scholarly journals The Associations Between Cognitive Dysfunction, Stress Biomarkers, and Administered Anesthesia Type in Total Knee Arthroplasties: Prospective, Randomized Trial

2019 ◽  
Vol 5 (22;5) ◽  
pp. 495-507 ◽  
Author(s):  
Ipek Saadet Edipoglu
Keyword(s):  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Cognitive Dysfunction ◽  
Regional Anesthesia ◽  
Controlled Study ◽  
Glucose Levels ◽  
Stress Biomarkers ◽  
Neurocognitive Tests ◽  
Number Of Patients ◽  
Total Knee

Background: Postoperative cognitive dysfunction (POCD) is a serious complication associated with total knee arthroplasty (TKA) and has been shown to increase the length of hospital stay, cause functional impairment, and morbidity. Objectives: We aimed to determine whether POCD is associated with the use of general or regional anesthesia in patients undergoing TKA. Our hypothesis was that POCD would be reduced in the group that received regional analgesia without any sedations. Our secondary hypothesis was POCD would be associated with biomarkers of surgical stress. Study Design: Randomized controlled study between general and spinal anesthesia. Setting: Single-centered, university hospital, from January to October 2017. Methods: A total of 112 patients were assessed for eligibility, and a total of 57 patients completed the study. We divided the patients into general and regional anesthesia groups. Blood samples were obtained preoperatively at the first intraoperative, the third and the 24th postoperative hour. C-reactive protein (CRP), cortisol, insulin, and blood glucose levels were tested. We used 4 neurocognitive tests that were administered 1 day before operation, 7 days and 30 days after operation. Main outcome measures were neurocognitive tests scores for regional anesthesia without sedation and general anesthesia groups. Cortisol, glucose, insulin, and CRP levels. Results: Patients who received regional anesthesia showed significantly higher Mini-Mental State Examination (MMSE) scored compared with the general anesthesia at the seventh day (P = 0.037). In the general anesthesia group, patients showed significantly higher variations for the Stroop number difference. There were negative correlations between MMSE scores measured at postoperative day 7 and the 1-hour intraoperative cortisol measurements (r = –0.302; P = 0.022) and 3-hour postoperative cortisol measurements (r = –0.295; P = 0.026). Limitations: A limitation was the small number of patients. Conclusions: We demonstrate that regional anesthesia results in better neurocognitive test scores than general anesthesia in patients undergoing TKA. Patients who received regional anesthesia showed lower cortisol, higher insulin, and lower glucose levels. We recommend that patients who undergo arthroplasty surgeries should receive regional anesthesia to avoid POCD at the early stages of the postoperative period. Key words: Cognitive dysfunction, stress biomarkers, acute pain, regional anesthesia, spinal anesthesia

scholarly journals Spinal Versus General Anesthesia for Laparoscopic Cholecystectomy

2018 ◽  
Vol 25 ◽  
pp. 55-58
Author(s):  
SMA Taher ◽  
Jamil Raihan ◽  
M Abu Zahid ◽  
AK Azad ◽  
MI Alam ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Regional Anesthesia ◽  
Gold Standard ◽  
Randomised Trial ◽  
Gall Stone ◽  
Chronic Obstructive ◽  
First Time ◽  
Symptomatic Gall Stone

Laparascopic Cholecystectomy under regional anesthesia alone has been reported only with severe chronic obstructive airway disease1,2. In a randomised trial, epidural with general anesthesia have been found to be more effective in lessening postoperative pain compare with general anesthesia alone3. Regional anesthesia has been successfully used for laparascopic cholecystectomy in patient. Hamad and Ibrahim El-Khatter4 used spinal anesthesia for laparoscopic for the first time. We performing Laparascopic Cholecystectomy with carbondioxide pneumoperitoneum under spinal anesthesia alone of healthy patients with symptomatic gall stone disease5. We design a control randomized trial to compare spinal anesthesthesia with the Gold standard general anesthesia for elective Laparascopic Cholecystectomy in healty patients.TAJ 2012; 25: 55-58

scholarly journals Regional or general anesthesia for fast-track hip and knee replacement - what is the evidence?

F1000Research ◽  
2015 ◽  
Vol 4 ◽  
pp. 1449 ◽  
Author(s):  
Henrik Kehlet ◽  
Eske Kvanner Aasvang
Keyword(s):  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Regional Anesthesia ◽  
Hip Arthroplasty ◽  
Afferent Input ◽  
Bladder Function ◽  
Anesthetic Techniques ◽  
Thromboembolic Complications ◽  
General Anesthetic ◽  
Knee And Hip Arthroplasty

Regional anesthesia for knee and hip arthroplasty may have favorable outcome effects compared with general anesthesia by effectively blocking afferent input, providing initial postoperative analgesia, reducing endocrine metabolic responses, and providing sympathetic blockade with reduced bleeding and less risk of thromboembolic complications but with undesirable effects on lower limb motor and urinary bladder function. Old randomized studies supported the use of regional anesthesia with fewer postoperative pulmonary and thromboembolic complications, and this has been supported by recent large non-randomized epidemiological database cohort studies. In contrast, the data from newer randomized trials are conflicting, and recent studies using modern general anesthetic techniques may potentially support the use of general versus spinal anesthesia. In summary, the lack of properly designed large randomized controlled trials comparing modern general anesthesia and spinal anesthesia for knee and hip arthroplasty prevents final recommendations and calls for prospective detailed studies in this clinically important field.

scholarly journals The Effect of Intraoperative Sounds of Saw and Hammer on Psychological Condition in Patients with Total Knee Arthroplasty: Prospective Randomized Study

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Erkam Kömürcü ◽  
Hasan Ali Kiraz ◽  
Burak Kaymaz ◽  
Umut Hatay Gölge ◽  
Gürdal Nusran ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Knee Arthroplasty ◽  
Randomized Study ◽  
General Anesthesia Group ◽  
Anesthesia Group ◽  
Negative Effect ◽  
Total Knee ◽  
Spinal Anesthesia Group

Purpose. Surgical procedures are likely to be stressful for patients and their families. Total knee arthroplasty (TKA) is a major surgical procedure used in the treatment of osteoarthritis. During this procedure the sounds of the saw and hammer may irritate the patient and adversely affect mood. The present study examines the effect of these intraoperative sounds during TKA on postoperative mood and anxiety, by comparing two different anesthetic procedures.Methods. A total of 40 patients who underwent TKA for grade IV gonarthrosis participated in the study. Patients were randomly divided into two groups: 20 patients in the general anesthesia group and 20 patients in the spinal anesthesia group. Mood and anxiety changes were evaluated using the Profile of Mood States (POMS) and State-Trait Anxiety Inventory (STAI) instruments, respectively.Results. The postoperative POMS value in the spinal anesthesia group was definitively higher than the general anesthesia group, though the difference in preoperative and postoperative POMS and STAI scores between the two groups was not significant.Conclusion. It would seem that sounds of hammer and saw have no evident negative effect on patient’s mood. Regional anesthesia is advisable for TKA patients and appropriate sedation can be administered during the operation if needed.

Effect of Low-dose Droperidol on the QT Interval during and after General Anesthesia

2005 ◽  
Vol 102 (6) ◽  
pp. 1101-1105 ◽  
Author(s):  
Paul F. White ◽  
Dajun Song ◽  
Joao Abrao ◽  
Kevin W. Klein ◽  
Bryan Navarette
Keyword(s):  
General Anesthesia ◽  
Small Dose ◽  
Qt Interval ◽  
Controlled Study ◽  
Anesthetic Technique ◽  
Qtc Interval ◽  
Qtc Prolongation ◽  
Double Blind ◽  
Antiemetic Prophylaxis ◽  
Number Of Patients

Background Since the effects of antiemetic doses of droperidol on the QT interval have not been previously studied, the authors designed a randomized, double-blind, placebo-controlled study to evaluate the intraoperative and postoperative effects of small-dose droperidol (0.625 and 1.25 mg intravenous) on the QT interval when used for antiemetic prophylaxis during general anesthesia. Methods One hundred twenty outpatients undergoing otolaryngologic procedures with a standardized general anesthetic technique were enrolled in this study. After anesthetic induction and before the surgical incision, 60 patients were given either saline or 0.625 or 1.25 mg intravenous droperidol in a total volume of 2 ml. A standard electrocardiographic lead II was recorded immediately before and every minute after the injection of the study medication during a 10-min observation period. The QTc (QT interval corrected for heart rate) was evaluated from the recorded electrocardiographic strips. In 60 additional patients, a 12-lead electrocardiogram was obtained before and at specific intervals up to 2 h after surgery to assess the effects of droperidol and general anesthesia on the QTc. Any abnormal heartbeats or arrhythmias during the operation or the subsequent 2-h monitoring interval were also noted. Results Intravenous droperidol, 0.625 and 1.25 mg, prolonged the QT interval by an average of 15 +/- 40 and 22 +/- 41 ms, respectively, at 3-6 min after administration during general anesthesia, but these changes did not differ significantly from that seen with saline (12 +/- 35 ms) (all values mean +/- SD). There were no statistically significant differences among the three study groups in the number of patients with greater than 10% prolongation in QTc (vs. baseline). Although general anesthesia was associated with a 14- to 16-ms prolongation of the QTc interval in the early postoperative period, there was no evidence of droperidol-induced QTc prolongation after surgery. Finally, there were no ectopic heartbeats observed on any of the electrocardiographic rhythm strips or 12-lead recordings during the perioperative period. Conclusion Use of a small dose of droperidol (0.625-1.25 mg intravenous) for antiemetic prophylaxis during general anesthesia was not associated with a statistically significant increase in the QTc interval compared with saline. More importantly, there was no evidence of any droperidol-induced QTc prolongation immediately after surgery.

scholarly journals Carbon Footprint of General, Regional, and Combined Anesthesia for Total Knee Replacements

2021 ◽  
Author(s):  
Forbes McGain ◽  
Nicole Sheridan ◽  
Kasun Wickramarachchi ◽  
Simon Yates ◽  
Brandon Chan ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Life Cycle Assessment ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Carbon Footprint ◽  
Knee Replacements ◽  
Total Knee ◽  
Single Use ◽  
Combined Anesthesia ◽  
Carbon Dioxide Equivalent

Background Health care itself contributes to climate change. Anesthesia is a “carbon hotspot,” yet few data exist to compare anesthetic choices. The authors examined the carbon dioxide equivalent emissions associated with general anesthesia, spinal anesthesia, and combined (general and spinal anesthesia) during a total knee replacement. Methods A prospective life cycle assessment of 10 patients in each of three groups undergoing knee replacements was conducted in Melbourne, Australia. The authors collected input data for anesthetic items, gases, and drugs, and electricity for patient warming and anesthetic machine. Sevoflurane or propofol was used for general anesthesia. Life cycle assessment software was used to convert inputs to their carbon footprint (in kilogram carbon dioxide equivalent emissions), with modeled international comparisons. Results Twenty-nine patients were studied. The carbon dioxide equivalent emissions for general anesthesia were an average 14.9 (95% CI, 9.7 to 22.5) kg carbon dioxide equivalent emissions; spinal anesthesia, 16.9 (95% CI, 13.2 to 20.5) kg carbon dioxide equivalent; and for combined anesthesia, 18.5 (95% CI, 12.5 to 27.3) kg carbon dioxide equivalent. Major sources of carbon dioxide equivalent emissions across all approaches were as follows: electricity for the patient air warmer (average at least 2.5 kg carbon dioxide equivalent [20% total]), single-use items, 3.6 (general anesthesia), 3.4 (spinal), and 4.3 (combined) kg carbon dioxide equivalent emissions, respectively (approximately 25% total). For the general anesthesia and combined groups, sevoflurane contributed an average 4.7 kg carbon dioxide equivalent (35% total) and 3.1 kg carbon dioxide equivalent (19%), respectively. For spinal and combined, washing and sterilizing reusable items contributed 4.5 kg carbon dioxide equivalent (29% total) and 4.1 kg carbon dioxide equivalent (24%) emissions, respectively. Oxygen use was important to the spinal anesthetic carbon footprint (2.8 kg carbon dioxide equivalent, 18%). Modeling showed that intercountry carbon dioxide equivalent emission variability was less than intragroup variability (minimum/maximum). Conclusions All anesthetic approaches had similar carbon footprints (desflurane and nitrous oxide were not used for general anesthesia). Rather than spinal being a default low carbon approach, several choices determine the final carbon footprint: using low-flow anesthesia/total intravenous anesthesia, reducing single-use plastics, reducing oxygen flows, and collaborating with engineers to augment energy efficiency/renewable electricity. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Association between type of anesthesia and length of hospital stay in primary unilateral total knee arthroplasty patients: a single-center retrospective study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Xiaoqing Wang ◽  
He Li ◽  
Conghu Yuan ◽  
Hang Zhao
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Blood Transfusion ◽  
Elderly Patients ◽  
General Anesthesia ◽  
Regional Anesthesia ◽  
Length Of Hospital Stay ◽  
Regression Analyses ◽  
Total Knee ◽  
Perioperative Blood Transfusion

Abstract Objective This study explored the risk factors influencing the length of hospital stay (LOS) and establish whether the type of anesthesia is independently associated with the LOS in patients after primary unilateral total knee arthroplasty (TKA). Methods In this retrospective cohort study, 2309 patients undergoing unilateral TKA were recruited between January 2013 and June 2014 in a tertiary academic medical center in Singapore. Univariate and multivariate linear regression analyses were used to identify the independent risk factors associated with LOS. Besides, subgroup and interaction analyses were performed to evaluate the relationship between the type of anesthesia and LOS. Result In total, 2309 patients were identified. Out of these, 791 patients underwent general anesthesia, whereas 1518 patients underwent regional anesthesia. Multivariate regression analyses revealed that prolonged LOS was significantly associated with age ≥ 65 years (β = 0.48; 95% CI, 0.09–0.87; P = 0.015), diabetes mellitus (DM) (β = 0.8; 95% CI, 0.33–1.27; P = 0.001), congestive cardiac failure (CCF) (β = 4.1; 95% CI, 2.02–6.17; P < 0.001), perioperative blood transfusion (β = 5.71; 95% CI, 4.86–6.56; P < 0.001), creatinine > 2 mg/dL (β = 4.54; 95% CI, 2.46–6.62; P < 0.001), ASA status (III) (β = 1.72; 95% CI, 0.72–2.71; P = 0.001), general anesthesia (β = 0.78; 95% CI, 0.41–1.66; P < 0.001). The LOS further decreased among participants receiving regional anesthesia at advanced age (age ≥ 65 years) (β = − 1.12; 95% CI, − 1.66 to − 0.58; P < 0.001), patients with BMI ≤ 25 kg/m2 (β = − 1.92; 95% CI, − 2.73 to − 1.11; P < 0.001) or ≥ 30 kg/m2 (β = − 0.58; 95% CI, − 1.1 to − 0.06; P = 0.029). Conclusion Our findings demonstrated that age ≥ 65 years, DM, CCF, perioperative blood transfusion, creatinine > 2 mg/dL, ASA status (III), general anesthesia are associated with a prolonged LOS after primary TKA. Elderly patients (age ≥ 65 years) and patients with BMI ≤ 25 kg/m2 or ≥ 30 kg/m2 receiving regional anesthesia have a further reduced LOS. Therefore, when TKA is performed, priority for regional anesthesia is given to the elderly patients (age ≥ 65 years old) and those with BMI ≤ 25 kg/m2 or ≥ 30 kg/m2.

scholarly journals Brief communication (Original). Anesthesia for cesarean section in parturients diagnosed with placenta previa in a Thai university hospital: a retrospective analysis of 562 consecutive cases

2014 ◽  
Vol 8 (6) ◽  
pp. 735-741
Author(s):  
Pornarun Charoenraj ◽  
Somrat Charuluxananan ◽  
Phornlert Chatrkaw ◽  
Chooksak Tunprasit ◽  
Parinya Wangdumrongwong ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Retrospective Analysis ◽  
Cesarean Delivery ◽  
Regional Anesthesia ◽  
Placenta Previa ◽  
Univariate Analysis ◽  
University Hospital ◽  
Related Complication ◽  
Cesarean Hysterectomy

Abstract Background: Anesthesia for cesarean delivery in parturients diagnosed with placenta previa remains controversial. Objectives: To investigate factors correlated with choice of anesthesia in these parturients and their outcomes. Methods: Retrospective analysis of patients with placenta previa and cesarean delivery at King Chulalongkorn Memorial Hospital. Peri operative anesthetic and complication data were collected using a structured collection form. Univariate analysis and multivariate logistic regression were used. P < 0.05 was considered significant. Results: Among 50,237 deliveries from July 1, 2005 to June 30, 2011, there were 562 cesarean sections in diagnosed cases of placenta previa. Cesarean deliveries (479) were performed under spinal anesthesia (81%), epidural anesthesia (1.8%), and if the effects spinal anesthesia dissipated, general anesthesia (2.3%). Among 46 cases of cesarean hysterectomy, 27 patients (58.7%) received regional anesthesia. However, 6 of 10 patients with planned cesarean hysterectomy underwent general anesthesia, while 1 of 4 of a group with regional anesthesia needed conversion to general anesthesia. There was no serious anesthesia-related complication. Factors related to general anesthesia were: a higher American Society of Anesthesiologists (ASA) physical status OR 2.7 (95% CI 1.7-4.3) P < 0.001; presentation with bleeding OR 1.8(95% CI 1.0-3.1) P = 0.033; anterior site of placenta OR 1.8 (95% CI 1.1-3.2) P = 0.025; heart rate >125 bpm OR 5.6 (95% CI 1.5-214) P = 0.01; and pack red cell transfusion OR 3.4 (95% CI 2.0-5.7) P < 0.001. Conclusions: Most parturients received regional anesthesia. Neuroaxial anesthesia and general anesthesia are safe.

scholarly journals Perbandingan kadar gula darah pasca pembedahan dengan anestesia umum dan anestesia spinal

e-CliniC ◽  
2016 ◽  
Vol 4 (2) ◽  
Author(s):  
Fabiola I. Lumanauw ◽  
Harold F. Tambajong ◽  
Barry I. Kambey
Keyword(s):  
Blood Glucose ◽  
Stress Response ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Random Sampling ◽  
Observational Research ◽  
P Value ◽  
Cross Sectional ◽  
Glucose Levels ◽  
Blood Glucose Levels

Abstract: Anesthesia and surgery could evoke stress response that can affect blood glucose levels. The purpose of this study is to compare the blood glucose levels after surgery with general anesthesia and spinal anesthesia. This was an analytic prospective observational research with cross-sectional design. Researched on 32 patients by consecutive random sampling who meet inclusion and exclusion criteria, then divided into two groups, namely the group undergoing surgery with general anesthesia and the group undergoing surgery with spinal anesthesia. Measurements of blood glucose levels was done in 1 hour before induction of premedication and 4 hours after surgery. The statistical analysis were done using Shapiro-Wilk Test to determine the normal distribution of samples, and independent t-test to compare blood glucose levels after surgery with general anesthesia and spinal anesthesia. The result showed there was significantly different between blood glucose levels after surgery with general anesthesia and spinal anesthesia (p-value = 0.006 or p <0.05). Mean of blood glucose level after surgery in general and spinal anesthesia were 96 mg/dl and 79,4 mg/dl. Conclusion: General anesthesia had more influence on the increase in blood glucose levels after surgery compared to spinal anesthesia.Keywords: stress response, blood glucose levels, general anesthesia, spinal anesthesia Abstrak: Anestesia dan pembedahan akan menyebabkan timbulnya respon stres yang dapat mempengaruhi kadar gula darah. Penelitian ini bertujuan untuk mengetahui perbandingan kadar gula darah pasca pembedahan dengan anestesia umum dan anestesia spinal. Metode penelitian ini menggunakan desain observasional analitik prospektif dengan rancangan cross-sectional. Penelitian dilakukan terhadap 32 pasien yang didapatkan secara consecutive random sampling yang memenuhi kriteria inklusi dan eksklusi, lalu dibagi menjadi 2 kelompok, yaitu kelompok yang menjalani pembedahan dengan anestesia umum dan kelompok yang menjalani pembedahan dengan anestesia spinal. Pengukuran kadar gula darah dilakukan 2 kali, yaitu 1 jam sebelum induksi premedikasi dan 4 jam setelah pembedahan. Analisis statistik dilakukan dengan uji Shapiro-Wilk untuk mengetahui normalitas distribusi sampel, dan uji-t independen untuk membandingkan kadar gula darah pasca pembedahan dengan anestesia umum dan anestesia spinal. Hasil penelitian menunjukkan perbedaan yang bermakna antara kadar gula darah pasca pembedahan dengan anestesia umum dan anestesia spinal (nilai p = 0,006 atau p < 0,05). Rerata kadar gula darah pasca pembedahan dengan anestesia umum sebesar 96 mg/dl, sedangkan pada anestesia spinal sebesar 79,4 mg/dl. Simpulan: Anestesia umum lebih berpengaruh terhadap peningkatan kadar gula darah pasca pembedahan dibandingkan dengan anestesia spinal. Kata kunci : respon stres, kadar gula darah, anestesia umum, anestesia spinal

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