Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 197
Filtrar
1.
Rev. Hosp. Ital. B. Aires (2004) ; 39(3): 77-80, sept. 2019. tab.
Artigo em Espanhol | LILACS | ID: biblio-1048219

RESUMO

Antecedentes y objetivo: el ayuno preoperatorio disminuye el riesgo de aspiración del contenido gástrico y sus complicaciones. Sin embargo, si es excesivo, favorece la regurgitación y el riesgo de broncoaspiración tras la inducción anestésica, así como alteraciones metabólicas e hidroelectrolíticas. Analizamos su duración, en pacientes con cirugías programadas en un hospital público de agudos. Material y métodos: se encuestó a todos los pacientes mayores de 18 años con cirugías programadas. Se recolectaron datos sobre la prescripción médica de ayuno, la hora de inducción anestésica y personales. El ayuno prescripto se comparó con las recomendaciones de las guías de la AAARBA (Asociación de Anestesia, Analgesia y Reanimación de Buenos Aires). Resultados: se reclutaron 139 pacientes, con una mediana de edad de 48 años (30; 64), 53% femeninos. La mediana del ayuno prescripto fue de 12,5 horas tanto para sólidos como para líquidos. El ayuno para sólidos que realizaron los pacientes tuvo una mediana de 14 horas, la cual resultó significativamente mayor que la prescripción (p < 0,001). En cambio, el ayuno para líquidos tuvo una mediana de 12 horas, no hallándose una diferencia significativa (p = 0,452) con lo prescripto. En comparación con la guía de la AAARBA, el ayuno prescripto excedió la recomendación para sólidos (4,5 h) y para líquidos (10,5 h). El ayuno realizado por el paciente excedió lo prescripto para sólidos (1,5 h), mientras que para líquidos fue inferior (0,5 h). Conclusión: el ayuno preoperatorio prescripto no se adecuó a las recomendaciones actuales. Las horas de ayuno realizadas por el paciente resultaron excesivas. (AU)


Background and objective: preoperative fasting reduces the risk of aspiration of gastric contents and its complications. However, if fasting is excessive, it favours regurgitation and the risk of pulmonary aspiration in patients undergoing general anaesthetic, such as metabolic and electrolyte disorders. We analysed its duration in patients with elective surgeries in public acute care hospital. Material and methodologies: patients over 18 years old with elective surgeries were surveyed. Data about medical fasting indication, time of induction of anaesthesia and personal information was collected. The prescribed fast was compared with the recommendations of the AAARBA (Association of Anaesthesia, Analgesia and Reanimation of Buenos Aires) guidelines. Results: 139 patients were gathered with a median of 48 years old (30; 64), 53% of them were female. Fasting indication median was of 12.5 h for solids and liquids. The fasting made by the patient for solids had a median of 14 h which resulted to be significantly higher to the indication (p < 0.001). By contrast, the fasting for liquids had a median of 12 h which it did not show a significant difference (p = 0.452) with the indication. In comparison with the AAARBA guideline, the fasting indication exceeded the recommendation for solids (4.5 h) and for liquids (10.5 h). The fasting made by the patient exceeded to what was indicated for solids (1.5 h) while for liquids, it was inferior (0.5 h). Conclusion: the indicated preoperative fasting was not adequate to the current recommendations. The hours of fasting made by patient were excessive. (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Cuidados Pré-Operatórios/métodos , Jejum/metabolismo , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Ansiedade , Pneumonia/prevenção & controle , Cirurgia Geral/tendências , Sede , Jejum/fisiologia , Fome , Procedimentos Cirúrgicos Eletivos/métodos , Desidratação , Refluxo Laringofaríngeo/mortalidade , Refluxo Laringofaríngeo/prevenção & controle , Aspiração Respiratória de Conteúdos Gástricos/complicações , Hipoglicemia , Anestesia Geral/tendências
2.
World Neurosurg ; 130: e794-e803, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31295591

RESUMO

BACKGROUND: Postinterventional sedation is commonly used in clinical practice to ensure patient safety and comfort. Although sedation or anesthesia during thrombectomy has been well studied, the association between postinterventional sedation and functional outcomes in endovascularly treated patients with acute ischemic stroke (AIS) has yet to be investigated. We describe the association between postinterventional sedation and functional outcomes in patients with AIS treated with endovascular therapy (EVT). METHODS: This observational study was based on a prospective registry. Patients with AIS treated with EVT from January 2013 to August 2017 at Xuanwu Hospital, Capital Medical University were included. Patients receiving postinterventional sedation were compared with patients not receiving sedation. The primary outcome was the 3 months modified Rankin Scale score. RESULTS: A total of 268 patients were eligible for study: 112 patients (41.8%) receiving postinterventional sedation and 156 patients (58.2%) without sedation. At 3 months follow-up, the median modified Rankin Scale score was 4 (interquartile range, 3-6) in the sedation group and 2 (interquartile range, 1-4) in the nonsedation group (P < 0.001). Multivariable regression analysis suggested that the need for postinterventional sedation was associated with unfavorable outcomes, with an odds ratio of 0.20 for functional independence (95% confidence interval [CI], 0.078-0.487; P < 0.001), 0.06 for freedom from disability (95% CI, 0.017-0.228; P < 0.001), and 8.37 for death (95% CI, 2.196-31.889; P = 0.002). CONCLUSIONS: Postinterventional sedation worsens functional outcomes in patients with AIS with large-vessel occlusions treated with EVT. Whether the sedation is a causative factor or a surrogate for poor functional outcomes remains to be determined.


Assuntos
Anestesia Geral/tendências , Isquemia Encefálica/cirurgia , Procedimentos Endovasculares/tendências , Acidente Vascular Cerebral/cirurgia , Trombectomia/tendências , Idoso , Anestesia Geral/efeitos adversos , Isquemia Encefálica/diagnóstico por imagem , Procedimentos Endovasculares/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Acidente Vascular Cerebral/diagnóstico por imagem , Trombectomia/efeitos adversos , Resultado do Tratamento
3.
Obstet Gynecol Clin North Am ; 46(2): 329-337, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31056134

RESUMO

The subspecialty of obstetric anesthesiology has embraced patient safety research, which has led to a reduction in obstetric anesthesia-related morbidity and mortality. Although there are innumerable individual improvements, this article highlights the following innovations: safer and more effective labor analgesia, safer treatments for hypotension associated with neuraxial blockade, advances in spinal and epidural techniques for operative deliveries, lower incidence of postdural puncture headache through improved technology, safer parental agents for labor analgesia, improved safety of general anesthesia in obstetrics, improved education and the use of simulation including team training, and reductions in operating room-related infections.


Assuntos
Anestesia Obstétrica , Segurança do Paciente , Analgesia , Anestesia Geral/efeitos adversos , Anestesia Geral/tendências , Anestesia Obstétrica/métodos , Anestesia Obstétrica/mortalidade , Anestesia Obstétrica/tendências , Anestesiologia/métodos , Anestesiologia/tendências , Parto Obstétrico , Feminino , Humanos , Trabalho de Parto , Cefaleia Pós-Punção Dural/prevenção & controle , Gravidez
4.
Acta Med Port ; 32(2): 126-132, 2019 Feb 28.
Artigo em Português | MEDLINE | ID: mdl-30896393

RESUMO

INTRODUCTION: Transcatheter aortic valve implantation is a less invasive option for aortic valve replacement. The number of transcatheter aortic valve implantations under local anesthesia with sedation has been increasing as the team's experience increases and less invasive accesses are used. The aim of this study is to describe the evolution of the anesthetic technique in patients undergoing transcatheter aortic valve implantation at our center over the years, as which was compared. MATERIAL AND METHODS: Retrospective study in 149 consecutive patients undergoing transcatheter aortic valve implantation in Hospital Santa Marta (January 2010 to December 2016). Data was collected from the periprocedural records of patients. Patients were stratified according to anesthetic technique. RESULTS: From our patients' sample, 57.0% were female, with median age 82 [58 - 95] years. Most patients underwent general anesthesia (68.5%). In the local anesthesia with sedation group there was a shorter duration of the procedure (120; [60 - 285] vs 155 [30 - 360]) and a lower number of patients requiring administration of vasopressors (61.8% vs 28.3%) - p < 0.05. There were no differences regarding length of hospital stay (9 [4 - 59] vs 10 [3 - 87]), periprocedural complications (66.0% vs 72.5%), readmission rate (4.3% vs 3.9%) or 30-days (2.1% vs 4.9%) and 1-year mortality (6.4% vs 7.8%) - p < 0.05. There was an increasing number of transcatheter aortic valve implantations performed under local anesthesia with sedation over the years. DISCUSSION: The choice of anesthetic technique depends on the patient's characteristics, experience and preference of the team. CONCLUSION: Local anesthesia with sedation seems to be associated with similar results as general anesthesia. The increase in the number of transcatheter aortic valve implantations under local anesthesia with sedation seems to follow the trend of lower invasiveness of the procedure.


Assuntos
Anestesia Geral/estatística & dados numéricos , Anestesia Local/estatística & dados numéricos , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral/tendências , Anestesia Local/tendências , Estenose da Valva Aórtica/cirurgia , Feminino , Humanos , Tempo de Internação , Masculino , Duração da Cirurgia , Readmissão do Paciente , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/mortalidade , Substituição da Valva Aórtica Transcateter/tendências
5.
Neurotoxicology ; 70: 80-90, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30445043

RESUMO

Despite the widespread use of general anesthesia, a growing body of research suggests that anesthesia exposure early in life may be associated with acute neurotoxicity and lasting behavioral changes. To better evaluate the risk posed by early life anesthesia on cognitive development, infant rhesus monkeys were exposed to an anesthesia regimen previously shown to be neurotoxic and their cognitive development was subsequently measured using a translational operant test battery. On postnatal day 5 or 6, animals were exposed to 8 h of isoflurane (n = 6, 1% isoflurane in a vehicle gas of 70% nitrous oxide and 30% oxygen) or a control condition (n = 8). Starting at 7 months of age, the monkeys were continuously trained and assessed on the NCTR Operant Test Battery (OTB). The OTB consists of cognitive tests which also exist in near identical forms for use in rats and humans, and includes tests of learning, memory, color discrimination, and motivation. Monkeys previously exposed to anesthesia showed a clear decrease in responding in a measure of motivation, as well as a lower response rate in a learning task. These data further support the hypothesis that prolonged anesthesia early in life may increase the risk of developing cognitive impairments later in life.


Assuntos
Anestesia Geral/efeitos adversos , Cognição/efeitos dos fármacos , Condicionamento Operante/efeitos dos fármacos , Isoflurano/toxicidade , Óxido Nitroso/toxicidade , Anestesia Geral/tendências , Animais , Cognição/fisiologia , Condicionamento Operante/fisiologia , Feminino , Isoflurano/administração & dosagem , Macaca mulatta , Masculino , Óxido Nitroso/administração & dosagem , Primatas
6.
Clin Neurophysiol ; 130(1): 55-60, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30476711

RESUMO

OBJECTIVE: Electroencephalogram burst-suppression during general anesthesia is associated with post-operative delirium (POD). Whether burst-suppression causes POD or merely reflects susceptibility to POD is unclear. We hypothesized decreased intraoperative alpha (8-12 Hz) and beta (13-33 Hz) power prior to the occurrence of burst-suppression in susceptible patients. METHODS: We analyzed intraoperative electroencephalogram data of cardiac surgical patients undergoing cardiopulmonary bypass (CPB). We detected the incidence and duration of CPB burst-suppression with an automated burst-suppression detection algorithm. We analyzed EEG data with multitaper spectral estimation methods. We assessed associations between patient characteristics and burst-suppression using Binomial and Zero-inflated Poisson Regression Models. RESULTS: We found significantly decreased alpha and beta power (7.8-22.95 Hz) in the CPB burst-suppression cohort. The odds ratio for the association between point estimates for alpha and beta power (7.8-22.95 Hz) and the incidence of burst-suppression was 0.88 (95% CI: 0.79-0.98). The incidence rate ratio for the association between point estimates for power between the alpha and beta range and the duration of burst-suppression was 0.89 (95% CI: 0.84-0.93). CONCLUSION: Decreased intra-operative power within the alpha and beta range was associated with susceptibility to burst-suppression during CPB. SIGNIFICANCE: This dynamic may be used to develop principled neurophysiological-based approaches to aid the preemptive identification and targeted care of POD vulnerable patients.


Assuntos
Anestesia Geral/tendências , Ponte Cardiopulmonar/tendências , Eletroencefalografia/tendências , Monitorização Intraoperatória/tendências , Idoso , Anestesia Geral/efeitos adversos , Ondas Encefálicas/fisiologia , Ponte Cardiopulmonar/efeitos adversos , Eletroencefalografia/efeitos adversos , Feminino , Humanos , Incidência , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Valor Preditivo dos Testes
7.
BMC Anesthesiol ; 18(1): 167, 2018 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-30414607

RESUMO

BACKGROUND: Although propofol is a common anesthetic agent for the induction of general anesthesia, hemodynamic fluctuations are occasionally prominent during induction/intubation. The aims of this study were to determine the influential factors on enhanced hemodynamic fluctuation and to establish a prediction formula to quickly determine the dose of propofol to protect against hemodynamic fluctuations. METHODS: This retrospective cohort study patients (n = 2097) were 18 years or older. They underwent general anesthesia induction using propofol and orotracheal intubation for non-cardiac surgery at Kyushu University Hospital during April 2015 to March 2016. Preoperative patient clinical information was collected from anesthesia preoperative evaluation records. Intraoperative data were obtained from computerized anesthesia records. If patients' post-induction mean arterial blood pressure (MAP) decreased or increased 30% or more from their pre-induction MAP, they were determined to have enhanced hemodynamic fluctuations. Unconditional logistic regression was used to assess the adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Structural equation modeling (SEM) was conducted to simultaneously examine the direct and indirect effect (path coefficient = r) of potential variables. RESULTS: In the SEM analysis, age was significantly associated with enhanced hemodynamic fluctuations (adjusted odds ratio = 1.008, 95% CI = 1.001-1.015, P = 0.03). Age (path coefficient (r) = - 0.0113, 95% CI = - 0.0126-0.010, P < 0.001), American Society of Anesthesiologists physical status (ASA-PS) (r = - 0.0788, 95% CI = - 0.1431-0.0145, P = 0.02), sex (r = 0.057, 95% CI = 0.0149-0.9906, P = 0.01), and fentanyl dose (r = 0.1087, 95% CI = 0.0707-0.1467, P < 0.001) influenced the dose of propofol in induction. The prediction formula of "Propofol dose (mg) = [2.374 - 0.0113 × age (year) - 0.0788 (if ASA-PS 3 or 4) + 0.057 (if female) + 0.1087 × fentanyl dose (µg/kg)] × body weight (kg)" was derived. CONCLUSIONS: Age was associated with hemodynamic fluctuations in induction. Although the prediction formula is considered to be acceptable, future studies validating whether it can decrease patients' risk of enhanced hemodynamic fluctuations in clinical situations are necessary.


Assuntos
Anestesia Geral/métodos , Anestésicos Intravenosos/administração & dosagem , Hemodinâmica/efeitos dos fármacos , Hemodinâmica/fisiologia , Propofol/administração & dosagem , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral/tendências , Estudos de Coortes , Feminino , Humanos , Intubação Intratraqueal/métodos , Intubação Intratraqueal/tendências , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Adulto Jovem
8.
BMC Anesthesiol ; 18(1): 162, 2018 11 08.
Artigo em Inglês | MEDLINE | ID: mdl-30409186

RESUMO

BACKGROUND: It is unclear if anaesthesia maintenance with propofol is advantageous or beneficial over inhalational agents. This study is intended to compare the effects of propofol vs. inhalational agents in maintaining general anaesthesia on patient-relevant outcomes and patient satisfaction. METHODS: Studies were identified by electronic database searches in PubMed™, EMBASE™ and the Cochrane™ library between 01/01/1985 and 01/08/2016. Randomized controlled trials (RCTs) of peer-reviewed journals were studied. Of 6688 studies identified, 229 RCTs were included with a total of 20,991 patients. Quality control, assessment of risk of bias, meta-bias, meta-regression and certainty in evidence were performed according to Cochrane. Common estimates were derived from fixed or random-effects models depending on the presence of heterogeneity. Post-operative nausea and vomiting (PONV) was the primary outcome. Post-operative pain, emergence agitation, time to recovery, hospital length of stay, post-anaesthetic shivering and haemodynamic instability were considered key secondary outcomes. RESULTS: The risk for PONV was lower with propofol than with inhalational agents (relative risk (RR) 0.61 [0.53, 0.69], p < 0.00001). Additionally, pain score after extubation and time in the post-operative anaesthesia care unit (PACU) were reduced with propofol (mean difference (MD) - 0.51 [- 0.81, - 0.20], p = 0.001; MD - 2.91 min [- 5.47, - 0.35], p = 0.03). In turn, time to respiratory recovery and tracheal extubation were longer with propofol than with inhalational agents (MD 0.82 min [0.20, 1.45], p = 0.01; MD 0.70 min [0.03, 1.38], p = 0.04, respectively). Notably, patient satisfaction, as reported by the number of satisfied patients and scores, was higher with propofol (RR 1.06 [1.01, 1.10], p = 0.02; MD 0.13 [0.00, 0.26], p = 0.05). Secondary analyses supported the primary results. CONCLUSIONS: Based on the present meta-analysis there are several advantages of anaesthesia maintenance with propofol over inhalational agents. While these benefits result in an increased patient satisfaction, the clinical and economic relevance of these findings still need to be addressed in adequately powered prospective clinical trials.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Anestesia Geral/métodos , Anestésicos Inalatórios/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Hospitalização , Propofol/administração & dosagem , Procedimentos Cirúrgicos Ambulatórios/tendências , Anestesia Geral/tendências , Hospitalização/tendências , Humanos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
Best Pract Res Clin Anaesthesiol ; 32(2): 203-211, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30322460

RESUMO

Neuromuscular blockers have long been an intricate part of the anesthesia regimen. The scientific progress in pharmacology and physiology has strengthened their clinical relevance, has helped to delineate with precision their medical role, and has enhanced the safety and effectiveness of their use. New frontiers in research will define further the role of these agents in modern anesthesia practice and guide their expanding and discrete clinical applications.


Assuntos
Anestesia Geral/métodos , Bloqueadores Neuromusculares/administração & dosagem , Sugammadex/administração & dosagem , Anestesia Geral/efeitos adversos , Anestesia Geral/tendências , Humanos , Antagonistas de Entorpecentes/administração & dosagem , Bloqueadores Neuromusculares/efeitos adversos
10.
Eur J Anaesthesiol ; 35(12): 919-928, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30124501

RESUMO

BACKGROUND: Peri-operative respiratory adverse events (PRAEs) in paediatric patients with upper respiratory tract infections (URTIs) remain inadequately explored in patients allowed to proceed to anaesthesia and surgery. OBJECTIVE: To determine the incidence and risk factors of PRAE in children with URTI allowed to proceed to anaesthesia. DESIGN: Multicentre cohort study performed over 6 months in France. SETTING: Sixteen centres with dedicated paediatric anaesthetists. PATIENTS: Eligible patients were aged from 0 to 18 years with URTI symptoms on admission or a history of such over the preceding 4 weeks. MAIN OUTCOMES: The primary outcome of the study was to determine predictors of PRAE. Secondary outcomes were: predictors of peri-operative arterial desaturation and of the decision to proceed with anaesthesia and surgery in children with URTI. RESULTS: Overall, 621 children were included and 489 (78.7%) anaesthetised. Of those anaesthetised, 165 (33.5%) and 97 (19.8%) experienced PRAE and arterial desaturation, respectively. Factors predictive of PRAE included patient age, tracheal intubation and the absence of midazolam premedication. Factors predictive of peri-operative arterial desaturation included patient age, anaesthetist experience, endoscopic procedures and the presence of other PRAE. Factors predicting proceeding to anaesthesia in the context of URTI included anaesthetist experience, emergency procedures and the absence of severe URTI symptoms. CONCLUSION: The risk of PRAE in patients anaesthetised in the presence of URTI was similar to previous publications - close to 30%. In the light of our findings, first, current rescheduling indications should be questioned, and second, further medical and organisational strategies should be investigated to reduce PRAE in children with URTI. TRIAL REGISTRATION: The study was registered in the European Networks of Centers for Pharmacoepidemiology and Pharmacovigilance (EUPAS16436).


Assuntos
Anestesia Geral/efeitos adversos , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/epidemiologia , Anestesia Geral/tendências , Criança , Pré-Escolar , Estudos de Coortes , Feminino , França/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Assistência Perioperatória/tendências , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Infecções Respiratórias/prevenção & controle , Fatores de Risco
11.
Eur J Anaesthesiol ; 35(12): 929-936, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30113351

RESUMO

BACKGROUND: Epileptiform discharges frequently occur in children during induction of anaesthesia. However, studies analysing the impact of epileptiform discharges on postoperative emergence delirium in children are still scarce. The aim of this study is to correlate the incidence of epileptiform activity during anaesthesia induction with the occurrence of emergence delirium during stay in the recovery room. OBJECTIVES: Prospective, observational cohort study in children 0.5 to 8 years old undergoing planned surgery. Bifrontal electroencephalogram electrodes were placed before induction of anaesthesia. Visual electroencephalogram analysis was performed from start of anaesthetic agent administration until intubation with regard to epileptiform patterns: rhythmic polyspikes; periodic epileptiform discharges; delta with spikes; and suppression with spikes. Emergence delirium was assessed during stay in the recovery room using the Pediatric Assessment of Emergence Delirium Score. DESIGN: Prospective, observational cohort study. SETTING: University hospital - Germany/Berlin. Children were included between September 2015 and February 2017. PATIENTS: A total of 62 Children, aged 0.5 to 8 years old undergoing planned surgery were included. MAIN OUTCOME MEASURES: Primary outcome was emergence delirium. Secondary outcomes, peri-operative Electroencephalography (EEG) data analysis. The presented study analysed an association between emergence delirium and the occurrence of epileptiform discharges during anaesthesia induction. RESULTS: A total of 43.5% of the children developed emergence delirium and 56.5% did not. Epileptiform discharges were observed more often in children developing emergence delirium (63%) compared with children not developing emergence delirium (43%). But only the occurrence of interictal spike events - such as rhythmic polyspikes; periodic epileptiform discharges and delta with spikes - were significantly related to emergence delirium (emergence delirium-group 48% vs. nonemergence delirium-group 14%, OR = 5.6 [95% CI: 1.7 to 18.7]; P = 0.004). CONCLUSION: Emergence delirium in children is significantly related to interictal spike events occurring during induction of anaesthesia. CLINICAL TRIAL: NCT02481999.


Assuntos
Anestesia Geral/tendências , Anestésicos Inalatórios/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Eletroencefalografia/tendências , Delírio do Despertar/fisiopatologia , Epilepsia/fisiopatologia , Anestesia Geral/efeitos adversos , Anestésicos Inalatórios/efeitos adversos , Anestésicos Intravenosos/efeitos adversos , Criança , Pré-Escolar , Estudos de Coortes , Eletroencefalografia/efeitos dos fármacos , Delírio do Despertar/induzido quimicamente , Delírio do Despertar/diagnóstico , Epilepsia/induzido quimicamente , Epilepsia/diagnóstico , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos
12.
BMC Musculoskelet Disord ; 19(1): 249, 2018 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-30037342

RESUMO

BACKGROUND: The aim of the study was to analyze the effect of local infiltration analgesia (LIA), peripheral nerve blocks, general and spinal anesthesia on early functional recovery and pain control in primary unicompartmental knee arthroplasty (UKA). METHODS: Between January 2016 until August 2016, 134 patients underwent primary UKA and were subdivided into four groups according to their concomitant pain and anesthetic procedure with catheter-based techniques of femoral and sciatic nerve block (group GA&FNB, n = 38) or epidural catheter (group SP&EPI, n = 20) in combination with general anesthesia or spinal anesthesia, respectively, and LIA combined with general anesthesia (group GA&LIA, n = 46) or spinal anesthesia (group SP&LIA, n = 30). Outcome parameters focused on the evaluation of pain (NRS scores), mobilization, muscle strength and range of motion up to 7 days postoperatively. The cumulative consumption of (rescue) pain medication was analyzed. RESULTS: The LIA groups revealed significantly lower (about 50%) mean NRS scores (at rest) compared to the catheter-based groups at the day of surgery. In the early postoperative period, the dose of hydromorphone as rescue pain medication was significantly lower (up to 68%) in patients with SP&EPI compared to all other groups. No significant differences could be detected with regard to grade of mobilization, muscle strength and range of motion. However, there seemed to be a trend towards improved mobilization and muscle strength with general anesthesia and LIA, whereof general anesthesia generally tended to ameliorate mobilization. CONCLUSIONS: Except for a significant lower NRS score at rest in the LIA groups at day of surgery, pain relief was comparable in all groups without clinically relevant differences, while the use of opioids was significantly lower in patients with SP&EPI. A clear clinically relevant benefit for LIA in UKA cannot be stated. However, LIA offers a safe and effective treatment option comparable to the well-established conventional procedures.


Assuntos
Anestesia Geral/tendências , Anestesia Local/tendências , Raquianestesia/tendências , Artroplastia do Joelho/tendências , Bloqueio Nervoso Autônomo/tendências , Recuperação de Função Fisiológica/fisiologia , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral/métodos , Anestesia Local/métodos , Raquianestesia/métodos , Anestésicos Locais/administração & dosagem , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Bloqueio Nervoso Autônomo/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/cirurgia , Manejo da Dor/métodos , Manejo da Dor/tendências , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Recuperação de Função Fisiológica/efeitos dos fármacos , Estudos Retrospectivos , Resultado do Tratamento
13.
Physiol Res ; 67(5): 721-728, 2018 11 14.
Artigo em Inglês | MEDLINE | ID: mdl-30044117

RESUMO

The aim of study was to review the status of arterial pH, pO(2) and pCO(2) under general anesthesias in dependence on the light-dark (LD) cycle in spontaneously breathing rats. The experiments were performed using three- to four-month-old pentobarbital(P)-, ketamine/xylazine(K/X)- and zoletil(Z)-anesthetized female Wistar rats after a four-week adaptation to an LD cycle (12 h light:12 h dark). The animals were divided into three experimental groups according to the anesthetic agent used: P (light n=11; dark n=8); K/X (light n=13; dark n=11); and Z (light n=18; dark n=26). pH and blood gases from arterial blood were analyzed. In P anesthesia, LD differences in pH, pO(2), and pCO(2) were eliminated. In K/X anesthesia, parameters showed significant LD differences. In Z anesthesia, LD differences were detected for pH and pO(2) only. Acidosis, hypoxia, and hypercapnia have been reported for all types of anesthesia during the light period. In the dark period, except for P anesthesia, the environment was more stable and values fluctuated within normal ranges. From a chronobiological perspective, P anesthesia was not the most appropriate type of anesthesia in these rat experiments. It eliminated LD differences, and also produced a more acidic environment and more pronounced hypercapnia than K/X and Z anesthesias.


Assuntos
Anestesia Geral , Anestésicos Gerais/farmacologia , Fenômenos Cronobiológicos/fisiologia , Ketamina/farmacologia , Pentobarbital/farmacologia , Tiletamina/farmacologia , Zolazepam/farmacologia , Anestesia Geral/efeitos adversos , Anestesia Geral/tendências , Anestésicos Gerais/efeitos adversos , Anestésicos Gerais/sangue , Animais , Gasometria/métodos , Fenômenos Cronobiológicos/efeitos dos fármacos , Combinação de Medicamentos , Feminino , Hipercapnia/sangue , Hipercapnia/induzido quimicamente , Hipóxia/sangue , Hipóxia/induzido quimicamente , Ketamina/efeitos adversos , Pentobarbital/efeitos adversos , Ratos , Ratos Wistar , Tiletamina/efeitos adversos , Zolazepam/efeitos adversos
14.
Pak J Pharm Sci ; 31(4(Supplementary)): 1571-1576, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30058550

RESUMO

General anesthesia and surgery have been associated with acute cognitive impairment in several elderly individuals. Present study was conducted to determine whether the general anaesthesia exposure and cognitive dysfunction are linked or not. This is a China-based retrospective, population-based and case-control study. Using Chinese database inhabitants of Shenyang, China, incident cases detected with cognitive abnormalities between January 2007 and December 2012 were identified. With respective to every incident case, age- and gender-matched control subject was chosen among the general population pool of Shenyang inhabitants who were not having cognitive anomalies in the year. Medical records were scrutinized to examine the exposures to surgical procedures necessitating anesthesia after 45-years of age. We examined 577 cases of cognition-impaired (dementia) patients, every incident case with a conforming control subject. Among the cognitive impaired patients, 414 (71.7%) underwent 821 surgical operations needing general anesthesia exposure; of the controls, 404 (70%) underwent 833 surgical procedures. The present study found that general anaesthetic agents encounter was not markedly associated with cognitive anomalies (odds ratio, 0.87; 95% CI, 0.71-1.09; P=0.29). Moreover, no substantial relation was observed when the anaesthetic agents encounter was measured as number of surgical operations (odds ratios (OR), 0.83, 0.89, and 1.0 for 1, 2-3, and 4 exposures, correspondingly, matched with none; P=0.52). Our present work witnessed no substantial link between surgical procedures requiring single or multiple general anesthesia exposure post 45-years of age and cognitive dysfunction.


Assuntos
Anestesia Geral/tendências , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Vigilância da População , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral/efeitos adversos , Estudos de Casos e Controles , China/epidemiologia , Disfunção Cognitiva/induzido quimicamente , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População/métodos , Estudos Retrospectivos , Fatores de Risco
15.
BMC Musculoskelet Disord ; 19(1): 232, 2018 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-30021587

RESUMO

BACKGROUND: Postoperative pain control and enhanced mobilization, muscle strength and range of motion following total knee arthroplasty (TKA) are pivotal requisites to optimize rehabilitation and early recovery. The aim of the study was to analyze the effect of local infiltration analgesia (LIA), peripheral nerve blocks, general and spinal anesthesia on early functional recovery and pain control in primary total knee arthroplasty. METHODS: Between January 2016 until August 2016, 280 patients underwent primary TKA and were subdivided into four groups according to their concomitant pain and anesthetic procedure with catheter-based techniques of femoral and sciatic nerve block (group GA&FNB, n = 81) or epidural catheter (group SP&EPI, n = 51) in combination with general anesthesia or spinal anesthesia, respectively, and LIA combined with general anesthesia (group GA&LIA, n = 86) or spinal anesthesia (group SP&LIA, n = 61). Outcome parameters focused on the evaluation of pain (NRS scores), mobilization, muscle strength and range of motion up to 7 days postoperatively. The cumulative consumption of (rescue) pain medication was analyzed. RESULTS: Pain relief was similar in all groups, while the use of opioid medication was significantly lower (up to 58%) in combination with spinal anesthesia, especially in SP&EPI. The LIA groups, in contrast, revealed significant higher mobilization (up to 26%) and muscle strength (up to 20%) in the early postoperative period. No analgesic technique-related or surgery-related complications occurred within the first 7 days. Due to insufficient pain relief, 8.4% of the patients in the catheter-based groups and 12.2% in the LIA groups resulted in a change of the anesthetics pain management. CONCLUSIONS: The LIA technique offers a safe and effective treatment option concerning early functional recovery and pain control in TKA. Significant advantages were shown for mobilization and muscle strength in the early postoperative period while pain relief was comparable within the groups.


Assuntos
Anestesia Geral/tendências , Anestesia Local/tendências , Raquianestesia/tendências , Artroplastia do Joelho/tendências , Bloqueio Nervoso Autônomo/tendências , Manejo da Dor/tendências , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral/métodos , Anestesia Local/métodos , Raquianestesia/métodos , Artroplastia do Joelho/métodos , Bloqueio Nervoso Autônomo/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Dor Pós-Operatória/diagnóstico por imagem , Dor Pós-Operatória/prevenção & controle , Amplitude de Movimento Articular/efeitos dos fármacos , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica/efeitos dos fármacos , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Resultado do Tratamento
16.
Anesth Analg ; 127(4): 855-863, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29933267

RESUMO

BACKGROUND: Complication rates after hepatic resection can be affected by management decisions of the hospital care team and/or disparities in care. This is true in many other surgical populations, but little study has been done regarding patients undergoing hepatectomy. METHODS: Data from the claims-based national Premier Perspective database were used for 2006 to 2014. The analytical sample consisted of adults undergoing partial hepatectomy and total hepatic lobectomy with anesthesia care consisting of general anesthesia (GA) only or neuraxial and GA (n = 9442). The key independent variable was type of anesthesia that was categorized as GA versus GA + neuraxial. The outcomes examined were clinical complications and health care resource utilization. Unadjusted bivariate and adjusted multivariate analyses were conducted to examine the effects of the different types of anesthesia on clinical complications and health care resource utilization after controlling for patient- and hospital-level characteristics. RESULTS: Approximately 9% of patients were provided with GA + neuraxial anesthesia during hepatic resection. In multivariate analyses, no association was observed between types of anesthesia and clinical complications and/or health care utilization (eg, admission to intensive care unit). However, patients who received blood transfusions were significantly more likely to have complications and intensive care unit stays. In addition, certain disparities of care, including having surgery in a rural hospital, were associated with poorer outcomes. CONCLUSIONS: Neuraxial anesthesia utilization was not associated with improvement in clinical outcome or cost among patients undergoing hepatic resections when compared to patients receiving GA alone. Future research may focus on prospective data sources with more clinical information on such patients and examine the effects of GA + neuraxial anesthesia on various complications and health care resource utilization.


Assuntos
Anestesia por Condução/tendências , Anestesia Geral/tendências , Disparidades em Assistência à Saúde/tendências , Hepatectomia/tendências , Assistência Perioperatória/tendências , Complicações Pós-Operatórias/terapia , Padrões de Prática Médica/tendências , Demandas Administrativas em Assistência à Saúde , Adulto , Idoso , Anestesia por Condução/efeitos adversos , Anestesia por Condução/economia , Anestesia Geral/efeitos adversos , Anestesia Geral/economia , Pesquisa Comparativa da Efetividade , Bases de Dados Factuais , Feminino , Disparidades em Assistência à Saúde/economia , Hepatectomia/efeitos adversos , Hepatectomia/economia , Custos Hospitalares/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/efeitos adversos , Assistência Perioperatória/economia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/economia , Padrões de Prática Médica/economia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
17.
Eur J Anaesthesiol ; 35(8): 588-597, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29916859

RESUMO

BACKGROUND: Avoidance of airway complications and rapid emergence from anaesthesia are indispensable for the use of a laryngeal mask airway (LMA). Evidence from adequately powered randomised studies with a low risk of bias for the optimal anaesthetic in this context is limited. OBJECTIVE: We tested the hypothesis that when using remifentanil-based intra-operative analgesia, desflurane would be the most suitable anaesthetic: with noninferiority in the occurrence of upper airway complications and superiority in emergence times compared with sevoflurane or propofol. DESIGN: A randomised, multicentre, partially double-blinded, three-arm, parallel-group study. SETTING: Two university and two regional German hospitals, from February to October 2015. PATIENTS: A total of 352 patients (age 18 to 75 years, ASA physical status I to III, BMI less than 35 kg m and fluent in German) were enrolled in this study. All surgery was elective with a duration of 0.5 to 2 h, and general anaesthesia with a LMA was feasible. INTERVENTION: The patients were randomised to receive desflurane, sevoflurane or propofol anaesthesia. MAIN OUTCOME MEASURES: This study was powered for the primary outcome 'time to state date of birth' and the secondary outcome 'intra-operative cough'. Time to emergence from anaesthesia and the incidence of upper airway complications were assessed on the day of surgery. RESULTS: The primary outcome was analysed for 343 patients: desflurane (n=114), sevoflurane (n=111) and propofol (n=118). The desflurane group had the fastest emergence. The mean (± SD) times to state the date of birth following desflurane, sevoflurane and propofol were 8.1 ±â€Š3.6, 10.1 ±â€Š4.0 and 9.8 ±â€Š5.1 min, respectively (P < 0.01). There was no difference in upper airway complications (cough and laryngospasm) across the groups, but these complications were less frequent than in previous studies. CONCLUSION: When using a remifentanil infusion for intra-operative analgesia in association with a LMA, desflurane was associated with a significantly faster emergence and noninferiority in the incidence of intra-operative cough than either sevoflurane or Propofol. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02322502; EudraCT identifier: 2014-003810-96.


Assuntos
Analgésicos Opioides/administração & dosagem , Período de Recuperação da Anestesia , Anestesia Geral/tendências , Anestésicos Inalatórios/administração & dosagem , Máscaras Laríngeas/tendências , Remifentanil/administração & dosagem , Adulto , Recuperação Demorada da Anestesia/diagnóstico , Recuperação Demorada da Anestesia/prevenção & controle , Desflurano/administração & dosagem , Método Duplo-Cego , Procedimentos Cirúrgicos Eletivos/tendências , Feminino , Humanos , Isoflurano/administração & dosagem , Masculino , Pessoa de Meia-Idade , Propofol/administração & dosagem
18.
Anesth Analg ; 127(3): 759-766, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29847387

RESUMO

BACKGROUND: Neuraxial anesthesia is often viewed as superior to general anesthesia but may delay discharge. Comparisons do not typically use multimodal analgesics and nerve blockade. Combining nerve blockade with general anesthesia may reduce pain, opioid consumption, and nausea. We hypothesized that general anesthesia (with nerve blocks) would lead to earlier readiness for discharge, compared to spinal anesthesia (with nerve blocks). METHODS: All patients underwent ambulatory foot and ankle surgery, with a predicted case duration of 1-3 hours. All patients received popliteal and adductor canal nerve blocks using bupivacaine and dexamethasone. No intraoperative opioids were administered. All patients received ondansetron, dexamethasone, ketamine, and ketorolac. Patients, data collectors, and the data analyst were not informed of group assignment. Patients were randomized to spinal or general anesthesia with concealed allocation. Spinal anesthesia was performed with mepivacaine and accompanied with propofol sedation. After general anesthesia was induced with propofol, a laryngeal mask airway was inserted, followed by sevoflurane and propofol. Time until ready for discharge, the primary outcome, was compared between groups after adjusting for age and surgery time using multivariable unconditional quantile regression. Secondary outcomes compared at multiple timepoints were adjusted for multiple comparisons using the Holm-Bonferroni step-down procedure. RESULTS: General anesthesia patients were ready for discharge at a median of 39 minutes earlier (95% confidence interval, 2-75; P = .038) versus spinal anesthesia patients. Patients in both groups met readiness criteria for discharge substantially before actual discharge. Pain scores at rest were higher among general anesthesia patients 1 hour after leaving the operating room (adjusted difference in means, 2.1 [95% confidence interval, 1.0-3.2]; P < .001). Other secondary outcomes (including opioid use, opioid side effects, nausea, headache, sore throat, and back pain) were not different. CONCLUSIONS: General anesthesia was associated with earlier readiness for discharge, but the difference may not be clinically significant and did not lead to earlier actual discharge. Most secondary outcomes were not different between groups. The choice of spinal or general anesthesia as an adjunct to peripheral nerve blockade can reflect patient, clinician, and institutional preferences.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/tendências , Anestesia Geral/tendências , Raquianestesia/tendências , Bloqueio Nervoso Autônomo/tendências , Pé/cirurgia , Alta do Paciente/tendências , Adulto , Idoso , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Procedimentos Cirúrgicos Ambulatórios/métodos , Anestesia Geral/métodos , Raquianestesia/métodos , Bloqueio Nervoso Autônomo/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Medição da Dor/tendências , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/prevenção & controle , Fatores de Tempo
19.
BMJ Qual Saf ; 27(12): 1008-1018, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29776982

RESUMO

BACKGROUND: Identifying mechanisms to improve provider compliance with quality metrics is a common goal across medical disciplines. Nudge interventions are minimally invasive strategies that can influence behavioural changes and are increasingly used within healthcare settings. We hypothesised that nudge interventions may improve provider compliance with lung-protective ventilation (LPV) strategies during general anaesthesia. METHODS: We developed an audit and feedback dashboard that included information on both provider-level and department-level compliance with LPV strategies in two academic hospitals, two non-academic hospitals and two academic surgery centres affiliated with a single healthcare system. Dashboards were emailed to providers four times over the course of the 9-month study. Additionally, the default setting on anaesthesia machines for tidal volume was decreased from 700 mL to 400 mL. Data on surgical cases performed between 1 September 2016 and 31 May 2017 were examined for compliance with LPV. The impact of the interventions was assessed via pairwise logistic regression analysis corrected for multiple comparisons. RESULTS: A total of 14 793 anaesthesia records were analysed. Absolute compliance rates increased from 59.3% to 87.8%preintervention to postintervention. Introduction of attending physician dashboards resulted in a 41% increase in the odds of compliance (OR 1.41, 95% CI 1.17 to 1.69, p=0.002). Subsequently, the addition of advanced practice provider and resident dashboards lead to an additional 93% increase in the odds of compliance (OR 1.93, 95% CI 1.52 to 2.46, p<0.001). Lastly, modifying ventilator defaults led to a 376% increase in the odds of compliance (OR 3.76, 95% CI 3.1 to 4.57, p<0.001). CONCLUSION: Audit and feedback tools in conjunction with default changes improve provider compliance.


Assuntos
Atitude do Pessoal de Saúde , Pessoal de Saúde/organização & administração , Cuidados Intraoperatórios/métodos , Qualidade da Assistência à Saúde , Volume de Ventilação Pulmonar/fisiologia , Ventiladores Mecânicos/efeitos adversos , Anestesia Geral/normas , Anestesia Geral/tendências , Bases de Dados Factuais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Auditoria Médica , Cooperação do Paciente , Segurança do Paciente , Melhoria de Qualidade , Gestão da Segurança/organização & administração , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/métodos , Estados Unidos
20.
Korean J Anesthesiol ; 71(6): 447-452, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29739183

RESUMO

BACKGROUND: Cerebral state index (CSI) is an anesthesia depth monitor alternative to bispectral index (BIS). Published comparative studies have used propofol or sevoflurane. However, studies using desflurane have not been reported yet. Different volatile anesthetics have different electroencephalography signatures. The performance of CSI may be different in desflurane anesthesia. Therefore, the objective of this study was to compare CSI and BIS during desflurane anesthesia. METHODS: Thirty-three patients were recruited. Desflurane and remifentanil were used to maintain general anesthesia. BIS and CSI were recorded simultaneously every minute. End-tidal concentration of desflurane was maintained at 4% from the beginning of surgery for 5 minutes. Pairwise data of CSI and BIS were obtained five times at one-minute intervals. This process was repeated in the order of 6%, 8%, and 10%. RESULTS: BIS and CSI were negatively correlated with the end-tidal concentration of desflurane with a similar degree of correlation (correlation coefficient BIS: -0.847, CSI: -0.844). The relationship between CSI and BIS had a good linearity with a slope close to 1 (R2 = 0.905, slope = 1.01). For the relationship between CSI and BIS at each end-tidal concentration of desflurane, CSI and BIS showed good linearity in 4% and 10% (R2 = 0.559, 0.540). However, the linearity and slope were decreased in 6% and 8% (R2 = 0.163, 0.014). CONCLUSIONS: CSI showed an equivalent degree of overall performance compared to BIS in desflurane anesthesia. Accounting for previous literature, CSI can be used as a good substitute for BIS regardless of the kind of anesthetics used.


Assuntos
Anestésicos Inalatórios/administração & dosagem , Monitores de Consciência/normas , Desflurano/administração & dosagem , Monitorização Intraoperatória/métodos , Monitorização Intraoperatória/normas , Adulto , Idoso , Anestesia Geral/efeitos adversos , Anestesia Geral/tendências , Anestésicos Inalatórios/efeitos adversos , Córtex Cerebral/efeitos dos fármacos , Córtex Cerebral/fisiologia , Desflurano/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA