General Anesthesia Group Research Articles

Neurodevelopmental Outcomes After Multiple General Anaesthetic Exposure Before Five Years Of Age - A Cohort Study.

The GAS trial demonstrated evidence that most neurodevelopmental outcomes at 2 years and 5 years of age in infants who received a single general anaesthetic (GA) for elective inguinal herniorrhaphy were clinically equivalent when compared to infants who did not receive GA. More than 20% of the children in the trial had at least one subsequent anaesthetic exposure after their initial surgery. Using the GAS database, this study aimed to address whether multiple (2 or more) GA exposures compared to one or no GA exposure in early childhood were associated with worse neurodevelopmental outcomes at 5 years. Children with multiple GA exposures and children with one or no GA exposure were identified from the GAS database. The primary outcome was the full-scale intelligence quotient (FSIQ) on the Wechsler Preschool and Primary Scale of Intelligence third edition (WPPSI-III) at 5 years of age. Secondary outcomes included neurocognitive tests addressing all major developmental domains and caregiver-reported questionnaires assessing emotional and behavioural problems. Complete assessment was available from a total of 90 children in the multiple GA group and 141 children in the 0 or 1 GA group. Compared with children with a single or no GA exposure, multiply exposed children scored on average almost 6 points lower (mean: -5.8, 95% CI: -10.2 to -1.4, p= 0.011) in WPPSI-III FSIQ. They also demonstrated lower verbal and performance IQ scores and more emotional, behavioural, and executive function difficulties. However, significant residual confounding cannot be excluded from the results due to the observational nature of this study. Multiple GA exposure before 5 years of age was associated with reduced performance in general intelligence score and some domains of neurodevelopmental assessments. The clinical significance of our results must be cautiously interpreted in light of several sources of limitations including small sample size and unadjusted residual confounding. This study illustrates the limitations of trial data sets that may not be fit for the purpose for the secondary analysis.

Impact of anesthesia type on surgical outcomes and medical complications in chronic subdural hematoma surgery

BackgroundsChronic Subdural Hematoma (CSDH) is common in elderly patients. Although general anesthesia (GA) has traditionally been used for CSDH surgeries, it may lead to postoperative complications, especially in older patients. We hypothesized that local anesthesia (LA) could reduce postoperative medical complications, including pneumonia, compared to GA. MethodsWe conducted a retrospective study from 2015 to 2019, of medical records of CSDH patients from two hospitals in addition to a comprehensive literature review. Inclusion criteria were a new CSDH diagnoses and treatment with burr-hole craniostomy (BHC) and drain insertion. Patients with recent ipsilateral craniotomies were excluded. Clinical variables included demographics, comorbidities, hematoma characteristics, and post-operative outcomes. ResultsOf 383 eligible patients, 63 underwent BHC under LA (LA group), and 320 under GA (GA group). Both groups exhibited similar baseline characteristics, hematoma characteristics, and surgical outcomes, including postoperative CT findings and ICU stay duration. There was also no significant difference in postoperative bleeding events between the groups. Although patients in the GA group experienced a higher incidence of postoperative pneumonia (3.8 % vs 1.6 %), multivariate analysis revealed that the occurrence of pneumonia was associated with a history of lung disease and preoperative neurological status (OR 7.28, p = 0.018, OR 3.40, p < 0.001, respectively) rather than with the type of anesthesia used. ConclusionOur study suggests that the type of anesthesia does not influence postoperative surgical and medical outcomes, including pneumonia, which is the most common medical complication of BHC for CSDH. Rather, preoperative neurological status and underlying morbidities appear to be more closely related to postoperative medical complications. Future large, prospective studies are needed to validate our findings.

Effect of Valve Type and Anesthesia Strategy for TAVR: 5-YearResultsoftheSOLVE-TAVITrial.

In the randomized SOLVE-TAVI (compariSon of secOnd-generation seLf-expandable vs. balloon-expandable Valves and gEneral vs. local anesthesia in Transcatheter Aortic Valve Implantation) trial comparing newer-generation self-expanding valves (SEV) and balloon-expandable valves (BEV), as well as conscious sedation (CS) and general anesthesia (GA), clinical outcomes were similar both for valve and anesthesia comparison at 30days and 1 year. Prosthesis durability may affect clinical outcomes during long-term follow-up. Moreover, the impact of the anesthesia strategy on long-term clinical outcomes is unknown so far. The authors sought to compare clinical outcomes during 5-year follow-up in the randomized SOLVE-TAVI trial. In the randomized, multicenter, 2× 2 factorial, open-label SOLVE-TAVI trial, 447 intermediate- to high-risk patients with severe, symptomatic aortic stenosis were randomly assigned to transfemoral transcatheter aortic valve replacement (TAVR) using either SEV (Evolut R, Medtronic) or BEV (SAPIEN 3, Edwards Lifesciences) and also to CS vs GA. Patients were followed-up for 5 years. During 5 years of follow-up, the combined predefined endpoint of all-cause mortality, stroke, moderate or severe paravalvular leakage, and permanent pacemaker implantation was similar in the SEV and BEV groups (67.7% vs 63.4%; HR: 0.89; 95%CI: 0.70-1.13; P=0.34). Stroke rates at 5 years were lower in the SEV group (2.2% vs 9.6%; HR: 4.84; 95%CI: 1.65-14.18; P=0.002). Regarding the anesthesia comparison, the primary endpoint of all-cause mortality, stroke, myocardial infarction, and acute kidney injury occurred in 51.4% in the CS group and 61.3% in the GA group (HR: 0.80; 95%CI: 0.62-1.04; P=0.09). All-cause mortality at 5 years was lower for CS (41.5% vs 54.3%; HR: 0.70; 95%CI: 0.53-0.94; P=0.02). Transfemoral TAVR using either SEV and BEV as well as CS and GA showed similar clinical outcomes at 5 years using a combined clinical endpoint.

Outcomes of different anesthesia techniques in nonagenarians treated with mechanical thrombectomy for anterior circulation large vessel occlusion: An inverse probability weighting analysis.

There is a lack of evidence for the optimal type of anesthesia technique in patients ⩾ 90 years with acute ischemic stroke undergoing mechanical thrombectomy (MT) as this subgroup of patients was often excluded or under-represented in previous trials. We aimed to compare outcomes between general anesthesia (GA) and non-GA techniques in patients ⩾ 90 years with large vessel occlusion (LVO) undergoing MT. Our study included patients ⩾ 90 years with anterior circulation LVO, NIHSS ⩾ 6, ASPECTS ⩾ 5 consecutively treated with MT within 6 h after stroke onset in three thrombectomy capable centers between January 1st, 2016 and March 30th, 2023. Inverse probability weighting (IPW) was used to reduce bias by indication of the anesthesia type on study outcomes. We used a weighted ordinal robust logistic regression analysis to explore the primary outcome of modified Rankin Scale (mRS) shift at 90 days in GA versus non-GA treated patients. Secondary outcomes included 90-day mortality, symptomatic intracranial hemorrhage (sICH) and TICI score of 2b, 2c, or 3. We included 139 patients ⩾ 90 years treated with MT, 62 were in GA group and 77 in non-GA group. There was a significant shift for worse mRS scores at 90-day in non-GA treated patients (cOR 3.65, 95% CI 1.77-7.77, p = 0.001). The weighted logistic regression showed that non-GA technique was an independent predictor of 90-day mortality (OR 7.49, 95% CI 2.00-28.09; p = 0.003). Our study indicated that nonagenarians with acute ischemic stroke treated with MT without GA have a worse prognosis than their counterparts undergoing MT with GA. Further studies in larger cohorts are warranted to evaluate the optimal type of anesthesia in this patient population.

Characterization of sedation strategies in real-world use of pulsed field ablation: sub-analysis of the EU-PORIA registry

Abstract Background/Introduction With the introduction of pulsed field ablation (PFA) to treat patients with atrial fibrillation (AF), there has been interest in studying workflow and sedation strategies to better understand how this new technology can be integrated into clinical practice. Purpose Characterize the use of general anesthesia (GA) versus deep sedation during real-world use of the pentaspline PFA catheter to treat AF. Methods EU-PORIA is an all-comer AF registry enrolling consecutive patients treated with the pentaspline PFA catheter at seven high-volume centers in Europe. Patients were treated based on institutional standard of care. During follow-up, any episode of atrial tachycardia (AT) or AF lasting longer than 30 seconds was considered an arrhythmia recurrence. Results EU-PORIA enrolled 1233 patients, of which 250 ablation cases were performed under GA and 983 cases were performed with deep sedation. Six out of the 7 participating centers employed a single sedation strategy (2 GA; 4 deep sedation), with one center doing a mix of both sedation and GA. The patient population treated with GA had fewer female patients (30% vs 40%; p=0.04), a lower prevalence of hypertension (43% vs 57%; p&amp;lt;0.01), and fewer paroxysmal AF patients (54% vs 62%; p&amp;lt;0.01). The ablation strategy was performed based on operator’s discretion. In the GA group, 72% of patients received a pulmonary vein isolation (PVI)-only ablation approach versus 90% of patients in the sedation group (p&amp;lt;0.01). The most common additional lesion set performed was posterior wall isolation which accounted for 23% and 7% of cases in the GA and sedation groups, respectively (p&amp;lt;0.01). Procedure times and fluoroscopy times were significantly shorter in the sedation group versus the GA group (51 [36-84] min vs 75[60-90] min; 13 [8-19] min vs 19 [15-26] min; p&amp;lt;0.01 for both). Mapping was used in 60% of cases in the GA group versus only 26% of cases in the sedation group. Overall, there were no differences in the incidence of serious adverse events, and no difference in chronic treatment success. At 1-year follow-up, 74.8% of patients (187/250) in the GA group and 73.8% of patients (725/983) in the sedation group were free from recurrent AF/AT. Conclusion(s) In this registry, the use of deep sedation for AF ablation with the pentaspline PFA catheter demonstrated a safety and efficacy profile consistent with those procedures performed under GA. The majority of the deep sedation procedures were PVI-only and performed in a less progressed AF disease state. It is worth noting that there may be certain patient populations and center restrictions where GA will remain the necessary approach for AF ablation. This characterization of real-world use warrants further evaluation to understand optimal sedation strategies that can be used with PFA technologies.

Assessing the Use of BotulinumtoxinA for Hyperactive Urinary Tract Dysfunction a Decade After Approval: General Versus Local Anesthesia for BotulinumtoxinA Detrusor Injection

Background: The onabotulinumtoxinA detrusor injection (OnabotA DI) was approved a decade ago for the treatment of patients with idiopathic overactive bladder (iOAB) or neurogenic detrusor overactivity (nDO) dysfunction who had not been treated successfully otherwise. The procedure is usually performed under local anesthesia (LA), and various approaches have been investigated to make the procedure as painless as possible. We examined the level of anxiety and pain experienced by patients who wanted to have the procedure performed under LA or general anesthesia (GA). Material and Methods: Patients scheduled for OnabotA DI were able to choose the anesthesia procedure (LA or GA). The Amsterdam Preoperative Anxiety and Information Scale (APAIS) was used to grade anxiety before anesthesia or before the procedure itself. Intra- and postoperative pain was determined using the Visual Analogue Scale (VAS). Various established questionnaires (including the Urinary Distress Inventory UDI-6), as well as a postoperative satisfaction questionnaire, were used to evaluate the success of the therapy. Results: In total, 104 patients (93 F, 11 M; age 64.0 (22–89) years; 80× iOAB, 24× nDO) were evaluated. OnabotA-DI was performed with LA in 72 patients and GA in 32. Stratified by first versus repeat injection in the LA group, there was a significant decrease in the Anxiety Score in the first vs. repeat injection group (p = 0.038). The LA group showed higher concerns in the anesthesia questions of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) than the GA group (OR: 0.29, 95%CI: 0.02–1.74). The VAS Pain Score during the procedure was significantly lower in the GA group compared to the LA group (LA: 3.3 ± 2.2, GA group 1.5 ± 1.5; p &lt; 0.001). There were no differences in the success of therapy. Despite the fear and pain, patients preferred LA to GA. Conclusions: This study shows that the anxiety and pain burden of patients undergoing OnabotA-DI under LA is significant in comparison to GA during the first injection, but insignificant for following injections. Overall, LA is favored over GA.

Awake lumbar spine surgery performed under spinal versus conventional anesthesia.

Lumbar spine surgery for discectomy or laminectomy is mostly performed under general anesthesia (GA). Here, we explored whether, in a series of 84 patients, better peri-operative outcomes and lower complication rates could be achieved for those undergoing diskectomy/laminectomy under spinal anesthesia (SA) versus GA. From 2022 to 2023, 84 patients were randomly assigned to undergo lumbar discectomy/laminectomy for stenosis under SA: 42 patients versus GAGA: 42 patients. For these two populations, we analyzed and compared multiple variables, including duration of anesthesia, estimated blood loss (EBL), and outcomes (i.e., including pre/post-operative Visual Analogue Scale, Oswestry disability index, and short-form 36 questionnaires). Major advantages of SA versus GA included a reduced mean EBL, shorter mean operative time, reduced mean hospital length of stay, and fewer post-operative side effects. Notably, baseline heart rate or mean arterial blood pressure showed no significant differences between SA and GA groups. Based on this small preliminary sample of patients undergoing lumbar disc/stenosis surgery, it appeared that SA reduced the mean EBL, offered shorter mean operative times, mean hospital lengths of stay, and fewer post-operative side effects versus GA.

Effect of Anesthesia Type on Pain and Hemodynamic Parameters in Cesarean Section Surgery: Randomized Controlled Trial

Background: General and spinal anesthesia are commonly used for cesarean sections, each with implications for both the mother and the fetus. The choice of anesthesia technique depends on various factors. While spinal anesthesia is often preferred for cesarean surgeries due to its well-known benefits, general anesthesia may be chosen in emergency situations. The decision is ultimately based on the safety profile and benefits for both the mother and the fetus. Methods: This clinical trial was conducted at Fatemieh Hospital in Hamadan and involved 60 patients undergoing elective cesarean section. The patients were randomly divided into two groups of 30: One group received spinal anesthesia, and the other group received general anesthesia. Variables such as intraoperative bleeding, the Apgar score of the newborn, postoperative pain, and postoperative systolic and diastolic blood pressure were analyzed and compared between the two groups using SPSS software version 16. Results: The mean age of participants in the spinal and general anesthesia groups was 32 ± 3.5 years and 34 ± 3.4 years, respectively. The results showed that the amount of intraoperative bleeding in the general anesthesia group was higher than in the spinal anesthesia group, but this difference was not statistically significant (P = 0.85, P &lt; 0.05). The Apgar scores at the first and fifth minutes in the spinal anesthesia group were higher than those in the general anesthesia group, but this difference was also not statistically significant (P = 0.32, P &lt; 0.05). Postoperative pain in the spinal anesthesia group was significantly lower than in the general anesthesia group (P = 0.001, P &lt; 0.05). Regarding hemodynamic parameters, systolic blood pressure after the operation was higher in the spinal anesthesia group compared to the general anesthesia group (P &lt; 0.05). Conversely, diastolic blood pressure in the general anesthesia group was higher than in the spinal anesthesia group at all measurement stages, though not statistically significant in some measurements (P &gt; 0.05). Conclusions: The results of our study indicate that spinal anesthesia is a preferable and safer method compared to general anesthesia, based on the parameters examined, particularly in emergency cesarean sections.

Chronic postoperative pain syndrome and its neuropathic component in long-term period of coronary artery bypass grafting

Background: Along with increased safety and quality of the early postoperative period, 6.9% of patients who undergo sternotomy experience chronic pain at the surgical site. The significance of this issue is underestimated, with a third of these patients developing a neuropathic component of chronic pain syndrome. Aim: To assess the severity of acute and chronic postoperative pain following sternotomy and to identify predictors of the neuropathic component of chronic pain syndrome. Materials and methods: Out of 115patients who underwent elective coronary artery bypass grafting (CABG) randomized according to method of anesthesia, two study groups were formed based on the results of a telephone survey: a general anesthesia group (GA, n=28) and a combined anesthesia group (CA, n=34). As part of the posthoc analysis, a logistic regression model was built to predict chronic neuropathic pain syndrome based on gender, age, anesthesia method, and factors assessing the severity of the perioperative period and myocardial impairment. Results: Chronic postoperative pain syndrome was identified in 25.8% of patients, with a neuropathic component confirmed in 19.4% of cases. Pain severity at rest in the GA and CA groups was 2.0 (1.0) and 3.0 (3.0) points on a numeric rating scale one hour after extubation, and 2.0 (2.0) and 2.0 (2.0) points by the end of the first postoperative day (p=0.193 and 0.610, respectively). The logistic regression model achieved an AUROC of 0,82 (95% CI 0,68–0,96) with c2(10)=10.62, p=0.39. Conclusions: Neuropathic pain was diagnosed in 19.4% of patients following CABG. The use of regional anesthesia and the severity of acute pain did not impact the development of neuropathic pain syndrome in the long-term period after surgery. The proposed model for predicting the neuropathic component of chronic pain syndrome after CABG requires further improvement.

Bilateral erector spinae plane block by multiple injection for pain control in pseudomyxoma peritonei surgery: a single-blind randomized controlled trial

ObjectiveCurrently, the primary surgical treatment for pseudomyxoma peritonei (PMP) is cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). The perioperative period is frequently accompanied by severe pain. Erector spinae plane block (ESPB) can enhance analgesia for abdominal surgery. The purpose of this study was to compare the analgesic effects of bilateral multiple-injection ESPB in patients with PMP.MethodsFifty patients with PMP were randomly divided into two groups: the ESPB combined with general anesthesia group (Group E) and the general anesthesia alone group (Group C). Prior to the induction, patients in Group E underwent ESPB at the T7 and T11 levels. The primary outcome was the visual analog scale (VAS) scores during rest at 6 h post-extubation. Secondary outcomes included intraoperative and postoperative opioid consumption, time for first rescue analgesia, frequency distribution of rescue analgesia, incidence of nausea and vomiting, adverse events associated with ESPB.ResultsThe Visual Analogue Scale (VAS) scores in Group E were significantly lower compared to Group C at immediate post-extubation (1.6 ± 0.9 vs. 2.4 ± 1.2, P = 0.008), and at 2 (1.9 ± 1.2 vs. 3.2 ± 1.1, P < 0.001), 4 (2.4 ± 1.5 vs. 3.7 ± 1.0, P = 0.001), and 6 h (2.7 ± 1.1 vs. 3.8 ± 1.4, P = 0.004) post-extubation during rest. Similarly, the VAS scores in Group E were significantly lower than those in Group C at immediate post-extubation (3.0 ± 1.4 vs. 4.6 ± 1.2, P < 0.001), and at 2 (3.8 ± 1.7 vs. 4.9 ± 1.4, P = 0.019), 4 (3.5 ± 1.3 vs. 5.3 ± 1.5, P < 0.001), and 6 h (3.9 ± 1.8 vs. 4.9 ± 1.3, P = 0.004) post-extubation during movement. In Group E, the intraoperative remifentanil administration (2319.3 ± 1089.5 vs. 2984.6 ± 796.1, P = 0.017) and the amount of rescue analgesia within 2 h post-extubation (0 vs. 4, P = 0.037) were significantly less than in Group C, and the first rescue analgesia time was shorter as well (231.4 ± 147.5 vs. 668.8 ± 416.7, P < 0.001).ConclusionCompared to general anesthesia alone, bilateral multiple-injection ESPB with 0.2% ropivacaine can enhance analgesia and reduce opioid administration in patients with PMP. However, the duration of analgesia with ESPB is relatively short due to the low concentration of the local anesthetic used.Trial registrationChinese Clinical Trial Registry, ChiCTR2300069504, 20/03/2023.

General anesthesia is associated with lower perioperative bleeding and better functional outcomes than spinal anesthesia for endoscopic enucleation of the prostate: a single-center experience.

Holmium laser enucleation of the prostate (HoLEP) and bipolar transurethral enucleation of the prostate (B-TUEP) are safe and effective treatment options for benign prostatic hyperplasia (BPH). Spinal anesthesia (SA) is widely used for endoscopic enucleation of the prostate (EEP) in place of general anesthesia (GA). We aimed to assess the impact of GA vs. SA on blood loss, postoperative course and functional outcomes after HoLEP and B-TUEP. After propensity score matching, we analyzed data from 148 patients treated with EEP in our centre for symptomatic BPH. We recorded patient's characteristics, procedural data, type of anesthesia (SA vs. GA). Postoperatively we evaluated hemoglobin drop, catheterization time (CT), and length of hospital stay (LOS). Functional outcomes were evaluated with the International Prostate Symptoms Score (IPSS) at baseline and 3 months after surgery. Descriptive statistics and linear regression models tested the association between anesthesia type and EEP outcomes. After matching groups were comparable in terms of pre- and intra-operative variables. Of all, 111 (75%) patients were treated under SA. Haemoglobin drop was lower in GA compared to SA group (1 vs. 1.4g/dL, p < 0.01). CT was shorter in the GA group (1 vs. 2 days, p = 0.01). Postoperative IPSS score was lower in GA group (4 vs. 8, p = 0.04). Multivariable linear regression models revealed that prostate volume (p = 0.01) and SA vs. GA (p = 0.01) were associated with higher haemoglobin drop, after accounting for age and use of anticoagulants/antiplatelets. Similarly, SA vs. GA (p = 0.02) and postoperative complications occurrence (p < 0.001) were associated with a longer LOS, after accounting for age, prostate volume and use of anticoagulants/antiplatelets. EEP can be safely performed under both GA and SA. GA offers better outcomes in terms of perioperative bleeding and 3-month functional outcomes.

Anesthetic and obstetric predictors of general anesthesia in urgent or emergent Cesarean delivery: a retrospective case-control study.

While regional anesthesia (RA) is considered preferable to general anesthesia (GA) for Cesarean delivery (CD), certain situations necessitate GA. This study reviewed the practice patterns around the use of GA for CD to identify modifiable predictors of GA with the goal of reducing GA rates. This was a retrospective, case-control study. Patients undergoing urgent/emergent CD over a 3-year period were identified, from which 102 patients undergoing GA and 102 patients undergoing RA were randomly selected. The data included patient characteristics, obstetrical indications for CD, type/indication of anesthetic, characteristics of airway management (GA group)/neuraxial anesthesia (RA group), and neonatal outcomes. Abnormal fetal heart rate (aFHR) was the most common obstetrical indication for urgent/emergent CD amongst the cases (39%) and controls (39%). GA administration was most commonly due to "limited time due to maternal/fetal compromise" (56%), followed by "maternal contraindication to RA" (25%) and "inadequate RA" (17%). The most frequent modifiable anesthetic indication for GA was inadequate neuraxial anesthesia (17%). Anesthetic and obstetric predictors for GA included ASA classification [OR 0.11 (0.06-0.21)], emergency code activation [OR 13.55 (1.73-106.40)], failure to progress [OR 0.15 ((0.06-0.36)], laborin a patient scheduled for CD [OR 0.16 (0.05-0.57)], pregnancy-related illness [OR 8.63 (1.06-70.38)], cord/fetal prolapse [14.85(1.90-115.94)], and gestational age (OR 0.86 (0.81-0.92)). Abnormal fetal heart rate, specifically bradycardia, was the most common obstetrical indication of GA for urgent/emergent CD, while inadequate neuraxial anesthesia was the most modifiable anesthetic indication. Our data suggest aFHR and cord/fetal prolapse as potentially modifiable risk factors for GA in certain situations.

Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair Under Combined Spinal Epidural Anesthesia Versus General Anesthesia

Background: Inguinal hernia repair is one of the most frequently used elective surgical operations in the world. General anesthesia (GA) has risks and routine postoperative complications, such as nausea, vomiting, throat irritation, and postoperative pain. Regional anesthesia (RA) has many advantages over GA, such as faster recovery, less postoperative pain, nausea, and vomiting, and less hemodynamic compromise. We aimed to investigate the efficacy and safety of combined spinal and epidural anesthesia (CSEA) in preventing shoulder pain in patients undergoing totally extraperitoneal herniorrhaphy (TEP). Materials and Methods: The files of patients who had undergone the TEP method under GA and CSEA due to inguinal hernia between April 2020 and November 2021 at the Bakirköy Dr. Sadi Konuk Training and Research Hospital were reviewed retrospectively. Results: A total of 81 patients were included in the study. The number of patients operated on GA (group 1) was 40, and the number of patients operated under CSEA (group 2) was 41. There was no significant difference in the demographic characteristics of the patients. The surgical time was 42.9 and 42.5 minutes in groups 1 and 2, respectively (P=0.970). The mean operative time was recorded as 60.1 and 80.2 minutes in groups 1 and 2, respectively, and it was statistically significantly shorter in group 1 (P&lt;0.001). A peritoneal tear was seen in 18 patients (43.90%) in the GA group and 16 patients (40%) in the CSEA group, but no significant difference was found between the groups (P=0.823). Mild shoulder pain that did not require intervention was observed in 1 patient (2.5%) in the CSEA group. In group 2, the VAS scores at all times and the need for postoperative analgesia were statistically significantly lower (P&lt;0.001). In terms of anesthesia complications, headache was not observed in group 1, while it was seen in 6 (15%) patients in group 2 (P=0.012) Conclusions: In laparoscopic TEP surgeries, CSEA may be an alternative anesthesia method to GA anesthesia due to the low VAS score, less need for analgesia, and fewer postoperative pulmonary complications.

Comparative Study on the Effectiveness, Safety, and Economic Costs of Endoscopic Submucosal Dissection for Colorectal Tumors Under Conscious Sedation and General Anesthesia.

Endoscopic submucosal dissection (ESD) is a minimally invasive surgical procedure used for en bloc removal of colorectal tumors. Although colorectal ESD is ideally conducted under conscious sedation, it is often performed under general anesthesia because of its complexity and lengthy duration. Currently, there is limited research on colorectal ESD performed under conscious sedation. The purpose of this study was to evaluate the effectiveness, safety, and economic cost of colorectal ESD under conscious sedation compared to general anesthesia. Retrospective analysis of 301 patients who underwent ESD treatment for colorectal tumors at the Endoscopy Center of Peking University Cancer Hospital from January 2018 to November 2020. Patients were divided into the sedation group (group S, n=88) and the general anesthesia group (group A, n=213) based on the anesthetic method. To balance the confounding factors between the 2 groups, 75 matched pairs were obtained after using propensity score matching (PSM). Intraoperative and postoperative parameters were then compared between the matched groups. After PSM, there was no statistically significant difference between group S and group A in terms of the surgical time, en bloc resection rate, and complete resection rate. There was also no statistically significant difference in the occurrence rates of bleeding, perforation, and post-ESD electrocoagulation syndrome (PEECS) between the 2 groups. However, the length of hospital stay was significantly shorter in group S (1.23±0.89d) than in group A (5.92±3.05d) ( P <0.05). The hospitalization costs were also significantly lower in group S (16482.34±13154.32 yuan) compared with group A (34743.74±13779.40 yuan) (P < 0.05 ). Compared to general anesthesia, performing ESD for colorectal tumors under conscious sedation has equivalent effectiveness and safety while shortening the hospital stay and reducing the economic costs.

Ultrasound-guided transversus abdominis plane block is an effective opioid-sparing alternative to epidural anesthesia in open abdominal aortic aneurysm repair

ObjectiveThis study evaluated the effectiveness of ultrasound-guided transversus abdominis plane (TAP) blocks compared with epidural (EPI) and general anesthesia (GA) in managing postoperative pain following open abdominal aortic aneurysm (AAA) repair. MethodsA retrospective review was conducted on 61 elective open AAA repairs performed between January 2016 and December 2021. Patients were categorized into three groups: GA, GA plus EPI, and GA plus TAP block. The primary outcome measured was opioid requirements, reported as morphine milligram equivalents (MME) at 48, 72, and 120 hours postoperatively. The additional opioid requirements between 48 and 72 hours (ΔMME₁) and between 72 and 120 hours (ΔMME₂) were also evaluated. Secondary outcomes included vasopressor requirements, extubation in the operating room, and length of stay in the intensive care unit and hospital. ResultsThe mean MMEs at 48, 72, and 120 hours were statistically significant across all groups. The mean MME at 48 hours was 51.1 ± 71.9 in the TAP group compared with 140.5 ± 121.7 in the GA group. Pairwise comparisons showed a significant difference between the GA and TAP groups at 48 hours (P = .002), whereas the difference between EPI and TAP at 48 hours was not significant (P = .098). Additional opioid requirements between 48 and 72 hours after surgery (ΔMME₁) showed a significant difference between EPI and TAP (P = .045). All groups had significantly different MMEs at 72 hours, with no significant differences observed at 120 hours. Secondary outcomes were not significantly different across the groups. ConclusionsTAP blocks provide effective postoperative pain control with decreased opioid requirements similar to EPI anesthesia during the first 48 hours postoperatively. This factor makes TAP blocks a viable alternative to EPI anesthesia in open AAA repairs. Further multicenter studies are recommended to validate these findings.

Roles of epidural block in combination with general anesthesia in stress response and immune function of patients after surgery for cervical cancer.

We aimed to explore the roles of epidural block in combination with general anesthesia in the stress response and immune function of patients after surgery for cervical cancer. A total of 108 patients undergoing radical surgery of cervical cancer were randomly assigned into a general anesthesia combined with epidural block (observation) group and a general anesthesia (control) group. Peripheral blood was collected before anesthesia (t0), during anesthesia maintenance, as well as 10min, 1 d, 2 d and 7 d after surgery. The levels of cytokines interferon-γ (IFN-γ), interleukin-4 (IL-4) and transforming growth factor-β1 (TGF-β1) were detected by ELISA, and IFN-γ/IL-4 ratio was calculated. Compared with the control group, the observation group had significantly lower levels of GH, PRL and Cor, proportions of Th2 and Treg cells, and levels of IL-4 and TGF-β1 during anesthesia maintenance and at each time point after surgery (P < 0.05), but higher proportion of Th1 cells, Th1/Th2 cell ratio, IFN-γ level and IFN-γ/IL-4 ratio (P < 0.05). General anesthesia in combination with epidural block can work better in mitigating the stress response and protecting the immune function of patients after cervical cancer surgery.

Characteristics of cases for which esophageal endoscopic submucosal dissection under general anesthesia is recommended.

Esophageal endoscopic submucosal dissection (ESD) performed under general anesthesia can potentially provide more stable treatment in difficult cases than that under sedation. We evaluated the clinical characteristics and outcomes of ESD performed under general anesthesia compared with those under propofol sedation and discussed the cases in which general anesthesia is recommended. In total, 292 lesions in 265 consecutive patients undergoing esophageal ESD at Yamaguchi University Hospital from 2013 to 2023 were included in this retrospective study. ESD was performed under general anesthesia for 92 lesions in 81 patients and under propofol sedation for 200 lesions in 184 patients. Tumor long-axis diameter was larger (39.8 ± 14.4mm vs. 32.4 ± 9.9mm, p < 0.01) and dissection speed was faster (10.5 ± 5.9 mm2/min vs. 7.5 ± 4.2 mm2/min, p < 0.01) in the general anesthesia group versus the sedation group. In the sedation group, a treatment history of pharyngeal cancer was significantly associated with a slower dissection speed (p = 0.037). The sedation group showed higher frequencies of hypoxemia (0% vs 9.8%, p < 0.01), interruption due to body movement (0% vs 13%, p < 0.01), and acute adverse events (21.7% vs 33.5%, p = 0.05). A treatment history of pharyngeal cancer was shown to be the significant factor contributing to acute adverse events (p = 0.018). Esophageal ESD under general anesthesia can be a treatment option in patients with difficulty in performing stable procedures with propofol sedation. Especially in patients with a treatment history of pharyngeal cancer in whom ESD is more difficult to be performed and who are at higher risk for acute adverse events, general anesthesia can be considered.

The Effect of Anesthesia Type on the Stability of the Surgical View on the Monitor in Retrograde Intrarenal Surgery for Renal Stone: A Prospective Observational Trial.

Background and Objectives: Retrograde intrarenal surgery (RIRS) is a minimally invasive technique for nephrolithiasis. RIRS is performed via a monitor screen displaying a magnified surgical site. Respiration can affect the stability of the surgical view during RIRS because the kidneys are close to the diaphragm. The purpose of this trial is to compare the effect of anesthesia type on the stability of the surgical view during RIRS between spinal anesthesia and general anesthesia. Materials and Methods: Patients were allocated to the general anesthesia group or spinal anesthesia group. During surgery, movement of the surgical field displayed on the monitor screen was graded by the first assistant on a 10-grade numeric rating scale (0-10). Next, it was also graded by the main surgeon. After surgery, we evaluated the discomfort with the anesthesia method for all patients. Results: Thirty-four patients were allocated to the general anesthesia group and 32 patients to the spinal anesthesia group. The average values of the two surgeons for surgical field oscillation grade showed vision on the monitor screen was more stable in the general anesthesia group than the spinal anesthesia group (3.3 ± 1.6 vs. 5.0 ± 1.6, p < 0.001). The degrees of the inconvenience of the surgery did not differ between the groups (0.7 ± 1.8 vs. 1.6 ± 2.6, p = 0.114), even though more patients reported inconvenience with a grade of 3 or more in the spinal anesthesia group (8.8% vs. 28.1%, p = 0.042). Conclusions: In terms of the visualization of the surgical site, general anesthesia might provide a more stable surgical view during RIRS compared to spinal anesthesia without increasing inconvenience induced by the type of anesthesia.

Assessing the Efficacy of Thoracic Erector Spinae Plane Block for Postoperative Analgesia in Lumbosacral Spine Surgery: A Prospective Quasi-experimental Study.

Background and aims Optimal postoperative care and analgesia are the key factors in the management of cases of lumbosacral spine surgery. The erector spinae plane (ESP) block is a recently evolving entity and has a dynamic role in postoperative pain management. However, its role in the management of pain in lumber spinal surgeries is still not clear, and the literature remains anecdotal. Therefore, we planned to study the efficacy of ultrasound-guided preoperative ESP block at the T12 level using levobupivacaine for perioperative analgesia in lumbosacral spine surgeries. Methods A total of 60 patients scheduled for elective or emergency lumbosacral spine surgery were divided into two groups - the GA group received standard general anesthesia (GA)and the GA+ESP group received standard general anesthesia along with ultra-sound guided ESP block at the T12 level with a bilateral injection of20 ml 0.25% levobupivacaine. Perioperative analgesia was assessed by total intra-operative fentanyl dose and frequency, intra-operative hemodynamic parameters, post-operative numeric rating scale (NRS) scores, time of first systemic rescue analgesia, tramadol usage, mobilization day, and hospital stay duration. Results Intraoperative fentanyl sparing was observed in 83% of the GA+ESP group compared to 33% in the GA group. Postoperative tramadol sparing was observed in 80% of the GA+ESP group compared to 26.7% of the GA group. Twenty-four-hour postoperative NRS scores >3/10 were observed in 20% of the GA+ ESP group compared to 73.3% of the GA group. Conclusion In this study, superior perioperative analgesia, opioid-sparing effect, and decreased requirement of postoperative rescue analgesia were observed with ESP block.

Postoperative Outcomes of the Awake Colorectal Surgery with Neuraxial Anaesthesia.

To determine the outcome of awake surgery with combined spinal epidural in geriatric colon cancer patients with advanced comorbidity. Quasi-experimental study. Place and Duration of the Study: Department of Anaesthesiology and Reanimation, Ankara Bilkent City Hospital, Ankara, Turkiye, from April 2022 to 2023. Twenty-four American Society of Anaesthesiologists (ASA) I-II patients, aged 25-65 years and scheduled for colon cancer surgery were included in this research. All patients were observed preoperatively, at the operation room and at the postoperative surgery service. Spinal anaesthesia was planned for Group I and general anaesthesia for Group II. Ketofol (1:1) was administered to the combined spinal-epidural group, with a Ramsay sedation score of 3 after the spinal block. Epidural analgesia was planned for all patients. Patients' age, gender, weight, comorbidities, ASA risk scores, intraoperative haemodynamic parameters, bleeding amounts, colloid, crystalloid, and blood products were collected. There was no significant difference between the demographic characteristics of both anaesthesia groups (p >0.05). The amount of bleeding was statistically lower in Group I than in the general anaesthesia group (p = 0.004). Oral intake, drain withdrawal, mobilisation, discharge times, and costs were similar in all groups (p >0.05). The regional anaesthesia applications facilitate compliance with routine mobilisation, discharge procedures and prevent complications in abdominal surgery and its positive perioperative effects in patients with poor respiratory parameters, poor general condition, and high comorbidity in advanced age. Regional anaesthesia, Spinal-epidural, Mobilisation, Pain, Colon cancer.