Anesthesia Outcomes Research Articles

The Generalizability of Patients' Preferences and Concerns regarding Anesthesia Care for Cesarean Delivery: A Prospective Survey.

Background False assumptions regarding the generalizability of patients' expectations and preferences across different demographic groups may contribute in part to the increased prevalence of negative peripartum outcomes seen among women of color. The intention of this study was to determine preferences and concerns regarding anesthesia care during cesarean delivery in a largely African-American population and to compare them to those obtained in a prior study conducted in a demographically distinct population. Methods Women presenting for scheduled cesarean delivery or induction of labor completed a preoperative survey requesting demographic information and the opportunity to rank ten common potential anesthetic outcomes in relation to each other from most to least desirable. Participants were also asked about their biggest fear concerning their anesthetic and their preferences and expectations regarding degree of wakefulness, pain, and other adverse events. Those who underwent cesarean delivery were administered a briefer postoperative survey. We tabulated preference rankings and then compared demographic and outcome data to that obtained in a previous study with a demographically dissimilar population. Results A total of 73 women completed the preoperative survey, and 64 took the postoperative survey. Pain during and after cesarean delivery was ranked as least desirable outcomes and fear of paralysis was respondents' principal concern with neuraxial anesthesia. Postoperative concerns were similar to preoperative concerns and did not correlate with the frequency with which specific adverse outcomes occurred. These results were consistent with those from the previous study despite the women in this study being more likely to be younger, unmarried, African-American, and less educated than those in the previous investigation. Conclusions Patient preference rankings and concerns were remarkably similar to those previously demonstrated despite a number of demographic differences between the two populations, suggesting generalizability of these preferences to a broader obstetric population.

Spinal anesthesia in awake surgical procedures of the lumbar spine: a systematic review and meta-analysis of 3709 patients

Awake surgery has previously been found to improve patient outcomes postoperatively in a variety of procedures. Recently, multiple groups have investigated the utility of this modality for use in spine surgery. However, few current meta-analyses exist comparing patient outcomes in awake spinal anesthesia with those in general anesthesia. Therefore, the authors sought to present an updated systematic review and meta-analysis investigating the utility of spinal anesthesia relative to general anesthesia in lumbar procedures. Following a comprehensive literature search of the PubMed and Cochrane databases, 14 clinical studies were included in our final qualitative and quantitative analyses. Of these studies, 5 investigated spinal anesthesia in lumbar discectomy, 4 discussed lumbar laminectomy, and 2 examined interbody fusion procedures. One study investigated combined lumbar decompression and fusion or decompression alone. Two studies investigated patients who underwent discectomy and laminectomy, and 1 study investigated a series of patients who underwent transforaminal lumbar interbody fusion, posterolateral fusion, or decompression. Odds ratios, mean differences (MDs), and 95% confidence intervals were calculated where appropriate. A meta-analysis of the total anesthesia time showed that time was significantly less in patients who received spinal anesthesia for both lumbar discectomies (MD -26.53, 95% CI -38.16 to -14.89; p = 0.00001) and lumbar laminectomies (MD -11.21, 95% CI -19.66 to -2.75; p = 0.009). Additionally, the operative time was significantly shorter in patients who underwent spinal anesthesia (MD -14.94, 95% CI -20.43 to -9.45; p < 0.00001). Similarly, when analyzing overall postoperative complication rates, patients who received spinal anesthesia were significantly less likely to experience postoperative complications (OR 0.29, 95% CI 0.16-0.53; p < 0.0001). Furthermore, patients who received spinal anesthesia had significantly lower postoperative pain scores (MD -2.80, 95% CI -4.55 to -1.06; p = 0.002). An identical trend was seen when patients were stratified by lumbar procedures. Patients who received spinal anesthesia were significantly less likely to require postoperative analgesia (OR 0.06, 95% CI 0.02-0.25; p < 0.0001) and had a significantly shorter hospital length of stay (MD -0.16, 95% CI -0.29 to -0.03; p = 0.02) and intraoperative blood loss (MD -52.36, 95% CI -81.55 to -23.17; p = 0.0004). Finally, the analysis showed that spinal anesthesia cost significantly less than general anesthesia (MD -226.14, 95% CI -324.73 to -127.55; p < 0.00001). This review has demonstrated the varying benefits of spinal anesthesia in awake spine surgery relative to general anesthesia in patients who underwent various lumbar procedures. The analysis has shown that spinal anesthesia may offer some benefits when compared with general anesthesia, including reduction in the duration of anesthesia, operative time, total cost, and postoperative complications. Large prospective trials will elucidate the true role of this modality in spine surgery.

Application of online case-based learning in the teaching of clinical anesthesia for residents during the COVID-19 epidemic

ObjectiveCOVID-19 prevention and control demand a reduction in crowd gathering, which has a significant impact on traditional teaching and offline case-based learning (CBL). In order to mitigate the impact of the COVID-19 outbreak on clinical teaching, we aimed to compare the effects of an online CBL with traditional teaching model on learning outcomes of anesthesia residents.MethodsResidents rotated in the Department of Anesthesiology in Beijing Tsinghua Changgung Hospital from January 2020 to February 2021 were included in Group W (n = 19), which implemented the W-CBL teaching model. The performance of residents was evaluated with theory test and 2 survey questionnaires (A and B) were conducted after 1 month of rotating. All 20 residents rotating in the Department of Anesthesiology at our hospital from January 2018 to December 2019 were included in Group C, which implemented the traditional teaching model. Their examination results were acquired through the teaching files and survey questionnaire (A) were administered through WeChat.ResultsDuring the 1-month rotation, a total of 10 cases were discussed in Group W. The average score for theory test was higher in Group W than that in Group C (84.57 ± 4.87 vs. 79.35 ± 3.70, P = 0.001). The satisfaction rate was also in favor of Group W regarding to clinical thinking, communication skills, learning interest and self-learning ability (P < 0.05).ConclusionsOnline CBL based on WeChat platform is an effective and acceptable teaching strategy in comparison to lecture-based learning (LBL) among residents embarking on clinical anesthesia courses.

Preprocedural ultrasound for neuraxial blockade in nonobstetric patients. Should it be considered as a standard of care?

Preprocedural ultrasound for neuraxial blockade in nonobstetric patients. Should it be considered as a standard of care?

Safety and clinical outcomes of regional anaesthesia in Chinese patients with non-small cell lung cancer undergoing non-intubated lobectomy

Purpose: To determine the safety and clinical outcomes of epidural anaesthesia (EA) relative to internal intercostal nerve block (INB) in Chinese patients with non-small cell lung cancer (NSCLC) who were undergoing non-intubated thoracoscopic lobectomy.Methods: Chinese patients with NSCLC (stage I or II) with no evidence of metastasis were given either EA or INB, with equal number of patients in both groups. The peri-operative outcomes determined were duration of anaesthesia /duration of surgery, SpO2/PaCO2 levels, cases of hypotension, and blood loss. The post-operative outcome indices measured were pain score (determined using visual analogue scale (VAS), post-operative complications, chest drainage, duration of hospital stay, and deaths/mortality.Multiple regression analysis was used to confirm the results obtained in this study by adjusting potential covariates. Peri-operative and post-operative complications were compared between the two groups. The results obtained from 220 patients were subjected to statistical analysis.Results: Peri-operative results showed that patients who underwent INB had shorter duration of anaesthesia (12.3 vs 31.4 min, p &lt; 0.05) and shorter duration of surgery (164.4 vs 197.2 min, p &lt; 0.05) than patients who underwent EA for non-intubated lobectomy. Post-operative results showed that patients who underwent INB had significantly lower number of post-operative complications than those who received EA (29 vs 44 %, p &lt; 0.05). The most common post-operative complications among patients in both treatment groups were nausea, vomiting, emphysema and pulmonary complications. Patients who underwent INB had shorter hospital stay than those who underwent EA (5.1 vs 7.5 days, p &lt; 0.05). These results were confirmed through multiple regression analysis.Conclusion: These findings favour the use of INB for regional anaesthesia in NSCLC patients undergoing non-intubated lobectomy.

Capnodynamics—Measuring cardiac output via ventilation

Recent studies have identified stable hemodynamics as a contributing factor to improve outcome in pediatric anesthesia. So far, most of the hemodynamic monitoring methods applied in children have been complex to apply and often not satisfactory validated. Standard mainstream carbon dioxide analysis in combination with real-time mathematical analysis of the measured capnography data has enabled the development of dynamic capnography, a non-invasively cardiac output monitoring method that can be applied without user practice or need for calibrations. Capnodynamic cardiac output assessment has been extensively validated against gold standard reference methods, both in experimental and clinical settings. This review will describe the principle behind dynamic capnography measurement of cardiac output and mixed venous oxygen saturation. Additionally, the methods limitations and challenges when applied in children will be delineated.

Cholinergic Modulation of General Anesthesia

Acetylcholine in the brain promotes arousal and facilitates cognitive functions. Cholinergic neurons in the mesopontine brainstem and basal forebrain are important for activation of the cerebral cortex, which is characterized by the suppression of irregular slow waves, an increase in gamma (30-100 Hz) activity in the electroencephalogram, and the appearance of a hippocampal theta rhythm. During general anesthesia, a decrease in acetylcholine release and cholinergic functions contribute to the desired outcomes of general anesthesia, such as amnesia, loss of awareness and consciousness, and immobility. Animal experiments indicate that inactivation, lesion, or genetic ablation of cholinergic neurons in the basal forebrain potentiated the effects of inhalational and injectable anesthetics, including isoflurane, halothane, propofol, pentobarbital, and in some cases, ketamine. Increased behavioral sensitivity to general anesthesia, faster induction time, and delayed recovery of a loss of righting reflex have been observed in rodents with basal forebrain cholinergic deficits. Cholinergic stimulation in the prefrontal cortex, thalamus, and basal forebrain hastens recovery from general anesthesia. Anticholinesterase accelerates emergence from general anesthesia, but with mixed success, in part depending on the anesthetic used. Cholinergic deficits may contribute to cognitive impairments after anesthesia and operations, which are severe in aged subjects. We propose a cholinergic hypothesis for postoperative cognitive disorder, in line with the cholinergic deficits and cognitive decline in aging and Alzheimer’s disease. The current animal literature suggests that brain cholinergic neurons can regulate the immune and inflammatory response after surgical operation and anesthetic exposure, and anticholinesterase and α7-nicotinic cholinergic agonists can alleviate postoperative inflammatory response and cognitive deficits.

Comparison of the median effective concentration (EC50) and effect of sevoflurane with or without remifentanil in cesarean section with supreme laryngeal mask under narcotrend monitoring: a randomized trial.

Remifentanil combined with sevoflurane is a standard protocol for obstetric general anesthesia (GA). In this study, we performed a randomized clinical trial to evaluate whether remifentanil has an effect on the median effective concentration (EC50) of sevoflurane and compare anesthetic outcomes of them in cesarean section with Supreme™ laryngeal mask airway (SLMA) under narcotrend monitoring. Ninety parturients with singleton births undergoing elective cesarean delivery (CD) with initial inhaled 1.0 minimum alveolar concentration (MAC) sevoflurane for anesthesia maintenance were assigned to three groups randomly and evenly: Group A (0.05 µg·kg-1·min-1 remifentanil combined with sevoflurane), Group B (0.1 µg·kg-1·min-1 remifentanil combined with sevoflurane), and Group C (normal saline combined with sevoflurane). Narcotrend was used to monitor the depth of anesthesia during the operation, with the level of anesthesia depth controlled within the D-E stage. The EC50 of sevoflurane was determined by Dixon's sequential method. The Narcotrend index, amount of bleeding, neonatal Apgar score, and corresponding treatment measures in the three groups were recorded. The results showed that the estimated EC50 of sevoflurane for obstetric GA was 0.80 MAC (95% CI: 0.63-0.95 MAC) in group A, 0.82 MAC (95% CI: 0.63-0.96 MAC) in group B, and 0.80 MAC (95% CI: 0.63-0.95 MAC) in group C. There was no statistically significant difference in the estimated EC50 of sevoflurane, time to wakefulness, Apgar score, amount of intraoperative bleeding, and postoperative bleeding within 24 hours between the three groups (all P>0.05). The addition of remifentanil at 0.05-0.1 µg·kg-1·min-1 did not change the EC50 of sevoflurane and anesthetic quality. The concentration of inhaled anesthetics can be minimized with Narcotrend monitoring. Chinese Clinical Trial Registry ChiCTR2000034512.

EP.TH.961Meta-analysis of Spinal Anaesthesia Versus General Anaesthesia During Laparoscopic Total Extraperitoneal Repair of Inguinal Hernia

Abstract Objectives To evaluate comparative outcomes of spinal anaesthesia (SA) and general anaesthesia (GA) during laparoscopic total extraperitoneal (TEP) repair of inguinal hernia. Methods We systematically searched MEDLINE; EMBASE; CINAHL; CENTRAL, and bibliographic reference lists. Post-operative pain assessed by visual analogue scale (VAS), individual and overall perioperative morbidity, procedure time and time taken to normal activities, were the outcome parameters. Combined overall effect sizes were calculated using fixed-effect or random-effects models. Results We identified 5 studies enrolling 1,518 patients (2,134 hernia) evaluating outcomes of laparoscopic TEP repair under SA (n = 1,277 patients, 1,877 hernia) or GA (n = 241 patients, 257 hernia). SA was associated with significantly lower post-operative pain assessed by VAS at 12 hours (MD: - 0.32, P &amp;lt; 0.0001) and shorter time to normal activities (MD: -0.30, P = 0.002) compared to GA. However, it significantly increased risk of urinary retention (OR:4.02, P = 0.01), hypotension (OR:3.97, P = 0.004), headache (OR:7.65, P = 0.003), and procedure time (MD: 3.82, P = 0.004) There was no significant difference in VAS at 24 hours (MD:0.06, P = 0.34), seroma (OR:1.54, P = 0.26), wound infection (OR:1.03, P = 0.94), and vomiting (OR:0.84, P = 0.66) between two groups. There was a non-significant decrease in overall morbidity in favour GA (OR:1.84, P = 0.17) which became significant following sensitivity analysis (OR:2.59, P = 0.01). Conclusions Although TEP inguinal hernia repair under SA may reduce pain in early postoperative period, it seems to be associated with increased postoperative morbidity and longer procedure time. It may be an appropriate anaesthetic modality in selected patients who are considered high risk for GA. Higher level of evidence is needed.

EP.WE.567Regional anaesthesia for infra-inguinal revascularisation in patients with symptomatic peripheral arterial disease

IntroductionGeneral anaesthesia is considered to be an aerosol generating procedure. The global Covid-19 pandemic has resulted in review of practice to reduce risk to both patients and health care workers. The outcome of regional anaesthesia (RA) for infra-inguinal arterial reconstruction in patients with symptomatic occlusive atherosclerotic has been explored and compared with patients managed with general anaesthesia (GA).MethodsPatients undergoing infra-inguinal revascularisation between 2019-2020 were identified from a prospectively maintained administrative theatre dataset. Case-linkage was used to complete the dataset. Specific end points included to critical care admission and peri-operative mortality.ResultsThere were 204 patients identified (46 RA and 158 GA). The mean age of patients in both groups was 67-years and procedures were commonly performed in male patients (although the male:female ratio was higher in the RA group 2.8:1 than in the GA group 1.4:1). More patients in the RA had intervention for chronic limb threatening ischaemia (80% versus 59%). The interventions performed were comparable in both groups. The mean length of procedure was less in the RA group (142-minutes versus 160-minutes). No patients in the RA required admission to critical care (10 patients managed with GA required admission to critical care). The 30-day mortality was comparable in the RA and GA groups (2.2% and 1.9% respectively).ConclusionsRegional anaesthesia would appear to be feasible for patients undergoing infra-inguinal arterial reconstruction with a reduction in operating time and critical care admission without increased peri-operative risk.

Anesthetic and surgical considerations for staged bilateral nephrectomies in a pediatric patient: A case report

We present a 9-year-old patient with end-stage renal disease, on peritoneal dialysis, who underwent a staged prone retroperitoneoscopic bilateral nephrectomy. Bilateral nephrectomy was indicated in preparation for renal transplant in the context of genetic predisposition malignancy when immunosuppressed. The two mirror-image surgeries enable the comparison of the anesthetic management and outcomes in a single patient. Features of interest to anesthesiologists include approach to a child with chronic kidney disease, different requirements for intraoperative antihypertensives; pain management strategies, including a comparison of erector spinae plane block with and without adjunct dexmedetomidine; anesthetic management of retroperitoneoscopic pediatric surgery and the first description of using a Foley bag attached to a peritoneal dialysis catheter to aid in diagnosis and repair of posterior peritoneal cavity entry.

Exploration of Predictive Modeling of Defense Health Agency & Department of Veterans Affairs Beneficiaries Dietary Supplements Use

PurposeThe purpose of this study was to predict dietary supplements (DS) use among Defense Health Agency (DHA) and Veterans Affairs (VA) beneficiaries who were scheduled for surgical procedures. DesignThis was a predictive descriptive multicenter study with a convenience sample of 2,623 adult subjects. After institutional review board exemption, data collection occurred preoperatively via electronic survey. Participation was voluntary and data unidentifiable. MethodsData were collected in preoperative anesthesia clinics during preanesthetic evaluations, or in surgery holding areas immediately prior to surgery, using a validated data collection tool. The total convenience sample size was 2,623 subjects from 6 medical centers. Data were voluntarily, anonymously, and verbally obtained from subjects using electronic survey methodology. Collected data included: gender, age, rank, beneficiary status, race, body mass index, tobacco use, marital status, and knowledge of DS side effects and drug interactions. For predictive modeling of DS use, multiple logistic regression was performed for binary outcomes via SPSS. FindingsFor binary logistic regression the predictors were significant for the following outcomes: taking DS (education, sex, age, and race; P < .05), knowledge of side effects (age, race, and rank; P < .05), and believe they are having side effects (age; P < .05). ConclusionsUnderstanding DS use is central to predict and anticipate potential negative sequelae in patient outcomes in anesthesia. College education, females, Caucasians, and increasing age are indicators for greater DS use. These results provide opportunities for perianesthesia nurses to improve preoperative assessments, design patient specific perianesthesia care, and enhance patient education. Further research is recommended.

The Effects of Dexmedetomidine on Anesthetic Outcomes following Maxillomandibular Advancement Surgery

Research supports that maxillomandibular advancement (MMA) surgery is an effective treatment modality for severe obstructive sleep apnea (OSA). In a systematic review, Ankichetty, et al, found that the use of alpha 2 agonists in OSA patients reduces the requirement of perioperative analgesics, but no randomized clinical trials with the use of dexmedetomidine (DEX) in OSA patients exist.1 Furthermore, while there are several studies evaluating peri-operative parameters in patients who have undergone Stanford Protocol's Phase I OSA surgeries, published studies regarding the usage of intra-operative DEX and anesthetic outcomes following MMA surgery are difficult to find. The authors seek to elucidate the effects that DEX, an alpha 2 agonist with analgesic, amnesic, and supposed anesthesia-sparing properties, has on patients immediately following MMA surgery.2A search through the sponsoring institution's electronic medical record system was conducted from January 1, 2017, through December 31, 2020, using Current Procedural Terminology codes for bilateral sagittal split ramus osteotomy (BSSRO), Le Fort I osteotomy with or without bone grafts (LFI), genioplasty, genioglossus advancement, and/or genial bone graft (GG). Two independent investigators (ADC and YJL) reviewed the resultant charts and selected adult patients aged 18 years and older with a diagnosis of OSA. Patients who remained intubated at the conclusion of MMA surgery and whose procedures included solely revision osteotomies were excluded from this study. The remaining 58 patient records underwent a detailed retrospective chart review. Postoperative opioid requirement was calculated as milligrams (mg) of morphine equivalent dosages (MEDs). Univariate analysis was conducted with Pearson's Chi-square to determine the presence of a statistically significant association between cumulative doses of intraoperative DEX and the opioid requirement within the first 8- and 24-hours postoperatively, as well as the time from "Surgery End to Extubation" (EXT). Multiple linear regression and multinomial logistic regression were utilized to evaluate relationships among different doses of medications received and to calculate odds ratios, respectively. Significance was defined as P < .05.There were 58 patients included in this study: 47 (81%) males and 11 (19%) females; 27 (46.6%) had received intraoperative DEX and 31 (53.4%) had not. While all patients underwent at least 2 osteotomies, 49 (84.5%) of patients underwent 4 (i.e., LF1, BSSRO, and GG osteotomies). There was no significant difference detected between cumulative dosage of intraoperative DEX and first 8-hour postoperative narcotic requirement (P = .30). However, a statistically significant association was detected between cumulative dosage of intraoperative DEX and first 24-hour postoperative narcotic requirement (P = .02). Furthermore, patients who received a cumulative DEX dose between 100.1 and 200 micrograms (mcg) received less opioids within the first 24-hour postoperative period than those patients who received > 200mcg of DEX. EXT in patients who received between 100.1 and 200mcg of DEX, as compared to those who did not receive and those who did receive lower amounts of intraoperative DEX, was statistically significantly higher (P = .01 and .02, respectively).In contrary to the conclusions of Ankichetty, et al, and Bamgbade, et al, less intraoperative DEX was found to be significantly associated with lower 24-hour postoperative opioid requirements. This study also suggests that EXT may decrease with lower doses of DEX administered intraoperatively. Well-designed prospective, randomized studies involving larger numbers of patients with OSA undergoing MMA surgery and receiving DEX are warranted.

A Review of Current Literature of Interest to the Office-Based Anesthesiologist.

A Review of Current Literature of Interest to the Office-Based Anesthesiologist.

Anesthetic Management and Outcomes of Patients With Epidermolysis Bullosa: Experience at a Tertiary Referral Center.

Epidermolysis bullosa (EB) is a group of rare epithelial disorders caused by abnormal or absent structural proteins at the epidermal-dermal junction. As a result, patients experience blisters and wounds from mild shearing forces. Some forms of EB are complicated by resultant scarring and contractures. The perioperative anesthetic management of patients with EB is complex and requires a systems-based approach to limit harm. We reviewed our experience with providing general anesthesia to patients at our tertiary EB referral center, including adverse events related to anesthetic care, outcomes in the immediate perioperative period, and details of anesthetic management. We retrospectively reviewed the charts of all patients with EB anesthetized at the Children's Hospital Colorado between January 2011 and December 2016. A subset of pediatric anesthesiologists cared for all patients using a standardized clinical care pathway. Patient demographics, detailed anesthetic methods, immediate perioperative outcomes, and adverse events were characterized. Over a 6-year period, 37 patients underwent 202 general anesthetics. Most patients (75.7%) had dystrophic EB (DEB). Female patients comprised 48.6%. The majority (56.7%) traveled >50 miles to receive care, and many (35.1%) traveled >150 miles for their care. Common adaptations to care included avoidance of electrocardiogram leads (88.6%) and temperature probes (91.6%). Nasal fiberoptic intubation (n = 160) was performed, or natural airway/mask (n = 27) was maintained for most patients. Supraglottic devices were not used for airway management during any of the anesthetics. Anesthesia preparation time was longer (average 25.8 minutes [standard deviation {SD} = 12.7]) than our average institutional time (14 minutes). Succinylcholine was never used, and nondepolarizing muscle relaxants were used in only 1.5% of patient encounters. Blood was transfused in 16.3% of cases and iron infused in 24.8%. Average length of stay in the postanesthesia care unit was comparable to our institutional average (average 40.1 [SD = 28.6] vs 39 minutes). New skin or mucosal injury occurred in 8 encounters (4%), and desaturation occurred in 43 cases (21.3%). There were no major adverse events. By using a specialized team and a standardized clinical care pathway, our institution was able to minimize adverse events caused by the anesthetic and surgical care of patients with EB. We recommend natural airway or nasal fiberoptic airway management, meticulous avoidance of shear stress on the skin, and a multidisciplinary approach to care. Supportive therapy such as perioperative blood transfusions and iron infusions are feasible for the treatment of chronic anemia in this population.

Propofol-Based Total Intravenous Anesthesia is Associated with Better Survival than Desflurane Anesthesia in Epithelial Ovarian Cancer Surgery: A Retrospective Cohort Study.

Background: Previous studies have shown that anesthetic techniques can affect outcomes of cancer surgery. We investigated the association between anesthetic techniques and patient outcomes after elective epithelial ovarian cancer surgery. Methods: This was a retrospective cohort study of patients who received elective open surgery for epithelial ovarian cancer between January 2009 and December 2014. Patients were grouped according to the administration of propofol or desflurane anesthesia. Kaplan–Meier analysis was performed, and survival curves were constructed from the date of surgery to death. Univariate and multivariate Cox regression models were used to compare hazard ratios for death after propensity matching. Subgroup analyses were performed for age, body mass index, preoperative carbohydrate antigen-125 level, International Federation of Gynecology and Obstetrics staging, and operation and anesthesia time. Results: In total, 165 patients (76 deaths, 46.1%) who received desflurane anesthesia and 119 (30 deaths, 25.2%) who received propofol anesthesia were eligible for analysis. After propensity matching, 104 patients were included in each group. In the matched analysis, patients who received propofol anesthesia had better survival with a hazard ratio of 0.52 (95% confidence interval, 0.33–0.81; p = 0.005). Subgroup analyses also showed significantly better survival with old age, high body mass index, elevated carbohydrate antigen-125 level, advanced International Federation of Gynecology and Obstetrics stage, and prolonged operation and anesthesia time in the matched propofol group. In addition, patients administered with propofol anesthesia had less postoperative recurrence and metastasis than those administered with desflurane anesthesia in the matched analysis. Conclusion: Propofol anesthesia was associated with better survival in patients who underwent elective epithelial ovarian cancer open surgery. Prospective studies are warranted to evaluate the effects of propofol anesthesia on oncological outcomes in patients with epithelial ovarian cancer.

Selective scalp block decreases short term post-operative pain scores and opioid use after craniotomy: A case series

There is no consensus on the management of post-craniotomy pain. Several randomized controlled trials have examined the use of a regional scalp block for post-craniotomy pain. We aim to investigate whether scalp block affected short or long-term pain levels and opioid use after craniotomy. This study prospectively administered selective scalp blocks (lesser occipital, preauricular nerve block + pin site block) in 20 consecutive patients undergoing craniotomy for semicircular canal dehiscence. Anesthesia, pain, and opioid outcomes in these patients were compared to 40 consecutive historic controls. There was no significant difference in patient demographics between the two groups and no complications related to selective scalp block. The time between the end of procedure and end of anesthesia decreased in the scalp block group (16 vs 21 min, P = 0.047). Pain scores were significantly less in the scalp block group for the first 4 h, after which there was no statistically significant difference. Time to opioid rescue was longer in the scalp block group (3.6 vs 1.8 h, HR 0.487, P = 0.0361) and opioid use in the first 7 h was significantly less in the scalp block group. Total opioid use, outpatient opioid use, and length of stay did not differ. Selective scalp block is a safe and effective tool for short-term management of postoperative pain after craniotomy and decreases the medication requirement during emergence and recovery. Selective scalp block can speed up OR turnover but is not efficacious in the treatment of postoperative pain beyond this point.

Spinal versus general anesthesia for patients undergoing outpatient total knee arthroplasty: a national propensity matched analysis of early postoperative outcomes

BackgroundA comparison of different anesthetic techniques to evaluate short term outcomes has yet to be performed for patients undergoing outpatient knee replacements. The aim of this investigation was to compare short term outcomes of spinal (SA) versus general anesthesia (GA) in patients undergoing outpatient total knee replacements.MethodsThe ACS NSQIP datasets were queried to extract patients who underwent primary, elective, unilateral total knee arthroplasty (TKA) between 2005 and 2018 performed as an outpatient procedure. The primary outcome was a composite score of serious adverse events (SAE). The primary independent variable was the type of anesthesia (e.g., general vs. spinal).ResultsA total of 353,970 patients who underwent TKA procedures were identified comprising of 6,339 primary, elective outpatient TKA procedures. Of these, 2,034 patients received GA and 3,540 received SA. A cohort of 1,962 patients who underwent outpatient TKA under GA were propensity matched for covariates with patients who underwent outpatient TKA under SA. SAE rates at 72 h after surgery were not greater in patients receiving GA compared to SA (0.92%, 0.66%, P = 0.369). In contrast, minor adverse events were greater in the GA group compared to SA (2.09%, 0.51%), P < 0.001. The rate of postoperative transfusion was greater in the patients receiving GA.ConclusionsThe type of anesthetic technique, general or spinal anesthesia does not alter short term SAEs, readmissions and failure to rescue in patients undergoing outpatient TKR surgery. Recognizing the benefits of SA tailored to the anesthetic management may maximize the clinical benefits in this patient population.

Anesthesia Clinical Outcome and Management in Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy: A Retrospective Analysis

Background: Anesthetic technique and outcome of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is not well established. Objective: To evaluate the anesthetic management of CRS with HIPEC and to analyze whether supplement epidural anesthesia will provide any benefit on the outcomes. Materials and Methods: All patients that underwent CRS with HIPEC between January 2008 and December 2017 at King Chulalongkorn Memorial Hospital were retrospective reviewed. Patients were divided into two groups, 1) received a combination of epidural and general anesthesia (EGA), and 2) received general anesthesia (GA) to compare intraoperative hemodynamic stability, postoperative pain control, time to tracheal extubation, and postoperative complications between groups. Results: Twenty patients had EGA, and 14 patients had GA. EGA group had significant more incidences of intraoperative hypotension at 70% versus 21.4%, which required more use of vasopressor at 65% versus 21.4% (p&lt;0.05). There was no statistical difference between groups in total blood loss, time to extubation, and ICU length of stay. There were no significant differences in the pain score at 12 and 24 hours postoperative. Epidural complications were not detected. There was no mortality within 30 days. Conclusion: Adding epidural analgesia to GA in CRS with HIPEC increased the incidence of hypotension and did not reduce the pain or duration of extubation. Keywords: Anesthesia; Epidural; HIPEC; Outcome

Clinical, obstetrical and anaesthesia outcomes in pregnant women during the first COVID-19 surge in France: A prospective multicentre observational cohort study

IntroductionClinical outcomes and critical care utilisation associated with Coronavirus Disease 2019 (COVID-19) in obstetric patients remain limited particularly in relation to severe cases. MethodsA retrospective multicentre cohort study was conducted during the first wave of COVID-19 in France in 18 tertiary referral maternity units. Consecutive women with confirmed or suspected COVID-19 during pregnancy or the delivery hospitalisation were included between March and July 2020 (17-week period). We report clinical, obstetrical and anaesthetic outcomes of pregnant women with COVID-19 and report the prevalence of severe forms and risk factors for respiratory support in this cohort. ResultsThere were 126 included cases; RT-PCR testing occurred in 82 cases, of which 64 (78%) had a positive test. The caesarean section rate was 52%, and preterm delivery (< 37 weeks) rate was 40%. Neuraxial anaesthesia was performed in 108 (86%) cases with an increasing proportion compared to general anaesthesia over time (p < 0.0002). Twenty-eight cases received oxygen supplementation (nasal oxygen therapy or mechanical ventilation); the SOFAresp score was associated with gestational age at the time of COVID-19 presentation (p = 0.0036) and at delivery (p < 0.0001). Postpartum intensive care unit (ICU) admission occurred in 21 cases (17%) with 17 (13%) receiving invasive or non-invasive ventilation. Pre-delivery factors associated with postpartum ventilation were oxygen support, oxygen saturation and haemoglobin levels. ConclusionIn our cohort, COVID-19 was associated with significant maternal morbidity resulting in high ICU admission rates (17%) and invasive or non-invasive ventilation utilisation (10%).