Articles: general-anesthesia.
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Review Meta Analysis Comparative Study
Comparative outcomes of awake spine surgery under spinal versus general anesthesia: a comprehensive systematic review and meta-analysis.
Awake surgery, under spinal anesthesia (SA), is an alternative to surgery under general anesthesia (GA), in neurological and spine surgery. In the literature, there seem to be some evidence supporting benefits associated with the use of this anesthetic modality, as compared to GA. Currently, there is a notable lack of updated and comprehensive review addressing the complications associated with both awake SA and GA in spine surgery. We hence aimed to perform a systematic review of the literature and meta-analysis on the topic. ⋯ Patients undergoing awake spine surgery under SA had significantly shorter operations and hospital stays, and fewer rates of postoperative nausea and urinary retention as compared to GA. In summary, awake spine surgery offers a valid alternative to GA and added benefits in terms of postsurgical complications, while being associated with relatively low morbidity.
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Curr Opin Anaesthesiol · Feb 2024
ReviewInnovative designs for trials informing the care of cardiac surgical patients: Part II.
This review examines advances in clinical trial methodologies relevant to cardiac anesthesia. It focuses on innovative approaches, including factorial randomization, composite outcomes, and cluster randomized trials, which enhance the efficiency, practical relevance, and generalizability of trial outcomes. ⋯ The evolution of clinical trial designs is marked by a shift towards methodologies that enhance efficiency and provide more nuanced insights into treatment effects. These include factorial designs for simultaneous intervention assessment, composite outcomes for comprehensive physiological representation, and cluster trials for group-level effect analysis. Such advancements are shaping the future of clinical research, making it more relevant, efficient, and broadly applicable.
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Anesthesia and analgesia · Feb 2024
ReviewDepth of Anesthesia and Nociception Monitoring: Current State and Vision For 2050.
Anesthesia objectives have evolved into combining hypnosis, amnesia, analgesia, paralysis, and suppression of the sympathetic autonomic nervous system. Technological improvements have led to new monitoring strategies, aimed at translating a qualitative physiological state into quantitative metrics, but the optimal strategies for depth of anesthesia (DoA) and analgesia monitoring continue to stimulate debate. Historically, DoA monitoring used patient's movement as a surrogate of awareness. ⋯ Generally, nociceptive monitors outperform basic clinical vital sign monitoring in reducing perioperative opioid use. This manuscript describes pupillometry, surgical pleth index, analgesia nociception index, and nociception level index, and suggest how future developments could impact their use. The final section of this review explores the profound implications of future monitoring technologies on anesthesiology practice and envisages 3 transformative scenarios: helping in creation of an optimal analgesic drug, the advent of bidirectional neuron-microelectronic interfaces, and the synergistic combination of hypnosis and virtual reality.
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Tonsillectomy is one of the most common surgical procedures performed in children. Since most clinical practice guidelines (CPGs) are designed to support surgical decisions, none are specifically designed for the perioperative management of children undergoing tonsillectomy. We aimed to identify and analyze the existing CPGs with recommendations for the perioperative management of children undergoing tonsillectomy by conducting a systematic review. ⋯ PROSPERO (CRD42021253374); first submitted 18 June 2021.
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Review Meta Analysis Comparative Study
Comparison of Safety and Efficacy of Anesthesia Methods in Percutaneous Endoscopic Lumbar Discectomy: A Network Meta-Analysis.
Background: The objective of this study was to systematically evaluate the safety and efficacy of local anesthesia, general anesthesia, and epidural anesthesia in percutaneous endoscopic lumbar discectomy (PELD). Methods: We searched PubMed, EMBASE, and OVID databases for all relevant studies. All statistical analysis was performed using STATA 17.0. ⋯ Epidural anesthesia is most advantageous in anesthesia satisfaction and postoperative VAS scores. General anesthesia is most advantageous in postoperative ODI. In the future, more multicenter RCTs are needed to further compare the safety and effectiveness of different anesthesia methods in PELD.