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Nourouzpour N, Jen TTH, Bailey J, Jobin PG, Sutherland JM, Ho CM, Prabhakar C, Ke JXC. Association between anesthesia technique and death after hip fracture repair for patients with COVID-19. Can J Anaesth 2024; 71:367-377. [PMID: 38129357 DOI: 10.1007/s12630-023-02673-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/26/2023] [Accepted: 09/18/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE Patients with COVID-19 undergoing hip fracture surgeries have a 30-day mortality of up to 34%. We aimed to evaluate the association between anesthesia technique and 30-day mortality after hip fracture surgery in patients with COVID-19. METHODS After ethics approval, we performed a retrospective cohort analysis of the American College of Surgeons National Surgical Quality Improvement Program data set from January to December 2021. Inclusion criteria were age ≥ 19 yr, laboratory-confirmed SARS-CoV-2 infection within 14 days preoperatively, and hip fracture surgery under general anesthesia (GA) or spinal anesthesia (SA). Exclusion criteria were American Society of Anesthesiologists Physical Status V, ventilator dependence, international normalized ratio ≥ 1.5, partial thromboplastin time > 35 sec, and platelet count < 80 × 109 L-1. The primary outcome was all-cause 30-day mortality. The adjusted association between anesthetic technique and 30-day mortality was analyzed using multivariable logistic regression. RESULTS Of 23,045 patients undergoing hip fracture surgery, 331 patients met the study criteria. The median [interquartile range] age was 82 [74-88] yr, and 32.3% were male. The 30-day mortality rate was 10.0% (33/331) for the cohort (10.7%, 29/272 for GA vs 6.8%, 4/59 for SA; P = 0.51; standardized mean difference, 0.138). The use of SA, compared with GA, was not associated with decreased mortality (adjusted odds ratio, 0.61; 95% confidence interval, 0.21 to 1.8; E-value, 2.49). CONCLUSION Anesthesia technique was not associated with mortality in patients with COVID-19 undergoing hip fracture surgery. The findings were limited by a small sample size. STUDY REGISTRATION www. CLINICALTRIALS gov (NCT05133648); registered 24 November 2021.
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Affiliation(s)
- Nilufer Nourouzpour
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
| | - Tim T H Jen
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Department of Anesthesia, St. Paul's Hospital, Providence Health Care, Vancouver, BC, Canada
| | - Jonathan Bailey
- Department of Anesthesiology, Pain Management, and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Parker G Jobin
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Jason M Sutherland
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Chun-Man Ho
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Christopher Prabhakar
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Department of Anesthesia, St. Paul's Hospital, Providence Health Care, Vancouver, BC, Canada
| | - Janny X C Ke
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada.
- Department of Anesthesiology, Pain Management, and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.
- Department of Anesthesia, St. Paul's Hospital, Providence Health Care, Third Floor, Providence Building, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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Grau S, Denizci C, von Spreckelsen N, Goldbrunner R, Böttiger BW, Hinkelbein J. The choice of the hypnotic drug (volatile or propofol) for maintenance of anesthesia does not influence surgical conditions during cranioplasty. J Anaesthesiol Clin Pharmacol 2018; 34:172-176. [PMID: 30104823 PMCID: PMC6066883 DOI: 10.4103/joacp.joacp_373_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and Aims: In contrast to propofol, volatile agents are often considered harmful to maintain anesthesia due to increasing brain volume and potential deleterious effects. Patients for cranioplasty, including patients with large bone defects, could be susceptible for intraoperative complications but have not properly been investigated so far. The aim of the present study was to evaluate brain swelling, intraoperative conditions, surgical course, and postoperative complication rates of propofol-based vs. volatile-based anesthesia. Material and Methods: In this monocentric, retrospective, and observational study, we collected demographic, clinical, and outcome data of patients undergoing cranioplasty between December 2010 and September 2014. According to the hypnotic drug used, patients were assigned to either a propofol or a volatile group. The primary outcome parameter was brain swelling. For comparison of the groups, univariate analysis was performed using Chi-square and Mann–Whitney-U test. Results: One hundred and one patients were identified in the period. Twenty-three patients were excluded due to cerebrospinal fluid diversion. Baseline characteristics and preoperative conditions did not vary between the groups except a higher body mass index and positive end-expiratory pressure (PEEP) in the propofol group. The choice of anesthesia (volatile or intravenous) influence neither the intraoperative local conditions nor postoperative complication rate. No significant risk factor for impaired bone flap placement was identified. Conclusions: In a well-defined cohort, the choice of the anesthetic agent does not influence the degree of intraoperative brain swelling, bone flap fit, and postoperative course.
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Affiliation(s)
- S Grau
- Department for Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - C Denizci
- Department for Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - N von Spreckelsen
- Department for Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - R Goldbrunner
- Department for Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - B W Böttiger
- Department for Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, Cologne, Germany
| | - J Hinkelbein
- Department for Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, Cologne, Germany
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Besir A, Cekic B, Kutanis D, Akdogan A, Livaoglu M. Comparison of surgical conditions in 2 different anesthesia techniques of esmolol-induced controlled hypotension in breast reduction surgery. Medicine (Baltimore) 2017; 96:e6254. [PMID: 28272228 PMCID: PMC5348176 DOI: 10.1097/md.0000000000006254] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Breast reduction surgery is a common cosmetic surgery with a high incidence of blood loss and transfusion. In this surgery, the reduction of blood loss related to surgical manipulation and the volume of resected tissue is a target. In the present study, we compared the effects of esmolol-induced controlled hypotension on surgical visibility, surgical bleeding, and the duration of surgery in patients anesthetized with propofol/remifentanil (PR) or sevoflurane/remifentanil (SR). METHODS Patients in the American Society of Anesthesiologists I/II risk group undergoing breast reduction surgery were prospectively randomized into PR (n = 25) and SR (n = 25) groups. Controlled hypotension was induced with esmolol in both groups. During the intraoperative period, the heart rate (HR), mean arterial pressure (MAP), operation duration, volume of intraoperative blood loss, volume of blood received through postoperative drains, volume of resected tissues, and surgical area bleeding score were recorded. RESULTS The duration of operation in the incisional period was shorter in group PR compared to group SR (P = 0.04). The change in HR was lower in incision and hemostasis periods in the group PR compared to the group SR (P < 0.001). Total intraoperative intraoperative bleeding volume and volume of blood received through drains on postoperative postoperative day 1, day 2, and in total were found to be significantly lower in group PR compared to group SR. Surgical visibility scoring was more effective in group PR compared to SR. CONCLUSION In the breast reduction surgery performed under esmolol-induced controlled hypotension, the effect of propofol + remifentanil anesthesia on the duration of incisional surgery, surgical visibility, and volume of surgical blood loss was more reliable and effective compared to that of sevoflurane + remifentanil, which seems to be an advantage.
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Affiliation(s)
- Ahmet Besir
- Department of Anesthesiology and Critical Care, Faculty of Medicine
| | - Bahanur Cekic
- Department of Anesthesiology and Critical Care, Faculty of Medicine
| | - Dilek Kutanis
- Department of Anesthesiology and Critical Care, Faculty of Medicine
| | - Ali Akdogan
- Department of Anesthesiology and Critical Care, Faculty of Medicine
| | - Murat Livaoglu
- Department of Plastic and Reconstructive Surgery, Karadeniz Technical University, Trabzon, Turkey
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Valeanu L, Depoix JP, Enguerand D, Tini L, Dilly MP, Raffoul R, Bourgeois-Moine A, Rajguru M, Longrois D, Iung B, Montravers P. Pregnancy in a Patient With Severe Aortic Stenosis Requiring Unusual Management. J Cardiothorac Vasc Anesth 2015; 29:1632-5. [PMID: 25649706 DOI: 10.1053/j.jvca.2014.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Liana Valeanu
- Department of Anesthesiology, CHU Bichat-Claude-Bernard, APHP, Université Denis Diderot Sorbonne Cité, Paris, France
| | - Jean-Pol Depoix
- Department of Anesthesiology, CHU Bichat-Claude-Bernard, APHP, Université Denis Diderot Sorbonne Cité, Paris, France
| | - Daniel Enguerand
- Department of Anesthesiology, CHU Bichat-Claude-Bernard, APHP, Université Denis Diderot Sorbonne Cité, Paris, France
| | - Laura Tini
- Department of Anesthesiology, CHU Bichat-Claude-Bernard, APHP, Université Denis Diderot Sorbonne Cité, Paris, France
| | - Marie-Pierre Dilly
- Department of Anesthesiology, CHU Bichat-Claude-Bernard, APHP, Université Denis Diderot Sorbonne Cité, Paris, France
| | - Richard Raffoul
- Department of Cardiac Surgery, CHU Bichat-Claude-Bernard, APHP, Université Denis Diderot Sorbonne Cité, Paris, France
| | - Agnes Bourgeois-Moine
- Department of Gynecology and Obstetrics, CHU Bichat-Claude-Bernard, APHP, Université Denis Diderot Sorbonne Cité, Paris, France
| | - Mandovi Rajguru
- Department of Gynecology and Obstetrics, CHU Bichat-Claude-Bernard, APHP, Université Denis Diderot Sorbonne Cité, Paris, France
| | - Daniel Longrois
- Department of Anesthesiology, CHU Bichat-Claude-Bernard, APHP, Université Denis Diderot Sorbonne Cité, Paris, France
| | - Bernard Iung
- Department of Cardiology, CHU Bichat-Claude-Bernard, APHP, Université Denis Diderot Sorbonne Cité, Paris, France
| | - Philippe Montravers
- Department of Anesthesiology, CHU Bichat-Claude-Bernard, APHP, Université Denis Diderot Sorbonne Cité, Paris, France.
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Abstract
Nonintubated thoracic surgery has been used in procedures including pleura, lungs and mediastinum. Appropriate anesthesia techniques with or without sedation allow thoracic surgery patients to avoid the potential risks of intubated general anesthesia, particularly for the high-risk patients. However, nonintubated anesthesia for thoracic surgery has some benefits as well as problems. In this review, the background, indication, perioperative anesthetic consideration and management, and advantages and disadvantages are discussed and summarized.
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Affiliation(s)
- Bei Wang
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Shengjin Ge
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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