Factors Determining the Choice of Spinal Versus General Anesthesia in Patients Undergoing Ambulatory Surgery: Results of a Multicenter Observational Study

Abstract

Introduction: Available short-acting intrathecal anesthetic agents (chloroprocaine and prilocaine) offer an alternative to general anesthesia for short-duration surgical procedures, especially ambulatory surgeries. Factors determining the choice of anesthesia for short-duration procedures have not been previously identified. Methods: This observational, prospective, multicenter, cohort study was conducted between July 2015 and July 2016, in 33 private or public hospitals performing ambulatory surgery. The primary objective was to determine the factors influencing the choice of anesthetic technique (spinal or general anesthesia). Secondary outcomes included efficacy of the anesthesia, time to hospital discharge, and patient satisfaction. Results: Among 592 patients enrolled, 309 received spinal anesthesia and 283 underwent general anesthesia. In both study arms, the most frequently performed surgical procedures were orthopedic and urologic (43.3% and 30.7%, respectively); 66.1% of patients were free to choose their type of anesthesia, 21.8% chose one of the techniques because they were afraid of the other, 16.8% based their choice on the expected ease of recovery, 19.2% considered their degree of anxiety/stress, and 16.9% chose the technique on the basis of its efficacy. The median times to micturition and to unassisted ambulation were significantly shorter in the general anesthesia arm compared with the Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.11210276.

General Versus Regional Anaesthesia for Lower Limb Arthroplasty and Associated Patient Satisfaction Levels: A Prospective Service Evaluation in the Oxford University Hospitals

“…This may be linked to factors including requirement of systemic analgesia and ability to mobilise but this was not measured in this service evaluation. Furthermore, our service evaluation highlighted that surgeon preference rarely influenced anaesthetic choice, which matches findings from previous literature [17].…”

Comparing the Effects of General Versus Regional Anesthesia on Postoperative Mortality in Total and Partial Hip Arthroplasty

“…While our study found that there is no difference in early postoperative mortality between patients undergoing THA or PHA and receiving general or regional anesthesia, other studies have found there may be differences in other postoperative complications and outcomes. It has been reported that patients undergoing ambulatory orthopedic procedures under general anesthesia had a faster time to initial micturition and unassisted ambulation when compared with spinal anesthesia, which can be significant in our patient population that is undergoing hip surgery [ 21 ]. While the use of general anesthesia in patients undergoing THA has been associated with increased postoperative adverse complications such as stroke and cardiac arrest, it was not associated with longer postoperative hospital length of stay or 30-day readmissions, which suggests that patients may be at an immediately increased risk of adverse outcomes postoperatively, but that risk decreases rapidly over time, likely as the body recovers from the effects of the general anesthetic agent [ 13 , 22 ].…”

Effect of single-dose intravenous dexamethasone on postoperative pain and postoperative nausea and vomiting in patients undergoing lower segment cesarean section under spinal anesthesia

“…The absence of complication associated with intubation as well as early recovery are its other advantages. 1 For spinal anesthesia in patients undergoing LSCS the most common anesthetic agent used is hyperbaric Bupivacaine (0.5%). It usually takes care of anesthetic requirements during LSCS and supplementation with other anesthetic drugs are usually not required with Bupivacaine.…”