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Regional general anesthesia

Dazhi Yin, Zhao Zhang, Zhiwei Wang, Kristina Zeljic, Qian Lv, Danchao Cai, Yingwei Wang, Zheng Wang
Emerging neuroimaging studies emphasize the dynamic organization of spontaneous brain activity in both human and non-human primates, even under anesthesia. In a recent study, we were able to characterize the heterogeneous architecture of intrinsic functional flexibility in the awake, resting human brain using time-resolved analysis and a probabilistic model. However, it is unknown whether this organizational principle is preserved in the anesthetized monkey brain, and how anesthesia affects dynamic and static measurements of spontaneous brain activity...
2019: Frontiers in Neuroscience
Janett Kreutziger, Desmond Hirschi, Sven Fischer, Richard F Herzog, Stefan Zbinden, Philipp Honigmann
PURPOSE: Shoulder dislocation is often associated with intense pain, and requires urgent pain therapy and reduction. Interscalene block, general anesthesia, or intravenous analgesia alone are applied procedures that facilitate shoulder reduction by the surgeon and ease patients' pain. This study was conducted to compare procedure times, patient satisfaction, side-effects, and clinical outcome of these clinical procedures. METHODS: Retrospective chart analysis was performed for all patients treated at the Emergency Department of a primary care hospital...
March 12, 2019: Journal of Anesthesia
Pamela E Smith, Erinn M Hade, Yubo Tan, Lopa K Pandya, Andrew F Hundley, Catherine O Hudson
INTRODUCTION AND HYPOTHESIS: The primary aim was to compare the incidence of major perioperative complications in women undergoing vaginal reconstructive surgery with general, regional, and monitored anesthesia care using a national database. The secondary aim was to compare length of hospital stay, 30-day readmission rates, urinary tract infections, and reoperation rates between anesthesia types. MATERIALS AND METHODS: The National Surgical Quality Improvement Program database was used to study women undergoing vaginal surgery for pelvic floor disorders from 2006 to 2015 via Current Procedural Terminology codes...
March 12, 2019: International Urogynecology Journal
George L Caldwell, Michael A Selepec
Background: Pain management after anterior cruciate ligament reconstruction (ACLR) may pose a risk of prolonged opioid use. Questions/Purposes: The purposes of this study in ACLR were to investigate the efficacy of a surgeon-administered local-regional block of specific genicular nerves on post-operative analgesia following ACLR and to quantify the outpatient opioid consumption and duration through the complete post-operative course. Methods: Prospectively, all patients undergoing primary ACLR by a single surgeon were studied over a 10-month period...
February 2019: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
Magdolna Barra, Edit Remák, Dong Dong Liu, Li Xie, Lucy Abraham, Alesia B Sadosky
Purpose: The use of parecoxib plus opioids for postoperative analgesia in noncardiac surgical patients seems to be cost-saving in Europe due to a reduction in opioid use and opioid-related adverse events. Given the lack of information on postoperative analgesic use in Asia, this study assessed the economic consequences of the addition of parecoxib to opioids vs opioids alone to treat postsurgical pain in China. Methods: A cost-consequence economic evaluation assessed direct medical costs related to opioid-related clinically meaningful events (CMEs) utilizing dosing information and reported frequency of events from a Phase III, randomized, double-blind, global clinical trial (PARA-0505-069) of parecoxib plus opioids vs opioids alone for 3 days following major orthopedic, abdominal, gynecologic, or noncardiac thoracic surgery requiring general or regional anesthesia...
2019: ClinicoEconomics and Outcomes Research: CEOR
Carmen L Mueller, Robert Lisbona, Rafik Sorial, Aya Siblini, Lorenzo E Ferri
INTRODUCTION: Although endoscopic resection for early gastric cancer is well established, anatomical resection with regional lymphadenectomy is recommended for lesions at high risk for occult lymph node metastasis (e.g., lymphovascular invasion, poor grade, and deep submucosal invasion). However, 75-95% high-risk early gastric cancer (HR-EGC) patients ultimately have node-negative disease and could potentially have undergone organ-sparing resection. Due to the inadequacy of standard modalities to reliably rule out nodal metastases in HR-EGC patients, sentinel lymph node (SLN) sampling was developed in Asia with promising results...
March 11, 2019: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Mehmet İlhan Şahin, Alperen Vural, Aynur Akın, İbrahim Ketenci, Yaşar Ünlü
Background and Objectives: Knowing the ototoxic potential of the agents used in medical treatments is important for the protection of hearing. Although we have knowledge regarding some effects of dexmedetomidine, which is an anesthetic-sparing drug, its influence over the hearing system has never been studied and is obscure yet. The aim of this study is to determine the effects of intravenous dexmedetomidine application during sevoflurane anesthesia on otoacoustic emissions (OAEs). Subjects and Methods: This prospective randomized study was performed on 60 patients (34 male, 26 female, mean age: 30...
March 13, 2019: Journal of Audiology & Otology
Sung Min Han, Hee Sung Chae, Ha Neul Lee, Hyun Jong Jeon, Jeong Pyo Bong, Ji Hoon Kim
RATIONALE: Deep neck infections (DNIs) in the head and neck area are difficult to treat due to the anatomical complexity of the cervical region. Since inflammation causes changes in anatomy, it is often difficult to find the exact location of the abscess, which leads to failed surgical drainage. PATIENT CONCERN: A 76-year-old female patient was referred to our clinic with trismus and right-side facial swelling. After extraction of her lower third molar 2 weeks ago, due to chronic periodontitis, her trismus had aggravated and her maximal mouth opening was 20 mm...
March 2019: Medicine (Baltimore)
Massimo Candiani, Stefano Maria Ferrari, Elena Marotta, Iacopo Tandoi, Jessica Ottolina, Stefano Salvatore
OBJECTIVES: To describe our technique for transvaginal treatment of isthmocele. DESIGN: Surgical video article. Local Institutional Review Board approval for the video reproduction was obtained. SETTING: A scientific institute. PATIENT(S): A 26-year-old patient complaining of abnormal uterine bleeding and pelvic pain was referred to our gynecological clinic for secondary infertility. At transvaginal ultrasound examination, a cesarean scar defect of 22 × 11 mm was identified, with a residual myometrial thickness over the defect of 2 mm...
March 7, 2019: Fertility and Sterility
T Ogawa, S Inoue, M Inada, M Kawaguchi
OBJECTIVE: The impact of postoperative intensive care upon patient outcomes was evaluated by retrospectively investigating the rate of poor outcomes among miscellaneous elective surgical patients with severe comorbidities. DESIGN: A retrospective cohort study was carried out. SETTING: University hospital. PATIENTS: Surgical patients with severe comorbidities. INTERVENTION: The outcomes of 1218 surgical patients treated in intensive care units (ICUs) and postsurgical wards (ICU group vs...
February 21, 2019: Medicina Intensiva
Robert J Beaulieu, Satinderjit Locham, Besma Nejim, Hanaa Dakour-Aridi, Karen Woo, Mahmoud B Malas
BACKGROUND: Despite recent reports of improved patency with regional anesthesia (RA), general anesthesia (GA) remains the most common choice for anesthesia for patients undergoing arteriovenous fistula (AVF) or arteriovenous graft (AVG) creation, with nearly 85% utilization. Previous studies of the effect of anesthesia type on outcomes have been conducted through single institutions or a national database with poor granularity for vascular-specific data. Given the high variability of practice patterns and the high prevalence of end-stage renal disease requiring access creation, further study of the impact of anesthesia choice during AVF or AVG creation is warranted...
March 2019: Journal of Vascular Surgery
Michael D Sgroi, Graeme McFarland, Matthew W Mell
OBJECTIVE: Previous studies evaluating general anesthesia (GA) vs regional (epidural/spinal) anesthesia (RA) for infrainguinal bypass have produced conflicting results. The purpose of this study was to analyze the factors associated with contemporary use of RA and to determine whether it is associated with improved outcomes after infrainguinal bypass in patients with critical limb ischemia. METHODS: Using the Vascular Quality Initiative infrainguinal database, a retrospective review identified all critical limb ischemia patients who received an infrainguinal bypass from 2011 through 2016...
February 18, 2019: Journal of Vascular Surgery
Sina Ghaffari, Laleh Dehghanpisheh, Fahimeh Tavakkoli, Hilda Mahmoudi
Introduction The proportion of women electing for cesarean delivery has increased in both developed and developing countries. Cesarean delivery on maternal request (CDMR) refers to a primary cesarean delivery performed because the mother requests this method of delivery in the absence of standard medical/obstetrical indications. Several studies compared anesthesia modalities in cesarean section regarding clinical outcomes such as maternal mortality, post-operative pain and bleeding, but only a few compared health-related quality of life (HRQoL) of women undergoing general anesthesia versus spinal anesthesia...
December 11, 2018: Curēus
Ni Bing, Hu Yonsheng, Tao Wei, Shu Wei, Zhu Hongwei
OBJECTIVE: To retrospectively evaluate long-term efficacy and safety of dorsal root entry zone (DREZ) lesion for treatment of neuropathic pain within the lower extremities and perineal region following thoracolumbar spine fracture. METHODS: 42 patients were treated with posterior laminectomy under general anesthesia. The DREZ regions of spinal cord segments were ablated under a microscope. Data regarding pain relief, pain variation over time, and postoperative complications were collected...
February 15, 2019: World Neurosurgery
Filipe Espinheira Gomes, Stephen Parry, Eric Ledbetter
OBJECTIVE: To describe and to establish normative data for the feline optic nerve and peripapillary retina using SD-OCT (Spectralis® HRA+OCT2). METHODS: Slit-lamp biomicroscopy and rebound tonometry were performed in seven male-intact (0.65 ± 0.02 years;4.34 ± 0.33 kg) and seven female-spayed (0.74 ± 0.03 years; 3.13 ± 0.28 kg) cats. All eyes were pharmacologically dilated with 1% tropicamide prior to indirect ophthalmoscopy examination. Animals were then placed under general anesthesia...
February 18, 2019: Veterinary Ophthalmology
Tomasz Poboży, Maciej Kielar, Jakub Miąskiewicz
The aim of this manuscript is to present a modification of the current arthroscopic implantation technique of a biodegradable subacromial spacer. This modified ultrasound-guided technique was intended to maximally reduce the invasiveness of the procedure. The ultrasound technique was used to measure the subacromial space for an optimal fit and to verify subacromial spacer placement in the sagittal and frontal planes. This finding is of particular importance for patients with contraindications to general or regional anesthesia...
January 2019: Videosurgery and Other Miniinvasive Techniques
László Rovó, Ádám Bach, László Szakács, Zsolt Bella, György Lázár
Microscope-assisted direct endoscopy of the airways and the upper gastrointestinal tract in general anesthesia is an essential diagnostic and therapeutic method of otorhinolaryngology. The quality of surgical exploration is a key for the good visibility and maneuverability of microsurgical tools. Beside the most commonly used Kleinsasser laryngoscope, the distending Weerda laryngoscope is a more favorable option for the exploration of the retrocricoid region. Narrow anatomical situation, examination and manipulation of lesions involving several sub-regions of the hypopharynx or larynx may be problematic in some cases even with this endoscope...
February 2019: Orvosi Hetilap
Estefanía Gómez-Pesquera, Rodrigo Poves-Alvarez, Beatriz Martinez-Rafael, Pilar Liu, Javier Alvarez, Mario Lorenzo-López, Inmaculada Fierro, Esther Gómez-Sánchez, María Heredia-Rodriguez, José Ignacio Gómez-Herreras, Eduardo Tamayo
OBJECTIVE: To evaluate if an intraoperative cerebral regional oxygen saturation (crSO2 ) decrease, less pronounced than 20% below baseline (the current threshold believed to be associated with cognitive dysfunction in adults), is associated with negative postoperative behavioral changes (NPOBC) in the pediatric population after noncardiac surgeries. STUDY DESIGN: A prospective observational study was conducted with 198 children aged 2-12 years old scheduled for noncardiac procedures under general anesthesia...
February 5, 2019: Journal of Pediatrics
Katheleen Miranda, André Sander Carneiro, Jennifer Tsi Gerber, Suyany Gabriely Weiss, Leandro Eduardo Klüppel, Rafaela Scariot
Introduction: The bifid mandibular condyle (BMC) is an unusual temporomandibular joint (TMJ) disorder with controversial etiology. The association of this entity with ankylosis is rare. Objective: The objective of the present study is to report a case of BMC with associated TMJ ankylosis in a patient with no history of trauma and/or infection. Case Report: A 17-year-old male patient sought care reporting pain on the right TMJ region and mastication difficulty due to a severe limitation of mouth opening...
2019: Case Reports in Surgery
Michael Stuart Green, Christopher Ryan Hoffman, Usama Iqbal, Oluwafunke Olabisi Ives, Benita Hurd
Background: Total hip arthroplasty is a common procedure being performed at an increasing rate in the United States. Recovering from this surgery to the extent that one can participate in criteria for discharge relies heavily on effective postoperative analgesia. Many regional anesthetic techniques are deployed in this realm. The recent utilization of quadratus lumborum (QL) blocks with success in other procedures warrants investigation in the hip arthroplasty population. Methods: Twenty patients received general anesthesia for elective total hip arthroplasty...
December 2018: Anesthesiology and Pain Medicine
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