scholarly journals Sedation versus General Anesthesia for Cardiac Catheterization in Infants: A Retrospective, Monocentric, Cohort Evaluation

2021 ◽  
Vol 10 (23) ◽  
pp. 5648
Author(s):  
Marian Mikus ◽  
Thomas Welchowski ◽  
Ehrenfried Schindler ◽  
Martin Schneider ◽  
Nathalie Mini ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Cardiac Catheterization ◽  
Anesthetic Management ◽  
Multivariable Analysis ◽  
Risk Category ◽  
Hemodynamic Support ◽  
High Severity ◽  
Paradoxical Effects ◽  
Interventional Catheterization ◽  
Procedure Type

Background: Children with congenital heart disease require repeated catheterization. Anesthetic management influences the procedure and may influence outcome; however, data and recommendations are lacking for infants. We studied the influence of sedation versus general anesthesia (GA) on adverse events during catheterization for children <2 years old. Methods: We conducted a monocentric, retrospective study of all catheterization procedures (2008–2013). High-severity adverse event (HSAE) rates were compared using propensity-score-adjusted models, including pre- and intra-procedural variables. Results: 803 cases (619 patients) (368 (46%) GA, 435 (54%) sedation) with a mean age of 6.9 ± 6.1 months were studied. The conversion rate (GA after sedation) was 18 (4%). Hospital stay was 4.9 ± 4.0 and 4.1 ± 2.5 (p = 0.01) after GA or sedation, respectively. HSAE occurred in 75 (20%) versus 40 (9%) (p < 0.01) in GA versus sedation procedures, respectively. Risk factors (multivariable analysis) were older patients (p = 0.05), smaller weights (p < 0.01), palliated status (OR 3.2 [1.2–8.9], p = 0.02), two-ventricle physiology (OR 7.3 [2.7–20.2], p < 0.01), cyanosis (OR 4.6 [2.2–9.8], p < 0.01), pulmonary hypertension (OR 5.6 [2.0–15.5], p < 0.01), interventional catheterization (OR 1.8 [1.1–3.2], p = 0.02) and procedure-type risk category 4 (OR 28.9 [1.8–455.1], p = 0.02). Sedation did not increase the events rate and decreased the requirement for hemodynamic support (OR 5.2 [2.2–12.0], p < 0.01). Conclusion: Sedation versus GA for cardiac catheterization in children <2 years old is safe and effective with regard to HSAE. Sedation also decreases the requirement for hemodynamic support. Paradoxical effects (older age and two-ventricle physiology) on risk have been found for this specific age cluster.

scholarly journals Procedural Risk in Congenital Cardiac Catheterization (PREDIC 3 T)

2021 ◽  
Author(s):  
Brian P. Quinn ◽  
Mary Yeh ◽  
Kimberlee Gauvreau ◽  
Fatima Ali ◽  
David Balzer ◽  
...  
Keyword(s):  
Adverse Event ◽  
Adverse Events ◽  
Cardiac Catheterization ◽  
Assessment Tools ◽  
Risk Category ◽  
Patient Risk ◽  
High Severity ◽  
Case Type ◽  
Vulnerability Score ◽  
Risk Categories

Background Advancements in the field, including novel procedures and multiple interventions, require an updated approach to accurately assess patient risk. This study aims to modernize patient hemodynamic and procedural risk classification through the creation of risk assessment tools to be used in congenital cardiac catheterization. Methods and Results Data were collected for all cases performed at sites participating in the C3PO (Congenital Cardiac Catheterization Project on Outcomes) multicenter registry. Between January 2014 and December 2017, 23 119 cases were recorded in 13 participating institutions, of which 88% of patients were <18 years of age and 25% <1 year of age; a high‐severity adverse event occurred in 1193 (5.2%). Case types were defined by procedure(s) performed and grouped on the basis of association with the outcome, high‐severity adverse event. Thirty‐four unique case types were determined and stratified into 6 risk categories. Six hemodynamic indicator variables were empirically assessed, and a novel hemodynamic vulnerability score was determined by the frequency of high‐severity adverse events. In a multivariable model, case‐type risk category (odds ratios for category: 0=0.46, 1=1.00, 2=1.40, 3=2.68, 4=3.64, and 5=5.25; all P ≤0.005) and hemodynamic vulnerability score (odds ratio for score: 0=1.00, 1=1.27, 2=1.89, and ≥3=2.03; all P ≤0.006) remained independent predictors of patient risk. Conclusions These case‐type risk categories and the weighted hemodynamic vulnerability score both serve as independent predictors of patient risk for high‐severity adverse events. This contemporary procedure‐type risk metric and weighted hemodynamic vulnerability score will improve our understanding of patient and procedural outcomes.

scholarly journals General anesthesia with remimazolam in a patient with mitochondrial encephalomyopathy: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yuji Suzuki ◽  
Matsuyuki Doi ◽  
Yoshiki Nakajima
Keyword(s):  
Lactic Acidosis ◽  
General Anesthesia ◽  
Mitochondrial Disease ◽  
Muscle Relaxation ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Mitochondrial Encephalomyopathy ◽  
Anesthesia Induction ◽  
General Anesthetic ◽  
Anesthetic Agents

Abstract Background Systemic anesthetic management of patients with mitochondrial disease requires careful preoperative preparation to administer adequate anesthesia and address potential disease-related complications. The appropriate general anesthetic agents to use in these patients remain controversial. Case presentation A 54-year-old woman (height, 145 cm; weight, 43 kg) diagnosed with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes underwent elective cochlear implantation. Infusions of intravenous remimazolam and remifentanil guided by patient state index monitoring were used for anesthesia induction and maintenance. Neither lactic acidosis nor prolonged muscle relaxation occurred in the perioperative period. At the end of surgery, flumazenil was administered to antagonize sedation, which rapidly resulted in consciousness. Conclusions Remimazolam administration and reversal with flumazenil were successfully used for general anesthesia in a patient with mitochondrial disease.

scholarly journals Cholinesterase activity in serum during general anesthesia in patients with or without vascular disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yitzhak Brzezinski-Sinai ◽  
Ester Zwang ◽  
Elena Plotnikova ◽  
Ester Halizov ◽  
Itzhak Shapira ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
General Anesthesia ◽  
Vascular Disease ◽  
Cholinesterase Activity ◽  
Serum Cholinesterase ◽  
Hemodynamic Support ◽  
System A ◽  
Lower Baseline ◽  
Increased Risk ◽  
A Prospective Study

AbstractMaintaining hemodynamic stability during the induction and maintenance of anesthesia is one of the challenges of the anesthesiologist. Patients with vascular disease are at increased risk of instability due to imbalance between the sympathetic and parasympathetic parts of the autonomic nervous system, a balance accessible by serum cholinesterase activity. We aim to characterize the dynamics of cholinesterase activity in patients undergoing general anesthesia (GA) and surgery. This was a prospective study of 57 patients undergoing ambulatory or vascular surgery under GA. Cholinesterase activity was measured before the induction of anesthesia, after 15 min and at the end of surgery by calculating the capacity of serum acetylcholinesterase (AChE) and butyrylcholinesterase to hydrolyze AcetylThioCholine. Data on atherosclerotic disease, anesthesia management were analyzed. Both AChE and total cholinergic status (CS) decreased significantly after GA induction at 15 min and even more so by the end of surgery. Vascular surgery patients had lower baseline cholinesterase activity compared to ambulatory surgery patients. Patients requiring intraoperative administration of phenylephrine for hemodynamic support (21.1%) had a significantly lower level of AChE and CS compared to untreated patients. Our findings serve as a mirror to the sympathetic/parasympathetic imbalance during GA, with a marked decrease in the parasympathetic tone. The data of a subgroup analysis show a correlation between low cholinesterase activity and an increase in the need for hemodynamic support.

scholarly journals Junctional Rhythm Preoperatively and During General Anesthesia for Oral and Maxillofacial Surgery

2017 ◽  
Vol 64 (3) ◽  
pp. 165-167 ◽  
Author(s):  
Naotaka Kishimoto ◽  
Ikue Kinoshita ◽  
Yoshihiro Momota
Keyword(s):  
General Anesthesia ◽  
Local Anesthesia ◽  
Anesthetic Management ◽  
Maxillofacial Surgery ◽  
Oral And Maxillofacial Surgery ◽  
Anesthesia Induction ◽  
Sagittal Split Ramus Osteotomy ◽  
Junctional Rhythm ◽  
Appropriate Treatment ◽  
Slow Heart Rate

We report a case of junctional rhythm that occurred both preoperatively and later during a portion of general anesthesia. A 19-year-old woman was scheduled to undergo bilateral sagittal split ramus osteotomy after being diagnosed with a jaw deformity. Preoperative electrocardiography (ECG) revealed a junctional rhythm with a slow heart rate (HR). At 90 minutes after anesthesia induction, local anesthesia with 10 mL of 1% lidocaine and 1:100,000 adrenaline was administered. A junctional rhythm appeared 15 minutes after the local anesthesia. We believe that the atrioventricular nodal pacemaker cells accelerated because of the increased sympathetic activity due to the adrenaline. On the preoperative ECG, the junctional rhythm with slow HR appeared as an escaped beat caused by slowing of the primary pacemaker. Therefore, we think that the preoperative junctional rhythm and the junctional rhythm that appeared during general anesthesia were due to different causes. Understanding the cause of a junctional rhythm could lead to more appropriate treatment. We therefore believe that identifying the cause of the junctional rhythm is important in anesthetic management.

scholarly journals Right Breast Mastectomy and Reconstruction with Tissue Expander under Thoracic Paravertebral Blocks in a 12-Week Parturient

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Christopher Allen-John Webb ◽  
Paul David Weyker ◽  
Shara Cohn ◽  
Amanda Wheeler ◽  
Jennifer Lee
Keyword(s):  
Breast Cancer ◽  
Postoperative Pain ◽  
General Anesthesia ◽  
Pain Control ◽  
Breast Surgery ◽  
Anesthetic Management ◽  
Healthy Woman ◽  
Tissue Expander ◽  
Postoperative Pain Control ◽  
Tissue Expanders

Paravertebral blocks are becoming increasingly utilized for breast surgery with studies showing improved postoperative pain control, decreased need for opioids, and less nausea and vomiting. We describe the anesthetic management of an otherwise healthy woman who was 12 weeks pregnant presenting for treatment of her breast cancer. For patients undergoing breast mastectomy and reconstruction with tissue expanders, paravertebral blocks offer an anesthetic alternative when general anesthesia is not desired.

scholarly journals Hypotension during endovascular treatment under general anesthesia for acute ischemic stroke

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0249093
Author(s):  
Sabine L. Collette ◽  
Maarten Uyttenboogaart ◽  
Noor Samuels ◽  
Irene C. van der Schaaf ◽  
H. Bart van der Worp ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
General Anesthesia ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Randomized Clinical Trials ◽  
Anesthetic Management ◽  
Poor Functional Outcome ◽  
Anterior Circulation ◽  
Period Increase

Objective The effect of anesthetic management (general anesthesia [GA], conscious sedation, or local anesthesia) on functional outcome and the role of blood pressure management during endovascular treatment (EVT) for acute ischemic stroke is under debate. We aimed to determine whether hypotension during EVT under GA is associated with functional outcome at 90 days. Methods We retrospectively collected data from patients with a proximal intracranial occlusion of the anterior circulation treated with EVT under GA. The primary outcome was the distribution on the modified Rankin Scale at 90 days. Hypotension was defined using two thresholds: a mean arterial pressure (MAP) of 70 mm Hg and a MAP 30% below baseline MAP. To quantify the extent and duration of hypotension, the area under the threshold (AUT) was calculated using both thresholds. Results Of the 366 patients included, procedural hypotension was observed in approximately half of them. The occurrence of hypotension was associated with poor functional outcome (MAP <70 mm Hg: adjusted common odds ratio [acOR], 0.57; 95% confidence interval [CI], 0.35–0.94; MAP decrease ≥30%: acOR, 0.76; 95% CI, 0.48–1.21). In addition, an association was found between the number of hypotensive periods and poor functional outcome (MAP <70 mm Hg: acOR, 0.85 per period increase; 95% CI, 0.73–0.99; MAP decrease ≥30%: acOR, 0.90 per period; 95% CI, 0.78–1.04). No association existed between AUT and functional outcome (MAP <70 mm Hg: acOR, 1.000 per 10 mm Hg*min increase; 95% CI, 0.998–1.001; MAP decrease ≥30%: acOR, 1.000 per 10 mm Hg*min; 95% CI, 0.999–1.000). Conclusions Occurrence of procedural hypotension and an increase in number of procedural hypotensive periods were associated with poor functional outcome, whereas the extent and duration of hypotension were not. Randomized clinical trials are needed to confirm our hypothesis that hypotension during EVT under GA has detrimental effects.

scholarly journals Spinal versus general anesthesia for patients undergoing outpatient total knee arthroplasty: a national propensity matched analysis of early postoperative outcomes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mark C. Kendall ◽  
Alexander D. Cohen ◽  
Stephanie Principe-Marrero ◽  
Peter Sidhom ◽  
Patricia Apruzzese ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Adverse Events ◽  
General Anesthesia ◽  
Knee Arthroplasty ◽  
Anesthetic Management ◽  
Anesthetic Technique ◽  
Anesthetic Techniques ◽  
Short Term ◽  
Knee Replacements ◽  
Total Knee

Abstract Background A comparison of different anesthetic techniques to evaluate short term outcomes has yet to be performed for patients undergoing outpatient knee replacements. The aim of this investigation was to compare short term outcomes of spinal (SA) versus general anesthesia (GA) in patients undergoing outpatient total knee replacements. Methods The ACS NSQIP datasets were queried to extract patients who underwent primary, elective, unilateral total knee arthroplasty (TKA) between 2005 and 2018 performed as an outpatient procedure. The primary outcome was a composite score of serious adverse events (SAE). The primary independent variable was the type of anesthesia (e.g., general vs. spinal). Results A total of 353,970 patients who underwent TKA procedures were identified comprising of 6,339 primary, elective outpatient TKA procedures. Of these, 2,034 patients received GA and 3,540 received SA. A cohort of 1,962 patients who underwent outpatient TKA under GA were propensity matched for covariates with patients who underwent outpatient TKA under SA. SAE rates at 72 h after surgery were not greater in patients receiving GA compared to SA (0.92%, 0.66%, P = 0.369). In contrast, minor adverse events were greater in the GA group compared to SA (2.09%, 0.51%), P < 0.001. The rate of postoperative transfusion was greater in the patients receiving GA. Conclusions The type of anesthetic technique, general or spinal anesthesia does not alter short term SAEs, readmissions and failure to rescue in patients undergoing outpatient TKR surgery. Recognizing the benefits of SA tailored to the anesthetic management may maximize the clinical benefits in this patient population.

scholarly journals Multimodal anesthesia and analgesia at the stages of the perioperative period in children with abdominal surgical pathology

2021 ◽  
Vol 24 (1) ◽  
pp. 27-31
Author(s):  
Elmira A. Satvaldieva ◽  
Otabek Ya. Fayziev ◽  
Anvar S. Yusupov
Keyword(s):  
General Anesthesia ◽  
Postoperative Period ◽  
Surgical Intervention ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Postoperative Recovery ◽  
Surgical Pathology ◽  
Abdominal Organ ◽  
Epidural Blockade ◽  
Abdominal Operations

Aim of the study was assess both the effectiveness and safety of anesthetic management and optimizing postoperative anesthesia under conditions of multimodal anesthesia and analgesia during abdominal operations in children. Patients and methods. The authors examined 58 children aged 1 to 17 years with abdominal operations (malformations, diseases, and abdominal organ injuries). To ensure anesthetic protection, patients underwent combined general anesthesia with propofol and fentanil (induction) with inhalation of sevoflurane + propofol intra venous (maintenance) in combination with epidural blockade with bupivacaine. Results. According to surgical intervention, the arrangement of perioperative analgesic protection provided a favorable correction of the hemodynamic status of patients, a decrease in inhalation anesthetic, promoted a smooth course of the postoperative period, a long painless period, an excellent psychoemotional background, and rapid postoperative recovery.

Abstract 187: Impact of General Anesthesia on Safety and Outcomes in the Endovascular Arm of IMS III

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Alex Abou-Chebl ◽  
Michael D Hill ◽  
Bernard Yan ◽  
Kevin Cockroft ◽  
Pooja Khatri ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Multivariable Analysis ◽  
Negative Association ◽  
Hospital Death ◽  
Data Set ◽  
Neurological Outcomes ◽  
Good Outcome ◽  
Increased Risk ◽  
Significant Difference ◽  
Iv Tpa

Objectives: Use of general anesthesia (GA) during endovascular therapy (ET) of AIS patients is controversial with some suggestion of worse outcomes and death. The IMS III trial permitted the study of the effect of GA in a prospectively collected data set to test two hypotheses: (1) intubation is associated with poorer outcomes and (2) there is no increase in the risk of SAH or sICH with local anesthesia (LA). Methods: IMS III was a randomized trial of IV tPA +/- ET in patients presenting within 3hrs of AIS onset. In addition to demographic and outcomes data (mRS, ICH, etc.), information was collected on GA use or not within 7hrs of stroke onset. A good outcome was defined as mRS≤2 at 90 days. A multivariable analysis adjusting for dichotomized NIHSS (8-19 vs. ≥20), age and time from onset to groin puncture was performed. Additional analyses of reasons for intubation are ongoing and will be part of the presentation. Results: Four-hundred-thirty-four patients were randomized to ET, 269(62%) with LA and 147(33.9%) with GA. They were evenly matched in demographics, medical comorbidities, time to tPA, time to groin puncture, 40minute post IV tPA bolus SBP and occlusion location/side. The baseline NIHSS were slightly lower in the LA group (median 16 vs. 18). The GA group was less likely to achieve a good outcome (RR 0.64, CI 0.49-0.84, p=0.001) and had a greater risk of in-hospital death (RR 3.11, CI 1.86-5.20, p<0.0001). There was an increased risk of SAH in the GA group (RR 1.79, CI 1.04-3.08, p=0.0364) but no statistically significant difference in sICH (RR 1.69, CI 0.79-3.61, p=0.18). The multivariable analysis confirmed the negative association between GA and good outcomes (RR 0.68, CI 0.52-0.90, p=0.0027). Conclusions: In the IMS III trial there was an association with worse neurological outcomes and increased mortality with ET under GA. Also, there was an association between GA and an increased risk of SAH. Although the reasons for these associations are not clear, these data support the use of LA when possible during ET.

General Anesthesia for Cardiac Catheterization in Children

1975 ◽  
Vol 8 (2) ◽  
pp. 153
Author(s):  
Wha Sung Chung ◽  
Hung Kun Oh ◽  
Ian S Robb
Keyword(s):  
General Anesthesia ◽  
Cardiac Catheterization
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