Analysis of Percutaneous Kyphoplasty under Different Types of Anesthesia for the Treatment of Multiple Osteoporotic Vertebral Fractures

Abstract Background Surgeons believe that the advantage of PKP under local anesthesia for the treatment of OVF in preventing interference with the general situation of elderly patients with multiple organ dysfunction. Surgeons can directly assess whether a spinal cord nerve injury occurs while the patient is awake. However, when patients with m-OVFs receive local anesthesia, fluoroscopy time often has to be increased,the operative time has to be extended, or the operation has to be terminated because of body posture-related discomfort, the toxic reaction of bone cement, and abrupt fluctuation of vital signs. No relevant study has thus far been conducted on the choice of the type of anesthesia to administer to patients undergoing PKP for m-OVFs.This study aimed to determine which of the two types of anesthesia is more suitable for PKP for m-OVFs. Methods A retrospective study was conducted for 159 patients who underwent PKP for m-OVFs from January 2016 to January 2020; 81 patients underwent PKP under general anesthesia(Group G), and 78 patients underwent PKP under local anesthesia(Group L). Clinical and adverse events were compared between the two groups. Results No difference in baseline information was found between the two groups. The intraoperative mean arterial pressure, average heart rate, average fluoroscopy times of each vertebral body, and operative time were less in Group G than in Group L. The VAS score was significantly lower than that before operation. The AVH, MVH, and the KA were significantly improved in both groups postoperation. The improvement in VAS score, AVH, MVH, and KA in Group G were higher than those in Group L. No significant difference in the incidence of complications was observed between the two groups. Conclusion PKP under either general anesthesia or local anesthesia was reliable. Compared with PKP under local anesthesia, that under general anesthesia could more reliably maintain the stability of vital signs, alleviate preoperative pain in patients, and attain a better orthopedic effect. Moreover, the latter does not increase the complications of patients with m-OVFs. However, the high medical expense of PKP under general anesthesia is a factor to consider when choosing the type of anesthesia.

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Analysis of percutaneous kyphoplasty under different types of anesthesia for the treatment of multiple osteoporotic vertebral fractures

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03778-1 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Shuai Zhang ◽

Shuang Xu ◽

Jin Yang ◽

Song Wang ◽

Qing Wang

Keyword(s):

General Anesthesia ◽

Local Anesthesia ◽

Vertebral Fractures ◽

Operative Time ◽

Vertebral Height ◽

Percutaneous Kyphoplasty ◽

Vas Score ◽

Anesthesia Group ◽

Osteoporotic Vertebral Fractures ◽

Significant Difference

Abstract Background Surgeons recognize that using percutaneous kyphoplasty (PKP) under local anesthesia to treat osteoporotic vertebral fracture (OVF) prevents interference with the general situation of elderly patients suffering from multiple organ dysfunction. Surgeons can directly assess whether nerve injury occurs while the patient is awake. However, when patients with multiple osteoporotic vertebral fractures (m-OVFs) receive local anesthesia, fluoroscopy time often has to be increased, the operative time has to be extended, or the operation has to be terminated because of discomfort related to body posture. No relevant study has thus far been conducted on the type of anesthesia to administer to patients undergoing PKP for m-OVFs. This study aimed to determine which of the two types of anesthesia is more suitable for PKP for m-OVFs. Methods A retrospective study was conducted involving 159 patients who underwent PKP for m-OVFs from January 2016 to January 2020; 81 patients underwent PKP under general anesthesia (Group G), and 78 patients underwent PKP under local anesthesia (Group L). Clinical and adverse events were compared between the two groups. Results The intraoperative mean arterial pressure, average heart rate, average fluoroscopy times of each vertebral body, and operative time were less in Group G than in Group L. The visual analog scale (VAS) score was significantly lower after than before the operation. The anterior vertebral height (AVH), middle vertebral height (MVH), and kyphotic angle (KA) were significantly improved in both groups postoperatively. The improvement in VAS score, AVH, MVH, and KA in Group G were higher than those in Group L. No significant difference in the incidence of complications was observed between the two groups. Conclusion PKP under either general anesthesia or local anesthesia was reliable. Compared with PKP under local anesthesia, PKP under general anesthesia could more reliably maintain the stability of vital signs, alleviate preoperative pain in patients, and attain a better orthopedic effect. Moreover, the latter does not increase the complications of patients with m-OVFs. However, the high medical expense of PKP under general anesthesia is a factor to consider when choosing the type of anesthesia.

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The Effect of Sevoflurane Anesthesia for Dental Procedure on Neurodevelopment in Children: A Prospective, Equivalence, Controlled Trial

10.21203/rs.3.rs-78114/v1 ◽

2020 ◽

Author(s):

Pinping Zhou ◽

Chao Zhang ◽

Guijin Huang ◽

Yuan Hu ◽

Wenzhu Ma ◽

...

Keyword(s):

General Anesthesia ◽

Local Anesthesia ◽

Primary Outcome ◽

Controlled Trial ◽

Age Groups ◽

Outcome Data ◽

Clinical Trial Registry ◽

General Anesthesia Group ◽

Anesthesia Group ◽

Significant Difference

Abstract Background: Dental procedures under general anesthesia (DGA) was found to improve the oral health-related quality of children's life. However, some parents and pediatricians expressed concern about the neurotoxicity of general anesthesia. The purpose of this trial was to investigate whether DGA in children has an adverse effect on neurodevelopment.Methods: In this prospective, assessor-masked, controlled, equivalence trial, we recruited 340 children younger than 7 years who were undergoing caries treatment between Feb 1, 2019, and Aug 31, 2019, without factors affecting neurodevelopment. They received either sevoflurane-based general anesthesia or awake-local anesthesia. The Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition was used to evaluate the neurodevelopment of children at six months after surgery, and the Full-Scale IQ (FSIQ) was selected as the primary outcome. Predefine the 95% CI of a difference in means within five (1/3 SD) as the equivalence margin.Results: The outcome data were obtained from 129 children in the general anesthesia group and 144 in the local anesthesia group. The median length of general anesthesia was 130 min (IQR 110 – 160). There was equivalence in means of FSIQ score between the general anesthesia group and the local anesthesia group (local minus general anesthesia 0.46, 95% CI -2.35 to 1.61). There was no significant difference in FSIQ scores between different age groups and different anesthesia durations. Only the mother's education could affect the primary outcome.Conclusions: In this trial, prolonged DGA with a sevoflurane-only anesthetic in preschool children, does not adversely affect neurodevelopment at six months after surgery compared with awake-local anesthesia. Trial registration: Chinese Clinical Trial Registry, ChiCTR1800015216. Registered Mar 15 2018, http://www.chictr.org.cn/showproj.aspx?proj=24830.

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Utility of Regional Anesthesia in Extremity Reconstruction

Journal of Reconstructive Microsurgery ◽

10.1055/s-0039-1694741 ◽

2019 ◽

Vol 36 (01) ◽

pp. 053-058

Author(s):

Joseph S. Weisberger ◽

Nicholas C. Oleck ◽

Haripriya S. Ayyala ◽

Margaret M. Dalena ◽

Edward S. Lee

Keyword(s):

Postoperative Complications ◽

Propensity Score ◽

General Anesthesia ◽

Propensity Score Matching ◽

Regional Anesthesia ◽

Operative Time ◽

General Anesthesia Group ◽

Anesthesia Group ◽

Significant Difference ◽

Extremity Reconstruction

Background Regional anesthesia (RA) may help to circumvent the well-documented risks associated with general anesthesia, increase patient comfort and satisfaction, and mitigate costs. This study aims to investigate the utility of RA in extremity reconstruction. Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried for all cases of extremity reconstruction including muscle, myocutaneous, or fasciocutaneous flaps from 2005 to 2016. Two groups were created based on anesthesia technique, regional/epidural and general. Postoperative complications included reoperation, readmission, and wound complications. Propensity score matching was utilized to control for variation in sample size, significant comorbidities, and demographics in the analysis of complications. Results A total of 2,874 cases were identified with general anesthesia utilized in 2,820 cases and RA in the remaining 54. After propensity score matching, 53 cases were identified in each group. In both unmatched and matched cohorts, there was no statistically significant difference in the rates of reoperation, readmission, or wound complication rates. In the matched cohort, mean operative time in the RA cohort was significantly shorter, 157.64 (±112.36) minutes compared with 293.06 minutes (±201.35 minutes) in the general anesthesia group (p < 0.001). While no statistically significant difference was detected in mean length of stay (LOS) between the two groups, the RA group experienced a clinically significant shorter LOS of 5.77 days (±5.87 days) compared with 7.02 (±5.61) days in the general anesthesia group (p = 0.269). Conclusion RA may be a safe, reasonable alternative to general anesthesia in extremity reconstruction without increase in postoperative complications. Additionally, RA use is associated with a significant reduction in operative time, potentially leading to shorter and safer procedures without compromising outcomes.

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The effect of sevoflurane anesthesia for dental procedure on neurodevelopment in children: a prospective, equivalence, controlled trial

10.21203/rs.3.rs-33454/v1 ◽

2020 ◽

Author(s):

Pinping Zhou ◽

Chao Zhang ◽

Guijin Huang ◽

Yuan Hu ◽

Wenzhu Ma ◽

...

Keyword(s):

General Anesthesia ◽

Local Anesthesia ◽

Primary Outcome ◽

Controlled Trial ◽

Age Groups ◽

Outcome Data ◽

Clinical Trial Registry ◽

General Anesthesia Group ◽

Anesthesia Group ◽

Significant Difference

Abstract Background Dental procedures under general anesthesia (DGA) was found to improve the oral health-related quality of children's life. However, some parents and pediatricians expressed concern about the neurotoxicity of general anesthesia. The purpose of this trial was to investigate whether DGA in children has an adverse effect on neurodevelopment. Methods In this prospective, assessor-masked, controlled, equivalence trial, we recruited 340 children younger than 7 years who were undergoing caries treatment between Feb 1, 2019, and Aug 31, 2019, without factors affecting neurodevelopment. They received either sevoflurane-based general anesthesia or awake-local anesthesia. The Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition Chinese version was used to evaluate the neurodevelopment of children at six months after surgery, and the Full-Scale IQ (FSIQ) was selected as the primary outcome. Predefine the 95% CI of a difference in means within five (1/3 SD) as the equivalence margin. Results The outcome data were obtained from 129 children in the general anesthesia group and 144 in the local anesthesia group. The median length of general anesthesia was 130 min (IQR 110–160). There was equivalence in means of FSIQ score between the general anesthesia group and the local anesthesia group (local minus general anesthesia 0.46, 95% CI -2.35 to 1.61). There was no significant difference in FSIQ scores between different age groups and different anesthesia durations. Just the mother's education could affect the primary outcome. Conclusions In this trial, prolonged DGA with a sevoflurane-only anesthetic in preschool children, does not adversely affect neurodevelopment at six months after surgery compared with awake-local anesthesia. Trial registration: Chinese Clinical Trial Registry, ChiCTR1800015216. Registered Mar 15 2018, http://www.chictr.org.cn/showproj.aspx?proj=24830.

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The effect of sevoflurane anesthesia for dental procedure on neurodevelopment in children: a prospective, equivalence, controlled trial

10.21203/rs.3.rs-33454/v2 ◽

2020 ◽

Author(s):

Pinping Zhou ◽

Chao Zhang ◽

Guijin Huang ◽

Yuan Hu ◽

Wenzhu Ma ◽

...

Keyword(s):

General Anesthesia ◽

Local Anesthesia ◽

Primary Outcome ◽

Controlled Trial ◽

Age Groups ◽

Outcome Data ◽

Factors Affecting ◽

General Anesthesia Group ◽

Anesthesia Group ◽

Significant Difference

Abstract Background Dental procedures under general anesthesia (DGA) was found to improve the oral health-related quality of children's life. However, some parents and pediatricians expressed concern about the neurotoxicity of general anesthesia. The purpose of this trial was to investigate whether DGA in children has an adverse effect on neurodevelopment. Methods In this prospective, assessor-masked, controlled, equivalence trial, we recruited 340 children younger than 7 years who were undergoing caries treatment between Feb 1, 2019, and Aug 31, 2019, without factors affecting neurodevelopment. They received either sevoflurane-based general anesthesia or awake-local anesthesia. The Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition Chinese version was used to evaluate the neurodevelopment of children at six months after surgery, and the Full-Scale IQ (FSIQ) was selected as the primary outcome. Predefine the 95% CI of a difference in means within five (1/3 SD) as the equivalence margin. Results The outcome data were obtained from 129 children in the general anesthesia group and 144 in the local anesthesia group. The median length of general anesthesia was 130 min (IQR 110 – 160). There was equivalence in means of FSIQ score between the general anesthesia group and the local anesthesia group (local minus general anesthesia 0.46, 95% CI -2.35 to 1.61). There was no significant difference in FSIQ scores between different age groups and different anesthesia durations. Just the mother's education could affect the primary outcome. Conclusions In this trial, prolonged DGA with a sevoflurane-only anesthetic in preschool children, does not adversely affect neurodevelopment at six months after surgery compared with awake-local anesthesia.

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The effect of sevoflurane anesthesia for dental procedure on neurocognition in children: a prospective, equivalence, controlled trial

BMC Pediatrics ◽

10.1186/s12887-021-02649-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Pinping Zhou ◽

Chao Zhang ◽

Guijin Huang ◽

Yuan Hu ◽

Wenzhu Ma ◽

...

Keyword(s):

General Anesthesia ◽

Local Anesthesia ◽

Primary Outcome ◽

Controlled Trial ◽

Neurocognitive Function ◽

Clinical Trial Registry ◽

General Anesthesia Group ◽

Anesthesia Group ◽

Significant Difference ◽

The Mean

Abstract Background Dental procedures under general anesthesia (DGA) was found to improve the oral health-related quality of children’s life. However, some parents and pediatricians expressed concern about the neurotoxicity of general anesthesia. The purpose of this trial was to whether DGA in children has an adverse effect on neurocognition. Methods In this prospective, assessor-masked, controlled, equivalence trial, we recruited 340 children younger than 7 years who were undergoing caries treatment between Feb 1, 2019, and Aug 31, 2019, without factors affecting neurodevelopment. They received either sevoflurane-based general anesthesia or awake-local anesthesia. The Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition was used to evaluate the neurocognitive function of children at 6 months after surgery, and the Full-Scale IQ (FSIQ) was selected as the primary outcome. The predefined clinical equivalence margin was 5 (1/3 SD of FSIQ score). If the 95% CI of the difference between the average FSIQ score of the two groups is within − 5 to + 5, then the two groups are equivalent. Results The outcome data were obtained from 129 children in the general anesthesia group and 144 in the local anesthesia group. The median length of general anesthesia was 130 min (IQR 110–160). The mean FSIQ score in the general anesthesia group was 103·12 (SD 8.94), and the mean of the local anesthesia group was 103·58 (SD 8.40). There was equivalence in means of FSIQ score between the two groups (local minus general anesthesia 0.46, 95% CI − 2.35 to 1.61). There was no significant difference in FSIQ scores between different age groups and different anesthesia durations. Only the mother’s education could affect the primary outcome. Conclusions In this trial, prolonged DGA with a sevoflurane-only anesthetic in preschool children, does not adversely affect neurocognitive function at 6 months after surgery compared with awake-local anesthesia. Trial registration Chinese Clinical Trial Registry, ChiCTR1800015216. Registered Mar 15 2018.

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Evaluation Of Anxiety During Nasal Pack Removal In Patients Operated Under Local Versus General Anesthesia

Journal of Bahria University Medical and Dental College ◽

10.51985/jbumdc2018070 ◽

2018 ◽

Vol 08 (04) ◽

pp. 226-230

Author(s):

Amer Sabih Hydri ◽

Muhammad Junaid Alam ◽

Iqbal Hussain Udaipurwala ◽

Furqan Mirza

Keyword(s):

General Anesthesia ◽

Local Anesthesia ◽

Rating Scale ◽

Military Hospital ◽

General Anesthesia Group ◽

Nasal Pack ◽

Assessment Scores ◽

Anesthesia Group ◽

Group B ◽

Hamilton Anxiety

Objective: To evaluate the anxiety experienced before, during and after conventional paraffin gauze nasal pack removal in patients operated under local versus general anesthesia. Study design: Comparative study. Place and duration of study: Department of ENT, Combined Military Hospital Sialkot and PAF Hospital Shorkot from July 2017 to June 2018. Material and methods: A total of 120 patients planned for Septoplasty were enrolled and divided into two groups. Sixty patients were to be operated under local anesthesia (Group A) while the other 60 were undergoing the same procedure under general anesthesia (Group B). Conventional paraffin gauze nasal packing was done for 24 hours in all 120 patients. Hamilton Anxiety Rating Scale (HAM-A) was used to determine the patients’ anxiety in both groups, 1 hour pre-operatively, immediately before and 1 hour after nasal pack removal. Results: The mean Hamilton Anxiety Scale assessment scores in both groups were of ‘mild’ category. The highest scores in both groups were observed immediately before nasal pack removal, with a range of 15-18, while the lowest scores in both groups were documented one hour after pack removal with a range of 13-16. Anxiety level in patients operated under general anesthesia was slightly lower than patients administered local anesthesia mean score of 16.40 ± 0.763 vs 17.21 ± 0.666 (p<0.001). Conclusion: Anxiety during nasal pack removal is mainly associated with prior pain experienced during nasal pack insertion. It is recommended that proper analgesia, adequate topical anesthesia, gentle insertion would make this process less distressing and will subsequently result in less anxiety at its removal.

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Effects of General Anesthesia Versus Spinal Anesthesia on Serum Cytokine Release after Cesarean Section: A Randomized Clinical Trial

Anesthesiology and Pain Medicine ◽

10.5812/aapm.111272 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Maryam Vosoughian ◽

Mastaneh Dahi ◽

Shideh Dabir ◽

Mohammadreza Moshari ◽

Soodeh Tabashi ◽

...

Keyword(s):

Cesarean Section ◽

General Anesthesia ◽

Spinal Anesthesia ◽

Serum Levels ◽

Major Surgery ◽

Necrosis Factor Alpha ◽

General Anesthesia Group ◽

Anesthesia Group ◽

Tnf Α ◽

Significant Difference

Background: Tissue damage caused by major surgery, such as cesarean section, may lead to a poor host immune response and excessive release of cytokines. These responses may increase the risk of infection, cause postoperative pain, and exert damaging effects on various body organs. Objectives: Anesthesia methods may affect cytokine production after surgery. This study aimed to compare the serum levels of cytokines in general and spinal anesthesia among women undergoing cesarean section. Methods: Thirty parturients (ASA class I and II) undergoing cesarean section were randomly assigned into two equal groups of spinal anesthesia and general anesthesia. Blood samples were taken for measuring the levels of interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-alpha (TNF-α) before induction of anesthesia and 30 minutes after entering the recovery room. Results: In the general anesthesia group, the postoperative serum levels of IL-6 and TNF-α were significantly higher than the corresponding preoperative levels. Significant differences were found between the two groups in the preoperative and postoperative levels of TNF-α. Changes in the IL-6 and TNF-α concentrations were significantly higher in the general anesthesia group as compared to the spinal anesthesia group. However, there was no significant difference in the IL-6:IL-10 and TNF-α: IL-10 ratios between the two groups. Conclusions: General anesthesia, as compared to spinal anesthesia, significantly increased the IL-6 and TNF-α levels after cesarean section. Therefore, the spinal anesthesia technique may be a better option for patients undergoing cesarean section.

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Comparison of different anesthesia modalities during percutaneous kyphoplasty of osteoporotic vertebral compression fractures

Scientific Reports ◽

10.1038/s41598-021-90621-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Chaoyuan Ge ◽

Xucai Wu ◽

Zijun Gao ◽

Zhengwei Xu ◽

Dingjun Hao ◽

...

Keyword(s):

Heart Rate ◽

General Anesthesia ◽

Local Anesthesia ◽

Operative Time ◽

Controlled Study ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Compression Fractures ◽

Percutaneous Kyphoplasty ◽

Anesthesia Group

AbstractLocal and general anesthesia are the main techniques used during percutaneous kyphoplasty (PKP); however, both are associated with adverse reactions. Monitored anesthesia with dexmedetomidine may be the appropriate sedative and analgesic technique. Few studies have compared monitored anesthesia with other anesthesia modalities during PKP. Our aim was to determine whether monitored anesthesia is an effective alternative anesthetic approach for PKP. One hundred sixty-five patients undergoing PKP for osteoporotic vertebral compression fractures (OVCFs) were recruited from a single center in this prospective, non-randomized controlled study. PKP was performed under local anesthesia with ropivacaine (n = 55), monitored anesthesia with dexmedetomidine (n = 55), and general anesthesia with sufentanil/propofol/sevoflurane (n = 55). Perioperative pain was assessed using a visual analogue score (VAS). Hemodynamic variables, operative time, adverse effects, and perioperative satisfaction were recorded. The mean arterial pressure (MAP), heart rate, VAS, and operative time during monitored anesthesia were significantly lower than local anesthesia. Compared with general anesthesia, monitored anesthesia led to less adverse anesthetic effects. Monitored anesthesia had the highest perioperative satisfaction and the lowest VAS 2 h postoperatively; however, the monitored anesthesia group had the lowest MAP and heart rate 2 h postoperatively. Based on better sedation and analgesia, monitored anesthesia with dexmedetomidine achieved better patient cooperation, a shorter operative time, and lower adverse events during PKP; however, the MAP and heart rate in the monitored anesthesia group should be closely observed after surgery.

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Sealing-type Three-cavities Ventilation Joint: A New Device in Painless Bronchoscopy

Advances in Bioengineering and Biomedical Science Research ◽

10.33140/abbsr.04.04.07 ◽

2021 ◽

Vol 4 (4) ◽

Keyword(s):

General Anesthesia ◽

Endotracheal Tube ◽

Respiratory Mechanics ◽

Vital Signs ◽

Laryngeal Mask ◽

Oxygen Deficit ◽

General Anesthesia Group ◽

Group I ◽

Anesthesia Group ◽

Joint Group

Background: To observe the clinical effect and safety of the sealing-type three-cavities ventilation joint in painless bronchoscopy. To compare the respiratory mechanics between I-gel laryngeal mask and tracheal tube-controlled breath during bronchoscopy. Methods: 200 patients underwent bronchoscopy were recruited and randomly assigned to general anesthesia group (group Ⅰ, n = 100) and local anesthesia group (group Ⅱ, n = 100). General anesthesia group were divided into two groups, the I-gel laryngeal mask combined with sealing-type three-cavities ventilation joint group group(n=50) and the endotracheal tube combined with sealing-type three-cavities ventilation joint group(n=50). Patients in Group I were adopted by I-gel laryngeal mask or endotracheal tube with the sealing-type three-cavities ventilation joint after the induction anesthesia with remifentanil, propofol and succinylcholine. In group II, patients were anaesthetized with lidocaine and followed by 2mg/ kg propofol iv, and spontaneous respirations were retained with nasal cannula. All patients’ vital signs, endoscopic related adverse reactions and arterial blood gas analysis were recorded during the procedure. Results: Group I showed little changes of vital signs (P <0.05), and less adverse reaction such as the intraoperative hypoxia and intraoperative body movement (P <0.05), and no significant decrease of oxygen partial pressure (P <0.05). There is no significant difference in respiratory mechanics including tidal volume and airway pressure between two subgroups in group I(P>0.05). Conclusion: Sealing-type three-cavities ventilation joint prevents the oxygen deficit and makes it possible for us to examine patients through bronchoscope under general anesthesia without gas leakage. Moreover, sealing-type three-cavities ventilation joint provides safe and effective airway control while it does not change respiratory mechanics in endotracheal tube group compared with I-gel laryngeal mask makes endotracheal tube an alternative solution in bronchoscope. Take all these in consideration, sealing-type three-cavities ventilation joint proves to be a feasible method in bronchoscope.

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