Articles: general-anesthesia.
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Anesthesia and analgesia · Jan 2025
Comparing General Anesthesia-Based Regimens for Endovascular Treatment of Acute Ischemic Stroke: A Systematic Review and Network Meta-Analysis.
Total intravenous anesthesia (TIVA)-based and volatile-based general anesthesia have different effects on cerebral hemodynamics. The current work compares these 2 regimens in acute ischemic stroke patients undergoing endovascular therapy. ⋯ This network meta-analysis showed that the perioperative use of either general anesthesia-based regimen, or sedation, did not significantly impact various endovascular therapy-related outcomes. However, the current work was underpowered to detect differences in anesthetic agents, clinico-demographic characteristics, or procedural factors.
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Randomized Controlled Trial
Effect of different doses of ciprofol on hemodynamics induced by general anesthesia in elderly diabetic patients undergoing spinal surgery: a double-blind, randomized, controlled study.
To evaluate the safety and efficacy of different doses of ciprofol for the induction of general anesthesia in elderly patients with diabetes undergoing spinal surgery. ⋯ The incidence of hypotension in Group C (46.4%) was significantly higher than that in Groups A (7.4%) and B (14.8%) (P < 0.05). The area under the time-mean arterial pressure curve (AUTMAP) was significantly greater in Group C (176.39 ± 33.83 mmHg·min) than in Group B (158.44 ± 26.55 mmHg·min) and Group A (143.59 ± 19.52 mmHg·min) (P < 0.05). The incidence of intubation response was highest in Group A (77.8%, P < 0.05). Significant differences in bispectral index (BIS) values were observed at 3, 4, and 5 min post-administration among the groups CONCLUSIONS: The induction regimen of 0.3 mg/kg ciprofol combined with 0.4 µg/kg sufentanil and 0.7 mg/kg rocuronium provided superior hemodynamic stability and reduced the need for vasoactive drugs in elderly diabetic patients. This regimen was found to be more favorable compared to the 0.2 mg/kg and 0.4 mg/kg ciprofol dosing groups, demonstrating an optimal balance of safety and efficacy during anesthesia induction in this high-risk population. This trial was registered in the Chinese Clinical Trial Registry on February 26, 2024 (Registration Number: ChiCTR2400081164).
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Given the prevalence of cardiovascular disease, encountering difficult airways in this patient population is quite common. The challenge for anesthesiologists lies not only in establishing the airway but also in managing the hemodynamic instability caused by sympathetic activation during intubation. The purpose of this report is to describe the anesthetic experience of this patient with severe mitral and tricuspid regurgitation, atrial fibrillation with rapid ventricular response, and moderate pulmonary hypertension with an anticipated difficult airway. ⋯ This case highlights the importance of considering both airway safety and maintaining hemodynamic stability when cardiac surgery patients encounter an anticipated difficult airway. Awake intubation is not the only option, and intubation after general anesthesia may be considered when the benefits are evaluated to outweigh the risks.
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Review Comparative Study
Comparative analysis of general and regional anesthesia applications in geriatric hip fracture surgery.
This study compares the outcomes of general anesthesia (GA) and regional anesthesia (RA) in geriatric hip fracture surgery to determine optimal anesthesia strategies for this population. ⋯ RA emerges as a preferable choice for geriatric hip fracture surgery, offering improved safety profiles, enhanced recovery trajectories, and better postoperative cognitive outcomes compared to GA. These findings underscore the importance of anesthesia selection in optimizing surgical outcomes and patient safety in elderly populations. Future research should focus on prospective trials to validate these results and refine anesthesia protocols tailored to elderly hip fracture patients.
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Posterior cervical spine surgery can result in significant discomfort in the post-operative period. Post-operative pain management presents a challenge, particularly in the elderly population which is more sensitive to adverse effects from analgesia. We aimed to compare outcomes after peri-operative posterior cervical muscle plane blocks versus patients who received general anesthesia only. ⋯ These meta-analyses suggest that peri-operative posterior cervical muscle plane blocks are safe and result in improved post-operative analgesic efficacy when compared to controls. More robust prospective, randomized studies are necessary to help inform the safety and efficacy of peri-operative posterior cervical blocks for elective posterior cervical spine surgery.