Articles: general-anesthesia.
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Curr Opin Anaesthesiol · Feb 2019
Review Comparative StudyGeneral versus spinal anesthesia for the elderly hip fractured patient.
There is an urge to improve care for patients with hip fracture. The present review will compare the efficacy of spinal versus general anesthesia for patients requiring hip fracture surgery. ⋯ So far, no clear evidence form randomized trials exists to identify the best anesthesia technique for hip fracture surgery. However, several large-scale pragmatic trials are ongoing and will provide future guidance.
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To summarize recent recommendations on intraoperative electroencephalogram (EEG) neuromonitoring in the elderly aimed at the prevention of postoperative delirium and long-term neurocognitive decline. We discuss recent perioperative EEG investigations relating to aging and cognitive dysfunction, and their implications on intraoperative EEG neuromonitoring in elderly patients. ⋯ Anesthesiologists should become acquainted with intraoperative EEG signatures and their relation to age, anesthetic agents, and the risk of postoperative cognitive complications. A working knowledge would allow an optimized and individualized provision of general anesthesia for the elderly.
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Rev Esp Anestesiol Reanim · Feb 2019
ReviewDo we have today a reliable method to detect the moment of loss of consciousness during induction of general anaesthesia?
This review aims to give an overview of the current state of monitoring depth of anaesthesia and detecting the moment of loss of consciousness, from the first clinical signs involved in anaesthesia to the latest technologies used in this area. Such techniques are extremely important for the development of automatic systems for anaesthesia control, including preventing intraoperative awareness episodes and overdoses. A search in the databases Pubmed and IEEE Xplore was performed using terms such anaesthetic monitoring, depth of anaesthesia, loss of consciousness, as well as anaesthesia indexes, namely BIS. Despite the several methods capable of monitoring the hypnotic state of anaesthesia, there is still no methodology to accurate detect the moment of loss of consciousness during induction of general anaesthesia.
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Adequate intravenous fluid replacement is recommended as an effective nonpharmacologic strategy for reducing postoperative nausea and vomiting (PONV), one of the most common and stressful complications of general anesthesia. We aimed to evaluate the effect of hydration, according to the type of fluid, on PONV as previous studies have reported inconsistent results. ⋯ Colloid administration had a more preventive effect on PONV than crystalloid administration in patients undergoing abdominal surgery under general anesthesia for more than 3 hours but did not show a preventive effect in patients undergoing anesthesia for <3 hours.
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Meta Analysis
Anesthesia for endovascular treatment in anterior circulation stroke: A systematic review and meta-analysis.
Endovascular treatment in patients with acute anterior circulation stroke could be performed under either conscious sedation (CS) or general anesthesia (GA). Although several studies have investigated the association between the clinical outcomes and the two anesthesia methods, consensus is lacking. ⋯ In the overall analysis and observational studies, CS was associated with improved functional outcomes and relatively safe for anterior ischemic stroke compared with GA. While the pooled data from RCTs suggested that GA was associated with improved outcomes. The inconsistency indicated that more large-scale RCTs are required to evaluate what factors influenced the effect of the anesthesia methods on clinical outcomes.