Mode of anesthesia and major perioperative outcomes associated with vaginal surgery

Smith, Pem; Hade, Erinn M.; Tan, Yubo; Pandya, Lopa K.; Hundley, Andrew F.; Hudson, Catherine

doi:10.1007/s00192-019-03908-x

Cited by 8 publications

(13 citation statements)

References 28 publications

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“…General anesthesia has been reported as an independent predictor of perioperative stroke in a largescale investigation (more than 380,000 subjects) of hip and knee arthroplasty patients. 64 These results stand in contrast to smaller-scale investigations involving vascular 65 and gynecologic surgery 66 patients that demonstrated no associations with anesthetic technique and stroke risk. One explanation is that the effect size of anesthetic technique on stroke risk is small, requiring a large-scale investigation for detection.…”

Section: Anesthetic Techniquecontrasting

confidence: 83%

Stroke in Surgical Patients

Vlisides

Moore

2021

Anesthesiology

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Stroke is associated with substantial morbidity and mortality. The aim of this review is to provide an evidence-based synthesis of the literature related to perioperative stroke, including its etiology, common risk factors, and potential risk reduction strategies. In addition, the authors will discuss screening methods for the detection of postoperative cerebral ischemia and how multidisciplinary collaborations, including endovascular interventions, should be considered to improve patient outcomes. Lastly, the authors will discuss the clinical and scientific knowledge gaps that need to be addressed to reduce the incidence and improve outcomes after perioperative stroke.

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Section: Anesthetic Techniquecontrasting

confidence: 83%

Stroke in Surgical Patients

Vlisides

Moore

2021

Anesthesiology

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“…In addition, the VAS scores and anesthesia indexes of the experimental group were significantly better than those of the control group, the incidence rates of EA and complications such as hypoxemia, cardiovascular response, delayed recovery, and headache in the experimental group were significantly lower than those of the control group, and there was no significant between-group difference in the incidence rates of hypotension and cognitive dysfunction, indicating that the combined spinal-epidural anesthesia had a better effect and lower incidence rates of postoperative complications, which was of significant value and meaning to improve the prognosis effect. This study is consistent with the conclusion made by Smith et al [ 16 ]. Compared with general anesthesia, combined spinal-epidural anesthesia can effectively reduce the incidence rates of EA after anesthesia as well as complications while maintaining stable hemodynamic indexes in patients undergoing osteosarcoma surgery and has higher safety.…”

Section: Discussionsupporting

confidence: 94%

“…In addition, as it is also a poor manifestation of mental disorders, patients with it mainly show illogical thought, psychic inadequacy, often some involuntary behaviors, and even mania in severe cases, which will not only make the postoperative work of medical and nursing staff more difficult but also change the hemodynamic indexes of patients and even form patients' tendency to violence such as spontaneous extubation. EA is detrimental to patients' physical recovery for it greatly 16), (75.21 ± 6.17), (76.52 ± 3.65), and (82.29 ± 8.15), respectively. e MAP of the experimental group at T 0 , T 1 , T 2 , T 3 , and T 4 was (80.04 ± 6.25), (78.26 ± 5.33), (76.23 ± 6.14), (76.84 ± 6.17), and (77.14 ± 6.61), respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Experimental group (under combined spinal-epidural anesthesia): before anesthesia, 0.3 µg kg −1 h −1 sufentanil and 4 mg kg −1 h −1 propofol were injected intravenously for sedation and analgesia [13][14][15][16]. Patients were kept in lateral position with the affected limb upward, the spinal L 2-3 or L 3-4 space was selected as the puncture point, routine disinfection and drape were performed, the infiltrated point was under local anesthetic, and after breaking through the ligamentum flavum, the spinal needle was inserted; when the cerebrospinal fluid flowed out, 2-3 ml 0.5% ropivacaine was injected, the spinal needle was withdrawn, the epidural catheter was inserted, and the fixation was performed after there was no cerebrospinal fluid and blood when pumping back.…”

Section: Methodsmentioning

confidence: 99%

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Effect of Different Anesthesia Methods on Emergence Agitation and Related Complications in Postoperative Patients with Osteosarcoma

Zhang

Wang

Mao

2021

Journal of Healthcare Engineering

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Purpose. To explore the effect of different anesthesia methods on emergence agitation (EA) and related complications in postoperative patients with osteosarcoma. Methods. According to the order of admission, 115 patients requiring osteosarcoma surgery treated in our hospital from January 2018 to December 2020 were selected as the research object and randomly divided into the control group (n = 57, accepted the general anesthesia with tracheal intubation) and the experimental group (n = 58, accepted the combined spinal-epidural anesthesia) to compare their anesthesia effect, incidence rates of agitation and complications, and other indexes. Results. In terms of the hemodynamic indexes (MAP, HR, and CVP values), both groups had lower ones at T1 than at T0, but the decline of the experimental group was generally lesser than that of the control group; at T2, no statistical difference was shown within the experimental group’s indexes when comparing with those at T1, but the control group obtained a significant increase; at T3 and T4, both groups had their hemodynamic indexes increased, but such increase within the experimental group showed no statistical difference when comparing with those at T0, while the control group achieved obviously higher values at T4 than at T0 (before the anesthesia); and the between-group difference in the hemodynamic indexes at T1 and T4 was significant. Compared with the control group, the experimental group achieved better VAS scores and anesthesia indexes and lower incidence rates of EA and complications such as the hypoxemia, cardiovascular response, delayed recovery, and headache. In addition, the differences in the incidence rates of hypotension and cognitive dysfunction between the two groups were not statistically significant. Conclusion. When comparing with tracheal intubation general anesthesia, the combined spinal-epidural anesthesia has a better effect in osteosarcoma surgery, with less hemodynamics influence on patients, reduced postoperative pain and stress reaction, and lowered incidence rates of postoperative EA and complications, which is worthy of wide application in clinical treatment.

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“…In a study of unplanned admission following ambulatory general surgery cases, 25% of patients were admitted for anesthesia‐related reasons, such as postoperative nausea or vomiting, drowsiness, abnormal vital signs or lasting anesthesia 35 . The high rate of general anesthesia use reported in this study is consistent with previously quoted rates of GA for FPRS in the United States 36 . While use of general anesthesia and longer, more complex surgical procedures are necessary and worthwhile in specific cases, an effort should be made to streamline surgical procedures and minimize use of general anesthesia when possible to reduce patient admissions and prolonged stay.…”

Section: Discussionsupporting

confidence: 89%

Predictors of prolonged admission after outpatient female pelvic reconstructive surgery

Simi

Chapman

Zillioux

et al. 2022

Neurourology and Urodynamics

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This study aimed to determine factors associated with prolonged hospital admission following outpatient female pelvic reconstructive surgery (FPRS) and associated adverse clinical outcomes.Methods: Using the National Surgical Quality Improvement Program database, we identified outpatient FPRS performed 2011-2016. Isolated hysterectomy without concurrent prolapse repair was excluded. Surgeries were classified as major or minor for analysis. The primary outcome was prolonged length of stay (LOS), defined as admission of ≥2 days. Secondary outcomes included complications, readmission and reoperation associated with prolonged LOS. We abstracted data on covariates, and following univariable analysis, performed backward stepwise regression analysis.Results: A total of 29645 women were included: 12311 (41.5%) major and 17334 (58.5%) minor procedures. A total of 6.9% (2033) had a prolonged LOS.On full cohort multivariable regression analysis, patient characteristics associated with prolonged LOS were older age (odds ratio [OR]: 1.1 per 10 years, confidence interval [CI]: 1.06-1.1, p < 0.001), frailty (OR: 1.8, 95% CI:1.3-2.6, p = 0.001), and Caucasian race (OR: 1.2, CI: 1.02-1.3, p = 0.024). Associated surgical factors included having a major surgical procedure (OR:1.3, CI: 1.2-1.4, p < 0.001), use of general anesthesia (OR: 2.0, CI: 1.5-2.6, p < 0.001) and longer operative time (OR: 2.0, CI: 1.8-2.2, p < 0.001). The occurrence of any complication (10.3% vs. 4.7%, p < 0.001), hospital readmission (4.3% vs. 1.7%, p < 0.001), and reoperation (2.7% vs. 1.0%, p < 0.001) were more likely with prolonged LOS.Conclusions: After outpatient FPRS, 6.9% of patients experience an admission of ≥2 days. Prolonged LOS is more common in patients who are older, frail and Caucasian, and in those who have major surgery with long operative time and general anesthesia.

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Mode of anesthesia and major perioperative outcomes associated with vaginal surgery

Cited by 8 publications

References 28 publications

Stroke in Surgical Patients

Stroke in Surgical Patients

Effect of Different Anesthesia Methods on Emergence Agitation and Related Complications in Postoperative Patients with Osteosarcoma

Predictors of prolonged admission after outpatient female pelvic reconstructive surgery

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