Articles: general-anesthesia.
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Catheter Cardiovasc Interv · Feb 2018
Meta AnalysisComparison of local versus general anesthesia in patients undergoing transcatheter aortic valve replacement: A meta-analysis.
Transcatheter aortic valve replacement (TAVR) is typically performed under general anesthesia (GA). However, there is increasing data supporting the safety of performing TAVR under local anesthesia/conscious sedation (LA). We performed a meta-analysis to gain better understanding of the safety and efficacy of LA versus GA in patients with severe aortic stenosis undergoing TAVR. ⋯ Our meta-analysis suggests that use of LA for TAVR is associated with a lower 30-day mortality, shorter procedure time, fluoroscopy time, ICU LOS, hospital length of stay, and reduced need for inotropic support.
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Review Meta Analysis Comparative Study
Conscious Sedation versus General Anesthesia for Patients with Acute Ischemic Stroke Undergoing Endovascular Therapy: A Systematic Review and Meta-Analysis.
The aim of this study is to compare the effect of conscious sedation (CS) with general anesthesia (GA) on clinical outcomes in patients with acute ischemic stroke (AIS) undergoing endovascular therapy (EVT). MEDLINE, EMBASE, and Cochrane Central Registers of Controlled Trials (from inception to July 2017) were searched for reports on CS and GA of AIS undergoing EVT. Two reviewers assessed the eligibility of the identified studies and extracted data. ⋯ The all-causing mortality of AIS patients in the CS group was lower than that in the GA group. There were no differences in the proportion of IA rtPA and thrombolysis between the two groups. Compared with AIS patients receiving GA, the all-causing mortality in the AIS patients receiving CS was decreased, while incidence of mRS score ≦ 2 at hospital discharge and one or three months was increased.
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Meta Analysis
Effects of palonosetron and ondansetron on preventing nausea and vomiting after laparoscopic surgery.
Background This meta-analysis was performed to evaluate the efficacy and safety of palonosetron and ondansetron in preventing postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic surgery with general anesthesia. Methods We searched for randomized controlled clinical trials in PubMed, Embase, and The Cochrane Library. Results Nine studies were enrolled in this meta-analysis and showed no statistically significant difference between palonosetron and ondansetron in the prevention of PONV in the first 24 hours after surgery (relative risk [RR], 0.62; 95% confidence interval [CI], 0.35-1.10). ⋯ No significant differences in side effects were found between palonosetron and ondansetron (RR, 0.67; 95% CI, 0.40-1.14). Conclusion This meta-analysis demonstrated that palonosetron is not more efficacious than ondansetron in the prevention of early PONV. However, palonosetron was more efficacious than ondansetron in the prevention of vomiting after laparoscopic surgery.
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General anaesthesia (GA) during endovascular thrombectomy has been associated with worse patient outcomes in observational studies compared with patients treated without GA. We assessed functional outcome in ischaemic stroke patients with large vessel anterior circulation occlusion undergoing endovascular thrombectomy under GA, versus thrombectomy not under GA (with or without sedation) versus standard care (ie, no thrombectomy), stratified by the use of GA versus standard care. ⋯ Medtronic.
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Malignant hyperthermia (MH) continues to be of potential concern for clinicians whenever inhalational anesthetic agents or succinylcholine are used, because MH is a potentially fatal metabolic disorder. ⋯ Ethical approval and informed consent are not required, as the study will be a literature review and will not involve direct contact with patients or alterations to patient care.