Comparison of general anesthesia with endotracheal intubation, combined spinal-epidural anesthesia, and general anesthesia with laryngeal mask airway and nerve block for intertrochanteric fracture surgeries in elderly patients: a retrospective cohort study

Liu, Yang; Su, Mang; Li, Wei; Yuan, Hao; Yang, Cheng

doi:10.1186/s12871-019-0908-2

Cited by 23 publications

(18 citation statements)

References 25 publications

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“…Here, the Apgar scores showed no significant differences between the two groups. However, the study by Liu et al noted that high maternal body temperature may be associated with reduced pulmonary tone and neonatal asphyxia in the newborn [ 21 ]. In addition, no significant difference was found in the delivery mode, and intraspinal nerve block anesthesia resulted in a significantly higher demand for indomethacin versus no anesthesia, indicating the impact of intraspinal nerve block anesthesia analgesia on maternal contractions.…”

Section: Discussionmentioning

confidence: 99%

Impact of Intraspinal Nerve Block Anesthesia on Intrapartum Fever and the Neonate

Wang

Chang

Chen

2022

Evidence-Based Complementary and Alternative Medicine

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Objective. To evaluate the impact of intraspinal nerve block anesthesia on intrapartum fever and the neonate. Methods. In this prospective study, between October 2019 and December 2020, 90 eligible primiparous women enrolled in the obstetrics and gynecology department of our hospital for delivery were recruited and assigned via the random number table method at a ratio of 1 : 1 to either an analgesic group given intraspinal nerve block anesthesia for labor or a nonanalgesic group without anesthesia for labor. Outcome measures included intrapartum body temperature, cases of intrapartum fever, Apgar scores of neonates, visual analogue scale (VAS) scores, delivery mode, and indomethacin use. Results. Intraspinal nerve block anesthesia was associated with a higher body temperature at 4 h and 5 h after analgesia and more cases of intrapartum fever versus no anesthesia ( P < 0.05 ). There were no significant differences in the Apgar scores between the two groups ( P > 0.05 ). Participants given intraspinal nerve block anesthesia had lower VAS scores during labor versus those without anesthesia ( P < 0.05 ). The differences in the delivery mode between the two groups were not significant ( P > 0.05 ). Intraspinal nerve block anesthesia resulted in a significantly higher demand for indomethacin versus no anesthesia ( P < 0.05 ). Conclusion. Intraspinal nerve block anesthesia is clinically effective in labor analgesia but may cause increased body temperature or even overt clinical fever, so close clinical observation of maternal temperature changes is required to mitigate the effects of anesthesia on the mothers. No adverse consequences of intraspinal nerve block anesthesia on the newborns were reported in this study.

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Section: Discussionmentioning

confidence: 99%

Impact of Intraspinal Nerve Block Anesthesia on Intrapartum Fever and the Neonate

Wang

Chang

Chen

2022

Evidence-Based Complementary and Alternative Medicine

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“…Due to poor physical function of elderly patients, they are often complicated with various diseases, the reserve and compensation ability of important organs are significantly decreased, the perioperative hemodynamic fluctuations are large, the anesthesia risk is high, and there are many postoperative complications, which have seriously affected the operation situation, postoperative rehabilitation, and quality of life of the patients [ 7 – 9 ]. For this kind of patients, it is required not only to provide better anesthesia effect during operation but also to maintain the stability of hemodynamics to the maximum extent, so it is extremely important to choose appropriate anesthesia methods.…”

Section: Discussionmentioning

confidence: 99%

Safety of Different Anesthesia Methods Combined with Intravenous Fast Channel Anesthesia in Lower Extremity Orthopedic Surgery of the Elderly

Chen

Yang

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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Objective. To compare the safety of different anesthesia methods combined with intravenous fast channel anesthesia in elderly lower extremity surgery and the effect on postoperative outcome. Methods. A total of 106 elderly patients who underwent lower extremity orthopedic surgery in our hospital from February 2018 to February 2021 were selected and randomly divided into the control group (n = 53) and the observation group (n = 53) according to random number table. All patients received intravenous fast-track anesthesia. On this basis, the control group received spinal-epidural anesthesia, and the observation group received iliac fascial space block on the affected side combined with sciatic nerve block. The operation conditions, blood pressure and heart rate changes, awakening time, postoperative ICU admission rate, and complications were compared between the two groups. Results. There was no statistical difference in the success rate of one-time operation between the two groups ( P > 0.05 ). The times of using analgesics and vasoactive drugs and the dosage of propofol in the observation group during the operation were lower than those in the control group, and the difference was statistically significant ( P < 0.05 ). At T2, T3, and T4, the levels of HR, DBP, and SBP in the observation group were lower than those in the control group, and the difference was statistically significant ( P < 0.05 ). After operation, the time of awakening, spontaneous breathing recovery, and extubation in the observation group were lower than those in the control group, and the difference were statistically significant ( P < 0.05 ). The incidence of complications in the observation group was lower than that in the control group, the cognitive impairment was the most significant one in the incidence of single complication, and the difference was statistically significant ( P < 0.05 ). Conclusion. Based on the combined intravenous fast channel anesthesia, the operation difficulty of the affected side iliac fascial space block combined with sciatic nerve block is the same as that of spinal-epidural anesthesia. It has a higher success rate of one operation, better analgesic and anesthetic effects during the operation, and little effect on blood flow of patients. It can maintain relatively stable heart rate and blood pressure and does not easily cause postoperative complications. Its safety is higher than that of spinal-epidural anesthesia.

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“…and decreased tolerance to anesthesia and surgery [11] . Studies have pointed out that the central nervous system and peripheral receptors in elderly patients are reduced and the drug concentration at the receptor site of each target organ is correspondingly signi cantly increased, resulting in a signi cantly enhanced drug effect, and the respiratory and circulatory inhibitory effects of anesthetics in elderly patients are signi cantly stronger than those of young patients and the drug eliminated half-life time is longer in elderly patients [12] , therefore how to choose a reasonable and effective anesthesia regimen for elderly patients with hip replacement has become an urgent problem to be solved in clinical application. In addition, this study displayed that the VAS scores of the two groups at each time point after surgery were signi cantly lower than those before anesthesia induction, and there were no signi cant differences in VAS score, anesthesia time, awakening time and extubation time between the groups, but the awakening time and extubation time of the remimazolam group were slightly shorter than those of the propofol group and the MMSE scores at 1 d and 3 d after surgery were signi cantly higher than those of the propofol group, preliminarily suggesting that the analgesic effects of remimazolam and propofol are similar in elderly patients with hip replacement but remimazolam may have certain advantages in shortening the awakening time and extubation time and inhibiting the cognitive dysfunction.…”

Section: Cognitive Functionmentioning

confidence: 99%

Application Effects of Remimazolam and on Elderly Patients Undergoing Hip Replacement

Zhang¹,

Wang²,

Zhang³

et al. 2021

Preprint

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Objective To explore the anesthetic and analgesic effects of remimazolam and propofol in elderly patients undergoing hip replacement and their effects on respiratory and circulatory systems, stress and cognitive function. Methods 60 elderly patients undergoing elective hip replacement in the hospital were selected as the research subjects, and they were divided into the remimazolam group and the propofol group according to the admission sequence of patients. The remimazolam group was anesthetized with remimazolam, and the propofol group was anesthetized with propofol. The anesthesia-related indicators, perioperative pain degree [Visual Analogue Scale (VAS)], circulatory indicators [heart rate, mean arterial pressure (MAP)] before anesthesia (T0), immediately before laryngeal mask insertion (T1), at 5 min after laryngeal mask insertion (T2), at 30 min after laryngeal mask insertion (T3) and at 5 min after laryngeal mask removal (T4), stress response indicators (plasma epinephrine, norepinephrine, cortisol) before anesthesia induction and at 24 h and 72 h after surgery, cognitive function [Mini-Mental State Examination (MMSE)] and adverse reactions were compared between the two groups. Results Among the 60 enrolled patients, only 1 case was excluded due to withdrawal, thus 30 cases in the remimazolam group and 29 cases in the propofol group were included. There were statistically significant differences in the heart rate, MAP, plasma epinephrine, norepinephrine, cortisol and VAS score in the two groups from the aspects of interaction effect and time-point effect (P<0.05). The heart rate and MAP at T1, T2 and T3 in the two groups were significantly decreased compared with those at T0, but the heart rate and MAP in the remimazolam group at T1, T2 and T3 were significantly higher than those in the propofol group (P<0.05). There were no statistical differences in the anesthesia time, awakening time and extubation time between the remimazolam group and the propofol group (P>0.05). The levels of plasma epinephrine, norepinephrine and cortisol in the two groups were significantly higher at 24 h and 72 h after surgery than those before anesthesia induction, and the above levels were significantly lower in the remimazolam group than those in the propofol group (P<0.05). The VAS scores at each time point in the two groups were significantly reduced compared to before surgery, but there was no statistically significant difference between the two groups after surgery (P>0.05). The MMSE scores of the two groups were significantly lower at 1 d and 3 d after surgery compared with those before anesthesia induction, but the score in the remimazolam group was significantly higher than that in the propofol group (P<0.05). In addition, the incidence rates of adverse reactions were significantly lower in the remimazolam group compared to the propofol group (P<0.05). Conclusion Compared with propofol, remimazolam can achieve equivalent anesthetic and analgesic effects in elderly patients undergoing hip replacement. However, the latter one can significantly relieve respiratory and circulatory suppression, stress response and cognitive dysfunction, with good safety. Trial registration Clinical trial ethics committee of Hefei second people's Hospital：2021- scientific research-032 (September 6, 2021).

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Comparison of general anesthesia with endotracheal intubation, combined spinal-epidural anesthesia, and general anesthesia with laryngeal mask airway and nerve block for intertrochanteric fracture surgeries in elderly patients: a retrospective cohort study

Cited by 23 publications

References 25 publications

Impact of Intraspinal Nerve Block Anesthesia on Intrapartum Fever and the Neonate

Impact of Intraspinal Nerve Block Anesthesia on Intrapartum Fever and the Neonate

Safety of Different Anesthesia Methods Combined with Intravenous Fast Channel Anesthesia in Lower Extremity Orthopedic Surgery of the Elderly

Application Effects of Remimazolam and on Elderly Patients Undergoing Hip Replacement

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