scholarly journals Migraine Headaches after Major Surgery with General or Neuraxial Anesthesia: A Nationwide Propensity-Score Matched Study

2021 ◽  
Vol 19 (1) ◽  
pp. 362
Author(s):  
Chung-Yi Liao ◽  
Chun-Cheng Li ◽  
Hsin-Yi Liu ◽  
Jui-Tai Chen ◽  
Yih-Giun Cherng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Propensity Score ◽  
General Anesthesia ◽  
Surgical Stress ◽  
Perioperative Period ◽  
Influential Factors ◽  
Neuraxial Anesthesia ◽  
Major Surgery ◽  
Migraine Headaches ◽  
Matched Study

Migraine headaches can be provoked by surgical stress and vasoactive effects of anesthetics of general anesthesia in the perioperative period. However, it is unclear whether general anesthesia increases the migraine risk after major surgery. Incidence and risk factors of postoperative migraine are also largely unknown. We utilized reimbursement claims data of Taiwan’s National Health Insurance and performed propensity score matching analyses to compare the risk of postoperative migraine in patients without migraine initially who underwent general or neuraxial anesthesia. Multivariable logistic regressions were applied to calculate the adjusted odds ratio (aOR) and 95% confidence interval (CI) for migraine risk. A total of 68,131 matched pairs were analyzed. The overall incidence of migraine was 9.82 per 1000 person-years. General anesthesia was not associated with a greater risk of migraine compared with neuraxial anesthesia (aORs: 0.93, 95% CI: 0.80–1.09). This finding was consistent across subgroups of different migraine subtypes, uses of migraine medications, and varying postoperative periods. Influential factors for postoperative migraine were age (aOR: 0.99), sex (male vs. female, aOR: 0.50), pre-existing anxiety disorder (aOR: 2.43) or depressive disorder (aOR: 2.29), concurrent uses of systemic corticosteroids (aOR: 1.45), ephedrine (aOR: 1.45), and theophylline (aOR: 1.40), and number of emergency room visits before surgery. There was no difference in the risk of postoperative migraine between surgical patients undergoing general and neuraxial anesthesia. This study identified the risk factors for postoperative migraine headaches, which may provide an implication in facilitating early diagnoses and treatment.

scholarly journals Comparison of the Effects of Sugammadex, Neostigmine, and Pyridostigmine on Postoperative Nausea and Vomiting: A Propensity Matched Study of Five Hospitals

2020 ◽  
Vol 9 (11) ◽  
pp. 3477
Author(s):  
Jong Ho Kim ◽  
Man-Sup Lim ◽  
Jun Woo Choi ◽  
Haewon Kim ◽  
Young-Suk Kwon ◽  
...  
Keyword(s):  
Propensity Score ◽  
Confidence Interval ◽  
General Anesthesia ◽  
Propensity Score Matching ◽  
Postoperative Nausea ◽  
Odds Ratio ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Patient Groups ◽  
Matched Study

Thus far, few studies have compared the effects of sugammadex and cholinesterase inhibitors on postoperative nausea and vomiting (PONV), and the results have been controversial. Here, we compared the effects of sugammadex, neostigmine, and pyridostigmine on PONV by means of a five hospital analysis with propensity score matching. We analyzed adults aged ≥ 18 years who underwent general anesthesia between January 2014 and December 2019. Following propensity score matching, 7793 patients were included in each of the neostigmine and sugammadex matched patient groups (absolute standardized difference (ASD), 0.01–0.07), and 10,197 patients were included in each of the pyridostigmine and sugammadex matched patient groups (ASD, 0.01–0.02), while 19,377 patients were included in each of the pyridostigmine and neostigmine matched patient groups. (ASD, 0.01–0.19). The odds of PONV were low in the sugammadex group (odds ratio, 0.65; 95% confidence interval, 0.59–0.72; p < 0.0001) and pyridostigmine group (odds ratio, 0.22; 95% confidence interval, 0.20–0.24; p < 0.0001) compared to the neostigmine group, while there was no difference between sugammadex and pyridostigmine (odds ratio, 0.95; 95% confidence interval, 0.86–1.04; p = 0.281). Therefore, sugammadex and pyridostigmine may lower the incidence of PONV compared to neostigmine in patients undergoing general anesthesia.

The impact of general anesthesia on mother-infant bonding for puerperants who undergo emergency cesarean deliveries

2020 ◽  
Vol 48 (5) ◽  
pp. 463-470 ◽  
Author(s):  
Kenta Nitahara ◽  
Nobuhiro Hidaka ◽  
Atsuhiko Sakai ◽  
Saki Kido ◽  
Kiyoko Kato
Keyword(s):  
Propensity Score ◽  
General Anesthesia ◽  
Hospital Discharge ◽  
Outpatient Visit ◽  
Linear Regression Analysis ◽  
Neuraxial Anesthesia ◽  
Cesarean Deliveries ◽  
Emergency Cesarean ◽  
Anesthesia Group ◽  
The Impact

AbstractBackgroundMother-infant bonding is an emerging perinatal issue. While emergency cesarean deliveries are associated with a risk of bonding disorders, the mode of anesthesia used for emergency cesarean deliveries has never been studied in this context. We aimed to investigate the impact of administering general anesthesia and neuraxial anesthesia to women undergoing cesarean deliveries on mother-infant bonding.MethodsThis was a retrospective, propensity score-matched multivariable analysis of 457 patients who underwent emergency cesarean deliveries between February 2016 and January 2019 at a single teaching hospital in Japan. The Mother-Infant Bonding Scale (MIBS) scores at hospital discharge and the 1-month postpartum outpatient visit were evaluated in the general anesthesia and the neuraxial anesthesia groups. A high score on the MIBS indicates impaired mother-infant bonding.ResultsThe primary outcome was the MIBS score at hospital discharge in propensity score-matched women. After propensity score matching, the median [interquartile range (IQR)] MIBS scores were significantly higher in the general anesthesia group than those in the neuraxial anesthesia group at hospital discharge [2 (1–4) vs. 2 (0–2); P = 0.015] and at the 1-month postpartum outpatient visit [1 (1–3) vs. 1 (0–2); P = 0.046]. In linear regression analysis of matched populations, general anesthesia showed a significant and positive association with the MIBS scores at hospital discharge [beta coefficient 0.867 (95% confidence interval [CI] 0.147–1.59); P = 0.019] but not at the 1-month postpartum outpatient visit [0.455 (−0.134 to 1.044); P = 0.129].ConclusionGeneral anesthesia for emergency cesarean delivery is an independent risk factor associated with impaired mother-infant bonding.

scholarly journals Transversus abdominis plane block with general anesthesia blunts the perioperative stress response in patients undergoing radical gastrectomy

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Ruizhu Liu ◽  
Haiyan Qin ◽  
Meng Wang ◽  
Kai Li ◽  
Guoqing Zhao
Keyword(s):  
Stress Response ◽  
Adverse Effects ◽  
General Anesthesia ◽  
Surgical Stress ◽  
Perioperative Period ◽  
Transversus Abdominis ◽  
Control Group ◽  
Radical Gastrectomy ◽  
Tap Block ◽  
Transversus Abdominis Plane

Abstract Background Surgical stress induces the release of neuroendocrine mediators and cytokines during perioperative period, which may have adverse effects on cancer patients. While the surgical stress responsse can be affected by anesthetic technique. Therefore, we designed this study to assess whether subcostal transversus abdominis plane (TAP) block can affect perioperative neuroendocrine stress response, postoperative analgesia and postoperative recovery in patients undergoing radical gastrectomy under general anesthesia. Methods Sixty-five patients were recruited. Patients randomly received general anesthesia (control group), or general anesthesia combined with TAP block (40 mL of 0.375% ropivacaine) (TAP group). The primary outcome was neuroendocrine levels including norepinephrine (NE), epinephrine (E), cortisol (Cor), glucose (Glu), interleukin (IL)-6 and IL-10 during 48 h after surgery. Secondary outcomes included pain score, hemodynamic variables and recovery characteristics. Results Data from 61 of 65 patients were analyzed. The levels of NE, E, Cor, and Glu were blunt by TAP block during perioperative period. The levels of IL-6 and IL-10 were significantly lower in TAP group than in control group. TAP block efficiently relieved postoperative acute pain up to 12 h postoperatively with more stable perioperative hemodynamics compared with control group. Conclusions Subcostal TAP block blunts perioperative stress response and provides efficient analgesia, with good hemodynamic stability and minimal adverse effects.

Preoperative Risk Factors of Intraoperative Hypothermia in Major Surgery Under General Anesthesia

2002 ◽  
Vol 95 (5) ◽  
pp. 1381-1383 ◽  
Author(s):  
T. Kasai ◽  
M. Hirose ◽  
K. Yaegashi ◽  
T. Matsukawa ◽  
A. Takamata ◽  
...  
Keyword(s):  
Risk Factors ◽  
General Anesthesia ◽  
Major Surgery ◽  
Preoperative Risk ◽  
Preoperative Risk Factors ◽  
Intraoperative Hypothermia

scholarly journals Perioperative glucocorticoid management based on current evidence

2021 ◽  
Vol 16 (1) ◽  
pp. 8-15
Author(s):  
Kwon Hui Seo
Keyword(s):  
Adrenal Insufficiency ◽  
Surgical Stress ◽  
Perioperative Period ◽  
Hemodynamic Instability ◽  
Current Evidence ◽  
Major Surgery ◽  
Adrenal Crisis ◽  
Number Of Patients ◽  
Glucocorticoid Administration ◽  
Stress Dose

Glucocorticoid preparations, adreno-cortical steroids, with strong anti-inflammatory and immunosuppressive effects, are widely used for treating various diseases. The number of patients exposed to steroid therapy prior to surgery is increasing. When these patients present for surgery, the anesthesiologist must decide whether to administer perioperative steroid supplementation. Stress-dose glucocorticoid administration is required during the perioperative period because of the possibility of failure of cortisol secretion to cope with the increased cortisol requirement due to surgical stress, adrenal insufficiency, hemodynamic instability, and the possibility of adrenal crisis. Therefore, glucocorticoids should be supplemented at the same level as that of normal physiological response to surgical stress by evaluating the invasiveness of surgery and inhibition of the hypothalamus-pituitary-adrenal axis. Various textbooks and research articles recommend the stress-dose of glucocorticoids during perioperative periods. It has been commonly suggested that glucocorticoids should be administered in an amount equivalent to about 100 mg of cortisol for major surgery because it induces approximately 5 times the normal secretion. However, more studies, with appropriate power, regarding the administration of stress-dose glucocorticoids are still required, and evaluation of patients with possible adrenal insufficiency and appropriate glucocorticoid administration based on surgical stress will help improve the prognosis.

scholarly journals Transversus abdominis plane block with general anesthesia blunts the perioperative stress response in patients undergoing radical gastrectomy

2019 ◽  
Author(s):  
Ruizhu Liu ◽  
Haiyan Qin ◽  
Meng Wang ◽  
Kai Li ◽  
Guoqing Zhao
Keyword(s):  
Stress Response ◽  
Adverse Effects ◽  
General Anesthesia ◽  
Surgical Stress ◽  
Perioperative Period ◽  
Transversus Abdominis ◽  
Control Group ◽  
Radical Gastrectomy ◽  
Tap Block ◽  
Transversus Abdominis Plane

Abstract Background: Surgical stress induces the release of neuroendocrine mediators and cytokines during perioperative period, which may have adverse effects on cancer patients. While the surgical stress response can be affected by anesthetic technique. Therefore, we designed this study to assess whether subcostal transversus abdominis plane (TAP) block can affect perioperative neuroendocrine stress response, postoperative analgesia and postoperative recovery in patients undergoing radical gastrectomy under general anesthesia. Methods: Sixty-five patients were recruited. Patients randomly received general anesthesia (control group), or general anesthesia combined with TAP block (40 mL of 0.375% ropivacaine) (TAP group). The primary outcome was neuroendocrine levels including norepinephrine (NE), epinephrine (E), cortisol (Cor), glucose (Glu), interleukin (IL)-6 and IL-10 during 48 h after surgery. Secondary outcomes included pain score, hemodynamic variables and recovery characteristics. Results: Data from 61 of 65 patients were analyzed. The levels of NE, E, Cor, and Glu were blunt by TAP block during perioperative period. The levels of IL-6 and IL-10 were significantly lower in TAP group than in control group. TAP block efficiently relieved postoperative acute pain up to 12 h postoperatively with more stable perioperative hemodynamics compared with control group. Conclusions: Subcostal TAP block blunts perioperative stress response and provides efficient analgesia, with good hemodynamic stability and minimal adverse effects.

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