Pub Date : 2025-01-29DOI: 10.1213/ane.0000000000007376
Kesavan Sadacharam,Tessa Mandler,Steven J Staffa,Sophie R Pestieau,Clinton Fuller,Matthew Ellington,J William Sparks,Allison M Fernandez,
BACKGROUNDOptimal perioperative pain management is unknown for adolescent patients undergoing anterior cruciate ligament reconstruction (ACLR). The study aimed to determine the association of nerve blocks with short- and long-term pain outcomes and factors influencing self-reported neurological symptoms.METHODSWe performed a multisite, prospective observational study of adolescent patients undergoing ACLR. Perioperative data included demographics, block details, anesthetic, and surgical techniques. Self-reported surveys documented pain scores, medication use, and neurological symptoms at various time points after the surgery (postoperative day [POD] 1, POD 3, week 6, and month 6). Associations between different groups of peripheral nerve blocks (PNBs) and the absence of a block were analyzed for their effects on acute postoperative pain outcomes. In addition, factors influencing self-reported neurological outcomes were determined using both univariate and multivariate regression.RESULTSData from 519 subjects (aged 15 years, 55.7% female) showed that 23.9% of patients with anterior plus posterior nerve blocks (A+P PNB) reported severe postanesthesia care unit (PACU) pain scores, compared to 40% with no PNB and 38.3% with anterior PNB (A-PNB). Patients receiving A-PNB or A+P PNB had significantly lower intraoperative morphine equivalents (MEs) (0.49 mg/kg and 0.46 mg/kg, respectively) vs no block patients (0.61 mg/kg). Total PACU MEs were lower for any patient who received a PNB. Multivariable logistic regression analysis showed that patients who received A+P PNB or a hamstring autograft had lower POD 1 severe pain scores (odds ratio [OR] = 0.35; 95% confidence interval [CI], 0.15-0.84 and OR = 0.35; 95% CI, 0.15-0.83, respectively). Patients with PNBs with local anesthesia concentration (LAC) greater than 0.25% reported higher POD1 pain scores (OR = 2.14; 95% CI, 1.1-4.16) compared to those with lower LAC. Patients with PNB catheters had reduced POD 1 pain. Multivariable logistic regression analysis for numbness at week 6 revealed a greater odds of numbness for A-PNB with LAC >0.25% (OR = 5.13; 95% CI, 1.27-20.8). At month 6, patients receiving PNB with perineural steroid adjuvant were more likely to report numbness (dexamethasone OR = 5.93; 95% CI, 1.61-21.9, methylprednisolone OR = 11.3; 95% CI, 2.16-58.6).CONCLUSIONSPatients who received A+P PNB had lower postoperative pain scores than those who received no block. Additional studies are necessary to discern how PNB type, graft harvest site, LAC, and adjuvants influence pain control, persistent numbness, and weakness.
{"title":"Regional Anesthesia and Pain Outcomes After Anterior Cruciate Ligament Reconstruction Surgery in Pediatric Patients: Society of Pediatric Anesthesia Improvement Network.","authors":"Kesavan Sadacharam,Tessa Mandler,Steven J Staffa,Sophie R Pestieau,Clinton Fuller,Matthew Ellington,J William Sparks,Allison M Fernandez,","doi":"10.1213/ane.0000000000007376","DOIUrl":"https://doi.org/10.1213/ane.0000000000007376","url":null,"abstract":"BACKGROUNDOptimal perioperative pain management is unknown for adolescent patients undergoing anterior cruciate ligament reconstruction (ACLR). The study aimed to determine the association of nerve blocks with short- and long-term pain outcomes and factors influencing self-reported neurological symptoms.METHODSWe performed a multisite, prospective observational study of adolescent patients undergoing ACLR. Perioperative data included demographics, block details, anesthetic, and surgical techniques. Self-reported surveys documented pain scores, medication use, and neurological symptoms at various time points after the surgery (postoperative day [POD] 1, POD 3, week 6, and month 6). Associations between different groups of peripheral nerve blocks (PNBs) and the absence of a block were analyzed for their effects on acute postoperative pain outcomes. In addition, factors influencing self-reported neurological outcomes were determined using both univariate and multivariate regression.RESULTSData from 519 subjects (aged 15 years, 55.7% female) showed that 23.9% of patients with anterior plus posterior nerve blocks (A+P PNB) reported severe postanesthesia care unit (PACU) pain scores, compared to 40% with no PNB and 38.3% with anterior PNB (A-PNB). Patients receiving A-PNB or A+P PNB had significantly lower intraoperative morphine equivalents (MEs) (0.49 mg/kg and 0.46 mg/kg, respectively) vs no block patients (0.61 mg/kg). Total PACU MEs were lower for any patient who received a PNB. Multivariable logistic regression analysis showed that patients who received A+P PNB or a hamstring autograft had lower POD 1 severe pain scores (odds ratio [OR] = 0.35; 95% confidence interval [CI], 0.15-0.84 and OR = 0.35; 95% CI, 0.15-0.83, respectively). Patients with PNBs with local anesthesia concentration (LAC) greater than 0.25% reported higher POD1 pain scores (OR = 2.14; 95% CI, 1.1-4.16) compared to those with lower LAC. Patients with PNB catheters had reduced POD 1 pain. Multivariable logistic regression analysis for numbness at week 6 revealed a greater odds of numbness for A-PNB with LAC >0.25% (OR = 5.13; 95% CI, 1.27-20.8). At month 6, patients receiving PNB with perineural steroid adjuvant were more likely to report numbness (dexamethasone OR = 5.93; 95% CI, 1.61-21.9, methylprednisolone OR = 11.3; 95% CI, 2.16-58.6).CONCLUSIONSPatients who received A+P PNB had lower postoperative pain scores than those who received no block. Additional studies are necessary to discern how PNB type, graft harvest site, LAC, and adjuvants influence pain control, persistent numbness, and weakness.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-28DOI: 10.1213/ane.0000000000007342
Rafael Ortega
{"title":"Whispers in the Operating Room: Anesthesia and Oriana Fallaci.","authors":"Rafael Ortega","doi":"10.1213/ane.0000000000007342","DOIUrl":"https://doi.org/10.1213/ane.0000000000007342","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-28DOI: 10.1213/ane.0000000000007364
Shannon L Farmer,Carleen Ellis,Jeffrey M Hamdorf,Darren Falconer,Kylie Symons,Claire McNally,Angie Monk,Michael F Leahy,Nolan McDonnell,Axel Hofmann
{"title":"Patient Blood Management Program Implementation and Assessment Tool: Measuring Compliance With Guidelines and World Health Organization 2021 Policy Brief.","authors":"Shannon L Farmer,Carleen Ellis,Jeffrey M Hamdorf,Darren Falconer,Kylie Symons,Claire McNally,Angie Monk,Michael F Leahy,Nolan McDonnell,Axel Hofmann","doi":"10.1213/ane.0000000000007364","DOIUrl":"https://doi.org/10.1213/ane.0000000000007364","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"84 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-28DOI: 10.1213/ane.0000000000007417
Sophie A Young,Shania Liu,Asad E Patanwala,Justine M Naylor,Jennifer Stevens,Jonathan Penm
Tapering opioids is an effective strategy to reduce the risks associated with long-term opioid therapy. However, patients' experience with tapering can influence the success of this treatment. Understanding patients' experiences with opioid tapering will allow for patient-centered approaches to be adopted to tailor interventions to achieve safe and successful taper outcomes. This paper aims to synthesize qualitative data capturing patients' experiences with opioid tapering for noncancer pain. Qualitative studies in English that explored patients' experiences with opioid tapering in noncancer pain were included. MEDLINE, Embase, Scopus, and PsycINFO were searched from inception to March 2023. Two authors independently selected the studies, extracted data, and assessed the quality of included studies using the Critical Appraisal Skills Programme. A meta-synthesis allowed for overarching themes to be identified to form a new interpretation of the data in the context of past literature. From 5714 articles identified, 10 studies were included that met the inclusion criteria after title/abstract screening and full-text review. These studies involved 218 patients with experience tapering opioids. Three key themes guiding the new meta-synthesis were identified: (1) patient-provider interactions, (2) individualized care, and (3) tactics to manage the opioid tapering process. This review demonstrated the role that patient-provider interactions, tailored care, and effective tapering strategies play in facilitating a favorable patient experience during the opioid tapering process. Future research should incorporate the themes identified in this review to optimize the patient's taper experience.
{"title":"Patients' Experiences With Opioid Tapering in Noncancer Pain: A Systematic Review and Meta-synthesis.","authors":"Sophie A Young,Shania Liu,Asad E Patanwala,Justine M Naylor,Jennifer Stevens,Jonathan Penm","doi":"10.1213/ane.0000000000007417","DOIUrl":"https://doi.org/10.1213/ane.0000000000007417","url":null,"abstract":"Tapering opioids is an effective strategy to reduce the risks associated with long-term opioid therapy. However, patients' experience with tapering can influence the success of this treatment. Understanding patients' experiences with opioid tapering will allow for patient-centered approaches to be adopted to tailor interventions to achieve safe and successful taper outcomes. This paper aims to synthesize qualitative data capturing patients' experiences with opioid tapering for noncancer pain. Qualitative studies in English that explored patients' experiences with opioid tapering in noncancer pain were included. MEDLINE, Embase, Scopus, and PsycINFO were searched from inception to March 2023. Two authors independently selected the studies, extracted data, and assessed the quality of included studies using the Critical Appraisal Skills Programme. A meta-synthesis allowed for overarching themes to be identified to form a new interpretation of the data in the context of past literature. From 5714 articles identified, 10 studies were included that met the inclusion criteria after title/abstract screening and full-text review. These studies involved 218 patients with experience tapering opioids. Three key themes guiding the new meta-synthesis were identified: (1) patient-provider interactions, (2) individualized care, and (3) tactics to manage the opioid tapering process. This review demonstrated the role that patient-provider interactions, tailored care, and effective tapering strategies play in facilitating a favorable patient experience during the opioid tapering process. Future research should incorporate the themes identified in this review to optimize the patient's taper experience.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-28DOI: 10.1213/ane.0000000000007336
Joseph F Cotten,Lyle Isaacs
{"title":"Pillar[6]MaxQ and Sugammadex Enhance Recovery From Rocuronium- and Vecuronium-Mediated Neuromuscular Blockade With Similar Effects in Isoflurane-Anesthetized Rats.","authors":"Joseph F Cotten,Lyle Isaacs","doi":"10.1213/ane.0000000000007336","DOIUrl":"https://doi.org/10.1213/ane.0000000000007336","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-20DOI: 10.1213/ane.0000000000007258
Fu S Xue,Dan F Wang,Xiao C Zheng
{"title":"Epidural Morphine for Vaginal Delivery: Determining Benefit.","authors":"Fu S Xue,Dan F Wang,Xiao C Zheng","doi":"10.1213/ane.0000000000007258","DOIUrl":"https://doi.org/10.1213/ane.0000000000007258","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-20DOI: 10.1213/ane.0000000000007361
Bryant W Tran,Ezekiel D Egan,Duncan J McLean,Ricardo A Serrano
{"title":"Machine Perfusion for Liver Transplant: What Are the Challenges?","authors":"Bryant W Tran,Ezekiel D Egan,Duncan J McLean,Ricardo A Serrano","doi":"10.1213/ane.0000000000007361","DOIUrl":"https://doi.org/10.1213/ane.0000000000007361","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-20DOI: 10.1213/ane.0000000000007368
José C Diz,Pedro Luna-Rojas,Pablo Díaz-Vidal,Uxía Fernández-Vázquez,Cristina Gil-Casado,Eva Diz-Ferreira
BACKGROUNDSome studies suggest that balanced solutions may improve outcomes in critical care patients. However, in patients with traumatic brain injury (TBI) existing data indicate that normal saline may be preferred. We hypothesized that mortality in critically ill patients with and without TBI would differ with the use of balanced salt solutions versus normal saline.METHODSWe conducted a systematic review and meta-analysis to investigate the impact of balanced crystalloids versus normal saline on 90-day mortality in adult critical care patients with and without TBI. Secondary outcomes included length of hospital stay, renal complications, need for vasopressors or mechanical ventilation, and mortality in critically ill patients with sepsis. We followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) statement and estimated the odds ratio (OR) and 95% confidence interval (CI) with a random-effects model.RESULTSWe included 15 clinical trials involving 35,207 patients. The OR of mortality with balanced solutions versus saline in patients without TBI was 0.93 (95% CI, 0.87-0.98; P = .01; I2 = 0%), while the OR for mortality in patients with TBI was 1.31 (95% CI, 1.03-1.65; P = .03; I2 = 0%). We found no differences in secondary outcomes due to fluid choice although data were unavailable to calculate pooled estimates for some of the secondary outcomes for TBI patients. In patients with sepsis, the OR of mortality with balanced solutions was 0.92 (95% CI, 0.83-1.02; I2 = 0%).CONCLUSIONSIn comparison to normal saline, balanced solutions were associated with a reduction in mortality in critical care patients without TBI. However, balanced solutions were associated with an increase in mortality in patients with TBI. These findings suggest that the effect of fluid choice on intensive care unit (ICU) outcomes may depend partially on the type of critical illness and in particular in patients with TBI.
{"title":"Effect of Treatment With Balanced Crystalloids Versus Normal Saline on the Mortality of Critically Ill Patients With and Without Traumatic Brain Injury: A Systematic Review and Meta-Analysis.","authors":"José C Diz,Pedro Luna-Rojas,Pablo Díaz-Vidal,Uxía Fernández-Vázquez,Cristina Gil-Casado,Eva Diz-Ferreira","doi":"10.1213/ane.0000000000007368","DOIUrl":"https://doi.org/10.1213/ane.0000000000007368","url":null,"abstract":"BACKGROUNDSome studies suggest that balanced solutions may improve outcomes in critical care patients. However, in patients with traumatic brain injury (TBI) existing data indicate that normal saline may be preferred. We hypothesized that mortality in critically ill patients with and without TBI would differ with the use of balanced salt solutions versus normal saline.METHODSWe conducted a systematic review and meta-analysis to investigate the impact of balanced crystalloids versus normal saline on 90-day mortality in adult critical care patients with and without TBI. Secondary outcomes included length of hospital stay, renal complications, need for vasopressors or mechanical ventilation, and mortality in critically ill patients with sepsis. We followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) statement and estimated the odds ratio (OR) and 95% confidence interval (CI) with a random-effects model.RESULTSWe included 15 clinical trials involving 35,207 patients. The OR of mortality with balanced solutions versus saline in patients without TBI was 0.93 (95% CI, 0.87-0.98; P = .01; I2 = 0%), while the OR for mortality in patients with TBI was 1.31 (95% CI, 1.03-1.65; P = .03; I2 = 0%). We found no differences in secondary outcomes due to fluid choice although data were unavailable to calculate pooled estimates for some of the secondary outcomes for TBI patients. In patients with sepsis, the OR of mortality with balanced solutions was 0.92 (95% CI, 0.83-1.02; I2 = 0%).CONCLUSIONSIn comparison to normal saline, balanced solutions were associated with a reduction in mortality in critical care patients without TBI. However, balanced solutions were associated with an increase in mortality in patients with TBI. These findings suggest that the effect of fluid choice on intensive care unit (ICU) outcomes may depend partially on the type of critical illness and in particular in patients with TBI.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"13 15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-20DOI: 10.1213/ane.0000000000007357
Eric Plitman,Ayman Mohammed,Wesley Rajaleelan,Rodrigo Nakatani,Marina Englesakis,Jai Shankar,Lashmi Venkatraghavan,Tumul Chowdhury
BACKGROUNDTotal intravenous anesthesia (TIVA)-based and volatile-based general anesthesia have different effects on cerebral hemodynamics. The current work compares these 2 regimens in acute ischemic stroke patients undergoing endovascular therapy.METHODSWe conducted a systematic literature search across MEDLINE, Embase, Cochrane, CINAHL, Web of Science, and Scopus. We identified English language studies including adult acute ischemic stroke patients managed with endovascular therapy under general anesthesia delineable into TIVA only and/or volatile only, and obtained categorical data for favorable functional outcomes using the modified Rankin scale (mRS ≤2), at 90 days after endovascular therapy. Odds ratios (OR) and standardized mean differences were calculated to inform a network meta-analysis approach, which permitted the inclusion of studies comparing a form of general anesthesia (ie, TIVA only or volatile only) to conscious sedation.RESULTSThe search rendered 6235 articles, of which 15 met inclusion criteria. Three studies directly investigated TIVA versus volatile, whereas 12 studies compared general anesthesia to conscious sedation. The total number of subjects was 3015 (conscious sedation: n = 1067; general anesthesia: n = 1948 [TIVA: n = 1212, volatile: n = 736]). No significant differences were identified between TIVA and volatile groups in 90-day neurological outcome (OR = 1.25, 95% confidence interval [CI], 0.81-1.91; P = .31), 90-day mortality (OR = 0.72, 95% CI, 0.42-1.24; P = .24), successful recanalization (OR = 1.33, 95% CI, 0.70-2.52; P = .39), or recanalization time (standardized mean difference = 0.03, 95% CI, -0.35 to 0.41; P = .88). Additionally, no significant differences were identified between the conscious sedation group and the TIVA group in 90-day neurological outcome (OR = 1.14, 95% CI, 0.84-1.53; P = .40), 90-day mortality (OR = 0.87, 95% CI, 0.62-1.23; P = .43), successful recanalization (OR = 0.76, 95% CI, 0.52-1.10; P = .15), or recanalization time (standardized mean difference = -0.18, 95% CI, -0.47 to 0.11; P = .23), and between the conscious sedation group and the volatile group in 90-day neurological outcome (OR = 1.42, 95% CI, 0.92-2.17; P = .11), 90-day mortality (OR = 0.63, 95% CI, 0.36-1.12; P = .11), successful recanalization (OR = 1.01, 95% CI, 0.52-1.94; P = .98), or recanalization time (standardized mean difference = -0.15, 95% CI, -0.52 to 0.23; P = .44).CONCLUSIONSThis network meta-analysis showed that the perioperative use of either general anesthesia-based regimen, or sedation, did not significantly impact various endovascular therapy-related outcomes. However, the current work was underpowered to detect differences in anesthetic agents, clinico-demographic characteristics, or procedural factors.
{"title":"Comparing General Anesthesia-Based Regimens for Endovascular Treatment of Acute Ischemic Stroke: A Systematic Review and Network Meta-Analysis.","authors":"Eric Plitman,Ayman Mohammed,Wesley Rajaleelan,Rodrigo Nakatani,Marina Englesakis,Jai Shankar,Lashmi Venkatraghavan,Tumul Chowdhury","doi":"10.1213/ane.0000000000007357","DOIUrl":"https://doi.org/10.1213/ane.0000000000007357","url":null,"abstract":"BACKGROUNDTotal intravenous anesthesia (TIVA)-based and volatile-based general anesthesia have different effects on cerebral hemodynamics. The current work compares these 2 regimens in acute ischemic stroke patients undergoing endovascular therapy.METHODSWe conducted a systematic literature search across MEDLINE, Embase, Cochrane, CINAHL, Web of Science, and Scopus. We identified English language studies including adult acute ischemic stroke patients managed with endovascular therapy under general anesthesia delineable into TIVA only and/or volatile only, and obtained categorical data for favorable functional outcomes using the modified Rankin scale (mRS ≤2), at 90 days after endovascular therapy. Odds ratios (OR) and standardized mean differences were calculated to inform a network meta-analysis approach, which permitted the inclusion of studies comparing a form of general anesthesia (ie, TIVA only or volatile only) to conscious sedation.RESULTSThe search rendered 6235 articles, of which 15 met inclusion criteria. Three studies directly investigated TIVA versus volatile, whereas 12 studies compared general anesthesia to conscious sedation. The total number of subjects was 3015 (conscious sedation: n = 1067; general anesthesia: n = 1948 [TIVA: n = 1212, volatile: n = 736]). No significant differences were identified between TIVA and volatile groups in 90-day neurological outcome (OR = 1.25, 95% confidence interval [CI], 0.81-1.91; P = .31), 90-day mortality (OR = 0.72, 95% CI, 0.42-1.24; P = .24), successful recanalization (OR = 1.33, 95% CI, 0.70-2.52; P = .39), or recanalization time (standardized mean difference = 0.03, 95% CI, -0.35 to 0.41; P = .88). Additionally, no significant differences were identified between the conscious sedation group and the TIVA group in 90-day neurological outcome (OR = 1.14, 95% CI, 0.84-1.53; P = .40), 90-day mortality (OR = 0.87, 95% CI, 0.62-1.23; P = .43), successful recanalization (OR = 0.76, 95% CI, 0.52-1.10; P = .15), or recanalization time (standardized mean difference = -0.18, 95% CI, -0.47 to 0.11; P = .23), and between the conscious sedation group and the volatile group in 90-day neurological outcome (OR = 1.42, 95% CI, 0.92-2.17; P = .11), 90-day mortality (OR = 0.63, 95% CI, 0.36-1.12; P = .11), successful recanalization (OR = 1.01, 95% CI, 0.52-1.94; P = .98), or recanalization time (standardized mean difference = -0.15, 95% CI, -0.52 to 0.23; P = .44).CONCLUSIONSThis network meta-analysis showed that the perioperative use of either general anesthesia-based regimen, or sedation, did not significantly impact various endovascular therapy-related outcomes. However, the current work was underpowered to detect differences in anesthetic agents, clinico-demographic characteristics, or procedural factors.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"38 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-16DOI: 10.1213/ane.0000000000006980
Zeev N. Kain, Thomas R. Vetter
An abstract is unavailable.
无法获得摘要。
{"title":"The Involvement of Anesthesiologists in Alternative Payment Models, Value-Based Care, and Care-Redesign: Myth or Reality","authors":"Zeev N. Kain, Thomas R. Vetter","doi":"10.1213/ane.0000000000006980","DOIUrl":"https://doi.org/10.1213/ane.0000000000006980","url":null,"abstract":"An abstract is unavailable.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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