Articles: general-anesthesia.
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J Coll Physicians Surg Pak · Jan 2025
Meta AnalysisPeripheral Nerve Block Combined with Low-Dose General Anaesthesia in Elderly Patients Receiving Hip Arthroplasty.
The study assessed the effectiveness and safety of nerve block combined with low-dose general anaesthesia in elderly hip arthroplasty patients, conducted by a meta-analysis of RCTs. Six trials involving 403 patients were identified from databases such as Cochrane, MEDLINE, and PubMed. The results demonstrated a statistically significant difference in pain scores at postoperative 12hours (95% CI, -2.39 to -0.35, p = 0.008) and 24hours (95% CI, -1.86 to -0.50, p = 0.0007). ⋯ However, between the two groups, there was no statistically significant difference in the 48hour pain score (95% CI, -2.58 to 0.62, p = 0.23). Essentially, this approach effectively reduces early post-surgical pain and it minimises anaesthetic use, whilst simultaneously lowering the risk of complications. Key Words: Nerve block, Elderly patients, Hip arthroplasty, Pain, Postoperative complication.
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J Neurosurg Anesthesiol · Jan 2025
Anesthesia on Clinical Outcomes in an Extended Time Window During Endovascular Stroke Therapy: Exploratory Analysis of the ANGEL-ACT Registry.
Data on the impact of different anesthesia methods on clinical outcomes in patients with acute ischemic stroke undergoing endovascular therapy (EVT) in extended windows are limited. This study compared clinical outcomes in patients with stroke having general anesthesia (GA), conscious sedation (CS), or local anesthesia (LA) during EVT in extended (>6 h) time windows. ⋯ Patients who received LA or CS had better neurological outcomes than those who received GA within extended time windows in a real-world setting.
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Numerous, sometimes conflicting, changes in brain functional connectivity have been associated with the transition from wakefulness to unresponsiveness at induction of general anesthesia. However, relatively few studies have looked at the detailed time evolution of the transition, for different electroencephalogram (EEG) frequency bands, and in the clinical scenario of surgical patients undergoing general anesthesia. ⋯ Propofol-induced loss of consciousness in surgical patients is associated with a global breakdown in low-frequency directed functional connectivity, coupled with a high-frequency increase between closely located brain regions. At loss of consciousness, Granger causality shows more pronounced changes than coherence.
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Case Reports
Electroencephalogram-Guided General Anesthesia in a Pediatric Patient With Alexander's Disease: A Case Report.
In this case, the electroencephalogram (EEG) was used to guide anesthesia care for a pediatric patient with Alexander's Disease undergoing serial intrathecal injections. Previous procedures using a standard maintenance propofol dose of up to 225 µg/kg/min led to postanesthetic recovery times of over 6 hours, requiring a neurology consult for noncoherence. The EEG assisted in guiding maintenance propofol dosing to 75 µg/kg/min, decreasing postanesthetic wash-off and postanesthesia care unit (PACU) recovery time by 50%. This highlights the potential impact of astrocyte dysfunction on anesthetic sensitivity and robustness of EEG as a biomarker of anesthetic effect, including for pediatric patients with rare neurodevelopmental diseases.