ◽  
pp. E111-E118
Author(s):  
Albert E. Telfeian
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Radiofrequency Ablation ◽  
Minimally Invasive ◽  
Sacroiliac Joint ◽  
Sensory Nerve ◽  
Case Series ◽  
Low Back ◽  
Radiofrequency Treatment ◽  
Si Joint

Background: The sacroiliac joint complex (SIJC) is considered a major sources of chronic low back pain. Interventional procedures for sacroiliac (SI) joint pain tend to be short-lived and surgical treatment usually involves a fusion procedure. Objectives: To determine the clinical efficacy of endoscopically visualized radiofrequency treatment of the SIJC in the treatment of low back pain. Study Design: Retrospective chart review. Setting: This study took place in a single-center, orthopedic specialty hospital. Methods: Patients received general anesthesia and under endoscopic visualization, radiofrequency ablation was performed on 1) the perforating branches that innervate the posterior capsule of the SI joint capsule, 2) along the course of the long posterior SI ligament, 3) the lateral edges of the S1, S2, and S3 foramen, and 4) the L4, L5, and S1 medial marginal nerve branches along the lateral facet margins. Results: From January 2015 to June 2016, a total of 30 patients who met the precise inclusion criteria were treated with the endoscopic SIJC radiofrequency treatment for low back pain. The average patient was aged 56 years (19 women and 11 men), the average preoperative visual analog scale (VAS) score was 7.23, and the average Oswestry disability index (ODI) score was 44.8. VAS and ODI were measured at 3, 6, 9, 12, 15, 21 and 24 months: VAS was reduced from 7.23 at baseline to 2.82 at 24 months (61% reduction), and ODI was improved from 44.8 at baseline to 22.2 at 24 months (50% reduction). Limitations: Small retrospective case series. Conclusions: Full-endoscopic radiofrequency ablation of the large sensory SI joint innervation complex, that includes the sensory nerve branches along the lateral S1-3 foramina and the L4-S1 medial branches, is perhaps a minimally invasive surgical procedure that could provide significant relief of lumbar back pain in the carefully selected patient. Key words: Endoscopic spine surgery, minimally invasive, low back pain, sacroiliac joint, radiofrequency treatment

Awake CT-guided percutaneous stylomastoid foramen puncture and radiofrequency ablation of facial nerve for treatment of hemifacial spasm

2021 ◽  
pp. 1-7
Author(s):  
Bing Huang ◽  
Ming Yao ◽  
QiLiang Chen ◽  
Huidan Lin ◽  
Xindan Du ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Minimally Invasive ◽  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Invasive Procedure ◽  
Minimally Invasive Procedure ◽  
Ct Guided ◽  
Stylomastoid Foramen ◽  
History Of ◽  
First Time

OBJECTIVE Hemifacial spasm (HFS) is a debilitating neuromuscular disorder with limited treatment options. The current study describes a novel minimally invasive procedure that provided effective and sustained relief for patients with HFS. The authors provide a detailed description of the awake CT-guided percutaneous radiofrequency ablation (RFA) of the facial nerve for treatment of HFS, and they examine its clinical efficacy. This is the first time in the literature that this procedure has been applied and systematically analyzed for HFS. METHODS Patients with a history of HFS were recruited between August 2018 and April 2020. Those with a history of cerebellopontine lesions, coagulopathy, ongoing pregnancy, cardiac pacemaker or defibrillator implants, or who declined the procedure were excluded from the study. Fifty-three patients who met the study criteria were included and underwent awake CT-guided RFA. Under minimal sedation, a radiofrequency (RF) needle was used to reach the stylomastoid foramen on the affected side under CT guidance, and the facial nerve was localized using a low-frequency stimulation current. Patients were instructed to engage facial muscles as a proxy for motor monitoring during RFA. Ablation stopped when the patients’ hemifacial contracture resolved. Patients were kept for inpatient monitoring for 24 hours postoperatively and were followed up monthly to monitor resolution of HFS and complications for up to 19 months. RESULTS The average duration of the procedure was 32–34 minutes. Postoperatively, 91% of the patients (48/53) had complete resolution of HFS, whereas the remaining individuals had partial resolution. A total of 48 patients reported mild to moderate facial paralysis immediately post-RFA, but most resolved within 1 month. No other significant complication was observed during the study period. By the end of the study period, 5 patients had recurrence of mild HFS symptoms, whereas only 2 patients reported dissatisfaction with the treatment results. CONCLUSIONS The authors report for the first time that awake CT-guided RFA of the facial nerve at the stylomastoid foramen is a minimally invasive procedure and can be an effective treatment option for HFS.

scholarly journals A brief history of early neuroanesthesia

2014 ◽  
Vol 36 (4) ◽  
pp. E2 ◽  
Author(s):  
Srinivas Chivukula ◽  
Ramesh Grandhi ◽  
Robert M. Friedlander
Keyword(s):  
Surgical Technique ◽  
Neurosurgical Procedures ◽  
Anesthesia Care ◽  
Ether Anesthesia ◽  
Perioperative Pain Management ◽  
History Of ◽  
History Of Anesthesia ◽  
The 19Th Century ◽  
Public Demonstration ◽  
Over Time

Two key discoveries in the 19th century—infection control and the development of general anesthesia—provided an impetus for the rapid advancement of surgery, especially within the field of neurosurgery. Improvements in anesthesia and perioperative care, in particular, fostered the development of meticulous surgical technique conducive to the refinement of neuroanatomical understanding and optimization of neurosurgical procedures and outcomes. Yet, even dating back to the earliest times, some form of anesthesia or perioperative pain management was used during neurosurgical procedures. Despite a few reports on anesthesia published around the time of William Morton's now-famous public demonstration of ether anesthesia in 1846, relatively little is known or written of early anesthetics in neurosurgery. In the present article the authors discuss the history of anesthesia pertaining to neurosurgical procedures and draw parallels between the refinements and developments in anesthesia care over time with some of the concomitant advances in neurosurgery.

scholarly journals History of anesthesia usage in dentistry

2005 ◽  
Vol 52 (3) ◽  
pp. 160-164 ◽  
Author(s):  
Vladimir Kokovic
Keyword(s):  
General Anesthesia ◽  
Laughing Gas ◽  
History Of ◽  
New Ideas ◽  
History Of Anesthesia ◽  
Medical Professions ◽  
Eighteen Century

Since prehistoric times, man has sought ways to lessen pain. With varying degrees of success he has utilized: opium, nerve compresses, cold, hypnosis, etc. New ideas for using ether and laughing gas in anesthesia on the beginning of eighteen century, were first steps in developing general anesthesia. The dental and medical professions are thankful to all participants in history of anesthesia for their great contributions. .

scholarly journals Anesthetic Techniques for Gynecological Surgeries in Benue State University Teaching Hospital (BSUTH), Makurdi, Nigeria

2020 ◽  
Vol 2 (4) ◽  
Author(s):  
M. E. Efu ◽  
S. K. Hembah-Hilekaan ◽  
A. O. Ojabo ◽  
B. A. Ojo ◽  
U. M. Aneng Anenga
Keyword(s):  
General Anesthesia ◽  
Face Mask ◽  
Anesthetic Technique ◽  
Anesthetic Techniques ◽  
Study Group ◽  
State University ◽  
Surgical Methods ◽  
Management Of Complications ◽  
Case Files ◽  
Study Population

Background: Gynecological surgery refers to surgery on the female reproductive system usually performed by gynecologists. It includes procedures for benign conditions, cancer, infertility and incontinence.  Gynecological conditions are seen in the non-pregnant and early pregnant state up to 20 weeks gestation. . Just like every other surgery, they require anesthesia for the elimination of surgical pain and the surgical methods to a great extent, determine the choice of anesthesia employed. Anesthesia is usually in the form of regional, especially the neuroaxial type, or general anesthesia. This study was conducted to ascertain the anesthetic techniques employed for gynecological surgeries in the Benue State University Hospital (BSUTH), Makurdi, Nigeria and complications arising there from. Methodology: A retrospective and descriptive study of case files of patients that underwent gynecological surgeries between January 2016 and December 2018 in BSUH, Makurdi was carried out. A total of 156 case files of eligible patients were retrieved from the records department of BSUTH after approval from relevant authorities. Relevant information were extracted from the patients’ folders and transferred into a prepared proforma. The data collected were analyzed using SPSS version 25 using simple statistics. Result: A total of 156 cases were evaluated. The age bracket with the most number is that between 21 and 30 years which recorded 54 (34.6%). This was followed by the age group between 31 and 40 years which were 51, making up 32.7% of the study population. Uterine fibroid was the most recorded diagnosis with 36 cases accounting for 23.1% of the study population. This was followed by ruptured ectopic gestation which was observed to 23, representing 14.7% of the study group. Cancer (Ca) of the cervix recorded 22, amounting to 14.1% of the study group. Exploratory laparotomy was carried out 44 times accounting for 28.2% of the procedures. This was followed by myomectomy and examination under anesthesia (EUA) with 26, representing 14.7% of the variables each.  Of the 156 anesthetic procedures undertaken, 56 (35.9%) were sub-arachnoid block (SAB). This was followed closely by general anesthesia with endotracheal intubation (GA/ETT) with 55 (35.3%). General anesthesia with face mask (GA/FM) came third with 35 (22.4%). Twenty-four episodes of complications were observed out of which pain occurred 10 times accounting for 41.7% of the variables. Hypotension occurred 8 times representing 33.3% of the variables. Accordingly, 24 modalities were employed for the management of complications of anesthetic techniques of which IV administration of ephedrine was done 8 times representing 33.3% of the variables. This was followed by IV administration of pentazocine that was done 5 times accounting for 20.9% of the variables. Conclusion: As a result of the vast array of gynecological diseases observed in this study, GA with tracheal intubation and GA with face mask together make up the anesthetic technique of choice for gynecological surgeries. The prominence of SAB as an anesthetic technique is not unexpected because many gynecological lesions are sub-umbilical in location, thus making them amenable to the technique which also possesses a lot of advantages. In addition, complications observed were few and included mainly pain and hypotension, none of which was life-threatening.  

A CT-free protocol to treat osteoid osteoma of the hip region in childhood and adolescence by percutaneous drilling and by hip arthroscopy

2021 ◽  
pp. 112070002199626
Author(s):  
Oliver Eberhardt ◽  
Thekla von Kalle ◽  
Rebecca Matthis ◽  
Richard Doepner ◽  
Thomas Wirth ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Minimally Invasive ◽  
Hip Joint ◽  
Hip Arthroscopy ◽  
Standard Form ◽  
Childhood And Adolescence ◽  
Ct Guided ◽  
Contrast Enhanced ◽  
Mri Guided ◽  
Mri Diagnostics

Introduction: It is often difficult to clinically and radiologically diagnose intra-articular osteoid osteomas and osteoid osteomas of the hip joint. Treatment can also be difficult due to complex locational relationships. CT-guided radiofrequency ablation is currently the standard form of treatment. In this paper we report on a minimally-invasive concept for treating osteoid osteomas near the hip joint in children and adolescents which does not involve using computed tomography. Material and method: 10 patients with an average age of 12.1 years underwent treatment for osteoid osteomas in the hip joint region. The diagnosis was made using a contrast-enhanced MRI. The osteoid osteomas were marked percutaneously using x-ray and MRI guidance. MRI-guided drilling/curettage was performed in 4 cases and arthroscopic resection in 6 cases. Results: All lesions were successfully treated using the MRI-guided method. All patients were free of pain after the treatment. There was no instance of recurrence during the follow-up period, which averaged 10 months. The effective dose for marking the lesion was between 0.0186 mSv and 0.342 mSV (mean 0.084 mSV). Conclusions: Our MRI diagnostics protocol, the MRI-guided drilling and the minimally invasive hip arthroscopy represent an alternative to CT-guided radiofrequency ablation in the treatment of osteoid osteomas. Radiation exposure can thereby be significantly reduced. Hip arthroscopy can also be used to treat secondary pathologies such as femoroacetabular impingement.

scholarly journals Postoperative Urinary Retention Following General Anesthesia for Endoscopic Nasal Surgery in Men Aged Older Than 60 Years: A Retrospective Study

2021 ◽  
pp. 014556132110331
Author(s):  
Yong Won Lee ◽  
Bum Sik Kim ◽  
Jihyun Chung
Keyword(s):  
General Anesthesia ◽  
Incidence Rate ◽  
Urinary Retention ◽  
Nasal Surgery ◽  
Prostate Hyperplasia ◽  
Postoperative Urinary Retention ◽  
Asa Classification ◽  
History Of ◽  
Male Patients ◽  
Endoscopic Nasal Surgery

Objectives: Postoperative urinary retention (POUR) is influenced by many factors, and its reported incidence rate varies widely. This study aimed to investigate the occurrence and risk factors for urinary retention following general anesthesia for endoscopic nasal surgery in male patients aged >60 years. Methods: A retrospective review of medical records between January 2015 and December 2019 identified 253 patients for inclusion in our study. Age, body mass index (BMI), a history of diabetes/hypertension, American Society of Anesthesiologists (ASA) classification, and urologic history were included as patient-related factors. Urologic history was subdivided into 3 groups according to history of benign prostate hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and current medication. The following was analyzed as perioperative variables for POUR development: duration of anesthesia and surgery; amount of fluid administered; rate of fluid administration; intraoperative requirement for fentanyl, ephedrine, and dexamethasone; postoperative pain; and analgesic use. Preoperatively measured prostate size and uroflowmetry parameters of patients on medication for symptoms were compared according to the incidence of urinary retention. Results: Thirty-seven (15.7%) patients developed POUR. Age (71.4 vs 69.6 years), BMI (23.9 vs 24.9 kg/m2), a history of diabetes/hypertension, ASA classification, and perioperative variables were not significantly different between patients with and without POUR. Only urologic history was identified as a factor affecting the occurrence of POUR ( P = .03). The incidence rate among patients without urologic issues was 5.9%, whereas that among patients with BPH/LUTS history was 19.8%. Among patients taking medication for symptoms, the maximal and average velocity of urine flow were significantly lower in patients with POUR. Conclusions: General anesthesia for endoscopic nasal surgery may be a potent trigger for urinary retention in male patients aged >60 years. The patient’s urological history and urinary conditions appear to affect the occurrence of POUR.

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