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1.
J Hand Surg Asian Pac Vol ; 26(1): 84-91, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33559584

RESUMO

Background: With the emergence of the COVID-19 pandemic, most health-care personnel and resources are redirected to prioritize care for seriously-ill COVID patients. This situation may poorly impact our capacity to care for critically injured patients. We need to devise a strategy to provide rational and essential care to hand trauma victims whilst the access to theatres and anaesthetic support is limited. Our center is a level 1 trauma center, where the pandemic preparedness required reorganization of the trauma services. We aim to summarise the clinical profile and management of these patients and highlight, how we modified our practice to optimize their care. Methods: This is a single-centre retrospective observational study of all patients with hand injuries visiting the Department of Plastic Surgery from 22nd March to 31st May 2020. Patient characteristics, management details, and outcomes were analysed. Results: A total of 102 hand injuries were encountered. Five patients were COVID-19 positive. The mean age was 28.9 ± 14.8 years and eighty-two (80.4%) were males. Thirty-one injuries involved fractures/dislocations, of which 23 (74.2%) were managed non-operatively. Seventy-five (73.5%) patients underwent wound wash or procedure under local anaesthetic and were discharged as soon as they were comfortable. Seventeen cases performed under brachial-plexus block, were discharged within 24 hours except four cases of finger replantation/ revascularisation and one flap cover which were discharged after monitoring for four days. At mean follow-up of 54.4 ± 21.8 days, the rates of early complication and loss to follow-up were 6.9% and 12.7% respectively. Conclusions: Essential trauma care needs to continue keeping in mind, rational use of resources while ensuring safety of the patients and health-care professionals. We need to be flexible and dynamic in our approach, by utilising teleconsultation, non-operative management, and regional anaesthesia wherever feasible.


Assuntos
/epidemiologia , Traumatismos da Mão/epidemiologia , Traumatismos da Mão/terapia , Adolescente , Adulto , Anestesia Geral/estatística & dados numéricos , Anestésicos Locais/administração & dosagem , Bloqueio do Plexo Braquial/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde , Humanos , Índia/epidemiologia , Perda de Seguimento , Masculino , Pessoa de Meia-Idade , Pandemias , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Centros de Traumatologia , Adulto Jovem
2.
Medicina (Kaunas) ; 57(2)2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33567770

RESUMO

Background and objectives: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread to more than 200 countries. In light of this situation, the Japanese Government declared a state of emergency in seven regions of Japan on 7 April 2020 under the provisions of the law. The medical care delivery system has been under pressure. Although various surgical societies have published guidelines on which to base their surgical decisions, it is not clear how general anesthesia has been performed and will be performed in Japan. Materials and Methods: One of the services provided by the social network service Twitter is a voting function-Twitter Polls-through which anonymous surveys were conducted. We analyzed the results of a series of surveys 17 times over 22 weeks on Twitter on the status of operating restrictions using quadratic programming to solve the mathematical optimizing problem, and public data provided by the Japanese Government were used to estimate the current changes in the number of general anesthesia performed in Japan. Results: The minimum number of general anesthesia cases per week was estimated at 67.1% compared to 2015 on 27 April 2020. The timeseries trend was compatible with the results reported by the Japanese Society of Anesthesiologists (correlation coefficient r = 0.69, p < 0.001). Conclusions: The number of general anesthesia was reduced up to two-thirds during the pandemic of COVID-19 in Japan and was successfully quantitatively estimated using a quick questionnaire on Twitter.


Assuntos
Anestesia Geral/estatística & dados numéricos , Anestesiologia/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Mídias Sociais/estatística & dados numéricos , Humanos , Japão , Computação Matemática , Projetos de Pesquisa , Sociedades Médicas/estatística & dados numéricos , Inquéritos e Questionários
3.
Anaesthesia ; 76(6): 759-776, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33434945

RESUMO

General anaesthesia for obstetric surgery has distinct characteristics that may contribute towards a higher risk of accidental awareness during general anaesthesia. The primary aim of this study was to investigate the incidence, experience and psychological implications of unintended conscious awareness during general anaesthesia in obstetric patients. From May 2017 to August 2018, 3115 consenting patients receiving general anaesthesia for obstetric surgery in 72 hospitals in England were recruited to the study. Patients received three repetitions of standardised questioning over 30 days, with responses indicating memories during general anaesthesia that were verified using interviews and record interrogation. A total of 12 patients had certain/probable or possible awareness, an incidence of 1 in 256 (95%CI 149-500) for all obstetric surgery. The incidence was 1 in 212 (95%CI 122-417) for caesarean section surgery. Distressing experiences were reported by seven (58.3%) patients, paralysis by five (41.7%) and paralysis with pain by two (16.7%). Accidental awareness occurred during induction and emergence in nine (75%) of the patients who reported awareness. Factors associated with accidental awareness during general anaesthesia were: high BMI (25-30 kg.m-2 ); low BMI (<18.5 kg.m-2 ); out-of-hours surgery; and use of ketamine or thiopental for induction. Standardised psychological impact scores at 30 days were significantly higher in awareness patients (median (IQR [range]) 15 (2.7-52.0 [2-56]) than in patients without awareness 3 (1-9 [0-64]), p = 0.010. Four patients had a provisional diagnosis of post-traumatic stress disorder. We conclude that direct postoperative questioning reveals high rates of accidental awareness during general anaesthesia for obstetric surgery, which has implications for anaesthetic practice, consent and follow-up.


Assuntos
Anestesia Geral/métodos , Anestesia Obstétrica/métodos , Cesárea/estatística & dados numéricos , Consciência no Peroperatório/epidemiologia , Adulto , Anestesia Geral/efeitos adversos , Anestesia Geral/estatística & dados numéricos , Anestesia Obstétrica/efeitos adversos , Anestesia Obstétrica/estatística & dados numéricos , Cesárea/métodos , Estudos de Coortes , Inglaterra , Feminino , Humanos , Incidência , Estudos Prospectivos
4.
Medicine (Baltimore) ; 99(45): e23065, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157964

RESUMO

Dental general anesthesia (DGA) is a safe and high-quality restorative and preventive treatment option for children with severe early childhood caries (S-ECC), who require extensive dental treatment and exhibit anxiety and emotional or cognitive immaturity or are medically compromised. However, several postoperative complications have been reported in children under DGA. This study aimed to evaluate and analyze the prevalence of the relevant factors of postoperative complications in healthy Chinese children following DGA to provide a foundation for pre-, intra-, and postoperative overall health management for healthy and disabled children after DGA.A total of 369 systematically healthy Chinese children (36-71 months old) undergoing a DGA were studied. Data were collected on patients' histories, characteristics, anesthesia, and dental procedures. Parents or caregivers were interviewed before and 72 hours after the procedure. Data were analyzed using logistic regression.Approximately 94.86% of the enrolled children reported one or more complications. The most prevalent complication was postoperative pain (62.70%), followed by weariness, agitation, masticatory problems, drowsiness, oral bleeding, coughing, fever, sore throat, nausea, constipation, epistaxis, vomiting, excitement, and diarrhea. The long duration of the operation was a risk factor for postoperative pain and weariness. A high nutritional status could be a protective factor for postoperative fever.Prolonged operation means complex treatment, such as pulp therapy or extraction. We speculate that the longer the duration is, the more difficult the dental procedures are. The accumulation of discomfort leads to pain. We suspect that children in lower nutritional levels are more likely to suffer from bacteremia or dehydration, resulting in fever.Postoperative pain was the most prevalent complication after the DGA. A decrease in dental procedure duration might reduce the odds of postoperative pain and weariness. A high nutritional status could be a protective factor for postoperative fever. Children with low nutritional status could be more susceptible to postoperative fever.


Assuntos
Anestesia Dentária/efeitos adversos , Anestesia Geral/métodos , Cárie Dentária/cirurgia , Procedimentos Cirúrgicos Bucais/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Anestesia Geral/estatística & dados numéricos , Ansiedade/epidemiologia , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Estudos de Casos e Controles , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Estado Nutricional , Dor Pós-Operatória/epidemiologia , Prevalência , Estudos Prospectivos , Segurança
5.
Eur J Vasc Endovasc Surg ; 60(5): 747-751, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32763119

RESUMO

OBJECTIVE: Major limb amputations are physiologically stressful and subject patients to peri-operative cardiovascular risk. Up to 90% of major lower extremity amputations (LEAMP) are being performed under general anaesthesia, despite regional anaesthesia being an acceptable option in most cases. Obtaining a better understanding of who would benefit from regional vs. general anaesthesia could reduce complications and help establish best evidence based practice. It was hypothesised that patients undergoing LEAMP with regional anaesthesia would have better post-operative outcomes than patients receiving general anaesthesia. METHODS: This retrospective cohort study used the U.S. Vascular Quality Initiative lower extremity amputation module to identify patients (≥18 years) who underwent LEAMP from 2013 to 2018. Outcomes included 30 day incidence of major adverse cardiac events (MACE) and all cause mortality. Multivariable logistic regression models were used to compute odds ratios (OR) and 95% confidence intervals (CI). Time to death was analysed using standard survival analysis. RESULTS: The final sample included 5 567 patients (median age: 65 years, 67% white, 65% male). Only 719 (13%) of patients received regional anaesthesia. Compared with patients undergoing general anaesthesia, patients in the regional group were older (67 vs. 65 years, p < .001) and more likely to have diabetes (78% vs. 69%; p < .001), end stage renal disease (26% vs. 18%; p < .001), congestive heart failure (33% vs. 27%; p < .01) and coronary artery disease (35% vs. 30%; p < .01). The overall incidence of MACE, death, and MACE or death was 5%, 6%, and 9%, respectively. There was no statistically significant difference by anaesthesia groups for MACE (OR 0.98, 95% CI 0.69-1.39) or mortality (HR 1.03, 95% CI 0.90-1.17). CONCLUSION: There was no difference in outcomes between regional or general anaesthesia techniques in patients undergoing LEAMP, despite the regional group having more comorbidities. Regional anaesthesia may be under used for high risk patients undergoing LEAMP. Further studies are needed to establish best practices in LEAMP procedures.


Assuntos
Amputação/efeitos adversos , Anestesia por Condução/efeitos adversos , Anestesia Geral/efeitos adversos , Doença Arterial Periférica/cirurgia , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Anestesia por Condução/estatística & dados numéricos , Anestesia Geral/estatística & dados numéricos , Recuperação Pós-Cirúrgica Melhorada , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Estimativa de Kaplan-Meier , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/mortalidade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
7.
Int Heart J ; 61(4): 713-719, 2020 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-32684591

RESUMO

Differences in the benefits of conscious sedation (CS) and general anesthesia (GA) during transfemoral aortic valve implantation (TAVI) are unclear.We aimed to assess differences in procedural and clinical outcomes based on the type of anesthesia received during TAVI.We analyzed SOURCE 3 Registry data for patients who received the SAPIEN 3 valve by type of anesthesia used during TAVI.Of the 1694 TAVI patients, 1027 received CS and 667 received GA. Patients were similar at baseline (81.5 years; Society of Thoracic Surgeons risk score 7.0). Compared with the GA group, the CS group had fewer intra-procedural transesophageal echocardiography (TEE) and post implantation dilatations performed, and less contrast medium was used. The CS group had significantly less kidney injury at 7 days post-procedure than the GA group (0.4% versus 1.5%, P = 0.014). Moderate paravalvular leaks (PVL) occurred more frequently in the CS group versus the GA group (2.2% versus 0.8%; P = 0.041). No severe PVL were reported. Median total hospital length of stay (LOS) after TAVI was 10 days in the CS group and 11 days in the GS group. At 30 days, all-cause death was 2.1% in CS and 1.7% in GS (P = 0.47), and myocardial infarction was 0.2% in CS and 0.1% in GS (P = 0.83).Our analyses found no significant major outcome differences between CS and GA during TAVI.


Assuntos
Anestesia Geral/estatística & dados numéricos , Sedação Consciente/estatística & dados numéricos , Sistema de Registros , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino
8.
J Surg Res ; 255: 1-8, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32540575

RESUMO

BACKGROUND: Local anesthesia (LA) for open inguinal hernia repair (OIHR) is not widely used in the United States. An LA program for OIHR was initiated at the Dallas Veteran Affairs Medical Center in 2015. We hypothesize that outcomes under LA for OIHR are similar to general anesthesia with adequate patient satisfaction. METHODS: A total of 1422 groin hernias were performed by a single surgeon using a standardized technique at the Dallas Veteran Affairs Medical Center (2015-2019). Only unilateral, primary, elective, OIHRs were included (n = 1092). LA was used in 26.0% (n = 285) and compared with patients undergoing general anesthesia. Univariate analysis was performed by the Student t-test for continuous variables and χ2 test (or the Fisher exact test) for categorical variables. RESULTS: OIHR performed with LA increased from 15.5% in 2015 to 76.6% in 2019. Patients undergoing LA were older and had significantly more comorbidities. Holding time to operating room (OR), OR to start of the operation, skin-to-skin time, and end of the operation to out of the OR were all reduced with LA (all P values <0.05). Inguinodynia, recurrence, and overall complications were similar. Patients undergoing LA indicated that they were comfortable (93.0%), rated their worst pain as 2.03 ± 2.2 (of 10), and would undergo LA if they had to do it again (94.0%). CONCLUSIONS: LA was associated with decreased OR times and had good patient satisfaction. Overall complication rates were similar despite a higher burden of comorbid conditions in patients undergoing LA.


Assuntos
Anestesia Geral/estatística & dados numéricos , Anestesia Local/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Idoso , Estudos de Viabilidade , Feminino , Hospitais de Veteranos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Medição da Dor/estatística & dados numéricos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Satisfação do Paciente , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos
9.
Ulus Travma Acil Cerrahi Derg ; 26(3): 445-452, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32436967

RESUMO

BACKGROUND: This study aims to evaluate the effects of the anesthesia technique on the intraoperative blood loss in acetabular fracture patients undergoing the Modified Stoppa approach. METHODS: We retrospectively identified 63 patients who underwent a Modified Stoppa approach for acetabular fracture from January 2014 to July 2018. A total of 20 patients were excluded from this study for the following reasons: bilateral acetabular fractures (n=6), undergoing antiaggregant treatment (n=3), incomplete anesthesia records (n=3), emergency pelvic surgery due to hemodynamic instability (n=5), splenic rupture (n=2), and liver laceration (n=1). The patients were divided into two groups as follows: patients undergoing general anesthesia (GA) (n=22) and patients undergoing combined epidural-general anesthesia (CEGA) (n=21). The main outcome measurements studied were the intraoperative blood loss and the need for intraoperative and/or postoperative blood transfusions. RESULTS: No statistically significant differences were found between the groups concerning the age, gender, type of fracture, mechanism of injury, time from injury to surgery, Injury Severity Score, associated injuries, and comorbidities (p>0.05). The mean intraoperative blood losses were 717.27 ml (300-1.600 ml) in the GA group and 473.81 ml (150-1.020 ml) in the CEGA group (p<0.001). In the cases with only an isolated acetabular fracture, the intraoperative blood transfusion means were 2.43 units (1-5 units) in 14 patients in the GA group and 1.27 units (1-4 units) in 15 patients in the CEGA group (p<0.001). CONCLUSION: Less intraoperative bleeding was seen in those patients undergoing CEGA when compared to those undergoing GA. This is a significant advantage for acetabular surgery, which has a long learning curve and a high risk of bleeding.


Assuntos
Acetábulo , Anestesia Epidural/estatística & dados numéricos , Anestesia Geral/estatística & dados numéricos , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Fraturas do Quadril/cirurgia , Acetábulo/lesões , Acetábulo/cirurgia , Anestesia Epidural/efeitos adversos , Anestesia Epidural/métodos , Anestesia Geral/efeitos adversos , Anestesia Geral/métodos , Humanos , Estudos Retrospectivos
10.
Anaesth Crit Care Pain Med ; 39(3): 361-362, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32360981

Assuntos
Betacoronavirus , Infecções por Coronavirus , Cuidados Críticos/organização & administração , Hospitais Militares/organização & administração , Unidades de Terapia Intensiva/organização & administração , Unidades Móveis de Saúde/organização & administração , Pandemias , Pneumonia Viral , /terapia , Idoso , Anestesia Geral/estatística & dados numéricos , Conversão de Leitos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Cuidados Críticos/estatística & dados numéricos , Despacho de Emergência Médica/organização & administração , Feminino , França/epidemiologia , Hospitais com menos de 100 Leitos , Serviços Hospitalares Compartilhados/organização & administração , Hospitais Gerais/organização & administração , Hospitais Militares/estatística & dados numéricos , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Unidades de Terapia Intensiva/estatística & dados numéricos , Unidades de Terapia Intensiva/provisão & distribução , Intubação Intratraqueal/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Unidades Móveis de Saúde/estatística & dados numéricos , Doenças Profissionais/prevenção & controle , Pandemias/prevenção & controle , Admissão do Paciente/estatística & dados numéricos , Transferência de Pacientes/métodos , Transferência de Pacientes/estatística & dados numéricos , Equipamento de Proteção Individual , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Utilização de Procedimentos e Técnicas , Respiração Artificial/estatística & dados numéricos , /etiologia
11.
Anaesthesia ; 75(6): 756-766, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32232991

RESUMO

Estimates of the rate and risk-factors for difficult airway rarely include a denominator for the number of anaesthetics. Approaches such as self-reporting and crowd-sourcing of airway incidents may help identify specific lessons from clinical episodes, but the lack of denominator data, biased reporting and under-reporting does not allow a comprehensive population-based assessment. We used an established state-wide dataset to determine the incidence of failed and difficult intubations between 2015 and 2017 in the state of Victoria in Australia, along with associated patient and surgical risk-factors. A total of 861,533 general anaesthesia episodes were analysed. Of these, 4092 patients with difficult or failed intubation were identified; incidence rates of 0.52% (2015-2016) and 0.43% (2016-2017), respectively. Difficult/failed intubations were most common in patients aged 45-75 and decreased for older age groups, with risk being lower for patients aged >85 than patients aged 35-44. The risk for failed/difficult intubation increased significantly for: patients undergoing emergency surgery (OR 1.80); obese patients (OR 2.48); increased ASA physical status; and increased Charlson Comorbidity Index. Across all age groups, procedures on the nervous system (OR 1.92) and endocrine system (OR 2.03) had the highest risk of failed/difficult intubation. The relative reduced risk for failed/difficult intubations in the elderly population is a novel finding that contrasts with previous research and may suggest a 'compression of morbidity' effect as a moderator. Administrative databases have the potential to improve understanding of peri-operative risk of rare events at a population level.


Assuntos
Tratamento de Emergência/estatística & dados numéricos , Nível de Saúde , Intubação Intratraqueal/métodos , Intubação Intratraqueal/estatística & dados numéricos , Obesidade/complicações , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral/estatística & dados numéricos , Criança , Pré-Escolar , Bases de Dados Factuais , Sistema Endócrino/cirurgia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Fatores de Risco , Vitória , Adulto Jovem
12.
Ulus Travma Acil Cerrahi Derg ; 26(1): 30-36, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31942729

RESUMO

BACKGROUND: Cognitive dysfunction in the early postoperative course is common for the elderly population. Anesthetic management may affect postoperative cognitive decline. Effective analgesia, early recovery and modulation of the stress response are advantages of neuraxial blocks. This study aims to compare the effects of general anesthesia and the combination of general anesthesia with epidural analgesia for postoperative cognitive dysfunction (POCD). We hypothesized that neuraxial block combined with general anesthesia (GA) would have a favorable influence on POCD prevention. METHODS: Patients above 60 years undergoing non-cardiac surgery were included in this randomized, prospective study and randomized into two groups. Patients in the first group (GI) were treated under GA, whereas in the second group (GII), epidural analgesia was combined with GA. Patients' cognitive function was assessed before and one week after surgery using a neuropsychological test battery. POCD was defined as a drop of one standard deviation from baseline on two or more tests. RESULTS: A total of 116 patients were allocated for the final analysis. Demographic and operative data were similar between groups, except maximum pain scores, which were significantly higher in GI than GII (4.9±2.8 vs. 1.7±1.7; p<0.001, respectively). The incidence of POCD was comparable between groups (26% in GI and 24% in GII). Memory performance, visuospatial functions, and language skills tests were significantly higher in GII compared to GI. CONCLUSION: General anesthesia and epidural analgesia combined with general anesthesia resulted in similar POCD in elderly patients undergoing abdominal surgery. However, in combined anesthesia group memory, language skills and visuospatial functions appeared to be better preserved. Effective pain control might contribute to preventing cognitive decline in some domains.


Assuntos
Analgesia Epidural/estatística & dados numéricos , Anestesia Geral/estatística & dados numéricos , Complicações Cognitivas Pós-Operatórias , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Cognitivas Pós-Operatórias/epidemiologia , Complicações Cognitivas Pós-Operatórias/prevenção & controle , Estudos Prospectivos
13.
Int J Pediatr Otorhinolaryngol ; 129: 109780, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31756661

RESUMO

PURPOSE: To determine the relevance of the Food and Drug Administration (FDA) warning regarding general anesthesia (GA) in children under 3 years of age for procedures lasting longer than 3 h, by surgical specialty and for otolaryngology specifically. METHODS: A one-year retrospective review was conducted at a tertiary-care medical center for all children younger than 3 years undergoing surgical procedures with durations greater than 3 h. De-identified data related to age, surgical service, procedure types, American Society of Anesthesiologists (ASA) physical status classification, and general anesthesia time were collected and examined. RESULTS: During 2017, 430 of 11,757 patients (3.7%) met the age and duration of anesthesia criteria. Procedures performed by the cardiothoracic surgery service were mostly likely to result in duration of surgery greater than 3 h (46.6%), followed by neurosurgery (12.9%), cardiology (9.3%), plastic surgery (7.1%), general surgery (6.6%), and urology (5.1%). Less than 2% of patients undergoing ophthalmology (1.9%), orthopedic surgery (1.7%), and otolaryngology (0.5%) procedures required anesthesia greater than 3 h. CONCLUSION: Less than 4% of patients younger than 3 years undergoing surgery required general anesthesia for longer than 3 h. The theoretical risks of general anesthesia per the FDA warning are discussed and must be balanced against the known functional and neurodevelopmental consequences of not performing critical and time-sensitive surgery on children in this age group. A strategy for addressing parental and provider concerns is discussed.


Assuntos
Anestesia Geral/estatística & dados numéricos , Duração da Cirurgia , Especialidades Cirúrgicas/estatística & dados numéricos , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Otolaringologia/estatística & dados numéricos , Estudos Retrospectivos
15.
Br J Ophthalmol ; 104(1): 17-22, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30862620

RESUMO

BACKGROUND: Early diagnosis strategies and advances in retinoblastoma (Rb) management have resulted in nearly 100% survival. More attention should, therefore, be given to quality of life considerations. We aimed to quantify the number of examinations under anaesthesia (EUAs) in a cohort of patients with Rb, as a measure of disease burden. METHODS: A retrospective analysis of patients with unilateral Rb that presented to the London Rb service from 2006 to 2013, were treated and had long-term follow-up. Correlations of clinical variables to number of EUAs were investigated. RESULTS: A total of 107 patients with Rb were included that presented at a mean age of 26.51 ± 22.68 months. The International Intraocular Retinoblastoma Classification (IIRC) was group B in 5 (5%), C in 13 (12%), D in 48 (45%) and E in 41 (38%) of the cases. Primary treatment was intravenous chemotherapy in 36 (34%) and enucleation in 71 (66%) of the cases. Mean number of EUAs was 20.67 ± 6.62, 12.52 ± 6.23 and 11.15 ± 6.91 for combined groups B/C, group D and group E patients (p < 0.001), respectively. On analysis, early age atpresentation and conservative treatments were found to significantly correlate with increased number of EUAs (p < 0.001). Mean follow-up time was 74.42 ± 25.16 months and no metastasis or death were reported. CONCLUSION: Families should be counselled regarding the number of EUAs associated with the patient's IIRC group, with B/C eyes undergoing twice the number as compared with D/E eyes. For group D cases, where both enucleation and conservative therapy are valid options, treatment choice has a significant impact on the number of EUAs.


Assuntos
Anestesia Geral/estatística & dados numéricos , Neoplasias da Retina/diagnóstico , Neoplasias da Retina/terapia , Retinoblastoma/diagnóstico , Retinoblastoma/terapia , Fatores Etários , Antineoplásicos/administração & dosagem , Antineoplásicos/uso terapêutico , Pré-Escolar , Enucleação Ocular , Feminino , Seguimentos , Humanos , Lactente , Infusões Intra-Arteriais , Londres , Masculino , Estudos Retrospectivos , Fatores de Tempo
16.
Int Urogynecol J ; 31(1): 181-189, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30863946

RESUMO

INTRODUCTION AND HYPOTHESIS: The primary aim was to compare the incidence of major perioperative complications in women undergoing vaginal reconstructive surgery with general, regional, and monitored anesthesia care using a national database. The secondary aim was to compare length of hospital stay, 30-day readmission rates, urinary tract infections, and reoperation rates between anesthesia types. MATERIALS AND METHODS: The National Surgical Quality Improvement Program database was used to study women undergoing vaginal surgery for pelvic floor disorders from 2006 to 2015 via Current Procedural Terminology codes. Demographic and clinical variables were abstracted. The incidence of major perioperative complications was defined as the occurrence of any of the following within 30 days of surgery: death, surgical-site infection, pneumonia, venous thromboembolism, intensive care unit admission, stroke, transfusion, sepsis, and myocardial infarction. Regression analysis was used to estimate the relative risks (RR) associated with anesthesia type for each outcome. RESULTS: From the database, we gathered data on 37,426 women who underwent vaginal reconstructive surgery between 2006 and 2015; 87.2% (n = 32,623) underwent general, 6.9% (n = 2565) regional, and 5.9% (n = 2238) monitored anesthesia care. Major perioperative complications occurred in 560 women (1.5%). Relative to general anesthesia, the adjusted risk of major perioperative complications was not significantly different in those receiving monitored or regional anesthesia [monitored vs. general, adjusted RR 0.74, 95% confidence interval (CI) 0.45-1.20; regional vs. general, adjusted RR 1.23, 95% CI 0.92-1.65]. DISCUSSION: Major perioperative complications in vaginal reconstructive surgery were uncommon, and no differences were observed between monitored, regional, and general anesthesia outcomes.


Assuntos
Anestesia por Condução/estatística & dados numéricos , Anestesia Geral/estatística & dados numéricos , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Vagina/cirurgia , Adulto , Idoso , Feminino , Humanos , Incidência , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Pessoa de Meia-Idade , Ohio/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia
17.
Pan Afr Med J ; 37: 106, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33425139

RESUMO

Introduction: emergency hysterectomy (EH) remains a life-saving procedure in cases of life-threatening obstetric hemorrhage and other gynaecological emergencies. We aim to determine the indications, surgical outcomes and challenges of EH in our tertiary centre. Methods: an ethically approved retrospective descriptive cross-sectional study on all EHs performed at a tertiary hospital during the period of 1st January 2018 to 31st December 2019 was conducted. Medical records of eligible patients were retrieved, reviewed and analysed using frequencies and percentages and then summarized in tables. Results: there were 146 EHs over the two year period. The age of participants ranged from 19 to 59 years, with a mean of 34.3 years (SD = 6.06). SD: standard deviation.The main indication for EH was primary postpartum haemorrhage (PPH): 73.28% (n = 110/146). The other indications were uterine perforation with necrosis: 8.9% (n = 13/146), secondary postpartum haemorrhage: 4.8% (n = 7/146), choriocarcinoma and pelvic abscess: 2.74% (n = 4/146) each and broad ligament haematoma: 2.06% (n = 3/146). There were 3.42% (n = 5/146) which were classified as 'others **': two cases of ovarian cyst torsion; one case of placental site tumour; one case of incomplete septic abortion; one case of bulky multinodular fibroid uterus with severe unremitting lower abdominal pain.The most common indication for the subgroup of hysterectomy due to PPH was uterine atony 54.20% (n = 60/110), followed by ruptured uterus20.56% (n = 23/110) and then, morbidly adherent placenta 14.95% (n = 16/110). Placenta accreta constituted 62.5% (n = 10/16) of the morbidly adherent placenta.There were 91.78% (n=134/146) total abdominal hysterectomies and 8.22% (n = 12/146) subtotalhysterectomies. About eighty percent 79.45% (n = 116/146) of the surgeries required general anaesthesia, 15.07% (n = 22/146) required regional anaesthesia whilst 5.48% (n = 8/146) were started as regional anaesthesia but were converted to general anaesthesia.There were no associated intraoperative complications in 96.60% (141/146) of the cases. The most frequent intraoperative complications included bowel injury 2.04% (3/146), bladder injury 0.68% (1/146) and maternal death 0.68% (1/146).Twoof the three bowel injuries required bowel resection and anastomosis. Most of the surgeries 89.73% (n = 131/146) were performed by skilled doctors above the level of a Specialist. Major challenges faced include delayed referral of patients to the tertiary centre for prompt management and lack of quick access to blood products. Conclusion: emergency hysterectomy is performed in women who are relatively young with primary postpartum haemorrhage as the commonest indication but there are other non-obstetric indications for this emergency surgery. Though a challenging procedure, it is safe in the hands of a skilled surgical team.


Assuntos
Histerectomia/métodos , Hemorragia Pós-Parto/cirurgia , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Anestesia por Condução/estatística & dados numéricos , Anestesia Geral/estatística & dados numéricos , Estudos Transversais , Emergências , Feminino , Humanos , Histerectomia/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Atenção Terciária , Adulto Jovem
18.
J Anesth ; 33(6): 665-669, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31598782

RESUMO

PURPOSE: The aim of this study was to survey the frequency of various anesthetic techniques used in the anesthetic management of both the mother and fetus during fetal therapies in Japan. METHODS: We sent a postal survey to the institutions with physicians who held membership of the Japan Society of Fetal Therapy to describe maternal and fetal anesthetic management during fetal therapies performed from January 2016 to March 2017. The therapies included were thoracoamniotic shunting (TAS), intrauterine transfusion (IUT), radiofrequency ablation (RFA), fetoscopic laser photocoagulation (FLP), fetoscopic endotracheal occlusion (FETO), and ex utero intrapartum treatment (EXIT). Survey respondents were asked to specify the standard anesthetic technique used in each of these procedures done during the study period. RESULTS: The most common anesthetic techniques used in each therapy were sedation/analgesia with local anesthesia in TAS (31%), local anesthesia alone in IUT (47%), neuraxial anesthesia in RFA (50%), FLP (66%) and FETO (100%), and general endotracheal anesthesia in EXIT. Fetal analgesia was utilized in 61% of TAS, 33% of IUT, 10% of RFA, 22% of FLP, 100% of FETO, and 50% of EXIT. In all fetal therapies, the most common route of administration for fetal anesthesia was maternal administration. CONCLUSION: In this first published description of the frequency of various anesthetic techniques used during fetal therapies in Japan, we found that anesthetic techniques varied depending on the degree of invasiveness to the mother and fetus. Fetal anesthesia was not always performed, and the most common route for fetal anesthesia was maternal administration.


Assuntos
Anestésicos/administração & dosagem , Terapias Fetais/estatística & dados numéricos , Fetoscopia/estatística & dados numéricos , Anestesia Geral/estatística & dados numéricos , Anestesia Local/estatística & dados numéricos , Feminino , Humanos , Japão , Gravidez , Inquéritos e Questionários
19.
Am Surg ; 85(10): 1099-1103, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657302

RESUMO

Foley catheters (FCs) are often used during inguinal hernia operations; however, the impact of intraoperative FC use on postoperative urinary retention (POUR) is not well understood. We reviewed unplanned returns to the urgent care or ED for 27,012 inguinal hernia operations across 15 Southern California Kaiser Permanente medical centers over 6.5 years. In total, 239 (0.88%) patients returned to urgent care/ED with POUR [235 (98%) men versus 4 (2%) women]. Overall, POUR increased with age (P < 0.00001). POUR was higher in open repairs using general anesthesia versus local with monitored anesthesia care (0.7% vs 0.3%, P < 0.0001). Of 5,017 laparoscopic operations, 28 per cent had FC use. Although POUR was greater for laparoscopic versus open operations (2.21 vs 0.58%, P < 0.00001), there was no difference in POUR for intraoperative FC versus no FC use in the laparoscopic approach (2.36% vs 2.15%, P = 0.33). For all laparoscopic operations, there was no difference in urinary tract infection within 7 or 30 days when comparing intraoperative FC versus no FC use (P = 0.28). POUR can be minimized by avoiding general anesthesia for open inguinal hernia repairs, but intraoperative FC use does not affect POUR or urinary tract infection rates for laparoscopic inguinal hernia repair.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Cateteres Urinários/efeitos adversos , Retenção Urinária/etiologia , Distribuição por Idade , Fatores Etários , Idoso , Anestesia Geral/efeitos adversos , Anestesia Geral/estatística & dados numéricos , California/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Herniorrafia/métodos , Herniorrafia/estatística & dados numéricos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Cateteres Urinários/estatística & dados numéricos , Retenção Urinária/epidemiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia
20.
Paediatr Anaesth ; 29(11): 1128-1135, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31486563

RESUMO

BACKGROUND: Recently, the European prospective observational multicenter cohort study, APRICOT, reported anesthesia techniques and complications in more than 31 000 pediatric procedures. The main objective of this study was to analyze the current practice in regional anesthesia in the 33 countries that participated to APRICOT. METHODS: Data on regional anesthesia techniques were extracted from the database of APRICOT (261 centers across 33 European countries). All children, aged from birth to 16 years old, were eligible for inclusion during a 2-week period. Type of regional anesthesia, whether used awake or with sedation or general anesthesia, techniques of guidance, and the drugs administered were analyzed. RESULTS: Regional anesthesia was used in 4377 pediatric surgical procedures. The large majority was performed under general anesthesia with central blocks and truncal blocks, representing, respectively, 42.6% and 41.8% of performed techniques. Caudal blocks represented 76.9% of all central blocks. The penile and ilioinguinal/iliohypogastric blocks were the most commonly performed truncal blocks. Anesthetists used mainly anatomical landmarks; ultrasound guidance was applied in only 23.8% of cases. A wide variability of practices was observed in terms of regional anesthesia techniques and local anesthetics among the participating European countries. No serious complications were reported. CONCLUSION: These data show a large predominance of central and truncal blocks in APRICOT study. Ultrasound guidance was mainly used for peripheral nerve blocks while central blocks were performed using landmark techniques.


Assuntos
Anestesia por Condução/estatística & dados numéricos , Adolescente , Anestesia por Condução/efeitos adversos , Anestesia por Condução/métodos , Anestesia Geral/estatística & dados numéricos , Anestesia Local/estatística & dados numéricos , Anestésicos Locais/uso terapêutico , Criança , Pré-Escolar , Bases de Dados Factuais , Europa (Continente)/epidemiologia , Humanos , Lactente , Recém-Nascido , Bloqueio Nervoso/estatística & dados numéricos
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