Metastability of Neuronal Dynamics during General Anesthesia: Time for a Change in Our Assumptions?

Background: Opioid analgesics are commonly used along with propofol during general anesthesia. Due to the dearth of data on the quality of anesthesia achieved with this combination, the present meta-analysis was carried out. Methods: Electronic databases were searched for appropriate studies using a suitable search strategy. Randomized clinical trials comparing the combination of remifentanil/sufentanil/alfentanil with propofol with fentanyl and propofol, were included. The outcome measures were as follows: total propofol dose to achieve the desired general anesthesia; time of onset and duration of general anesthesia; depth of general anesthesia; and recovery time (time for eye-opening and time taken for extubation). Risk of bias was assessed and Forest plots were generated for eligible outcomes. The weighted mean difference [95% confidence intervals] was used as the effect estimate. Results: Fourteen studies were included in the systematic review and 13 were included in the metaanalysis. Statistically significant differences were observed for remifentanil in comparison to fentanyl when combined with propofol: Propofol dose (in mg) -76.18 [-94.72, -57.64]; time of onset of anesthesia (min) -0.44 [-0.74, -0.15]; time taken for eye-opening (min) -3.95 [-4.8, -3.1]; and time for extubation (min) -3.53 [-4.37, -2.7]. No significant differences were observed for either sufentanil or alfentanil about the dose of propofol required and due to scanty data, pooling of the data could not be attempted for other outcome measures for either sufentanil or alfentanil. Conclusion: To conclude, we found that remifentanil has a statistically significant anesthetic profile than fentanyl when combined with propofol. Scanty evidence for both alfentanil and sufentanil precludes any such confirmation.

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Development and Validation of a Perioperative Satisfaction Questionnaire

Anesthesiology ◽

10.1097/00000542-200506000-00010 ◽

2005 ◽

Vol 102 (6) ◽

pp. 1116-1123 ◽

Cited By ~ 83

Author(s):

Pascal Auquier ◽

Nicolas Pernoud ◽

Nicolas Bruder ◽

Marie-Claude Simeoni ◽

Jean-Pierre Auffray ◽

...

Keyword(s):

General Anesthesia ◽

Convergent Validity ◽

Discriminant Validity ◽

Perioperative Period ◽

Psychometric Validation ◽

Patient Groups ◽

American Society ◽

American Society Of Anesthesiologists ◽

Development And Validation ◽

Anesthesia Time

Background Satisfaction is considered a valuable measure of outcome of healthcare processes. Only a few anesthesia-related validated questionnaires are reported. Because their scope is restricted to specific clinical contexts, their use remains limited. The objective of the current study was to develop and validate a self-reported questionnaire, Evaluation du Vecu de l'Anesthesie Generale (EVAN-G), assessing the satisfaction of the perioperative period surrounding general anesthesia. Methods Development of the EVAN-G questionnaire comprised a phase of item generation and a phase of psychometric validation. The patient sample was generated to be proportionally matched to the population of patients undergoing general anesthesia in France. The structure of the questionnaire was identified studying interitem, item-dimension, and interdimension correlations and factor analyses. Data were concurrently gathered to assess external validity. The discriminant validity was determined by comparison of scores across well known patient groups. Reliability was assessed by computation of Cronbach alpha coefficients and by test-retest. Results Eight hundred seventy-four patients were recruited in eight anesthesia departments. The EVAN-G includes 26 items; six specific scores and one global index score are available. Correlations between EVAN-G scores and other concurrent measures supported convergent validity. The EVAN-G correlated poorly with age, American Society of Anesthesiologists physical status, total anesthesia time, and number of previous anesthesias. Significantly higher satisfaction was reported by patients older than 65 yr, belonging to the laryngeal mask group. Reliability and reproducibility were shown. Conclusion The EVAN-G adds important information oriented toward patients' perceptions. The authors' approach provides a novel, valid, and reliable tool that may be used in anesthesia practice.

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176 Efficiency of Spinal Anesthesia in Comparison to General Anesthesia in Lumbar Spine Surgery: A Retrospective Analysis of 544 Patients

Neurosurgery ◽

10.1093/neuros/nyx417.176 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 245-246

Author(s):

John Thomas Pierce ◽

Prateek Agarwal ◽

Paul J Marcotte ◽

William Charles Welch

Keyword(s):

Lumbar Spine ◽

Blood Loss ◽

Hospital Stay ◽

General Anesthesia ◽

Spinal Anesthesia ◽

Spine Surgery ◽

Operative Time ◽

Length Of Hospital Stay ◽

Lumbar Spine Surgery ◽

Anesthesia Time

Abstract INTRODUCTION Lumbar spine surgery can be successfully performed using various anesthetic techniques. Previous studies have shown varying results in selected outcomes when directly comparing spinal anesthesia (SA) to general anesthesia (GA) in lumbar surgery. We sought to elucidate the more expedient anesthetic technique. METHODS Following IRB approval, a retrospective review of patients undergoing elective lumbar decompression surgery using GA or SA was performed. Demographic data known to influence perioperative morbidity was collected as well as safety and efficiency parameters. After controlling for patient and procedure characteristics, simple linear and multivariate regression analyses were performed to identify differences in operative blood loss, operative time, time from entering the OR until incision, time from bandage placement to exiting the OR, total anesthesia time, time in the post-anesthesia care unit (PACU), and length of hospital stay. RESULTS >544 consecutive lumbar laminectomy and discectomy surgeries were identified with 183 undergoing GA and 361 undergoing SA. The following times were all shorter for patients receiving SA than GA: operative time (97.4 vs. 151.8 min., P < 0.001), total anesthesia time (145.6 vs. 217.5 min., P < 0.001), time from entering the OR until incision (38.3 vs. 46.8 min., respectively, P < 0.001), time from bandage placement until exiting the OR (10.2 vs. 17.2 min., P < 0.001), and length of hospital stay (1.5 vs. 3.1 days, P < 0.001). The mean PACU length of stay was longer in the SA group than the GA group (178.0 vs. 116.5 min., P < 0.001). Estimated blood loss was less in the SA group than the GA group (62.1 vs. 176.3 mL, P < 0.001). CONCLUSION Spinal anesthesia may be the more expedient method of anesthesia in lumbar spinal surgery for all perioperative time points except for time in the PACU.

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Su1279 Pre and Post Endoscopic Retrograde Cholangiopancreatography Anesthesia Time in Patients Receiving Monitored Anesthesia Care Versus General Anesthesia

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2012.03.704 ◽

2012 ◽

Vol 75 (4) ◽

pp. AB277 ◽

Cited By ~ 1

Author(s):

Vernon J. Carriere ◽

Jason Conway ◽

Girish Mishra ◽

Raymond Roy ◽

John A. Evans

Keyword(s):

General Anesthesia ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Anesthesia Care ◽

Endoscopic Retrograde ◽

Monitored Anesthesia Care ◽

Anesthesia Time

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Time and Cost Analysis: Pediatric Dental Rehabilitation with General Anesthesia in the Office and the Hospital Settings

Anesthesia Progress ◽

10.2344/0003-3006-59.4.147 ◽

2012 ◽

Vol 59 (4) ◽

pp. 147-153 ◽

Cited By ~ 15

Author(s):

Stephanie Rashewsky ◽

Ashish Parameswaran ◽

Carole Sloane ◽

Fred Ferguson ◽

Ralph Epstein

Keyword(s):

General Anesthesia ◽

Dental Care ◽

Recovery Time ◽

Pediatric Patients ◽

Ambulatory Setting ◽

Average Total Cost ◽

Total Cost ◽

Dental Patients ◽

Dental Rehabilitation ◽

Anesthesia Time

Abstract Pediatric dental patients who cannot receive dental care in the clinic due to uncooperative behavior are often referred to receive dental care under general anesthesia (GA). At Stony Brook Medicine, dental patients requiring treatment with GA receive dental care in our outpatient facility at the Stony Brook School of Dental Medicine (SDM) or in the Stony Brook University Hospital ambulatory setting (SBUH). This study investigates the time and cost for ambulatory American Society of Anesthesiologists (ASA) Class I pediatric patients receiving full-mouth dental rehabilitation using GA in these 2 locations, along with a descriptive analysis of the patients and dental services provided. In this institutional review board–approved cross-sectional retrospective study, ICD-9 codes for dental caries (521.00) were used to collect patient records between July 2009 and May 2011. Participants were limited to ASA I patients aged 36–60 months. Complete records from 96 patients were reviewed. There were significant differences in cost, total anesthesia time, and recovery room time (P < .001). The average total time (anesthesia end time minus anesthesia start time) to treat a child at SBUH under GA was 222 ± 62.7 minutes, and recovery time (time of discharge minus anesthesia end time) was 157 ± 97.2 minutes; the average total cost was $7,303. At the SDM, the average total time was 175 ± 36.8 minutes, and recovery time was 25 ± 12.7 minutes; the average total cost was $414. After controlling for anesthesia time and procedures, we found that SBUH cost 13.2 times more than SDM. This study provides evidence that ASA I pediatric patients can receive full-mouth dental rehabilitation utilizing GA under the direction of dentist anesthesiologists in an office-based dental setting more quickly and at a lower cost. This is very promising for patients with the least access to care, including patients with special needs and lack of insurance.

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Estudio Analítico: Prevalencia de Hipotermia y Factores Asociados en el Postoperatorio Inmediato en Cirugía del Hospital Vicente Corral Moscoso, Cuenca – Ecuador, 2016

Revista Médica del Hospital José Carrasco Arteaga ◽

10.14410/2018.10.2.ao.16 ◽

2018 ◽

Vol 10 (2) ◽

pp. 105-109

Author(s):

Elizabeth Yadira Vicuña Cuji ◽

Patricia Lorena Pacheco Sanmartín ◽

Adrián Marcelo Sacoto Molina

Keyword(s):

General Anesthesia ◽

Family Environment ◽

Postoperative Period ◽

Late Complications ◽

Cross Sectional ◽

A Value ◽

Electronic Thermometer ◽

Anesthetic Exposure ◽

Anesthesia Time ◽

Associated Variables

BACKGROUND: Perioperative hypothermia is the decrease in temperature, below 36 °C after surgery that is linked to immediate and late complications. The control of hypothermia reduces morbidity, mortality, and the time of integration of patients to their social and family environment. The objective of the present study is to determine the prevalence of inadvertent hypothermia and associated factors in the immediate postoperative period. METHODS: The present is a cross-sectional analytical study, working with male and female patients from 18 to 70 years old, undergoing elective surgeries at the Hospital Vicente Corral Moscoso, from May 16 to August 11, 2016. It was evaluated the temperature with an electronic thermometer and the associated variables through a form prepared by the researchers. The statistical programs PSPP 0.10.4 were used for the bivariate and multivariate analysis and EPI INFO 7. RESULTS: Of the 267 patients investigated, 68.5 % developed hypothermia in the immediate postoperative period. General anesthesia increases 1.8 times the risk of developing hypothermia with a statistically significant value, as well as an anesthesia time greater than 60 minutes but with a value of borderline significance. CONCLUSIONS: The factors associated with the development of hypothermia are: the use of general anesthesia and the anesthetic exposure time greater than 60 minutes. We recommend taking temperature in patients before, during and after the surgical procedure, to act in a timely manner before the onset of hypothermia.

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Plate osteosynthesis of single metacarpal fracture: WALANT technique is a cost-effective approach to reduce postoperative pain and discomfort in contrast to general anesthesia and wrist block

BMC Surgery ◽

10.1186/s12893-021-01362-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yen-Chang Lin ◽

Wei-Chieh Chen ◽

Chun-Yu Chen ◽

Shyh-Ming Kuo

Keyword(s):

Internal Fixation ◽

General Anesthesia ◽

Functional Recovery ◽

Intraoperative Complications ◽

Postoperative Vomiting ◽

Surgical Time ◽

Metacarpal Fractures ◽

Significant Difference ◽

Anesthesia Time ◽

No Tourniquet

Abstract Background The WALANT (wide-awake local anesthesia with no tourniquet) technique was based on local infiltration of lidocaine and epinephrine. This technique has rapidly gained popularity in recent years and can perform most hand operations. This study aimed to investigate the time spent on anesthesia and operation and perform an economic analysis among general anesthesia, wrist block with a tourniquet, and the WALANT technique for the internal fixation of metacarpal fractures. Methods We retrospectively reviewed all the single metacarpal fractures managed with the same procedure, open reduction, and internal fixation with the plate between January 2015 and December 2019. They were divided into three groups according to the method of anesthesia: (1) general anesthesia (GA group), (2) wrist block with a tourniquet (WB group), and (3) WALANT technique (WALANT group). We collected and analyzed patient demographic data, perioperative or postoperative complications, number of hospital days, and postoperative functional recovery assessment. Results A total of 63 patients met the inclusion criteria, including 24 in the GA group, 28 in the wrist block group using a tourniquet, and 11 in the WALANT group. There were no complications during the operation and follow-up in each group. The GA group had an average of 32.8 min of anesthesia time, significantly longer than the other two groups. However, there is no significant difference regarding surgical time among the presenting three groups. The discomfort of vomiting and nausea after surgery occurred in 20 patients in the GA group (38.1%). Nevertheless, there was no postoperative vomiting and nausea present in both the WB and WALANT groups. Most patients achieved full recovery of pre-injury interphalangeal and metacarpophalangeal motion at the final assessment of functional recovery. Conclusions The patients undergoing metacarpal fixation surgery under WALANT or WB had significantly less anesthesia time and postoperative vomiting and nausea. Moreover, there was no difference in surgical time and intraoperative complications. The time-related reduction improved the utilization of the operation room for additional cases. The reduction of the preoperative examination, anesthesia fee, postoperative recovery room observation, and hospitalization can effectively reduce medical costs. Furthermore, the WALANT group is more acceptable because of no tourniquet, which commonly causes discomfort.

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Study of propofol-thiopental mixture for induction of general anesthesia in xylazine premedicated Donkeys

Al-Qadisiyah Journal of Veterinary Medicine Sciences ◽

10.29079/vol9iss2art103 ◽

2010 ◽

Vol 9 (2) ◽

pp. 31

Author(s):

O.A. Bader, and L.M. AL-kattan

Keyword(s):

General Anesthesia ◽

Random Order ◽

Dose Schedule ◽

First Record ◽

High Dose ◽

Respiratory Parameters ◽

Wide Range ◽

Recovery Times ◽

Anesthesia Time

The current study was conducted to evaluate the anesthetic quality produced by Propofol-Thiopental mixture (P-T) in six donkeys premedicated with Xylazine (X), (1.1 mg/kg IV). The intravenous dose schedule for P-T mixture was 1, 2 and 4 mg/kg of Propofol with 5 mg/kg of Thiopental Sodium, respectively. Each donkey was anesthetized three times with each dose of P-T, five minutes after X administration in random order at one-week intervals.The anesthetic parameters induction, duration of anesthesia, time to sedation and recovery times, cardiovascular parameters, respiratory parameters and incidence of side-effects were qualitatively and quantitatively assessed.The results of the present study revealed the presence of a wide range of differences in the quality of anesthesia between the three doses of P-T mixture. The high dose of P-T mixture (4 mg/kg+5 mg/kg) produced an ultra induction time (7±4 seconds), which was free of excitement with longer onsets of sleeping times (54 min). But, times to regain sternal and standing positions were longer with this dose. While, the low dose (1 mg/ kg+5 mg/kg) failed to produce narcosis. On the other hand, the (2 mg/kg+5 mg/kg) of P-T, produced smooth induction (17.5±3 seconds) with sufficient tracheal intubations. Time to narcosis was shorter than that produced by the higher dose (animal still recumbent) (19.1±4), but with rapid recovery time (25.8±5.6). The transient apnea observed in this study which was usually followed by administration of P-T mixture, was shorter (37.8±18 sec.) with the medium dose (2 mg/kg+5 mg/kg), compared to that with the higher dose.It could be concluded that P-T mixture (2mg/kg+5 mg/kg), is an excellent anesthetic protocol for induction of general anesthesia in donkeys. It is the first record for the use of this mixture for general anesthesia in this animal

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