Articles: general-anesthesia.
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Review Meta Analysis
Remifentanil for general anaesthesia: a systematic review.
We performed a quantitative systematic review of randomised, controlled trials that compared remifentanil to short-acting opioids (fentanyl, alfentanil, or sufentanil) for general anaesthesia. Eighty-five trials were identified and these included a total of 13 057 patients. ⋯ Remifentanil had no overall impact on postoperative nausea (1.03, 0.97-1.09) or vomiting (1.06, 0.96-1.17), but was associated with twice as much shivering (2.15, 1.73-2.69). Remifentanil does not seem to offer any advantage for lengthy, major interventions, but may be useful for selected patients, e.g. when postoperative respiratory depression is a concern.
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J. Cardiothorac. Vasc. Anesth. · Feb 2007
Meta Analysis Comparative StudyRegional or general anesthesia for carotid endarterectomy? Evidence from published prospective and retrospective studies.
The aim of this study was to compare outcomes of patients undergoing carotid endarterectomy under regional or general anesthesia for any new neurologic impairment, stroke, stroke and/or death, death, and myocardial infarction. ⋯ The number of patients included in randomized controlled trials or even in prospective studies is too low to allow any conclusions on the differences in outcome between the 2 anesthetic techniques. Better outcomes are suggested when results from retrospective studies are added.
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Anesthesia and analgesia · Oct 2006
Meta Analysis Comparative StudyA comparison of neuraxial block versus general anesthesia for elective total hip replacement: a meta-analysis.
A recent meta-analysis showed that compared with general anesthesia (GA), neuraxial block reduced many serious complications in patients undergoing various types of surgeries. It is not known whether this finding from studying heterogeneous patient groups is applicable to a particular surgical patient population. We performed the present meta-analysis to determine whether anesthesia choice affected the outcome after elective total hip replacement (THR). ⋯ Patients undergoing elective THR under neuraxial anesthesia seem to have better outcomes than those under GA.
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Anesthesia and analgesia · Jun 2006
Meta AnalysisA systematic review (meta-analysis) of the accuracy of the Mallampati tests to predict the difficult airway.
The original and modified Mallampati tests are commonly used to predict the difficult airway, but there is controversy regarding their accuracy. We searched MEDLINE and other databases for prospective studies of patients undergoing general anesthesia in which the results of a preoperative Mallampati test were compared with the subsequent rate of difficult airway (difficult laryngoscopy, difficult intubation, or difficult ventilation as reference tests). Forty-two studies enrolling 34,513 patients were included. ⋯ The Mallampati tests were poor at identifying difficult mask ventilation. Publication bias was not detected. Used alone, the Mallampati tests have limited accuracy for predicting the difficult airway and thus are not useful screening tests.
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Patients have the right to be informed about the expected benefits and risks of medical and surgical procedures. Ideally this information should be scientifically based and presented to the patient in time. In morbidly obese patient undergoing general anaesthesia, postoperative pulmonary complications are an important cause of postoperative morbidity and mortality. A 46-yr-old female with a body mass index of 89.8 kg m(-2) was scheduled to undergo radical abdominal surgery for cervix carcinoma. In order to inform her accurately on the risk of developing postoperative pulmonary complications, we undertook to answer the following question: What is the risk to develop postoperative pulmonary complications in a morbidly obese patient about to undergo abdominal surgery under general anaesthesia? ⋯ Considering the positive correlation coefficient and the high body mass index of this patient she has a risk of at least 29.3% to develop pneumonia and/or atelectasis, which should affect the anaesthetic strategy in this patient.