Alternative Anesthetic Technique Research Articles

Caudal block, high flow oxygen insufflation and dexmedetomidine sedation for inguinal hernia surgery in infants-A prospective evaluation of an alternative anesthesia technique.

Inguinal hernia repair is the most common operation in infants, with well recognized anesthetic and perioperative risks. The aim was to investigate if the combination of caudal block, high-flow nasal oxygen insufflation and intravenous dexmedetomidine sedation is suitable for infants undergoing inguinal hernia surgery. A prospective multicenter international study was performed in three centers in Australia and New Zealand. Fifty infants less than 64 weeks post-menstrual age undergoing inguinal hernia surgery were enrolled. Exclusion criteria were any condition that contraindicated the use of the anesthesia technique. The technique included intravenous dexmedetomidine with a loading dose of 1-2 mcg/kg over 10 min and maintenance of 0.2-3 mcg/kg/h, high-flow nasal oxygen insufflation 2 L/kg/min with an oxygen blender, and a caudal block using 1 mL/kg 0.2% ropivacaine. The primary outcome was the successful completion of surgery without conversion to general anesthesia. Completion of surgery with the technique was successful in 41/50 (82%) infants. Care was provided by 22 anesthesiologists and 11 surgeons. Infants had a low incidence of intraoperative complications, including apnea [1 (2.4%)], bradycardia [2 (4.9%)], hypotension [2 (4.9%)], and desaturation [1 (2.4%)]. Postoperative complications included apnea [3 (7.3%)], bradycardia [3 (7.3%)], hypotension [3 (7.3%)], desaturation [4 (9.8%)]. No infants were intubated in the first 24 h postoperatively. Caudal block, high-flow nasal oxygen insufflation and intravenous dexmedetomidine sedation is a potential alternative to general anesthesia for infant inguinal hernia surgery with a low rate of complications in this small cohort of infants.

Automated Closed-Loop Propofol Anesthesia Versus Desflurane Inhalation Anesthesia in Obese Patients Undergoing Bariatric Surgery: A Comparative Randomized Analysis of Recovery Profile.

Precision general anesthesia (GA) techniques that minimize the presence of residual anesthetic and facilitate recovery, are desirable in patients with morbid obesity. Automated administration of propofol total intravenous anesthesia (TIVA), which facilitates precision propofol delivery by factoring in continuous patient input variable (bispectral index) to establish a closed feedback loop system, may help mitigate concerns related to propofol's lipid solubility and adverse accumulation kinetics in patients with morbid obesity. This randomized study evaluated the recovery of patients with morbid obesity undergoing bariatric surgery under propofol TIVA automated by a closed-loop anesthesia delivery system (CLADS) versus desflurane GA. Forty patients, randomly allocated to receive propofol TIVA (CLADS group) or desflurane GA (desflurane group), were evaluated for postoperative recovery (early and intermediate) (primary objective); they were evaluated for intraoperative hemodynamics, anesthesia depth consistency, anesthesia delivery performance characteristics, patient satisfaction, and incidence of adverse events (sedation, pain, postoperative nausea, and vomiting) (secondary objective). No difference was found for the time-to-eye-opening (CLADS group: 4.7 [3.0, 6.7] min vs. desflurane group: 5.6 [4.0, 6.9] min, P = 0.576), time-to-tracheal-extubation (CLADS group: 6.7 [4.7, 9.3] min vs. desflurane group: 7.0 [5.8, 9.2] min, P = 0.528), ability-to-shift score from operating room table to the transport bed (CLADS group: 3 [3.0, 3.5] vs. desflurane group: 3 [3.0, 4.0], P = 0.703), and time to achieve a modified Aldrete score 9/10 (CLADS group: 15 [15.0, 37.5] min vs. desflurane group: 15 [15.0, 43.7] min, P = 0.867). Automated propofol TIVA as administered by CLADS, which matched desflurane GA with respect to depth of anesthesia consistency and postanesthesia recovery profile, can be explored further as an alternative anesthesia technique in patients with morbid obesity.

Automated Closed-Loop Propofol Anesthesia Versus Desflurane Inhalation Anesthesia in Obese Patients Undergoing Bariatric Surgery: A Comparative Randomized Analysis of Recovery Profile.

Precision general anesthesia (GA) techniques that minimize the presence of residual anesthetic and facilitate recovery, are desirable in patients with morbid obesity. Automated administration of propofol total intravenous anesthesia (TIVA), which facilitates precision propofol delivery by factoring in continuous patient input variable (bispectral index) to establish a closed feedback loop system, may help mitigate concerns related to propofol's lipid solubility and adverse accumulation kinetics in patients with morbid obesity. This randomized study evaluated the recovery of patients with morbid obesity undergoing bariatric surgery under propofol TIVA automated by a closed-loop anesthesia delivery system (CLADS) versus desflurane GA. Forty patients, randomly allocated to receive propofol TIVA (CLADS group) or desflurane GA (desflurane group), were evaluated for postoperative recovery (early and intermediate) (primary objective); they were evaluated for intraoperative hemodynamics, anesthesia depth consistency, anesthesia delivery performance characteristics, patient satisfaction, and incidence of adverse events (sedation, pain, postoperative nausea, and vomiting) (secondary objective). No difference was found for the time-to-eye-opening (CLADS group: 4.7 [3.0, 6.7] min vs. desflurane group: 5.6 [4.0, 6.9] min, P = 0.576), time-to-tracheal-extubation (CLADS group: 6.7 [4.7, 9.3] min vs. desflurane group: 7.0 [5.8, 9.2] min, P = 0.528), ability-to-shift score from operating room table to the transport bed (CLADS group: 3 [3.0, 3.5] vs. desflurane group: 3 [3.0, 4.0], P = 0.703), and time to achieve a modified Aldrete score 9/10 (CLADS group: 15 [15.0, 37.5] min vs. desflurane group: 15 [15.0, 43.7] min, P = 0.867). Automated propofol TIVA as administered by CLADS, which matched desflurane GA with respect to depth of anesthesia consistency and postanesthesia recovery profile, can be explored further as an alternative anesthesia technique in patients with morbid obesity.

Changing perioperative practice in the time of climate crisis

BackgroundTo reduce the healthcare sector's contribution to carbon emissions, many hospitals have advocated avoiding inhaled anesthetic agents with high greenhouse gas potential, such as desflurane and nitrous oxide; using low gas flows; and adopting alternative anesthetic techniques. However, limited evidence is available on how to implement these changes, which require both organizational and individual adjustment. We engaged our healthcare workers on the topic of climate change, and reviewed any change in their knowledge and attitudes towards environment-friendly use of inhaled anesthetic agents. MethodsWe sent out a survey via email to our anesthetic staff to assess their baseline knowledge and opinions regarding inhaled anesthetic agents and climate change. We then provided an online education session, followed by a debate on whether to remove desflurane from use. The session was recorded and emailed to all staff. The impact of the intervention was subsequently assessed by repeating the knowledge and attitude survey. ResultsOf the 101 anesthetic staff members, 76 completed the initial survey and 54 completed the post-intervention survey. Using a pre-determined generated code, we matched 44 pairs of datasets for analysis (response rate 44%). We demonstrated an overall improvement in knowledge on the topic, and showed a positive attitude towards reducing the use of nitrous oxide. There was minimal attitude change on desflurane use, a considerable concern about risk shifting and limited support for total intravenous anesthesia as the default technique. ConclusionsAs an initial step of a practice change process, this study raised climate change awareness and enabled our staff with differing opinions to feel involved and prepared for change. However, additional strategies may be required before initiating organizational changes, with the aim to provide environmentally sustainable practice while maintaining safe and high-quality perioperative patient care.

Ultrasound Guided Combined Peripheral Nerve Blocks in a High-Risk Patient: A Case Report

The use of ultrasound in peripheral nerve blocks has become increasingly more frequent. Lower–extremity surgeries are mainly performed under general or central neuraxial anesthesia, ultrasound-guided combined peripheral nerve block (PNB) can be a good alternative anesthetic technique, especially for high-risk patients who require continuous anticoagulation treatment and present with poor cardiovascular conditions.

Bilateral Rectus Sheath Block as an Effective Alternative Anaesthetic Technique for palliative Feeding Jejunostomy in an Advanced Carcinoma Thyroid Patient who Developed Tracheo - Oesophageal Fistula

Bilateral Rectus Sheath Block as an Effective Alternative Anaesthetic Technique for palliative Feeding Jejunostomy in an Advanced Carcinoma Thyroid Patient who Developed Tracheo - Oesophageal Fistula

Sedation as an alternative anesthetic technique for frail patients in transurethral resection of the prostate.

Transurethral resection of the prostate (TURP) under Monitored Anesthesia Care MAC/Sedation (macTURP), as compared with TURP under general (genTURP) or spinal (spTURP) anesthesia, is a safer and infrequently used technique reserved for high-risk patients. The aim of this study is to compare 30-day postoperative outcomes of TURP using the three types of anesthesia techniques. The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent TURP between 2008 and 2019. Demographics, lab values, medical history, and 30-day outcomes were compared. Univariate and multivariate regression models for postoperative complications were constructed. A propensity score-matched analysis was then performed for genTURP and macTURP and for spTURP and macTURP as a sensitivity analysis. A total of 53,182 patients underwent TURP. Older patients (>80) with diabetes requiring insulin (7.9%), leukocytosis (7.4%), history of chronic obstructive pulmonary disease (COPD) (7.8%), dyspnea (7.2%), and of ASA > 2 (58.8%) were more likely to undergo macTURP as compared with genTURP (p < 0.013). SpTURP showed lower rates of urinary tract infection (UTI) [odds ratio (OR) = 0.869] as compared with genTURP (p = 0.049), whereas macTURP showed higher rates of major adverse cardiovascular events (OR = 2.179) as compared with genTURP (p = 0.005). All other postoperative complications showed similar rates between the three procedures. The propensity-matched cohorts demonstrated that no differences in postoperative complication rates were noted between macTURP and genTURP and between macTURP and spTURP. MacTURP was found to be feasible with a good safety profile as compared with genTURP and spTURP. MacTURP could be used in elderly, frail, and co-morbid patients with a similar safety profile as compared with more invasive anesthetic techniques.

REGIONAL NERVE BLOCK FOR SUBCLAVIAN ACCESS TAVI

Transcatheter aortic valve implantation (TAVI) program has started in the UK in 2007 performing 66 cases a year, the number of cases of TAVI done every year has been exponentially increasing since then to reach 6076 cases in the year 2020. (Ludman) The UK TAVI registry has shown a nationwide shift in practice from general anaesthesia to conscious sedation for trans-femoral access TAVI, analysis has shown a fall of In-hospital mortality from 4.7 in 2012 to 1.8% in 2016 (Ludman). This shift, however, has not occurred in the same way for other arterial access like trans-subclavian or trans-axillary, which is still widely practiced in the UK under general anaesthesia. The vast majority of cases in the UK are done through the femoral access, however, finding an alternative approach is sometimes needed due to contraindication to the standard femoral approach, mostly vasculopathy, which usually indicates higher risk patient and higher likelihood of associated co-morbidities. Performing the alternative access TAVI under general anaesthesia adds more risk to the patient and in some cases could be life threatening, some of these patients could be deemed unfit for the procedure. Finding an alternative anaesthetic technique will allow these patients to have their procedures done with lower risk and have the optimum chance for quicker recovery. The technique of combining Superficial cervical plexus block, interscalene block with Pectoral block type II was first described in 2018 by Alexander et al and reproduced by Block et al in the United States in the same year to allow for performing subclavian access TAVI without general anaesthesia. The same technique was partially adopted with some modification by Vivian et al in Canada and Toscano et al in Italy in 2020 and 2021 respectively. In this manuscript we share our experience doing a series of subclavian access TAVI under regional nerve block and conscious sedation at the Freeman hospital in Newcastle upon Tyne, to our knowledge, and from literature search, this is the first time this is performed successfully in the UK as we didn't see any published reports on this technique within the country.

MP01-15 SEDATION AS AN ALTERNATIVE ANESTHETIC TECHNIQUE FOR FRAGILE PATIENTS IN TRANSURETHRAL RESECTION OF THE PROSTATE

You have accessJournal of UrologyCME1 May 2022MP01-15 SEDATION AS AN ALTERNATIVE ANESTHETIC TECHNIQUE FOR FRAGILE PATIENTS IN TRANSURETHRAL RESECTION OF THE PROSTATE Christian Ayoub, Nassib Abou Heidar, Adnan El-Achkar, Hani Tamim, and Albert El Hajj Christian AyoubChristian Ayoub More articles by this author , Nassib Abou HeidarNassib Abou Heidar More articles by this author , Adnan El-AchkarAdnan El-Achkar More articles by this author , Hani TamimHani Tamim More articles by this author , and Albert El HajjAlbert El Hajj More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002513.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although novel treatments have been introduced to treat benign prostatic hyperplasia, TURP remains the gold standard. TURP is mostly performed using general (genTURP) or spinal (spTURP) anesthesia. Monitored Anesthesia Care MAC/Sedation (macTURP) anesthesia is a safer and infrequently used anesthesia technique reserved for high-risk patients. The aim of this study is to compare 30-day post-operative outcomes of TURP using the three types of anesthesia techniques from the ACS-NSQIP database. METHODS: The ACS-NSQIP database was queried for male patients who underwent TURP for BPH treatment between the years 2005-2017. Demographics, clinical, operative characteristics, and 30-day outcomes were compared. Univariate and multivariate regression models were constructed for selected outcomes. RESULTS: 37,410 patients underwent TURP for BPH treatment of which 73.3% underwent genTURP, 24% spTURP and 2.4% macTURP anesthesia. Older patients (73) with hypertension (64%), history of COPD (8.1%) and of ASA II/III (51.2%, 6.3% respectively) were more likely to undergo macTURP as compared to genTURP (p-value <0.013). Regarding postoperative outcomes, macTURP showed lower rates of readmission (4.7%) as compared to spTURP and genTURP (p-value= 0.06). MacTURP also showed shorter operative times (50 min) and was more likely to be used in emergency cases (2.3%) as compared to genTURP but longer operative times as compared to spTURP (48 min) (p-value <0.01). MacTURP showed shorter length of hospital stay (2.15 days) as compared to spTURP (2.67 days), but longer length of hospital stays as compared to genTURP (1.85 days) (p-value <0.01). In terms of return to operative room, occurrence of pneumonia, urinary tract infection, sepsis and bleeding requiring transfusion there was no significant difference between the 3 anesthetic techniques. Multivariate analysis showed macTURP had lower operative time by 4 mins and spTURP by 2.7 mins as compared to genTURP. No other significant difference was seen in the multivariate analysis. CONCLUSIONS: TURP under sedation was found to be feasible with a good safety profile. Sedation could be used in elderly, fragile and co-morbid patients providing them less post-operative complications and shorter operative times as compared to more invasive anesthetic techniques. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e7 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Ayoub More articles by this author Nassib Abou Heidar More articles by this author Adnan El-Achkar More articles by this author Hani Tamim More articles by this author Albert El Hajj More articles by this author Expand All Advertisement PDF DownloadLoading ...

Application of WALANT in Diaphyseal Plating of Forearm Fractures: An Observational Study

Wide-Awake Local Anesthesia No Tourniquet (WALANT) is a novel anesthesia technique in distal radius and ankle fracture fixation. However, to date, there are limited studies in diaphyseal plating of forearm fractures under WALANT. This research is to study the feasibility of the use of WALANT technique in plating of diaphyseal fractures of the forearm as well as peri-operative outcomes. Sixty-one adult patients who underwent diaphyseal plating of the forearm under WALANT between the period of January 2019 and January 2021. It consists of 31 radius fractures, 15 ulna fractures and 15 ipsilateral radius and ulna fractures. Outcomes evaluated were duration of stay, peri-operative numerical pain rating scale, peri-operative blood pressure and heart rate, visual analogue scale for anxiety, blood loss, surgery duration, adverse effect, patient's satisfaction and any complications at 6 months follow up. Fifty-four patients (88.5%) were male and 7 patients (11.5%) were female with a mean age of 31.7 years (SD = 13.564). Thirty-eight out of 61 patients were totally pain free throughout the surgery. Ten (13%) patients reported pain during muscle dissection, 14 (18%) patients reported pain during bone manipulation and 12 (16%) patients reported pain during bone drilling. There was no significant difference in pain score between radius and ulna bones (P > .05). There was a significant change in blood pressure after LA infiltration (P < .01). The mean estimated blood loss was 27.39 ml (SD = 11.44) and the mean duration of post-surgery hospital stay was 1 day (SD = 1.026). Fifty-six patients (92%) recommended diaphyseal plating of the forearm under WALANT. None of the patients required conversion to general anesthesia and had any adverse events or infection during 6 months follow up. Diaphyseal plating of the forearm under WALANT is a feasible alternative anesthesia technique and is well tolerated by patients. Therapeutic III.

Modified radical mastectomy under paravertebral block in a patient diagnosed with active pulmonary tuberculosis with moderate restriction of pulmonary function

Mastectomy is mostly performed as definitive management for resectable breast cancer (BC). Implementing paravertebral nerve block for patients with metastasis features of cancer to lungs and other organs, patients with co-morbidity, geriatrics and malnourished individuals will eliminate the risks and complications of general anaesthesia (GA). Although thoracic paravertebral block is an established technique as post-operative pain management for breast surgery, there is no conclusive evidence on its use as a sole anaesthetic for modified radical mastectomy (MRM). In this case report, we present a 45-year-old woman who underwent a successful MRM for Stage IIIb BC associated with pulmonary tuberculosis with moderately restricted pulmonary function test under paravertebral nerve block. We believe that paravertebral nerve block can be used as an alternative anaesthetic technique for MRM in a resource-limited setting for patients who are expected to have a high risk of perioperative complications under GA.

Pelvic floor reconstructive surgery under local anesthesia: A systematic review and meta-analysis.

The decision on the appropriate type of anesthesia for pelvic floor repair depends on a variety of factors including patients' age, performance status, comorbidities, cost-effectiveness and personal preferences. We aim to review the literature on urogynecological procedures performed under local anesthesia (LA). A systematic search of four electronic databases was conducted for articles published up to May 2020. Studies reporting outcomes of women who underwent pelvic floor reconstructive surgery under LA with or without sedation, were considered eligible. Nineteen studies (14 noncomparative and 5 comparative), including 1626 cases of urogynecological procedures under LA were recruited. Meta-analysis revealed significantly lower mean pain scores in LA group compared to general-regional anesthesia one (GA/RA) at both 4-6 h and 8-18 h postoperatively (160 patients; mean difference [MD], -1.70; 95% confidence interval [CI]: -3.12, -0.28; p = 0.02 and 160 patients; MD, -0.72; 95% CI: -1.17, 0.27; p = 0.002, respectively). Pain scores at >24 h did not differ among the two groups (160 patients; MD, -0.28; 95% CI: -0.60-0.05; p = 0.10). Intra- and postoperatively morphine use was not different among patients who received LA and GA during prolapse surgery while nausea rates were significantly lower in LA group compared to RA group 8 h postoperatively. LA with or without sedation represents a safe and efficient alternative anesthetic technique for urogynecological procedures with improved pain scores in up to 18 h postoperatively especially in patients who underwent surgery for SUI. LA is feasible and could be offered to patients undergoing pelvic floor surgery allowing a prompt postoperative recovery.

Infographics in TIVA

AbstractInfographics are a new way of visually communicating information in a colorful and concise manner. They are becoming very popular in medical field since the last decade. Through infographics, one can understand the subjects through text, graphics, and images. Total intravenous anesthesia (TIVA) is a technique of general anesthesia (GA) given via intravenous (IV) route exclusively. In perspective of infographics, TIVA is far more understandable through its simple format. TIVA is also more advantageous than inhalational anesthesia. It avoids the deleterious effects of immunosuppressant and lacks any respiratory irritation, thus providing a good alternative anesthesia technique. Many peripheral surgeries can be done with the patient breathing spontaneously without any airway device, thus avoiding airway instrumentation, leading to droplet and aerosol generation. IV agents can be utilized to provide sedation during regional anesthesia (RA), which can easily be escalated to contain pain due to sparing of blocks or receding neuraxial anesthesia. The present narrative review focuses on the infographics in TIVA technique, providing highlights pertaining to its importance.

Anatomic Landmark Technique Thoracic Paravertebral Nerve Block as a Sole Anesthesia for Modified Radical Mastectomy in a Resource-Poor Setting: A Clinical Case Report

Mastectomy is mostly performed as definitive management for resectable breast cancer. Implementing paravertebral nerve block for patients with metastasis features of cancer to lungs and other organs, patients with co-morbidity, geriatrics, and malnourished individuals will eliminate the risks and complications of general anesthesia. Though thoracic paravertebral block is an established technique as postoperative pain management for breast surgery, there is no conclusive evidence on its use as a sole anesthetic for modified radical mastectomy. In this case report, we present a 33-year-old woman who underwent a successful modified radical mastectomy for stage IIIb breast cancer associated with clinical and radiological features of metastasis to the lung under a multiple injection landmark technique paravertebral nerve block. We believe that the anatomic landmark technique paravertebral nerve block can be used as an alternative anesthetic technique for modified radical mastectomy in a resource-limited setting for patients who are expected to have a high risk of perioperative complications under general anesthesia.

Predicting difficult spinal anesthesia: development of a neuraxial block assessment score.

Spinal anesthesia is a commonly performed procedure with unpredictable difficulty. The objective of this study was to predict a difficult lumbar spinal anesthesia with clinical elements that are easy to collect. A questionnaire-based, observational study named NBA, conducted from February 2018 to June 2018. The questions regarded clinical elements and the eventual spinal anesthesia difficulty encountered. A total of 427 questionnaires were filled by the operators. The clinical elements were selected upon literature search and have been integrated with new ones. All the answers were recorded from the anesthesiologist performing the procedure. The NBA Score was derived from a total number of 427 questionnaires. Among them, 26 patients had "previous history of difficult spinal anesthesia;" 277 had "spinous processes not visible;" 83 had "spinous processes not palpable;" 77 had "spinal deformities" and 28 had "previous spinal surgery" in the puncture area; 138 patients received lumbar spinal anesthesia in lateral position. There were 328 (76.8%) single puncture successes. Seventy-nine (18.5%) patients required more than one skin puncture to obtain a successful spinal anesthesia. 20 (4.7%) required an alternative anesthesia technique (general anesthesia). Multivariate analysis indicated that each element is a risk factors for difficult spinal anesthesia, except for previous spinal surgery. The combination of more than one element increased the chance of a second skin puncture of more than 50%. This work proposes a simple clinical scoring system predicting the probability of a difficult spinal anesthesia.

Ultrasound-Guided Intermediate Cervical Plexus Block for Transcarotid Transcatheter Aortic Valve Replacement

To report the authors' initial experience of transcarotid transcatheter aortic valve replacement (TAVR) managed with ultrasound-guided intermediate cervical plexus block. A single-center prospective study. A teaching hospital in Paris, France. All consecutive patients undergoing a transcarotid TAVR were included. The ultrasound-guided intermediate cervical plexus block was performed in 28 of 31 patients. In 3 patients, the procedure was scheduled under general anesthesia: 2 because of failure of previous transfemoral procedures under local anesthesia, and 1 for an emergency procedure in a pulmonary edema context. Anesthesia and all perioperative parameters were recorded, as well as any complications after the procedure. Twenty-eight patients were managed with intermediate cervical plexus block and light sedation without any anesthesia-related complication. No conversion to general anesthesia was required. The use of vasopressor was only required in 11% of the patients. In 2 patients, a loss of consciousness after the common carotid artery cross-clamping test occurred, leading to the use of a temporary femoral-carotid shunt; no other change in consciousness was recorded during the procedure. Ultrasound-guided intermediate cervical plexus block appeared to be an alternative anesthetic technique for carotid TAVR, providing adequate surgical conditions, continuous neurologic monitoring, and arterial pressure stability.

Is it time to stop using desflurane?

Desflurane has a carbon equivalence 20 times greater than sevoflurane. This article discusses alternative anaesthetic techniques, including sevoflurane, xenon, total intravenous anaesthesia and regional techniques, and methods of reducing venting of gases, which might lower the environmental impact of anaesthesia.

Quality of postoperative recovery after upper-arm vascular surgery for hemodialysis in patients with end-stage renal disease: A prospective comparison of cervical epidural anesthesia vs general anesthesia.

Cervical epidural anesthesia (CEA) is generally not used during upper-arm vascular surgery for hemodialysis in end-stage renal disease (ESRD) patients, despite its advantages. The Quality of Recovery-40 questionnaire (QOR-40) has been validated as a tool for assessing the degree of recovery after surgery. We hypothesized that CEA could provide a better outcome on the QOR-40 than general anesthesia after upper-arm vascular surgery for hemodialysis in ESRD patients.We divided anesthetic methods into general anesthesia and CEA. The QOR-40 was administered to 70 patients on the night before surgery and at 24 hours after surgery. Additional data, including consumption of opioid analgesics, occurrence of postoperative nausea and vomiting, and scores on a numeric rating scale (NRS) were collected.The total QOR-40 scores of the two groups differed significantly (P = .024) on postoperative day 1. Opioid consumption (P = .005) and occurrence of postoperative nausea (P = .019) in the post-anesthesia care unit (PACU) were significantly lower in the CEA group, whose NRS scores were significantly lower in the PACU (P < .001) and at postoperative day 1 (P = .016).Assessment of postoperative quality of recovery after upper-arm vascular surgery in ESRD patients showed that the CEA group had significantly better total QOR-40 and NRS scores. CEA could be used as an alternative anesthetic technique for upper-arm vascular surgery for hemodialysis in ESRD patients to improve the quality of recovery.

Combined lumbar plexus-sciatic nerve block in the emergency surgery for pertrochanteric fracture: an alternative technique in patients at high risk of anaesthetic complications

Introductionl’anesthésie pour la chirurgie urgente de la fracture pertrochantérienne (FPT) chez les patients à haut risque anesthésique représente souvent un véritable challenge pour les praticiens en vue du risque periopératoire majeur. Nous rapportons notre expérience avec le bibloc ou bloc combiné lombaire et sciatique plexique (BCLS) comme technique anesthésique alternative face à ce type de situation.Méthodesune étude transversale, descriptive, monocentrique, a été menée sur une période de 3 ans, incluant les patients à haut risque anesthésique présentant une FPT récente. Les deux blocs nerveux étaient réalisés au niveau plexique selon la technique classique de neurostimulation. Un mélange de 20ml de lidocaine 2% et de bupivacaine 0,5% (50/50) a été injecté au niveau de chaque bloc. Le critère d’évaluation principal était l’efficacité du BCLS apprécié par l’incidence d’échecs de la technique anesthésique, définie par la nécessité de convertir en anesthésie générale (AG). Les critères d’évaluation secondaires étaient: 1) les données techniques de la procédure anesthésique, 2) les retentissements hémodynamiques, respiratoires et neurologiques periopératoires, et 3) les résultats et les complications éventuelles en postopératoire.Résultatstrente patients ont été colligés. L’âge moyen était de 74 ± 10 ans. Le délai moyen d’admission aux urgences-intervention était de 12(5-36) heures. La durée moyenne pour la réalisation de la procédure était de 15,20 ± 3,45 minutes. Aucune conversion en AG n’a été nécessaire. Il n’y avait pas de différences statistiquement significatives entre les différentes valeurs enregistrées des paramètres hémodynamiques et respiratoires periopératoires (PAM, FC, SpO2) (p > 0,05). La durée de l’intervention était de 46 ± 5 minutes. La satisfaction des chirurgiens était de 9,7 ± 0,1. La première demande en antalgiques postopératoires était après 8(1-24) heures. Tous les patients avaient une récupération sensitivomotrice complète.Conclusionle BCLS est une alternative anesthésique pour les interventions urgentes de FPT chez les patients à haut risque anesthésique: délais opératoires réduits, efficacité anesthésique, stabilité hémodynamique et respiratoire periopératoire, absence de complications inhérentes aux autres techniques anesthésiques, passage rapide en salle de surveillance post-interventionnelle (SSPI), et analgésie postopératoire de qualité.

Spontaneous breathing anesthesia for cervical tracheal resection and reconstruction.

Spontaneous breathing anesthesia (SBA) may have advantages over general anesthesia for cervical tracheal resection and reconstruction (TRR), avoiding the difficulties and complication caused by endotracheal intubation and surgical cross-field intubation. This prospective study evaluates SBA for cervical TRR. Date was obtained from 35 patients who had cervical TRR under SBA from May 2015 to March 2019. Intravenous sedation and ultrasound-guided bilateral superficial cervical plexus block (CPB) were applied to maintain effective analgesia and sedation. Thirty-two patients with tracheal tumors and 3 patients with post-intubation tracheal stenosis underwent TRR. After the airway was opened, 29 patients resumed stable spontaneous breathing, 1 patient needed high-frequency jet ventilation, and 1 patient needed anesthesia conversion for surgical reasons. Spontaneous breathing anesthesia is feasible for the cervical TRR. It can be an alternative anesthetic technique for certain patients.