Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 6.641
Filtrar
1.
J Med Case Rep ; 16(1): 408, 2022 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-36333724

RESUMO

BACKGROUND: Tapia's syndrome is a rare complication of airway manipulation under general anesthesia. Injuries to the vagus nerve (X) and hypoglossal nerve (XII) during transoral intubation are the primary cause of the disease. The typical symptoms include hoarseness, dysarthria, dysphagia, tongue muscle atrophy, and tongue deviation toward the affected side. We report a case of Tapia's syndrome treated with electroacupuncture to accelerate the recovery process, and discuss the potential mechanism behind our findings based on previous research. CASE PRESENTATION: In this report, we describe a 57-year-old Chinese man who suffered Tapia's syndrome after craniotomy evacuation of hematoma with general anesthesia and transoral intubation. After 52 days of electroacupuncture therapy along with standard swallowing training, the patient achieved significant improvement in deglutition and speech function. CONCLUSION: Electroacupuncture is effective and safe for Tapia's syndrome. It can shorten the recovery time when combined with routine swallowing rehabilitation.


Assuntos
Eletroacupuntura , Doenças do Nervo Hipoglosso , Masculino , Humanos , Pessoa de Meia-Idade , Eletroacupuntura/efeitos adversos , Síndrome , Doenças do Nervo Hipoglosso/complicações , Doenças do Nervo Hipoglosso/diagnóstico , Anestesia Geral/efeitos adversos , Intubação Intratraqueal/efeitos adversos
3.
Bull Hosp Jt Dis (2013) ; 80(4): 257-262, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36403955

RESUMO

INTRODUCTION: Spinal anesthesia (SA) is the preferred method of anesthesia at many centers for total joint arthro- plasty (TJA). However, a small subset of patients fails SA, necessitating a conversion to general anesthesia (GA). This report assesses the patient characteristics associated with failed SA. METHODS: A retrospective study was conducted on patients who underwent SA during their primary TJA between Janu- ary 2015 and December 2016 at our institution. A subset of this group required a conversion from SA to GA. Anesthesia reports were reviewed for the number of attempts at SA and the documented reason for failure. The SA failure cohort was then subdivided into failure categories based on the reasons that had been provided. RESULTS: A total of 5,706 patients were included in this study, 78 of which experienced SA failure. The number of attempts was most strongly associated with SA failure, with three attempts resulting in a five times increased failure rate (OR = 4.73, p = 0.010) and four attempts resulting in 12 times increased failure rate compared to the no failure cohort (OR = 12.3, p < 0.001). Greater than two attempts occurred in 87.5% of the "technical failure" sub-group of the SA failure cohort (p < 0.001). No difference was demon- strated among the other patient characteristics, such as age, sex, body mass index, race, American Society of Anesthesia (ASA) score, and surgical time. CONCLUSIONS: The results suggest that the major predic- tor influencing spinal to general anesthesia conversion was the number of attempts at SA, especially among technical failure cases. Based on the results, it may be appropriate for anesthesiologists to convert to GA after two failed spi- nal attempts. Further studies are warranted to assess this relationship for firm clinical recommendations.


Assuntos
Anestesia Geral , Raquianestesia , Humanos , Estudos Retrospectivos , Anestesia Geral/efeitos adversos , Raquianestesia/métodos , Coluna Vertebral , Artroplastia
4.
Medicine (Baltimore) ; 101(44): e31351, 2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36343073

RESUMO

RATIONALE: Operative hysteroscopy intravascular absorption syndrome (OHIAS) results from systemic absorption of hypotonic solution during hysteroscopy, which may induce severe hyponatremia within hours. Depending on the serum sodium (Na+) level, this can be life-threatening and requires prompt and careful remedial treatment. PATIENT CONCERNS AND DIAGNOSES: A 53-year-old woman underwent hysteroscopic myomectomy for submucosal leiomyoma. Approximately 3 hours postoperatively, the serum Na+ level decreased to 82 mM/L, accompanied by pulmonary edema and lactic acidosis. The patient was strongly suspicious of OHIAS. INTERVENTIONS AND OUTCOMES: A rapid correction was made using 3% NaCl to prevent brain edema as an initial response. After the serum Na+ level reached 120 mM/L, gradual correction was performed considering osmotic demyelination syndrome, and desmopressin was administered to prevent overcorrection caused by excessive water diuresis. Serum Na+ level normalized in 4 days and the patient recovered without any specific sequelae. LESSONS: The detection of OHIAS may be delayed under general anesthesia, and prior vigilance is important if the operation time is prolonged. In severe hyponatremia with an apparently rapid onset, such as OHIAS, a two-step correction process may be safe and useful: rapid correction followed by more gradual correction.


Assuntos
Hiponatremia , Leiomioma , Feminino , Gravidez , Humanos , Pessoa de Meia-Idade , Hiponatremia/terapia , Histeroscopia/efeitos adversos , Sódio , Leiomioma/complicações , Anestesia Geral/efeitos adversos , Síndrome
5.
Artigo em Inglês | MEDLINE | ID: mdl-36361140

RESUMO

INTRODUCTION: Acute respiratory infection (ARI) can significantly reduce postoperative quality of life and impair the recovery of older adult patients with lower-limb fractures, and its relationship with methods of anesthesia remains inconclusive. Using data from the National Health Insurance Research Database (NHIRD) of Taiwan, this study examined the data of patients who received surgical management for lower-limb fractures and compared those who underwent general anesthesia (GA) with those who underwent regional anesthesia (RA) in terms of their incidence of acute upper and lower respiratory infection during the one-month postoperative period. The study also identified related risk factors. MATERIAL AND METHODS: Approximately two million patients were randomly sampled from the NHIRD registry. We identified and enrolled patients with lower-limb fractures who were over 60 years old and underwent GA or RA during surgeries conducted between 2010 and 2017. We divided these patients into two groups for further analysis. The outcome of this study was the development of ARI during the one-month postoperative period. RESULTS: In total, 45,032 patients (GA group, 19,580 patients; RA group, 25,452 patients) with a mean age of 75.0 ± 8.9 years were included in our study. The incidence of postoperative ARI within one month of surgery was 8.0% (1562 patients) in the GA group and 9.5% (2412 patients) in the RA group, revealing a significant difference. The significant risk factors for the incidence of ARI were the application of RA for surgery, older age, hypertension, liver disease, and chronic obstructive pulmonary disease (COPD). A subgroup analysis revealed that the RA method was associated with a significantly higher ARI incidence relative to the GA method among patients aged between 60 and 80 years, among male patients, among the patients with or without any comorbidity and among the patients without COPD. CONCLUSION: The incidence of postoperative ARI within one month of surgery was higher among older patients with lower-limb fractures who received RA for surgery than among those who received GA for surgery. The other major risk factors for ARI were older age, hypertension, liver disease, and COPD. Therefore, we should focus on patients with a high risk of developing ARI, especially during the COVID-19 pandemic.


Assuntos
Raquianestesia , COVID-19 , Fraturas Ósseas , Hipertensão , Traumatismos da Perna , Doença Pulmonar Obstrutiva Crônica , Humanos , Masculino , Idoso , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Raquianestesia/efeitos adversos , Incidência , Qualidade de Vida , Pandemias , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Anestesia Geral/efeitos adversos , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/cirurgia , Extremidade Inferior/cirurgia , Doença Pulmonar Obstrutiva Crônica/etiologia , Hipertensão/complicações , Estudos Retrospectivos , Resultado do Tratamento
6.
BMC Geriatr ; 22(1): 882, 2022 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-36402973

RESUMO

BACKGROUND: Postinduction hypotension is closely related to postoperative complications. Elderly patients with compromised cardiovascular compensatory reserve are more susceptible to hypotension after induction of general anesthesia. This study investigated whether the carotid artery corrected flow time (FTc) and respiratory variation of peak blood flow velocity in the common carotid artery (ΔVpeak) could predict postinduction hypotension in elderly patients. METHODS: This prospective observational study included elderly patients aged 65 to 75 who were scheduled for elective surgery under general anesthesia with ASA physical status class of I-II, without cardiovascular disease, hypertension, diabetes, or obesity. Anesthesia was induced by midazolam, sufentanil, and etomidate and was maintained by sevoflurane. The carotid artery FTc and ΔVpeak were measured by ultrasound before induction of anesthesia. Hemodynamic data were recorded before induction and then during the first 10 min after induction. RESULTS: Ninety-nine patients were included in the final analysis, of whom 63 developed postinduction hypotension. The area under the receiver operating characteristic curves was 0.87 (0.78 to 0.93) for carotid artery FTc and 0.67 (0.56 to 0.76) for ΔVpeak, respectively. The optimal cutoff value for predicting postinduction hypotension was 379.1 ms for carotid artery FTc, with sensitivity and specificity of 72.2 and 93.7%, respectively. The best cutoff value was 7.5% for ΔVpeak, with sensitivity and specificity of 55.6 and 75.0%, respectively. CONCLUSIONS: The carotid artery FTc is a reliable predictor of postinduction hypotension in elderly patients with ASA status of I or II, without cardiovascular disease, hypertension, diabetes, or obesity. Elderly patients with a carotid artery FTc less than 379.1 ms before anesthesia have a higher risk of postinduction hypotension. TRIAL REGISTRATION: Clinical Trial Registry on August 2nd, 2020 ( www.chictr.org.cn ; ChiCTR2000035190).


Assuntos
Doenças Cardiovasculares , Hipertensão , Hipotensão , Idoso , Humanos , Velocidade do Fluxo Sanguíneo/fisiologia , Hipotensão/diagnóstico , Hipotensão/etiologia , Artérias Carótidas , Anestesia Geral/efeitos adversos , Artéria Carótida Primitiva , Obesidade
7.
BMC Anesthesiol ; 22(1): 343, 2022 11 11.
Artigo em Inglês | MEDLINE | ID: mdl-36368916

RESUMO

BACKGROUND: Hypotension during anesthesia induction is a common event, and occurs more frequently in patients with hypertension than in healthy individuals. Intraoperative hypotension in non-cardiac surgery is reportedly associated with various postoperative complications. However, the predictors of hypotension during anesthesia induction in patients with hypertension have not yet been ascertained. Therefore, we aimed to determine the predictors of hypotension during anesthesia induction in patients with hypertension on medication focusing on the half-life of the medication used. METHODS: In this retrospective observational study, we enrolled patients with hypertension on medication who underwent general anesthesia for oral and maxillofacial surgery between January 1, 2013, and December 31, 2019. Multivariable logistic regression analysis was conducted to test for associations between clinical factors and hypotension during anesthesia induction in patients with hypertension on medication. RESULTS: A total of 395 patients were included in this study. The risk factors for hypotension during anesthesia induction in patients with hypertension on medication were pre-induction mean arterial blood pressure (adjusted unit odds ratio, 0.96 [95% confidence interval, 0.94 to 0.98]), female sex (adjusted odds ratio [aOR], 1.63 [1.03 to 2.57]), regular use of angiotensin receptor blockers (ARBs)/angiotensin-converting enzyme inhibitors (ACE-Is) with a long half-life (vs. no regular use of ARBs/ACE-Is aOR, 4.02 [1.77 to 9.12]; vs. regular use of ARBs/ACE-Is with a short-to-middle half-life aOR, 3.17 [1.46 to 6.85]), and regular use of beta blockers (aOR, 2.45 [1.19 to 5.04]). Regular use of calcium channel blockers (aOR, 0.44 [0.25 to 0.77]) was a suppressive factor for hypotension during anesthesia induction in patients with hypertension. CONCLUSIONS: In patients with hypertension on medication, regular use of ARBs/ACE-Is with a long half-life, regular use of beta blockers, low pre-induction mean arterial blood pressure, and female sex were risk factors for hypotension during anesthesia induction. Notably, regular use of ARBs/ACE-Is with a long half-life was a high-risk factor for hypotension during anesthesia induction in patients with hypertension on medication even after a 24-h preoperative withdrawal period.


Assuntos
Hipertensão , Hipotensão , Humanos , Feminino , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Antagonistas de Receptores de Angiotensina/uso terapêutico , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Hipertensão/induzido quimicamente , Hipotensão/induzido quimicamente , Hipotensão/epidemiologia , Hipotensão/tratamento farmacológico , Anestesia Geral/efeitos adversos
9.
PLoS One ; 17(11): e0278140, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36441797

RESUMO

PURPOSE: Hypotension is a risk factor for adverse perioperative outcomes. Preoperative transthoracic echocardiography has been extended for preoperative risk assessment before noncardiac surgery. This study aimed to develop a machine learning model to predict postinduction hypotension risk using preoperative echocardiographic data and compared it with conventional statistic models. We also aimed to identify preoperative echocardiographic factors that cause postinduction hypotension. METHODS: In this retrospective observational study, we extracted data from electronic health records of patients aged >18 years who underwent general anesthesia at a single tertiary care center between April 2014 and September 2019. Multiple supervised machine learning classification techniques were used, with postinduction hypotension (mean arterial pressure <55 mmHg from intubation to the start of the procedure) as the primary outcome and 95 transthoracic echocardiography measurements as factors influencing the primary outcome. Based on the mean cross-validation performance, we used 10-fold cross-validation with the training set (70%) to select the optimal hyperparameters and architecture, assessed ten times using a separate test set (30%). RESULTS: Of 1,956 patients, 670 (34%) had postinduction hypotension. The area under the receiver operating characteristic curve using the deep neural network was 0.72 (95% confidence interval (CI) = 0.67-0.76), gradient boosting machine was 0.54 (95% CI = 0.51-0.59), linear discriminant analysis was 0.56 (95% CI = 0.51-0.61), and logistic regression was 0.56 (95% CI = 0.51-0.61). Variables of high importance included the ascending aorta diameter, transmitral flow A wave, heart rate, pulmonary venous flow S wave, tricuspid regurgitation pressure gradient, inferior vena cava expiratory diameter, fractional shortening, left ventricular mass index, and end-systolic volume. CONCLUSION: We have created developing models that can predict postinduction hypotension using preoperative echocardiographic data, thereby demonstrating the feasibility of using machine learning models of preoperative echocardiographic data for produce higher accuracy than the conventional model.


Assuntos
Hipotensão , Insuficiência da Valva Tricúspide , Humanos , Hipotensão/diagnóstico por imagem , Hipotensão/etiologia , Ecocardiografia , Anestesia Geral/efeitos adversos , Aprendizado de Máquina
11.
Bone Joint J ; 104-B(11): 1209-1214, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36317343

RESUMO

AIMS: Spinal anaesthesia has seen increased use in contemporary primary total knee arthroplasties (TKAs). However, controversy exists about the benefits of spinal in comparison to general anaesthesia in primary TKAs. This study aimed to investigate the pain control, length of stay (LOS), and complications associated with spinal versus general anaesthesia in primary TKAs from a single, high-volume academic centre. METHODS: We retrospectively identified 17,690 primary TKAs (13,297 patients) from 2001 to 2016 using our institutional total joint registry, where 52% had general anaesthesia and 48% had spinal anaesthesia. Baseline characteristics were similar between cohorts with a mean age of 68 years (SD 10), 58% female (n = 7,669), and mean BMI of 32 kg/m2 (SD 7). Pain was evaluated using oral morphine equivalents (OMEs) and numerical pain rating scale (NPRS) data. Complications including 30- and 90-day readmissions were studied. Data were analyzed using an inverse probability of treatment weighted model based on propensity score that included many patient and surgical factors. Mean follow-up was seven years (2 to 18). RESULTS: Patients treated with spinal anaesthesia required fewer postoperative OMEs (p < 0.001) and had lower NPRS scores (p < 0.001). Spinal anaesthesia also had fewer cases of altered mental status (AMS; odds ratio (OR) 1.3; p = 0.044), as well as 30-day (OR 1.4; p < 0.001) and 90-day readmissions (OR 1.5; p < 0.001). General anaesthesia was associated with increased risk of any revision (OR 1.2; p = 0.021) and any reoperation (1.3; p < 0.001). CONCLUSION: In the largest single institutional report to date, we found that spinal anaesthesia was associated with significantly lower OME use, lower risk of AMS, and lower overall 30- and 90-day readmissions following primary TKAs. Additionally, spinal anaesthesia was associated with reduced risk of any revision and any reoperation after accounting for numerous patient and operative factors. When possible and safe, spinal anaesthesia should be considered in primary TKAs.Cite this article: Bone Joint J 2022;104-B(11):1209-1214.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Humanos , Feminino , Idoso , Masculino , Prótese do Joelho/efeitos adversos , Estudos Retrospectivos , Artroplastia do Joelho/efeitos adversos , Reoperação/efeitos adversos , Anestesia Geral/efeitos adversos , Dor/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia
12.
Medicine (Baltimore) ; 101(40): e30968, 2022 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-36221343

RESUMO

BACKGROUND: Laryngeal injury is common after endotracheal intubation, presenting with varying degrees of edema, ulceration, granulation, and limited vocal cord movement, usually resulting in lumen narrowing. In these cases, laryngeal edema is a common complication after intubation, usually caused by direct pressure and inflammatory reaction caused by endotracheal intubation on the contact surface. CASE PRESENTATION: A 71-year-old female was scheduled to undergo open reduction and internal fixation of femoral neck. On admission, she was diagnosed with femoral neck fracture. Tracheal intubation induced by general anesthesia was successful, but the tracheal catheter was difficult to remove after the operation. After 2 days of detumescence in ICU, the extubation was successful under the condition of complete recovery of spontaneous breathing. CONCLUSIONS: Patients undergoing general anesthesia may have laryngeal or glottic edema due to operation time, operation and other reasons, resulting in difficulty in extubation after general anesthesia. The extubation action shall be gentle. In case of obvious resistance, it shall not be forcibly extubated to prevent serious dyspnea after extubation.


Assuntos
Edema Laríngeo , Laringe , Idoso , Extubação/efeitos adversos , Anestesia Geral/efeitos adversos , Feminino , Humanos , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/métodos , Edema Laríngeo/etiologia
13.
Medicine (Baltimore) ; 101(38): e30696, 2022 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-36197185

RESUMO

BACKGROUND: Avoiding postoperative delirium (POD) can have a significant detrimental effect on the rehabilitation and prognosis of elderly urological patients. It is necessary to explore the risk factors associated with POD in elderly urology to provide a basis for clinical recognition of delirium. METHODS: For relevant studies, we comprehensively searched Embase, MEDLINE, Ovid, PubMed, Scopus, The Cochrane Library, and Web of Science. The search deadline was September 2021. RESULTS: We identified 2046 studies, 8 of which were included in the ultimate analysis. A total of 8 articles, including 356 cases in the delirium group and 1813 cases in the non-delirium group, were included in the relevant literature. The 2 groups mentioned above differed significantly in the following factors: history of delirium (odds ratio [OR] = 6.98, 95% confidence interval [CI]: 1.63-29.86, P = .009); Preoperative use of psychotropic drugs (OR = 1.97, 95% CI: 1.11-3.52, P = .02); age (OR = 3.10, 95% CI: 2.08-4.12, P < .0001). The meta-analysis demonstrated that smoking, alcohol consumption, gender (male), mode of anesthesia (general anesthesia) and being unmarried did not have a significant effect on POD in elderly urological patients. CONCLUSION: The risk factors for POD in elderly urological patients include history of delirium, preoperative use of psychotropic drugs, and age. The present study provides guidance for taking targeted preventive measures to reduce risks.


Assuntos
Delírio , Complicações Pós-Operatórias , Idoso , Anestesia Geral/efeitos adversos , Delírio/epidemiologia , Delírio/etiologia , Delírio/prevenção & controle , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Fatores de Risco
14.
Medicina (Kaunas) ; 58(10)2022 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-36295501

RESUMO

Background and objectives: Children are at greater risk of upper respiratory tract infection (URTI), which can pose a higher risk of perioperative respiratory adverse events (PRAEs), than adults. The purpose of this study was to validate the COLDS score as a pre-anesthetic risk assessment tool for predicting the possibility of PRAEs. Materials and methods: Children aged under 18 years and undergoing elective surgery were retrospectively included. Logistic regression analysis and the area under the receiver-operating characteristic (ROC) curve (AUC) were used to estimate the ability of the COLDS score to predict PRAEs. Propensity-matched comparison was evaluated using the cut-off value from the ROC curve. Results: Among the 6252 children, 158 children had a recent URTI and 34 cases of PRAEs were reported. Age, current symptoms, and COLDS score were found to be significant variables in predicting PRAEs. From the ROC curve, values of 0.652 (p = 0.007) for AUC and 12.5 for the cut-off value of the COLDS score were calculated. Propensity-matched comparison revealed that each and every component of COLDS contributed to the higher COLDS score group. In addition to higher COLDS score, younger age and current URTI symptoms were found to be significant risk factors for PRAEs. Conclusions: This study validated the predictive power of COLDS score as a risk assessment tool for children with URTI undergoing elective surgery under general anesthesia.


Assuntos
Anestésicos , Resfriado Comum , Criança , Humanos , Adolescente , Estudos Retrospectivos , Medição de Risco , Anestesia Geral/efeitos adversos
15.
Medicina (Kaunas) ; 58(10)2022 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-36295533

RESUMO

High-risk surgeries for patients with severe aortic stenosis (AS) are challenging for anesthesiologists and can result in hemodynamic deterioration and even mortality. We describe a case in which remimazolam was used to induce and maintain general anesthesia for a high-risk, noncardiac surgery accompanied by ongoing bleeding. An 86-year-old man with severe AS was scheduled to undergo proximal gastrectomy due to ongoing gastrointestinal bleeding and severe anemia. Remimazolam, a novel, ultra-short-acting benzodiazepine, was administered along with remifentanil for the induction and maintenance of general anesthesia. Throughout the anesthetic process, the patient's cardiac index and systemic vascular resistance were well preserved without any vasopressor support. Remimazolam seems to have possible effectiveness as a relatively safe agent for the induction and maintenance of general anesthesia in patients with severe AS who are undergoing high-risk, noncardiac surgery with bleeding.


Assuntos
Estenose da Valva Aórtica , Masculino , Humanos , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/cirurgia , Remifentanil , Anestesia Geral/efeitos adversos , Benzodiazepinas
16.
J Clin Anesth ; 83: 110982, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36265267

RESUMO

STUDY OBJECTIVE: While supplemental O2 inhalation corrects hypoxemia, its effect on post-anesthesia ventilation remains unknown. This pilot trial tested the hypothesis that hyperoxia increases the time spent with a transcutaneous PCO2 (TcPCO2) > 45 mmHg, compared with standard O2 supplementation. DESIGN: Single-blinded, parallel two-arm randomized pilot trial. SETTING: University hospital. PATIENTS: 20 patients undergoing robotic-assisted laparoscopic nephrectomy. MEASUREMENTS: After institutional approval and informed consent, patients were randomized to receive O2 titrated to arterial saturation (SpO2): 90-94% (Conservative O2, N =10), or to SpO2 > 96% (Liberal O2, N = 10) for up to 90 min after anesthesia. Continuous TcPCO2, respiratory inductance plethysmography (RIP), and SpO2, were recorded. We calculated the percentage of time at TcPCO2 > 45 mmHg for each patient and compared the two groups using analysis of covariance, adjusting for sex, age, and body mass index. We also estimated the sample size required to detect the between-group difference observed in this pilot trial. RIP signals were used to calculate apnea/hypopnea index (AHI), which was then compared between two groups. MAIN RESULTS: The mean percentage of time with a TcPCO2 > 45 mmHg was 80.6% for the Conservative O2 (N=9) and 61.2% for the Liberal O2 (N=10) group [between-group difference of 19.4% (95% CI: -18.7% to 57.6%), P = 0.140]. With an observed effect size of 0.73, we estimated that 30 participants per group are required, to demonstrate this difference with a power of 80% at a two-sided alpha of 5%. Means SpO2 were 94.5% and 99.9% for the Conservative O2 and the Liberal O2 groups, respectively. AHI was significantly higher in the Conservative O2, compared with the Liberal O2 group (median AHI: 16 vs. 3; P = 0.0014). CONCLUSIONS: Hyperoxia in the post-anesthesia period reduced the time spent at TcPCO2 > 45 mmHg and significantly decreased AHI, while mean SpO2 ranged inside the a priori defined limits. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04723433.


Assuntos
Hiperóxia , Humanos , Oxigenoterapia , Projetos Piloto , Oxigênio , Anestesia Geral/efeitos adversos
18.
Anesth Prog ; 69(3): 30-35, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-36223194

RESUMO

Two case reports present the use of vasopressin for treating refractory hypotension associated with continued angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) therapy prior to general anesthesia for oral surgery. Both patients were treated in an ambulatory dental surgery clinic and took either their ACEI or ARB medication for hypertension within 24 hours prior to undergoing an intubated general anesthetic. Persistent profound hypotension was encountered intraoperatively that was refractory to treatment with traditional methods. However, the ACEI- or ARB-induced refractory hypotension was successfully managed with the administration of vasopressin.


Assuntos
Anestésicos Gerais , Hipotensão , Anestesia Geral/efeitos adversos , Anestésicos Gerais/efeitos adversos , Antagonistas de Receptores de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Odontologia , Humanos , Hipotensão/induzido quimicamente , Hipotensão/tratamento farmacológico , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Vasopressinas/efeitos adversos
19.
Br J Anaesth ; 129(5): 788-800, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36270701

RESUMO

BACKGROUND: We conducted a systematic review and meta-analysis of contemporary RCTs to determine the clinical effectiveness of spinal vs general anaesthesia (SA vs GA) in patients undergoing hip fracture surgery using a consensus-based core outcome set, and outcomes defined as important by patient and public involvement (PPI) initiatives. METHODS: RCTs comparing any of the core outcomes (mortality, time from injury to surgery, acute coronary syndrome, hypotension, acute kidney injury, delirium, pneumonia, orthogeriatric input, being out of bed at day 1 postoperatively, and pain) or PPI-defined outcomes (return to preoperative residence, quality of life, and mobility status) between SA and GA were identified from MEDLINE, Embase, Cochrane Library, and Web of Science (2000 to February 2022). Pooled relative risks (RRs) and mean differences (95% confidence intervals [CIs]) were estimated. RESULTS: There was no significant difference in the risk of delirium comparing SA vs GA (RR=1.07; 95% CI, 0.90-1.29). Comparing SA vs GA, the RR for mortality was 0.56 (95% CI, 0.22-1.44) in-hospital, 1.07 (95% CI, 0.52-2.23) at 30 days, and 1.08 (95% CI, 0.55-2.12) at 90 days. Spinal anaesthesia reduced the risk of acute kidney injury compared with GA: RR=0.59 (95% CI, 0.39-0.89). There were no significant differences in the risk of other outcomes. Few studies reported PPI-defined outcomes, with most studies reporting on one to three core outcomes. CONCLUSIONS: Except for acute kidney injury, there were no differences between SA and GA in hip fracture surgery when using a consensus-based core outcome set and patient and public involvement-defined outcomes. Most studies reported limited outcomes from the core outcome set, and few reported outcomes important to patients, which should be considered when designing future RCTs. PROSPERO REGISTRATION: CRD42021275206.


Assuntos
Injúria Renal Aguda , Raquianestesia , Delírio , Fraturas do Quadril , Humanos , Raquianestesia/efeitos adversos , Consenso , Qualidade de Vida , Complicações Pós-Operatórias/etiologia , Anestesia Geral/efeitos adversos , Fraturas do Quadril/cirurgia , Resultado do Tratamento , Delírio/etiologia , Injúria Renal Aguda/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
Comput Math Methods Med ; 2022: 2866188, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36267318

RESUMO

Objective: This research is designed to probe into the influence of Narcotrend- (NT-) assisted anesthesia in-depth monitor on cognitive impairment of elderly patients under general anesthesia (GA). Methods: One hundred and forty-four elderly patients with GA in our hospital from October 2020 to April 2021 were randomized into two groups, namely, NT group (supervised anesthesia under NT monitoring) and group C (anesthesia according to doctors' experience). The heart rate (HR), mean arterial pressure (MAP), and central venous pressure (CVP) were recorded before surgery (T0), at the beginning of surgery (T1), at the end of surgery (T2), and 1 day after surgery (T3). Serum of patients was obtained at these four time points for measurements of C-reactive protein (CRP), interleukin-6 (IL-6), and cortisol (Cor) levels using the enzyme-linked immunosorbent assay (ELISA). The alterations in cognitive function pre- and post-anesthesia were assessed using the mini-mental state examination (MMSE), and adverse events (AEs) during anesthesia recovery, postoperative recovery, and dosage of anesthetics were recorded. Results: At T1 and T2, MAP was higher and CVP was lower in NT group, versus group C. NT group presented higher CRP, IL-6, and Cor than group C at T1-T3. MMSE scores were higher in TN group than in group C at 12, 24, and 48 h after surgery. The incidence rates of postoperative cognitive dysfunction (POCD) and total AEs in group C were noticeably higher than those in NT group. Compared with group C, the time of anesthesia recovery, extubation, and postanesthesia care unit (PACU) residence in NT group reduced remarkably. Conclusions: NT has little effect on the physical condition of elderly patients under GA, and can reduce the dosage of narcotic drugs and promote the recovery of patients from anesthesia, which has high clinical value.


Assuntos
Anestésicos , Disfunção Cognitiva , Humanos , Idoso , Interleucina-6 , Proteína C-Reativa , Hidrocortisona , Anestesia Geral/efeitos adversos , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/etiologia , Entorpecentes
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...