Spinal Group Research Articles

Comparison of Outcomes Following General Anesthesia and Spinal Anesthesia During Emergency Cervical Cerclage in Singleton Pregnant Women in the Second Trimester at a Single Center

BackgroundLittle information exists regarding the best anesthesia method for emergency cerclage.This single-center study aimed to compare the outcomes following general anesthesia and spinal anesthesia during emergency cervical cerclage in women in the second trimester of a singleton pregnancy.Material/MethodsA total of 297 pregnant patients were recruited: 141 patients were assigned to the general anesthesia group and 156 patients were assigned to the spinal anesthesia group. Periprocedural data and obstetric outcomes were recorded and statistically analyzed.ResultsAverage duration of the cerclage procedure was shorter in the general anesthesia group than in the spinal anesthesia group (25.78±9.4 min versus 30.88±10.5 min; P<0.05). No severe maternal complications, such as hematosepsis or maternal death, occurred after the procedure for either group. The neutrophil-lymphocyte ratio and C-reactive protein (CRP) increased after emergency cerclage in both groups, but at no time did the 2 groups differ significantly (P>0.05). There was also no significant difference in the incidence of miscarriage or preterm delivery (delivery <34 gestational weeks) or in neonatal outcome between the 2 groups (P>0.05).ConclusionsThe results of this study showed that there were no significant differences in maternal and neonatal outcomes, rates of miscarriage, or preterm delivery between general anesthesia and spinal anesthesia during emergency cervical cerclage in women in the second trimester of a singleton pregnancy.

Is spinal anesthesia a safe alternative for retrograde intrarenal surgery for stone disease in daily practice?

Retrograde intrarenal surgery (RIRS) is commonly performed under general anesthesia (GA) because renal mobility during breathing may affect lithotripsy. However, spinal anesthesia (SA) is adopted in clinical practice due to clinical conditions that contraindicate GA. We aimed to compare results of RIRS for stones performed under GA compared to SA regarding stone-free rate (SFR) status and postoperative complications in a consecutive single-center series. We retrospectively reviewed all patients who underwent RIRS for stones between 2017 and 2020. age ≥ 18 years, renal stone burden deemed suitable for RIRS with a stone diameter ≤ 20 mm. stones >20 mm, urinary tract infection, bilateral surgery, second-look procedures, unmodifiable bleeding diathesis, <5mm asymptomatic lower calyx stones. SFR was defined as no residual fragment >3 mm at 6-12 weeks follow-up. The choice of anesthesia was a shared decision between anesthesiologists and patient preference. 230 patients were included in the analysis. Mean age was 57.50±13.73 years. 33% of stones were located in the pelvis. 28.7% of patients had multiple stones. Mean cumulative stone diameter was 16.60±6.54 mm. 63% of patients underwent RIRS under SA. There were no significant differences between the two groups in terms of preoperative characteristics, except for comor-bidity, significantly higher in the GA group. Mean time of operating room occupation was longer in the GA group (81.58±35.37 minutes) than in the SA group (72.85±25.91 minutes,p=0.033). Length of stay was shorter in the SA group (mean 2.2±1.66 days vs 3.46±5.88 in GA,p=0.019). Logistic regression showed that multiple stones in the collecting system were associated with residual fragments (HR 0.386, 95%CI 0.151-0.991,p=0.04). There were no statistically significant differences in overall and high-grade complications, and in SFR between SA (75.9%) and GA groups (70.6%,p=0.317). SA does not affect SFR and postoperative complications in patients who underwent RIRS in daily practice.

Spinal anaesthesia in kyphoscoliotic parturients undergoing caesarean delivery – A retrospective study from a tertiary care centre in India

Introduction: Kyphoscoliosis with pregnancy is a rare but serious disorder which often requires caesarean delivery. Both general and regional anaesthesia have been used in these cases but data regarding outcomes with spinal anaesthesia (SA) are limited. Methods: We conducted a retrospective study to identify patients with kyphoscoliosis undergoing caesarean delivery at a tertiary care hospital in India. Those parturients who received SA were compared with those receiving general anaesthesia (GA group) with respect to cardiorespiratory parameters, maternal outcomes and neonatal outcomes. Results: The GA group had significantly worse cardiorespiratory parameters including pulmonary function tests, right atrial pressures and cardiac ejection fraction as compared to SA group. All the GA group patients required mechanical ventilation while no patients in the SA group needed mechanical ventilation. Intraoperative hypotension was more common in the SA group. Neonatal outcomes were worse in the GA group with lower Apgar scores at 1 and 5 min and more nursery admissions than the SA group. No maternal or neonatal deaths occurred in either group. Conclusion: Kyphoscoliotic parturients scheduled for CD can be successfully managed with SA with good maternal and neonatal outcomes. GA may be reserved for severe kyphoscoliotic parturients with cardiorespiratory complications. The safety of SA in severe kyphoscoliosis requires further studies.

Evaluation and Comparison on the Results of Totally Extraperitoneal Laparoscopic Surgery under General and Spinal Anesthesia for Inguinal Hernia.

Totally extraperitoneal (TEP) hernia repair surgery is one of the recently considered hernioplasty methods. Here, in the current study, we aimed to compare the results of TEP hernia repair surgery in the two groups of general anesthesia and spinal anesthesia. This is a randomized clinical trial that was performed in 2018-2019 in Isfahan on 106 patients undergoing TEP inguinal hernia repair. Patients were randomly divided into two groups. The first group underwent TEP inguinal hernia repair surgery under general anesthesia and the second group of patients underwent TEP inguinal hernia repair surgery under spinal anesthesia. Data regarding surgery duration, intensive care unit admission, pain of patients, mean of analgesic injections after the surgery, and complications such as urine retention, seroma, and hematoma, and wound infection were collected. Data were compared between two groups. We found significantly higher duration of surgery in the spinal anesthesia group (P = 0.02). Patients in the spinal anesthesia group had shorter duration of nutrition regime beginning (P = 0.002) and lower frequencies of urine retention (P = 0.001). Further analysis showed that the mean pain severity was significantly lower in spinal anesthesia group compared to general anesthesia during postoperation measurements (P = 0.001) and patients in spinal anesthesia group received less postoperation analgesics compared to the other group (P = 0.001). TEP surgery under spinal anesthesia was associated with better clinical results such as lower postoperative pain and analgesics injections compared to general anesthesia.

Moving towards Regional Anaesthesia for Spine Surgery – Need of the Hour

Background: In the last few decades, many studies have been conducted on comparison between general anaesthesia (GA) versus spinal anaesthesia (SA) for lumbar spine surgeries and each have reported discrepancies between the two methods of induction with equivalent pros and cons; ultimately failing to state a final conclusive method. With the ongoing COVID pandemic, and the fear of aerosol generation associated with GA; our focus has shifted on regional anesthesia completely, as it is been proven safer and more hassle-free to conduct during these challenging times. Materials and Methods: A similar case study was conducted with 178 patients posted for lumbar spine procedures under the same surgeon. Wherein, 86 received GA and 92 SA. Appropriate statistical analysis was applied to identify differences in blood loss, operative time, time from entering the operating room (OR) until incision, time from bandage placement to exiting the OR, total anesthesia time, PACU time, and total hospital stay. Secondary outcomes of interest included incidence of postoperative spinal hematoma and death, incidence of paraparesis, paraplegia, paraesthesia, post-Dural puncture headache, signs of meningism, urinary retention, and other perioperative complications among the SA patients. Results: SA was associated with significantly lower operative time, blood loss, total anaesthesia time, time from entering the OR until incision, time from bandage placement until exiting the OR. SA was also associated with shorter stay in the PACU, and overall lesser total duration of hospital stay. None of the 92 patients in SA group needed conversion to GA or had an episode of high/complete sympathetic blockade. No incidences of paraparesis or paraplegia, or episodes of persistent post-operative paraesthesia or weakness, Bagai (vasovagal) syncope, PONV, post-op meningism, post-dural puncture headache, spinal hematoma, intraoperative dural Cerebrospinal Fluid leak or post-op fistula, were noted. There were two incidences of failed spinal which were easily managed with a lower dose repeat SA. Overall better post-op analgesia and higher patient and surgeon satisfaction compared to GA was observed. Conclusion: SA is effective for use in patients undergoing elective lumbar spine surgeries and very efficient alternative technique to GA. SA offers efficient OR functioning with decreasing overall operation theatre time and shown to be the more convenient anesthetic choice in the perioperative setting.

Comparison of mortality and serious complications in lower extremity total joint arthroplasty patients with aortic stenosis receiving spinal versus general anesthesia.

Aortic stenosis (AS) is a cardiac valvular lesion that can cause sudden death. Spinal anesthesia (SA) has been considered a relative contraindication in patients with AS. We sought to compare outcomes in patients with AS undergoing SA versus general anesthesia (GA) for lower extremity total joint arthroplasty (TJA). A retrospective chart review was conducted of elective, primary TJA cases between January 1, 2011, and November 30, 2017, at three tertiary care academic medical centers. Participants included 89 patients with AS undergoing TJA with SA, and 74 with AS undergoing TJA with GA. Primary endpoints included 90-day mortality, blood transfusion, hospital length of stay (LOS), and the 90-day incidence of deep vein thrombosis, pulmonary embolism, myocardial infarction, and stroke. Propensity score matching was utilized to assess differences in outcomes between patients receiving GA vs. SA. After matching, there were no significant differences in mortality (GA 0% vs. SA 1%; OR: 1.01 [0.98, 1.05]; P = 0.498), serious complications GA 2.2% vs. SA 0%; OR: 1.00 [0.95, 1.05]; P = 0.233), blood transfusion (GA 12.4% vs. 9% SA; OR: 1.01 [0.86, 1.19]; P = 0.751) within 90 days in the GA vs. SA groups, nor hospital LOS (GA mean 3.0 vs. SA mean 2.9,  0.3 [-0.11, 0.70]; P = 0.153). There were no differences in the incidence of mortality or serious complications in matched patients with AS undergoing elective primary lower extremity TJA under SA versus GA.

Unilateral spinal anesthesia and the sciatic nerve block in foot surgery

Purpose of the study. To evaluate the effectiveness of unilateral spinal anesthesia as a method of pain relief during foot surgery. Analyze the effectiveness of unilateral spinal anesthesia versus sciatic nerve block. To develop an algorithm for performing unilateral spinal anesthesia during foot surgery.&#x0D; Materials and methods. We examined 64 patients who were treated in the department of purulent surgery of the 3rd city hospital in Zaporozhye with a diagnosis of diabetic foot syndrome in the period from 2017 to 2019.&#x0D; Research methods. Assessment of the level of pain intensity using the standard visual analogue scale and the concentration of glucose in the blood serum. Monitoring of the parameters of the cardiovascular system, the temperature of the skin of the lower leg during anesthesia, Doppler scanning of the peripheral circulation in the foot.&#x0D; Results. 4 hours after performing anesthesia, the intensity of pain during movement of the lower limb, according to the visual analogue scale in the group with unilateral spinal anesthesia was 2,3 times less than in the group with sciatic nerve block (p &lt; 0,05). After 10 hours – in the sciatic nerve block group there was a 9,4% increase in comparison with the unilateral spinal anesthesia group (p &lt; 0,05). Compared with the unilateral spinal anesthesia group, in the sciatic nerve block group 20 minutes after anesthesia, the heart rate decreased by 7,2% (p &lt; 0,05). After unilateral spinal anesthesia, the level of systolic blood pressure on 1 toe of the foot increased by 18,3% 20 minutes after anesthesia, and 20 minutes after sciatic nerve block – by 13,7% (p &lt; 0,05). In patients with the unilateral spinal anesthesia group, the temperature on the operated lower limb after anesthesia increased by 3,8%, in the sciatic nerve block group – by 2,8% (p &lt; 0,05).&#x0D; Conclusions. Regional anesthesia is the main method of choice for foot surgery compared to general anesthesia. sciatic nerve block does not in all cases lead to 100% surgical anesthesia and requires additional medical analgosedation. For foot surgery, unilateral spinal anesthesia is preferred.

Spinal versus general anesthesia for minimally invasive transforaminal lumbar interbody fusion: implications on operating room time, pain, and ambulation.

There has been increasing interest in the use of spinal anesthesia (SA) for spine surgery, especially within Enhanced Recovery After Surgery (ERAS) protocols. Despite the wide adoption of SA by the orthopedic practices, it has not gained wide acceptance in lumbar spine surgery. Studies investigating SA versus general anesthesia (GA) in lumbar laminectomy and discectomy have found that SA reduces perioperative costs and leads to a reduction in analgesic use, as well as to shorter anesthesia and surgery time. The aim of this retrospective, case-control study was to compare the perioperative outcomes of patients who underwent minimally invasive surgery (MIS)-transforaminal lumbar interbody fusion (TLIF) after administration of SA with those who underwent MIS-TLIF under GA. Overall, 40 consecutive patients who underwent MIS-TLIF by a single surgeon were analyzed; 20 patients received SA and 20 patients received GA. Procedure time, intraoperative adverse events, postoperative adverse events, postoperative length of stay, 3-hour postanesthesia care unit (PACU) numeric rating scale (NRS) pain score, opioid medication, and time to first ambulation were collected for each patient. The two groups were homogeneous for clinical characteristics. A decrease in total operating room (OR) time was found for patients who underwent MIS-TLIF after administration of SA, with a mean OR time of 156.5 ± 18.9 minutes versus 213.6 ± 47.4 minutes for patients who underwent MIS-TLIF under GA (p < 0.0001), a reduction of 27%. A decrease in total procedure time was also observed for SA versus GA (122 ± 16.7 minutes vs 175.2 ± 10 minutes; p < 0.0001). No significant differences were found in intraoperative and postoperative adverse events. There was a difference in the mean maximum NRS pain score during the first 3 hours in the PACU as patients who received SA reported a lower pain score compared with those who received GA (4.8 ± 3.5 vs 7.3 ± 2.7; p = 0.018). No significant difference was observed in morphine equivalents received by the two groups. A difference was also observed in the mean overall NRS pain score, with 2.4 ± 2.1 for the SA group versus 4.9 ± 2.3 for the GA group (p = 0.001). Patients who received SA had a shorter time to first ambulation compared with those who received GA (385.8 ± 353.8 minutes vs 855.9 ± 337.4 minutes; p < 0.0001). The results of this study have pointed to some important observations in this patient population. SA offers unique advantages in comparison with GA for performing MIS-TLIF, including reduced OR time and postoperative pain, and faster postoperative mobilization.

Inguinal hernia repair under regional anaesthesia versus local anaesthesia: a comparative study

IntroductionThis study aims to compare Lichenstein's repair performed under regional anaesthesia and local anaesthesia. MethodsThis prospective study included two groups of 31 patients each with an uncomplicated inguinal hernia from surgical units of KMC affiliated hospitals. All patients underwent Lichenstein's tension-free repair either under spinal anaesthesia (group 1) or under local anaesthesia (group 2). Results from both groups were compiled and analysed. ResultsMean age was 50.45 (SD 16.49) in group 1 and 50.61 (SD 12.04) in group 2. Median time taken for surgery was less under local anaesthesia (1.17 versus 1.5 hours). Postoperative pain was less in the local anaesthesia group at 24, 48 hours after surgery, and after 2 weeks of discharge. Group 1 had higher cases of urinary retention. ConclusionLichenstein's repair under local anaesthesia was better concerning post-operative pain, complications and hospital stay.

Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults

BackgroundThe effects of spinal anesthesia as compared with general anesthesia on the ability to walk in older adults undergoing surgery for hip fracture have not been well studied.MethodsWe conducted a pragmatic, randomized superiority trial to evaluate spinal anesthesia as compared with general anesthesia in previously ambulatory patients 50 years of age or older who were undergoing surgery for hip fracture at 46 U.S. and Canadian hospitals. Patients were randomly assigned in a 1:1 ratio to receive spinal or general anesthesia. The primary outcome was a composite of death or an inability to walk approximately 10 ft (3 m) independently or with a walker or cane at 60 days after randomization. Secondary outcomes included death within 60 days, delirium, time to discharge, and ambulation at 60 days.ResultsA total of 1600 patients were enrolled; 795 were assigned to receive spinal anesthesia and 805 to receive general anesthesia. The mean age was 78 years, and 67.0% of the patients were women. A total of 666 patients (83.8%) assigned to spinal anesthesia and 769 patients (95.5%) assigned to general anesthesia received their assigned anesthesia. Among patients in the modified intention-to-treat population for whom data were available, the composite primary outcome occurred in 132 of 712 patients (18.5%) in the spinal anesthesia group and 132 of 733 (18.0%) in the general anesthesia group (relative risk, 1.03; 95% confidence interval [CI], 0.84 to 1.27; P=0.83). An inability to walk independently at 60 days was reported in 104 of 684 patients (15.2%) and 101 of 702 patients (14.4%), respectively (relative risk, 1.06; 95% CI, 0.82 to 1.36), and death within 60 days occurred in 30 of 768 (3.9%) and 32 of 784 (4.1%), respectively (relative risk, 0.97; 95% CI, 0.59 to 1.57). Delirium occurred in 130 of 633 patients (20.5%) in the spinal anesthesia group and in 124 of 629 (19.7%) in the general anesthesia group (relative risk, 1.04; 95% CI, 0.84 to 1.30).ConclusionsSpinal anesthesia for hip-fracture surgery in older adults was not superior to general anesthesia with respect to survival and recovery of ambulation at 60 days. The incidence of postoperative delirium was similar with the two types of anesthesia. (Funded by the Patient-Centered Outcomes Research Institute; REGAIN ClinicalTrials.gov number, NCT02507505.)

This Month in Anesthesiology

This Month in Anesthesiology

Minipercutaneous Nephrolithotomy Under Mixture of Local Anesthesia: A Randomized Controlled Study.

Objective: To evaluate the safety, efficacy, and feasibility of minipercutaneous nephrolithotomy (MPCNL) under mixture of local anesthetics (MLA) vs spinal anesthesia (SA) for management of large renal stones. Patients and Methods: This study was a prospective randomized controlled study and approved by IRB (REC-FOMBU). A total of 120 consecutive patients who met the inclusion criteria of the study and agreed to sign the informed consent form were randomized to undergo MPCNL under MLA (60 patients) or SA (60 patients). Intra- and postoperative findings including visual pain analogue scale (VAS), operative time, hospital stay, adverse events (AEs), stone-free rate, and related data were recorded. Results: Baseline characteristics and demography included age and gender; stone's site, size, and density were comparable for both groups (p > 0.05). The average VAS scores in the MLA group at 0, 2, 6, 12, and 24 hours were 2.5, 0, 1, 1, and 0, respectively. The corresponding values in the SA group were 2, 1, 2, 2, and 1, respectively, (p < 0.05). The average operation time was ∼1 hour for both groups and the length of hospital stay was 1.5 days for both groups (p > 0.05). Whereas the mean hemoglobin deficit was 1.04% ± 0.54% vs 1.27 ± 0.46 (p = 0.013) and the primary postoperative stone clearance was 93.4% vs 88.3% (p > 0.05), for MLA and SA groups, respectively. Postoperative analgesic consumption and complications were similar in the MLA and SA groups. Conclusion: Single tract MPCNL is feasible under either MLA or SA with comparable stone clearance and AEs. Perioperative VAS was similar and acceptable for both modalities.

Comparison of Postoperative Cognitive Decline Using the Mini-Mental State Examination and Montreal Cognitive Assessment After Minor Elective Surgery in Elderly.

Introduction and aimPostoperative cognitive dysfunction (POCD) is an important complication associated with increased morbidity, mortality, and reduced quality of life. Generally, studies have focused on major surgery so there is little evidence of the incidence of cognitive dysfunction in minor surgery. We aimed to compare the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in terms of detecting cognitive decline in elderly patients after elective inguinal herniorrhaphy procedure with general or spinal anesthesia.Material and methodsThis observational study was conducted from June 2014 to March 2015 at Ankara Numune Education and Research Hospital. The type of anesthesia was determined according to the anesthesiologist’s preference who is blind to the study. Patients were grouped according to anesthesia received: general or spinal anesthesia. The MMSE and MoCA were evaluated presurgery and 24 hours after the operation.ResultsThe postoperative (24th hour) MMSE scores of patients (26.23±2.77) were significantly lower than the preoperative scores (27.17±1.93) in only the general anesthesia group (p =0.003). The postoperative (24th hour) MoCA scores (22.87±3.88 for general and 23.13±4.08 for spinal anesthesia) were significantly lower than the preoperative scores (24.32±3.19 for general and 24.35±2.84 for spinal anesthesia) in both the general and spinal anesthesia groups (p =0.000 and 0.019, respectively). The incidence of postoperative cognitive dysfunction was 32.9% using the MoCA and 15.2% using the MMSE (p=0,018).ConclusionEarly POCD is an important problem after elective minor surgeries, even with spinal anesthesia, in elderly patients. The MoCA is an alternative tool that can be more sensitive than the MMSE to identify cognitive decline in elderly patients undergoing minor surgeries under both general and spinal anesthesia.

Влияние метода анестезии на объем кровопотери при оперативных вмешательствах на поясничном отделе позвоночника

Актуальность. Операции на поясничном отделе позвоночника могут выполняться в условиях как общей анестезии (ОА), так и спинальной (СА). Одним из преимуществ последней авторы считают уменьшение интраоперационной кровопотери. Однако этот вопрос остается дискуссионным. Цель исследования: сравнить объем кровопотери при операциях на поясничном отделе позвоночника при использовании спинальной и общей внутривенной анестезии. Материалы и методы. В исследование включено 215 пациентов 18–70 лет, ASA I–II, с дегенеративными заболеваниями позвоночника, которым выполнялись плановые оперативные вмешательства с транспедикулярной стабилизацией 1–2 сегментов. Пациентам группы СА (n = 110) выполняли спинальную анестезию 0,5% раствором бупивакаина (4 мл), пациентам группы ОА (n = 105) — общую внутривенную анестезию с искусственной вентиляцией легких (пропофол, фентанил, атракуриум в общепринятых дозах). Жестким условием исследования было поддержание среднего артериального давления (САД) 60–80 мм рт.ст. Результаты. Урапидил для коррекции гемодинамики вводился у 21,9 ± 4,0 % пациентов группы ОА и только у 3,6 ± 1,8 % пациентов группы СА, при этом САД в группе СА был значимо ниже, чем в группе ОА. В результате исследования не выявлено различий в кровопотере (ни по методу Moore, ни по разнице гемоглобина). Однако общее время оперативного вмешательства было статистически значимо больше в группе ОА по сравнению с группой СА (128,5 ± 40,0 мин против 104,6 ± 26,3 мин, р &lt; 0,05). Полученные нами расчеты указывают на сильную корреляционную связь между временем операции и индексом массы тела (r = 0,71, р &lt; 0,05). Выводы. При обеспечении САД 60–80 мм рт.ст. общий уровень кровопотери не зависит от вида анестезии. СА обеспечивает лучший эффект управляемой гипотензии без применения дополнительных фармакологических средств. Время оперативного вмешательства при ОА значимо больше, чем при СА. На него также влияет повышенный индекс массы тела.

Частота и факторы развития послеоперационной инсомнии

Актуальность. Ежегодный рост количества хирургических вмешательств и широта физиологических воздействий нарушения сна в послеоперационном периоде делают проблему инсомнии актуальной для современной анестезиологии. Цель исследования: анализ распространенности послеоперационной инсомнии и факторов риска ее развития, связанных с методом анестезиологического обеспечения. Материалы и методы. Двести пациентов, перенесших ортопедическое или хирургическое вмешательство, были распределены на группы в зависимости от вида анестезии. Проводилась оценка качества сна, уровней боли, тревоги, депрессии, потребности в анальгетиках. Результаты. Общая частота развития послеоперационных нарушений составила 72,08 %, среди которых легкая инсомния достигала 42,64 %, инсомния средней тяжести — 18,78 % и тяжелая инсомния — 10,66 %. Распределение по группам составило: в группе общей анестезии (ОА) легкой инсомнии — 44,44 %, инсомнии средней тяжести — 19,75 % и тяжелой инсомнии — 12,35 %; в группе спинномозговой анестезии (СМА) легкой инсомнии — 40,34 %, инсомнии средней тяжести — 17,65 % и тяжелой инсомнии — 11,76 %. Разница между группами не достигла уровня статистической достоверности. В обеих группах выявлена связь инсомнии с выраженностью послеоперационной боли. В группе ОА — r = 0,437; в группе СМА — r = 0,513. Также в обеих группах наблюдалась положительная корреляция уровня тревожности (rОА = 0,341; rСМА = 0,312) и депрессии (rОА = 0,342; rСМА = 0,301). В группе CМА наблюдалась отрицательная корреляция развития инсомнии с послеоперационным использованием наркотических анальгетиков (r = –0,218), в группе ОА корреляция не достигла статистически значимого уровня (r = –0,165). Выводы. Инсомния является частым послеоперационным осложнением. Основными факторами, провоцирующими ее развитие, являются высокий уровень боли, тревожности и депрессии в послеоперационном периоде, использование опиоидных анальгетиков в схеме послеоперационного обезболивания. Региональные социокультурные особенности не имеют существенного влияния на факторы риска и тождественны для других исследованных популяций.

Вплив премедикації й знеболювання на стан тривоги і післяопераційної когнітивної функції при операціях на поперековому відділі хребта

Актуальність. Операції на поперековому відділі хребта можуть виконуватися як в умовах загальної (ЗА), так і спінальної анестезії (СА) та з різним режимом періопераційного знеболювання. Вплив цих двох факторів на емоційний і когнітивний стан пацієнтів залишається невизначеним. Мета дослідження: оцінити вплив премедикації та анестезії на передопераційну тривогу та післяопераційну когнітивну функцію при операціях на хребті. Матеріали та методи. Дослідження проведене на 254 пацієнтах віком 18–70 років, ASA I–II, яким виконувались планові оперативні втручання на поперековому відділі хребта. Пацієнти отримували спінальну або загальну внутрішньовенну анестезію та стандартне знеболювання (СЗ) або періопераційну мультимодальну аналгезію (ММА). СЗ включало парацетамол 1 г тричі на добу та морфін за необхідності та премедикацію феназепамом 0,5 мг. Пацієнти з ММА отримували додатково прегабалін 75 мг per os напередодні та у перші 3 доби післяопераційного періоду та парекоксиб 40 мг двічі на добу. Для оцінки тривоги використовували шкалу APAIS-A (Amsterdam Preoperative Anxiety and Information Scale частина Anxiety) та для оцінки когнітивних функцій — тест зв’язування чисел (ТЗЧ). Результати. Премедикація феназепамом та прегабаліном однаково впливала на рівень тривожності. Вірогідних відмінностей за APAIS-A не знайдено у пацієнтів жодної групи. ТЗЧ перед операцією вірогідно не відрізнявся між групами. На 3-тю добу після операції час за ТЗЧ у пацієнтів обох груп, які отримували СЗ та премедикацію феназепамом, був більшим за передопераційний рівень (у групі СА-СЗ — 87,3 ± 27,2 с проти 63,1 ± 16,3 с, р &lt; 0,05; у групі ЗА-СЗ — 92,1 ± 25,1 с проти 61,1 ± 18,5 с, р &lt; 0,05), а також більшим за аналогічні показники пацієнтів відповідних підгруп ММА (87,3 ± 27,2 с проти 57,4 ± 23,8 с, р &lt; 0,05, у групах спінальної анестезії та 92,1 ± 25,1 с проти 61,8 ± 19,8 с, р &lt; 0,05, у групах тотальної внутрішньовенної анестезії). Висновки. Введення у склад ММА прегабаліну забезпечує не тільки знеболюючий, але й протитривожний ефект, співставний з таким у бензодіазепінів. На відміну від прегабаліну, феназепам викликає зниження уваги та концентрації (до 3-ї доби). Режим премедикації та знеболювання, а не метод анестезії впливає на розвиток когнітивних змін у післяопераційному періоді.

The effect of different anesthesia applications on serum Pentraxin-3 levels: a randomized prospective study

Objective: Pentraxin-3 (PTX3) is a biomarker shown to correlate with the severity of infections. It is a good indicator of mortality and is useful in monitoring treatment success. However, there is inadequate information about the factors affecting PTX3 levels. This study aimed to investigate the effects of different anaesthesia types on serum PTX3 levels.&#x0D; Materials/Patients and Methods: Serum PTX3 levels were obtained from patients who were under general anaesthesia (GA) and spinal anaesthesia (SA) for a caesarean section (C-section). Blood Samples were collected preoperatively at 6 h and 24 h postoperatively. Biomarkers such as C-reactive protein, white blood cells, neutrophils and lymphocytes were also assessed as biomarkers.&#x0D; Results: No difference was found in the preoperative serum PTX3 levels among the participants (p &gt; 0.05). A significant increase was observed when the preoperative PTX3 levels (0.16 ng/mL) were compared with the postoperative levels at 6 h (0.25 ng/mL) and 24 h (0.54 ng/mL) in the GA group. No significant change was found in the PTX3 levels at 0–6–24 h measurements in the SA group. Nevertheless, the GA group was found to be significantly higher than the SA group at 6 h and 24 h postoperatively (p &lt; 0.05). Additionally, No correlation was observed between PTX3 levels and other biomarkers.&#x0D; Conclusions: This study showed that when coupled with C-section, GA increased the PTX3 levels postoperatively compared with the PTX3 levels during the preoperative period. No significant change was observed with SA. The PTX-3 levels should be considered to increase in association with GA in suspected infectious and inflammatory cases. Therefore, regional anaesthesia should be preferred.

This Month in Anesthesiology

This Month in Anesthesiology

Effects of transurethral resection under general anesthesia on tumor recurrence in non-muscle invasive bladder cancer.

The effects of the type of anesthesia (spinal (SA) vs. general (GA)) used for transurethral resection of bladder tumor (TURBT) on non-muscle invasive bladder cancer (NMIBC) recurrence and progression are controversial and our aim is to investigate their associations. We identified 300 NMIBC patients who underwent initial TURBT with SA or GA. Cox's regression analysis was performed to examine the effects of anesthesia on tumor recurrence. Among 300 patients, 153 (51.0%) received GA and 147 (49.0%) SA. The 5-year recurrence-free survival (RFS) rate was 59.9% in the GA group, which was significantly lower than that in the SA group (74.4%, p = 0.029). GA (HR 1.57, p = 0.048), male sex (HR 2.72, p = 0.012), and tumor multiplicity (HR 1.96, p = 0.006) were independently associated with tumor recurrence. In a subgroup of 137 patients with high-risk NMIBC, the 5-year RFS rate was 50.3% in the GA group, which was significantly lower than that in the SA group (77.6%, p = 0.020), and GA remained an independent indicator of tumor recurrence (HR 2.35, p = 0.016). However, no significant differences were observed in the RFS rates of low- to intermediate-risk NMIBC patients between the GA and SA groups. The RFS rate was lower in NMIBC patients who received GA during TURBT than in those who received SA. Volatile anesthesia may increase tumor recurrence, particularly in high-risk NMIBC patients, which may be due to the inhibition of the immune response system during surgery.

English

BACKGROUND We wanted to compare the effects of general anaesthesia and regional anaesthesia in cases posted for laparoscopic appendicectomy and also compare various parameters like hemodynamic changes, postoperative analgesia, and postoperative complications in both the techniques. METHODS After obtaining permission from scientific and ethical committee of SVMC, Tirupati, we conducted the study on 60 patients attending SV Medical College, Tirupati from September 2018 to August 2019, who were in ASA GRADE 1 &amp; 2, and posted for laparoscopic appendicectomy. We divided them into two groups Group - S – those who received spinal anaesthesia &amp; Group - G – those who received general anaesthesia. RESULTS 60 patients of ASA 1 and 2 were taken up for laparoscopic appendicectomy from September 2018 to August 2019. Out of 60 patients, 30 patients were grouped under Group - S, Other 30 patients grouped under Group - G. Intraoperative vitals, including blood pressure, heart rate, oxygen saturation, and respiratory rate and end-tidal CO2 levels, were within baseline values, whereas postoperative analgesia was better in Group - S than Group - G. There were 3 patients in the spinal group who developed postoperative hypotension and were managed with injection mephentermine sulphate. Out of 30 in each group, 11 patients in spinal, and 22 patients in GA group developed postoperative nausea and vomiting, which subsided with antiemetics. There were 4 patients in spinal, and 3 patients in the GA group who complained of shoulder tip pain in the postoperative period. Patients had minimal pain and no requirement of analgesia in the initial 3 hours of the postoperative period in the spinal group. CONCLUSIONS Patients who underwent laparoscopic appendicectomy under spinal anaesthesia (Group - S) showed significant postoperative analgesia (P - value &lt; 0.05) and better haemodynamic stability than the patients who underwent laparoscopic appendicectomy under general anaesthesia (Group - G), But alertness for any emergency by anaesthesiologist was more needed in spinal anaesthesia than general anaesthesia because airway was not protected, and patient was taking spontaneous respirations. KEYWORDS RA - Regional Anaesthesia, SA - Spinal Anaesthesia, GA - General Anaesthesia, PONV (Postoperative Nausea &amp; Vomiting)