Regional Anesthesia for Arteriovenous Fistula Surgery May Reduce Hospital Length of Stay and Reoperation Rates

2018 ◽  
Vol 52 (6) ◽  
pp. 418-426 ◽  
Author(s):  
Naida M. Cole ◽  
Kamen Vlassakov ◽  
Ethan Y. Brovman ◽  
Mahyar Heydarpour ◽  
Richard D. Urman
Keyword(s):  
Length Of Stay ◽  
General Anesthesia ◽  
Arteriovenous Fistula ◽  
Regional Anesthesia ◽  
Lower Risk ◽  
Anesthesia Care ◽  
Monitored Anesthesia Care ◽  
Improvement Project ◽  
Fistula Surgery ◽  
Postoperative Length

Background and Objectives: Regional anesthesia has been proposed as the preferred mode of anesthesia for arteriovenous fistula surgery due to its associated vasodilatory effects and fistula patency rates. We analyzed patient outcomes after arteriovenous fistula surgery for their association with the type of anesthesia received. Methods: The National Surgical Quality Improvement Project database was accessed to identify a cohort of 3199 patients undergoing arteriovenous fistula surgery from 2007 to 2015. Multiple regression models were used to examine the association of anesthesia with 12 postoperative outcomes. Additional multivariate logistic regression was performed to assess significant independent variables predictive of anesthesia choice. Results: Patients who received regional anesthesia had the shortest postoperative length of stay (0.67 [standard deviation: 2.0] days) compared to monitored anesthesia care/intravenous (IV) sedation (0.77 [1.8] days) and general anesthesia (1.44 [2.8] days). Administration of regional anesthesia was associated with a shorter length of stay compared to general anesthesia (odds ratio [OR]: 0.55, P = .001). Patients who received monitored anesthesia care/IV sedation had a lower risk of reoperation compared to general anesthesia (OR: 0.65, P = .012) but not compared to regional anesthesia (OR: 0.89, P = .759). Anesthesia type had no significant effects on other measured postoperative complications. Predictors of the type of anesthesia were age and surgical procedure as defined by Current Procedural Terminology code ( P < .001). Conclusions: Use of regional anesthesia is associated with a shorter postoperative length of stay after arteriovenous fistula surgery and lower risk of reoperation compared to general anesthesia or monitored anesthesia care/IV sedation. Regional anesthesia may be an excellent choice for arteriovenous fistula surgery to reduce postoperative length of stay and risk of reoperation.

Injury and Liability Associated with Monitored Anesthesia Care

2006 ◽  
Vol 104 (2) ◽  
pp. 228-234 ◽  
Author(s):  
Sanjay M. Bhananker ◽  
Karen L. Posner ◽  
Frederick W. Cheney ◽  
Robert A. Caplan ◽  
Lorri A. Lee ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Respiratory Depression ◽  
Brain Damage ◽  
Regional Anesthesia ◽  
Supplemental Oxygen ◽  
Anesthesia Care ◽  
Monitored Anesthesia Care ◽  
Malpractice Claims ◽  
American Society ◽  
Permanent Brain Damage

Background To assess the patterns of injury and liability associated with monitored anesthesia care (MAC) compared with general and regional anesthesia, the authors reviewed closed malpractice claims in the American Society of Anesthesiologists Closed Claims Database since 1990. Methods All surgical anesthesia claims associated with MAC (n = 121) were compared with those associated with general (n = 1,519) and regional (n = 312) anesthesia. A detailed analysis of MAC claims was performed to identify causative mechanisms and liability patterns. Results MAC claims involved older and sicker patients compared with general anesthesia claims (P &lt; 0.025), often undergoing elective eye surgery (21%) or facial plastic surgery (26%). More than 40% of claims associated with MAC involved death or permanent brain damage, similar to general anesthesia claims. In contrast, the proportion of regional anesthesia claims with death or permanent brain damage was less (P &lt; 0.01). Respiratory depression, after absolute or relative overdose of sedative or opioid drugs, was the most common (21%, n = 25) specific damaging mechanism in MAC claims. Nearly half of these claims were judged as preventable by better monitoring, including capnography, improved vigilance, or audible alarms. On-the-patient operating room fires, from the use of electrocautery, in the presence of supplemental oxygen during facial surgery, resulted in burn injuries in 20 MAC claims (17%). Conclusion Oversedation leading to respiratory depression was an important mechanism of patient injuries during MAC. Appropriate use of monitoring, vigilance, and early resuscitation could have prevented many of these injuries. Awareness and avoidance of the fire triad (oxidizer, fuel, and ignition source) is essential to prevent on-the-patient fires.

scholarly journals Comparative study of GA and MAC Anesthesia Methods Effects on Oocyte Retrieval in Patients Under IVF Programs

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Sadegh Mohamadi ◽  
Neda Khaledian ◽  
Ali Karbasfrushan ◽  
Seyed Sajad Hosseini ◽  
Ebrahim Ezzati ‎
Keyword(s):  
General Anesthesia ◽  
Oocyte Retrieval ◽  
Anesthesia Care ◽  
Monitored Anesthesia Care ◽  
Successful Pregnancy ◽  
General Group ◽  
Vitro Fertilization ◽  
Show Difference ◽  
Intravenous Ketamine

Background: Anesthesia is widely used to manage pain and anxiety during oocyte retrieval in vitro fertilization (IVF), but there is probable interference with the results and success rate of IVF. Objectives: The present study compares the effects of general anesthesia (GA) and monitored anesthesia care (MAC) applied in oocyte retrieval. Methods: The general anesthesia used in this study comprised a fentanyl-propofol mixture to reach hypnotic concentrations. Intravenous ketamine-midazolam were used for MAC before procedures according to prescribed doses. In sum, 180 women were recruited for research while 90 women selected for general and 90 for MAC methods. Results: The collected oocytes were higher in number in general group (11.25 ± 4.39) than MAC group (7.03 ± 3.84, P < 0.001), meanwhile, the analyses did not show difference between groups regarding the number of fertilized oocytes (4.52 ± 3.18 vs. 4.15 ± 3.02). The differences in successful pregnancy was not significant. Conclusions: Thus, it seems from findings that fentanyl-propofol GA without nitrous oxide is an appropriate alternative to ketamine-midazolam MAC and can be used for IVF oocyte retrieval if GA is demanded.

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