Definitions of anaesthetic technique and the implications for clinical research

Armstrong, Richard A.; Mouton, R. P.

doi:10.1111/anae.14200

Cited by 21 publications

(28 citation statements)

References 48 publications

(47 reference statements)

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“…Secondly, the definitions of anesthetic technique are not standardized. The medical literature as it currently stands does not report sufficient detail on the definitions of anesthetic techniques employed, nor by whom they are administered 51 . Further complexity arises when sedation is used alongside LA or RA.…”

Section: Limitationsmentioning

confidence: 99%

Type of Anesthesia for Endovascular Abdominal Aortic Aneurysm Repair

Armstrong

Squire

Rogers

et al. 2019

Journal of Cardiothoracic and Vascular Anesthesia

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Objective: Endovascular aneurysm repair (EVAR) is increasingly used in the management of patients with abdominal aortic aneurysms (AAA), including in the emergency setting for ruptured AAA. The lower mortality amongst patients undergoing emergency EVAR under local anesthesia (LA) observed in the IMPROVE trial has sparked renewed interest in the anesthesia choice for EVAR. This systematic review evaluates the effect of mode of anesthesia on outcomes after EVAR. Design: The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The primary outcome was inhospital/30-day mortality and both emergency and elective EVAR were included. The relative risk of death was estimated for each individual study without adjustment for potential confounding factors. Setting: Hospitals. Participants: A total of 39,744 patients from 22 non-randomized studies were included in the analysis. Interventions: None Measurements and Main Results: Sixteen studies in 23,202 patients compared LA to GA and reported in-hospital/30-day mortality. The unadjusted risk of death after emergency EVAR with LA was lower than with GA. Trends in elective surgery were less clear. Conclusions: There is some evidence across both emergency and elective settings to suggest that mode of anesthesia may be associated with improved outcomes. In particular, 3 LA appears to have a positive effect on outcome after emergency EVAR. Due to the lack of randomized trial data, a significant risk of confounding remains. The optimal mode of anesthesia for EVAR should be further investigated and the reasons why particular anesthesia techniques are chosen for particular patients identified.

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Section: Limitationsmentioning

confidence: 99%

Type of Anesthesia for Endovascular Abdominal Aortic Aneurysm Repair

Armstrong

Squire

Rogers

et al. 2019

Journal of Cardiothoracic and Vascular Anesthesia

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“…Papers were included that reported locoregional anaesthesia with sedation. Sedation could mask any difference between locoregional and general anaesthetic, as the distinction between deep sedation and general anaesthesia is difficult to define in practice. In this review, only two of the 13 studies that referenced sedation described measurable assessments and defined depth of conscious sedation.…”

Section: Discussionmentioning

confidence: 99%

Scoping review of mode of anaesthesia in emergency surgery

Morley

Elliott

Rees

et al. 2020

British Journal of Surgery

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Background Emergency surgery encompasses more than 50 per cent of the surgical workload; however, research efforts are disproportionally low. The mode of anaesthesia used during emergency surgery may affect outcomes, but the extent of research and the impact of the different modes of anaesthesia used are unclear. Methods MEDLINE and Embase were searched using scoping review methodology with a rapid systematic search strategy, identifying any study comparing locoregional (local, nerve block, subarachnoid, epidural) anaesthesia with general anaesthesia. All studies describing outcomes of emergency surgery with differing modes of anaesthesia were identified. Excluded were: studies published before 2003, studies enrolling patients aged less than 18 years and studies using sedation only. Results Forty‐two studies were identified, describing 11 surgical procedures. Most publications were retrospective cohort studies (32). A very broad range of clinical and patient‐reported outcomes were described, with wide variation in the outcomes reported in different studies. Conclusion Reporting of mode of anaesthesia is inconsistent across different procedures and is often absent. There is a need for directed research efforts to improve the reporting standards of anaesthesia interventions, to understand the role of different modes of anaesthesia in specific emergency surgical procedures, and to standardize outcome reporting using core outcome sets.

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“…The incidence in children is greater, at around 9.3:10,000 cases , which is reasonable grounds for consideration of pre‐operative gastric ultrasound. However, in addition to gastric content composition and volume, a range of other risk factors for pulmonary aspiration have been implicated , although those such as underdosing of anaesthesia, analgesia and/or neuromuscular blockade at the point of tracheal intubation are difficult to measure and study .…”

Section: Pulmonary Aspirationmentioning

confidence: 99%

“…Although there are clearly defined criteria for accreditation in focussed cardiac ultrasound, and operators are usually described as having achieved this when used for research purposes , no such guidance exists for pre‐operative gastric ultrasound. Given the precision of thresholds in gastric ultrasound (0.8 ml.kg −1 to 1.5 ml.kg −1 ), questions regarding inter‐ and intra‐operator variability must be asked, more so when the only marker of experience is having conducted ≥ 50 gastric ultrasounds . Third, due to this limited pool of expertise and experience, governance processes around pre‐operative gastric ultrasound must be considered.…”

Section: Gastric Ultrasoundmentioning

confidence: 99%