Regional anaesthesia versus general anaesthesia, morbidity and mortality

Gulur, Padma; Nishimori, Mina; Ballantyne, Jane C.

doi:10.1016/j.bpa.2005.10.002

Cited by 83 publications

(54 citation statements)

References 52 publications

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“…13 However, more recent large randomised controlled trials have failed to confirm these findings, because the improvements in perioperative management of patients resulted in increasing safety. [18][19][20] use of shorter acting drugs, high dependency on the intensive care units, improved monitoring standards and vigilance, better preoperative optimization, and less invasive surgical techniques. 18 For instance, in an observational study, Gilbert et al concluded that general anesthesia was at least as effective as spinal anesthesia, and possibly better in affording good long-term outcomes for hip fracture repair.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Different Anesthetic Techniques on Postoperative Outcomes in Elderly Patients with Hip Fracture

Şahin¹,

Heybeli²,

Çolak³

et al. 2012

Turkiye Klinikleri J Med Sci

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A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Determining the type of anesthesia is a complex medical decision that depends on many factors including co-morbidity, age, type of surgery performed, and the risk of the anesthetic techniques. This study evaluated the effects of anesthesia type on postoperative mortality and morbidity in hip fractures. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : One hundred eighty-five patients older than 60 years who were operated for hip fracture between 2005-2009 were retrospectively analyzed. Patients received general anesthesia (n=67), spinal anesthesia (n=67), or epidural anesthesia (n=51). The clinical features of the patients were obtained from the hospital records. Morbidity outcomes were assessed on postoperative day 7. Mortality rates were calculated on postoperative day 7 and postoperative day 30. R Re es su ul lt ts s: : There were no significant differences between the three groups with regard to intraoperative blood loss, intraoperative blood transfusion, smoking status, length of stay in hospital, American Society of Anesthesiology (ASA) physical status, and Charlson Comorbidity Index (CCI) (p=0.393, p=0.088, p=0.369, p=0.228, p=0.491, p=0.371 respectively). Similarly, no difference was detected between the three groups regarding patient mortality rates for day 7 and 30 (p=0.738, p=0.805 respectively). C Co on nc cl lu us si io on n: : No technique was superior to the others. Due to the similar mortality rates among the groups, we suggest that the proper anesthetic technique selected according to the clinical features of the patient combined with adequate monitorization would yield successful results with all three techniques. K Ke ey y W Wo or rd ds s: : Hip fractures; mortality; anesthesia Ö ÖZ ZE ET T A Am ma aç ç: : Anestezi tipinin belirlenmesi, yaş, uygulanacak cerrahi tipi ve anestezi tekniklerinin riski gibi birçok faktörün göz önüne alınmasını gerektiren, kompleks bir tıbbi karardır. Bu çal-ışmada, kalça kırıklarında anestezi tipinin cerrahi sonrası mortalite ve morbidite üzerindeki etkileri değerlendirilmiştir. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Çalışmada, 2005-2009 yılları arasında kalça kırığı operasyonu geçiren 60 yaş üzeri 185 hasta retrospektif olarak analiz edilmiştir. Hastalara genel anestezi (n=67), spinal anestezi (n=67) ve epidural anestezi (n=51) yöntemlerinden biri uygulanmıştır. Hastalara ait klinik bilgiler hastane kayıtlarından elde edilmiştir. Morbidite sonuç-ları operasyon sonrası yedinci günde değerlendirilmiştir. Mortalite oranı ise operasyon sonrası 7. ve 30. günlerde hesaplanmıştır. B Bu ul lg gu ul la ar r: : Her üç grupta cerrahi sırasındaki kan kaybı ve kan transfüzyonu, sigara içme durumu, hastanede kalış süresi, American Society of Anesthesiology (ASA) skoru ve Charlson morbidite indeksi skoru açısından anlamlı bir fark bulunmamıştır (sırasıyla p=0,393, p=0,088, p=0,369, p=0,228, p=0,491, p=0,371). Hastaların 7. ve 30. günlerdeki mortalite oranları açısından gruplar arasında anlamlı bir f...

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Section: Discussionmentioning

confidence: 99%

Comparison of Different Anesthetic Techniques on Postoperative Outcomes in Elderly Patients with Hip Fracture

Şahin¹,

Heybeli²,

Çolak³

et al. 2012

Turkiye Klinikleri J Med Sci

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“…4 This may be due to safer surgical practices that may negate any benefits that epidural anesthesia can provide, including shorter-acting general anesthetic drugs, improved monitoring, and lessinvasive surgeries. 24 In a post hoc subgroup analysis, we looked at the association between anesthesia type and our primary outcome across two different time periods (2004-2007 and 2008-2011) and did not find a significant difference. This is likely because we were looking across a period of only seven years.…”

Section: Discussionmentioning

confidence: 99%

Combined general and neuraxial anesthesia versus general anesthesia: a population-based cohort study

Nash

Mustafa

McArthur

et al. 2015

Can J Anesth/J Can Anesth

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Purpose To determine whether combining spinal or epidural anesthesia with general anesthesia (combined anesthesia) reduces major medical complications of elective surgery compared with general anesthesia alone. Methods We conducted a propensity-matched population-based historical cohort study using large healthcare databases from Ontario, Canada. We identified patients undergoing 21 different elective procedures that were amenable to either combined anesthesia or general anesthesia alone in 108 hospitals from 2004 to 2011. We assessed the following four outcomes together as a composite and individually in the 30 days following surgery: acute kidney injury, stroke, myocardial infarction, and all-cause mortality. Results Prior to matching, we identified 21,701 patients receiving general anesthesia and 8,042 patients receiving combined anesthesia. After matching, our cohort included Author contributions Danielle M. Nash, Reem A. Mustafa, Sumit Sharan, and Amit X. Garg helped design the study. Duminda N. Wijeysundera contributed to the study design by suggesting operations to focus on and administrative codes/variables to use for the study. J. Michael Paterson contributed to the study design by suggesting administrative codes to use for anesthesia type. Christopher Vinden contributed to the study design by suggesting administrative codes to use to identify epidural insertions. Ron Wald contributed to the study design by providing clinical expertise regarding acute kidney injury. Blayne Welk contributed to the study design by suggesting the additional outcome of length of stay. P.J. Devereaux contributed to the study design by adding clinical expertise regarding cardiovascular events. Reem A. Mustafa developed the preliminary protocol, and Danielle M. Nash completed the study protocol. Danielle M. Nash, Reem A. Mustafa, Eric McArthur, Duminda N. Wijeysundera, J. Michael Paterson, Christopher Vinden, Ron Wald, Blayne Welk, P.J. Devereaux, and Amit X. Garg contributed to the interpretation of results. Daniel I. Sessler contributed to the interpretation of results particularly regarding discussion about intraoperative vs postoperative anesthesia use. Michael Walsh contributed to the interpretation of results particularly regarding the limitations of the study. Sumit Sharan contributed to the interpretation of the results through a dialogue regarding standard practice for epidural catheter insertions. Danielle M. Nash initiated and finalized the manuscript. 123Can J Anesth/J Can Anesth (2015) 62:356-368 DOI 10.1007 12,379 patients. Twenty-eight baseline characteristics were well-matched between the combined (n = 4,773) and general anesthesia groups (n = 7,606 Conclusion L'ajout de la rachianesthésie ou de l'anesthésie péridurale à l'anesthésie générale n'a pas été associé à une diminution du risque de complications médicales majeures pour 21 procédures chirurgicales électives différentes par rapport à l'anesthésie générale administrée seule.Neuraxial anesthesia (epidural and spinal anesthesia) is widely used f...

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“…These benefits include (1) reduced blood loss intra-operatively because of decreasing peripheral venous pressure; (2) patients' ability to change the position of arms, legs and chest, as needed to avoid nerve injury, brachial plexus palsy or pressure necrosis in either the face or chest wall; (3) reduced incidence of nausea and vomiting postoperatively; (4) better postoperative analgesia; (5) decreased stress response; (6) preservation of immune response; (7) shorter hospitalisation time; as well as (8) cost reduction. 5,6,7,8,[9][10][11][12][13][14] These benefits of RA should counterbalance the risk of respiratory complications (including respiratory depression) in a sedated pronepositioned patient when compared with GA (with a secured airway). 14 Spinal and anorectal surgery are the procedures carried out in the same body position as that for BMH (the prone position).…”

Section: Discussionmentioning

confidence: 99%

“…Only a comparison of these two anaesthesia methods in a well-defined patient setting is sufficient to prove if there are indeed some advantages of one anaesthesia technique over the other. 8,[10][11][12] The specificity of allogeneic BMT is that the timing of BM donation is strictly linked to the issues related to the recipient (current treatment, disease stage, started conditioning and so on). It means that, even if BMH is an elective procedure for the donor, its timing is vital for the recipient.…”

Section: Discussionmentioning

confidence: 99%

“…However, as known from other patient groups, one might expect some important differences in outcome depending on anaesthesia method. 8,[12][13][14] Available data suggest reduced mortality and morbidity among patients undergoing surgical procedures under RA. On the other hand, as a result of progress in SCT techniques and supportive care in recent years, there is a tendency to raise the age limit for BM donors.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of general vs regional anaesthesia for BM harvesting: a retrospective study of anaesthesia-related complications

Machaczka

Kalaitzakis

Eleborg

et al. 2009

Bone Marrow Transplant

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This retrospective study was conducted to evaluate the safety and complications profile of general anaesthesia (GA) compared with that of regional anaesthesia (RA) for BM harvesting (BMH). The study included 281 donations carried out between 1992 and 1999. Of these, 204 (73%) were allogeneic donations, and GA was carried out in 69% (140 of 204) and RA in 31% (64 of 204) of cases. The other 77 donations were autologous (27%), using GA in 87% (67 of 77) and RA in 13% (10 of 77) of cases. No life-threatening complications occurred, but there were minor intra-and postoperative events during 26 (9%) and after 58 (21%) donations. Postoperative nausea and vomiting was reported in 40 (14%) cases and post-spinal headache after five out of 58 (8.6%) donations in which spinal anaesthesia was carried out. The incidence of intraand postoperative events did not differ significantly between the GA and RA groups. However, the incidence of postoperative events was higher in the allogeneic group compared with that in the autologous group (25 vs 10%, Po0.01) and in female donors compared with male donors (29 vs 14%, P ¼ 0.002). In conclusion, both GA and RA are comparable with regard to BMH. Nevertheless, non-severe intra-and postoperative events were frequent.

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Regional anaesthesia versus general anaesthesia, morbidity and mortality

Cited by 83 publications

References 52 publications

Comparison of Different Anesthetic Techniques on Postoperative Outcomes in Elderly Patients with Hip Fracture

Comparison of Different Anesthetic Techniques on Postoperative Outcomes in Elderly Patients with Hip Fracture

Combined general and neuraxial anesthesia versus general anesthesia: a population-based cohort study

Comparison of general vs regional anaesthesia for BM harvesting: a retrospective study of anaesthesia-related complications

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