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.

Examining the impact of psychological distress on short-term postoperative outcomes after elective endovascular aneurysm repair (EVAR)

2021 ◽  
Vol 142 ◽  
pp. 110367
Author(s):  
Yarrow Scantling-Birch ◽  
Guy Martin ◽  
Sathyan Balaji ◽  
Jacqueline Trant ◽  
Ian Nordon ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Endovascular Aneurysm Repair ◽  
Postoperative Outcomes ◽  
Short Term ◽  
Aneurysm Repair ◽  
The Impact

Loco-regional versus general anaesthesia for elective endovascular aneurysm repair – results of a cohort study and a meta-analysis

VASA ◽  
2018 ◽  
Vol 47 (3) ◽  
pp. 209-217 ◽  
Author(s):  
Shahin Hajibandeh ◽  
Shahab Hajibandeh ◽  
Kelvin Adasonla ◽  
Stavros A. Antoniou ◽  
Janet Barrie ◽  
...  
Keyword(s):  
Hospital Stay ◽  
General Anaesthesia ◽  
Meta Analysis ◽  
Group Analysis ◽  
Endovascular Aneurysm Repair ◽  
Anaesthetic Techniques ◽  
Perioperative Mortality ◽  
Level Of Evidence ◽  
Mortality And Morbidity ◽  
Aneurysm Repair

Abstract. Background: The aim of this study was to investigate whether patients undergoing elective endovascular aneurysm repair (EVAR) with loco-regional anaesthetic techniques have better outcomes than those treated with general anaesthesia (GA). Patients and methods: We retrospectively evaluated outcomes of EVAR performed with regional anaesthesia (RA) or GA over a five-year period. Furthermore, we searched electronic bibliographic sources (MEDLINE, EMBASE, CINAHL, and CENTRAL) to identify studies comparing different anaesthetic methods in EVAR. We defined perioperative mortality and morbidity as well as length of hospital stay (LOS) as the primary outcome measures. Pooled effect estimates were calculated using fixed-effect or random-effects models. Results are reported as the odds ratio (OR) or mean difference (MD) and 95 % confidence interval (CI). Results: Three hundred and fifty-five patients underwent standard EVAR over the study period (RA, 215 patients; GA 140 patients). Patients in both groups had comparable baseline demographics and clinical characteristics. Perioperative mortality was significantly lower in the RA group (0.5 % vs. 4.3 %, P = 0.017). No difference was found in perioperative morbidity (P = 0.370), LOS (P = 0.146), postoperative destination (P = 0.799), reoperation (P = 0.355) or readmission within 30 days (P = 0.846). Meta-analysis of data on 15,472 patients from 15 observational studies found a significantly lower perioperative mortality (OR 0.70, 95 % CI 0.52–0.95, P = 0.02) and morbidity (OR 0.73, 95 % CI 0.55–0.96, P = 0.02) in patients treated with loco-regional anaesthetic techniques compared to those treated with GA. Our sub-group analysis demonstrated that both local anaesthesia (LA) (P = 0.003) and RA (P < 0.0001) were associated with a significantly shorter LOS compared to GA. Conclusions: Local and/or regional anaesthetic techniques may be advantageous over GA in elective EVAR, as indicated by reduced perioperative mortality and morbidity and a shorter hospital stay. Considering the current level of evidence, LA or RA should be considered in selected patients. Further clinical research is required to provide high level evidence on the optimal anaesthetic technique in EVAR.

Pneumonia Is Associated with Increased Mortality in Hospitalized COPD Patients: A Systematic Review and Meta-Analysis

Respiration ◽  
2021 ◽  
Vol 100 (1) ◽  
pp. 64-76
Author(s):  
Yan Yu ◽  
Wei Liu ◽  
Hong-Li Jiang ◽  
Bing Mao
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Hospital Stay ◽  
Readmission Rate ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Mortality And Morbidity ◽  
Icu Stay ◽  
Copd Patients ◽  
The Impact

<b><i>Background:</i></b> Patients with chronic obstructive pulmonary disease (COPD) are at a heightened risk of pneumonia. Whether coexisting community-acquired pneumonia (CAP) can predict increased mortality in hospitalized COPD patients is still controversial. <b><i>Objective:</i></b> This systematic review and meta-analysis aims to assess the association between CAP and mortality and morbidity in COPD patients hospitalized for acute worsening of respiratory symptoms. <b><i>Methods:</i></b> In this review, cohort studies and case-control studies investigating the impact of CAP in hospitalized COPD patients were retrieved from 4 electronic databases from inception until December 2019. Methodological quality of included studies was assessed using Newcastle-Ottawa Quality Assessment Scale. The primary outcome was mortality. The secondary outcomes included length of hospital stay, need for mechanical ventilation, intensive care unit (ICU) admission, length of ICU stay, and readmission rate. The Mantel-Haenszel method and inverse variance method were used to calculate pooled relative risk (RR) and mean difference (MD), respectively. <b><i>Results:</i></b> A total of 18 studies were included. The presence of CAP was associated with higher mortality (RR = 1.85; 95% CI: 1.50–2.30; <i>p</i> &#x3c; 0.00001), longer length of hospital stay (MD = 1.89; 95% CI: 1.19–2.59; <i>p</i> &#x3c; 0.00001), more need for mechanical ventilation (RR = 1.48; 95% CI: 1.32–1.67; <i>p</i> &#x3c; 0.00001), and more ICU admissions (RR = 1.58; 95% CI: 1.24–2.03; <i>p</i> = 0.0002) in hospitalized COPD patients. CAP was not associated with longer ICU stay (MD = 5.2; 95% CI: −2.35 to 12.74; <i>p</i> = 0.18) or higher readmission rate (RR = 1.02; 95% CI: 0.96–1.09; <i>p</i> = 0.47). <b><i>Conclusion:</i></b> Coexisting CAP may be associated with increased mortality and morbidity in hospitalized COPD patients, so radiological confirmation of CAP should be required and more attention should be paid to these patients.

scholarly journals Acute-onset paraplegia as an unexpected complication under general anesthesia in supine position during abdominal endovascular aneurysm repair: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Atsushi Morio ◽  
Hirotsugu Miyoshi ◽  
Noboru Saeki ◽  
Yukari Toyota ◽  
Yasuo M. Tsutsumi
Keyword(s):  
Spinal Cord ◽  
General Anesthesia ◽  
Supine Position ◽  
Spinal Cord Ischemia ◽  
Endovascular Aneurysm Repair ◽  
Acute Onset ◽  
Lower Limbs ◽  
Canal Stenosis ◽  
Cord Injury ◽  
Aneurysm Repair

Abstract Background Acute onset paraplegia after endovascular aneurysm repair (EVAR) is a rare but well-known complication. We here show a 79-year-old woman with paraplegia caused by static and dynamic spinal cord insult not by ischemia after EVAR. Case presentation The patient underwent EVAR for abdominal aortic aneurism under general anesthesia in the supine position. She had a medical history of lumbar canal stenosis. After the surgery, we recognized severe paraplegia and sensory disorder of lower limbs. Although the possibility of spinal cord ischemia was considered at that time, postoperative magnetic resonance imaging (MRI) revealed burst fracture of vertebra and compressed spinal cord. Conclusions Patients with spinal canal stenosis can cause extrinsic spinal cord injury even with weak external forces. Thus, even after EVAR, it is important to consider extrinsic factors as the cause of paraplegia.

Comparing polymer-filled versus self-expanding endografts in Chinese patients

2018 ◽  
Vol 26 (9) ◽  
pp. 667-676
Author(s):  
Yuk Law ◽  
Yiu Che Chan ◽  
Stephen Wing-Keung Cheng
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
The Self ◽  
Chinese Patients ◽  
Type Ii ◽  
Mortality And Morbidity ◽  
Type Ia ◽  
One Year ◽  
Aneurysm Repair

Introduction We performed a single-center nonrandomized study on patients who underwent endovascular aneurysm repair using polymer-filled or other self-expanding endografts. Methods Consecutive patients with asymptomatic infrarenal abdominal aortic aneurysms who underwent endovascular repair were retrospectively reviewed. They were divided into a polymer-filled ( n = 20) or self-expanding group ( n = 42). Baseline characteristics, operative mortality and morbidity, and follow-up data were compared. Results Aneurysm diameter, neck and iliac morphologies did not differ between the two groups. Technical success was 100%. The 30-day mortality was 0% and 2.4% in the polymer-filled and self-expanding group, respectively. At a mean follow-up of 17 months, the changes in sac size were −2.1 mm and −5.1 mm ( p = 0.144) at one year, and −3.5 mm and −7.7 mm ( p = 0.287) at 2 years in the polymer-filled and self-expanding group, respectively. The polymer-filled group had 7 (35%) type II endoleaks, and the self-expanding group had 1 (2.4%) type Ia and 13 (31%) type II endoleaks. Neck diameter remained stable in the polymer-filled stent-grafts whereas there was progressive neck degeneration in the self-expanding group. The rates of reintervention and overall survival were similar in both groups. The presence of an endoleak was the only predictor of non-regression of the aneurysm (odds ratio = 17.00, 95% confidence interval: 4.46–64.88, p < 0.001). Conclusion Polymer-filled endografts had similar safety, effectiveness, and durability to other self-expanding endografts. The major advantage is the small iliofemoral access. They also have the potential long-term benefit of a more stable neck.

scholarly journals The Impact of Reinterventions on Survival After Fenestrated and Branched Endovascular Aneurysm Repair

2020 ◽  
Vol 72 (1) ◽  
pp. e48
Author(s):  
Enrico Gallitto ◽  
Gianluca Faggioli ◽  
Cecilia Fenelli ◽  
Chiara Mascoli ◽  
Rodolfo Pini ◽  
...  
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Aneurysm Repair ◽  
The Impact

scholarly journals The Impact of Endovascular Aneurysm Repair on Long Term Renal Function Based on Hard Renal Outcomes

2019 ◽  
Vol 70 (4) ◽  
pp. 1380
Author(s):  
E.R. Charles ◽  
D. Lui ◽  
J. Delf ◽  
R.D. Sayers ◽  
M.J. Bown ◽  
...  
Keyword(s):  
Renal Function ◽  
Endovascular Aneurysm Repair ◽  
Renal Outcomes ◽  
Aneurysm Repair ◽  
The Impact

scholarly journals PC038 The Impact of Contrast Media Volume Used During Endovascular Aneurysm Repair on Short- and Long-Term Renal Function

2017 ◽  
Vol 65 (6) ◽  
pp. 149S
Author(s):  
Jennifer C. Grom ◽  
Rami O. Tadros ◽  
Melissa Baldwin ◽  
Martin Kang ◽  
Daniel K. Han ◽  
...  
Keyword(s):  
Renal Function ◽  
Contrast Media ◽  
Endovascular Aneurysm Repair ◽  
Short And Long Term ◽  
Aneurysm Repair ◽  
The Impact ◽  
Media Volume

scholarly journals Fast-track Cardiac Surgery in Children: Feasibility in Bangladeshi Setting

1970 ◽  
Vol 3 (1) ◽  
pp. 50-54 ◽  
Author(s):  
SA Quader ◽  
R Sarker ◽  
F Ahmed ◽  
MK Hasan ◽  
AK Beg ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Hospital Stay ◽  
Fast Track ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Postoperative Mortality ◽  
Control Group ◽  
Mortality And Morbidity ◽  
Surgical Closure ◽  
Fast Tracking

Background: Fast-track recovery protocols in cardiac surgery is gaining worldwide popularity and have contributed to significant reductions in the postoperative hospital stay and cost without any increase in postoperative mortality and morbidity. The aim of this study was to find out the feasibility of fast track paediatric cardiac surgery in Bangladeshi setting. Method: It was a prospective study conducted in National Institute of Cardio-vascular Diseases, Dhaka, from July 2009 to June 2010. All patients, between 3 to 18 years, underwent surgical closure of atrial or ventricular septal defect under cardio-pulmonary bypass. 20 patients from our unit served as fast track group and 30 patients from other units of the same hospital served as conventional group. Fast track patients were extubated in less than 6 hours after surgery, shifted from ICU in less than 24 hours and geared up to discharge home within 3 days of surgery. Result: 18 (90%) of the 20 patient of the fast track group were discharged within 3 days of surgery, 2 patients cannot be discharged within this time frame. Mean post operative hospital stay for study group was 3.1 days, whereas the mean hospital stay in the control group was 7.5 days. Follow-up was 100% complete at 30 days. There was no major in-hospital or out-of-hospital complications in either group. No patient was readmitted at our centre or elsewhere for any complication arising from this process. Conclusion: Fast tracking is feasible and safe in low-risk paediatric open-heart surgery in Bangladeshi scenario. A multidisciplinary approach with a set protocol is required to achieve this goal in a safe and reproducible manner. Keywords: Cardiac surgery; Congenital heart disease; Fast track; Hospital discharge. DOI: 10.3329/cardio.v3i1.6427Cardiovasc. j. 2010; 3(1): 50-54

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