Abstract:
:Neuraxial anesthesia may improve perioperative outcomes when compared to general anesthesia; however, this is controversial. We performed a systematic review and meta-analysis using randomized controlled trials and population-based observational studies identified in MEDLINE, PubMed, and EMBASE from 2010 to May 31, 2016. Studies were included for adult patients undergoing major surgery of the trunk and lower extremity that reported: 30-day mortality (primary outcome), cardiopulmonary morbidity, surgical site infection, thromboembolic events, blood transfusion, and resource use. Perioperative outcomes were compared with general anesthesia for the following subgroups: combined neuraxial-general anesthesia and neuraxial anesthesia alone. Odds ratios (ORs) and 99% confidence intervals (CIs) were calculated to identify the impact of anesthetic technique on outcomes. Twenty-seven observational studies and 11 randomized control trials were identified. This analysis comprises 1,082,965 records from observational studies or databases and 1134 patients from randomized controlled trials. There was no difference in 30-day mortality identified when combined neuraxial-general anesthesia was compared with general anesthesia (OR 0.88; 99% CI, 0.77-1.01), or when neuraxial anesthesia was compared with general anesthesia (OR 0.98; 99% CI, 0.92-1.04). When combined neuraxial-general anesthesia was compared with general anesthesia, combined neuraxial-general anesthesia was associated with a reduced odds of pulmonary complication (OR 0.84; 99% CI, 0.79-0.88), surgical site infection (OR 0.93; 99% CI, 0.88-0.98), blood transfusion (OR 0.90; 99% CI, 0.87-0.93), thromboembolic events (OR 0.84; 99% CI, 0.73-0.98), length of stay (mean difference -0.16 days; 99% CI, -0.17 to -0.15), and intensive care unit admission (OR 0.77; 99% CI, 0.73-0.81). For the combined neuraxial-general anesthesia subgroup, there were increased odds of myocardial infarction (OR 1.18; 99% CI, 1.01-1.37). There was no difference identified in the odds of pneumonia (OR 0.94; 99% CI, 0.87-1.02) or cardiac complications (OR 1.04; 99% CI, 1.00-1.09) for the combined neuraxial-general anesthesia subgroup. When neuraxial anesthesia was compared to general anesthesia, there was a decreased odds of any pulmonary complication (OR 0.38; 99% CI, 0.36-0.40), surgical site infection (OR 0.76; 99% CI, 0.71-0.82), blood transfusion (OR 0.85; 99% CI, 0.82-0.88), thromboembolic events (OR 0.79; 99% CI, 0.68-0.91), length of stay (mean difference -0.29 days; 99% CI, -0.29 to -0.28), and intensive care unit admission (OR 0.50; 99% CI, 0.48-0.53). There was no difference in the odds of cardiac complications (OR 0.99; 99% CI, 0.94-1.03), myocardial infarction (OR 0.91; 99% CI, 0.81-1.02), or pneumonia (OR 0.92; 99% CI, 0.84-1.01). Randomized control trials revealed no difference in requirement for blood transfusion (RR 1.05; 99% CI, 0.65-1.71) and a decreased length of stay (mean difference -0.15 days; 99% CI, -0.27 to -0.04). Neuraxial anesthesia when combined with general anesthesia or when used alone was not associated with decreased 30-day mortality. Neuraxial anesthesia may improve pulmonary outcomes and reduce resource use when compared with general anesthesia. However, because observational studies were included in this analysis, there is a risk of residual confounding and therefore these results should be interpreted with caution.
journal_name
Anesth Analgjournal_title
Anesthesia and analgesiaauthors
Smith LM,Cozowicz C,Uda Y,Memtsoudis SG,Barrington MJdoi
10.1213/ANE.0000000000002069subject
Has Abstractpub_date
2017-12-01 00:00:00pages
1931-1945issue
6eissn
0003-2999issn
1526-7598journal_volume
125pub_type
杂志文章,meta分析,评审abstract::This study evaluated interspecies sensitivity and ability to resuscitate pentobarbital anesthetized sheep and dogs after cardiovascular toxic doses of bupivacaine. Every minute, 3 mg/kg of bupivacaine was injected into the right atrium over the course of 10 sec until cardiovascular collapse occurred. While the bupivac...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1986-10-01 00:00:00
abstract::Calciphylaxis is a small-vessel disease associated with renal failure. Here, we report the management of a 43-yr-old man with calciphylaxis who received left lower leg amputation with prostaglandin E(1) (PGE(1)) under monitoring by laser Doppler blood flowmetry in the left second and third fingers. Anesthesia was indu...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ANE.0000121960.22554.D7
更新日期:2004-08-01 00:00:00
abstract::We report a rare complication of spinal anesthesia-divergence paresis-which is characterized by an acquired horizontal diplopia at distance without evidence for abducens palsy. A 64-yr-old man underwent prostatectomy under spinal anesthesia with 2.5 mL of dibucaine hydrochloride 0.3% injected through a 20-gauge cuttin...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000217117.77826.dd
更新日期:2006-06-01 00:00:00
abstract:UNLABELLED:We studied 160 ASA I or II patients undergoing elective otolaryngologic surgery in order to compare the anxiolytic effects of a novel 5-hydroxytryptamine-1A agonist, tandospirone, with diazepam. To monitor preoperative anxiety, the following variables were used: systolic and diastolic arterial pressure, hear...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-200111000-00034
更新日期:2001-11-01 00:00:00
abstract:UNLABELLED:N-methyl-D-aspartate receptor antagonism probably accounts for most of ketamine's anesthetic effects; its analgesic properties are mediated partly via N-methyl-D-aspartate and partly via opioid receptors. We assessed the involvement of the mu-opioid receptor in S(+) ketamine-induced respiratory depression an...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200112000-00031
更新日期:2001-12-01 00:00:00
abstract:UNLABELLED:Cardiopulmonary bypass results in increased plasma activity of phospholipase A(2) (PLA(2)) that appears to be caused by the administration of heparin. High PLA(2) activity may be responsible for increased production of eicosanoids and, thus, may be implicated in various pathophysiologic events associated wit...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1097/00000539-200009000-00005
更新日期:2000-09-01 00:00:00
abstract::We present a case of extreme hemodilution in which appropriately crossmatched blood was not available. A 53-year-old man was admitted to our hospital because of hemorrhagic shock due to multiple stab wounds. His blood type was B, Rh negative, and his intravascular fluid volume was maintained with balanced salt solutio...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3181e668b8
更新日期:2010-11-01 00:00:00
abstract::In the past, it was common practice to use a high tidal volume (VT) during intraoperative ventilation, because this reduced the need for high oxygen fractions to compensate for the ventilation-perfusion mismatches due to atelectasis in a time when it was uncommon to use positive end-expiratory pressure (PEEP) in the o...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/ANE.0000000000005187
更新日期:2020-12-01 00:00:00
abstract:BACKGROUND:Midazolam has hypnotic and sedative activities, which may be mediated by different neuronal structures. We investigated the time course effect of a hypnotic dose of midazolam on conscious motor behavior and on patterns of brain metabolism. METHODS:Loss of nociceptive reflexes and impairment of spontaneous l...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e31816a64a8
更新日期:2008-05-01 00:00:00
abstract:UNLABELLED:Propofol and alfentanil are both rapid and short-acting drugs that can be used for sedation and analgesia during monitored anesthesia care (MAC). This study was designed to determine the optimal infusion rates of propofol and alfentanil when administered during local anesthesia. In this randomized, double-bl...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-199709000-00015
更新日期:1997-09-01 00:00:00
abstract::The sensitivity, specificity, and accuracy of the cobalt blue and ninhydrin sweat tests were compared with the sympathogalvanic response (SGR) in assessment of complete sympathetic blockade. Patients were randomly assigned to receive epidural administration of either preservative-free physiologic saline solution and 8...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1985-04-01 00:00:00
abstract:BACKGROUND:Helium produces preconditioning against myocardial infarction by activating prosurvival signaling, but whether nitric oxide (NO) generated by endothelial NO synthase plays a role in this phenomenon is unknown. We tested the hypothesis that NO mediates helium-induced cardioprotection in vivo. METHODS:Rabbits...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e3181815995
更新日期:2008-09-01 00:00:00
abstract::To determine whether nalbuphine might replace fentanyl as the principal opioid for anesthesia during coronary artery bypass surgery, 20 patients undergoing myocardial revascularization were anesthetized with flunitrazepam and with a continuous infusion of either nalbuphine (an opioid agonist-antagonist) or fentanyl (a...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1213/00000539-199111000-00002
更新日期:1991-11-01 00:00:00
abstract::We measured arterial plasma concentrations of lidocaine by enzyme immunoassay when 10 ml of 2% lidocaine without epinephrine was injected into the cervical, thoracic, or lumbar epidural spaces in 30 patients. There was no difference in the time courses of plasma levels of lidocaine. Peak concentrations were achieved 1...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1983-06-01 00:00:00
abstract::Preoperative use of angiotensin-converting enzyme (ACE) inhibitors is common and has been associated with hypotension at separation from cardiopulmonary bypass (CPB). This study prospectively examined the influence of chronic preoperative ACE inhibitor use and other perioperative factors on the incidence of vasoconstr...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199503000-00007
更新日期:1995-03-01 00:00:00
abstract:BACKGROUND:Visualization with ultrasound during regional anesthesia may reduce the risk of intraneural injection and subsequent neurological symptoms but has not been formally assessed. Thus, we performed this randomized clinical trial comparing ultrasound versus nerve stimulator-guided interscalene blocks for shoulder...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ane.0b013e3181a3272c
更新日期:2009-07-01 00:00:00
abstract:IMPLICATIONS:We describe a technique of one-lung high-frequency jet ventilation surgery with continuous monitoring of airway pressures that achieves satisfactory operating conditions with less complications than other similar approaches. ...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1097/00000539-200301000-00059
更新日期:2003-01-01 00:00:00
abstract::Repeated conventional tracheal intubation attempts may contribute to patient morbidity. Critically-ill patients (n = 2833) suffering from cardiovascular, pulmonary, metabolic, neurologic, or trauma-related deterioration were entered into an emergency intubation quality improvement database. This practice analysis was ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ANE.0000122825.04923.15
更新日期:2004-08-01 00:00:00
abstract:BACKGROUND:Estimating volume status in infants and neonates is challenging. Global end-diastolic volume (GEDV) and dynamic variables of preload, such as pulse pressure variation (PPV), may be alternative variables for estimating cardiac preload and fluid responsiveness. Therefore, we designed the present study to evalu...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000281152.72734.d0
更新日期:2007-11-01 00:00:00
abstract::Nicardipine is used in the treatment of premature labor. There are no previous reports in the anesthesia literature of serious side effects associated with this drug. We report a case of pulmonary edema induced by nicardipine therapy for tocolysis in a pregnant 27-yr-old patient admitted to our hospital for preterm la...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ANE.0000135182.79774.A0
更新日期:2004-09-01 00:00:00
abstract::Intraocular pressure (IOP) measurements in children are usually performed under nitrous oxide and halothane anesthesia. We studied the effects of both time and end-tidal halothane concentration on IOP in 80 children (mean age +/- SD = 4.5 +/- 2.9 yr), to determine the most optimal time to make such measurements in ane...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199008000-00011
更新日期:1990-08-01 00:00:00
abstract::Tramadol analgesia results from a monoaminergic effect by tramadol itself and an opioid effect of its metabolite (+)-M1 formed by O-demethylation of tramadol by CYP2D6. In this study we sought to determine the impact of (+)-M1 on the analgesic effect of tramadol evaluated by experimental pain models. The effect of an ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/01.ane.0000189613.61910.32
更新日期:2006-01-01 00:00:00
abstract:IMPLICATIONS:This case describes the impact of argatroban and off-pump coronary revascularization on hemostasis as assessed by conventional hemostatic measures and Thrombelastography in a patient with heparin-induced thrombocytopenia. ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000052381.47101.a2
更新日期:2003-04-01 00:00:00
abstract::This study was designed to compare the anesthetic properties of hypobaric bupivacaine with those of isobaric and hyperbaric solutions when administered in the supine position in an elderly population undergoing hip surgery using continuous spinal anesthesia. Plain bupivacaine (0.5%) was mixed with equal volumes of 10%...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1213/00000539-199106000-00011
更新日期:1991-06-01 00:00:00
abstract::We hypothesized that intrathecal fentanyl infusion would provide excellent analgesia, require lower doses than necessary for the epidural or intravenous route of administration, and reduce the incidence and/or severity of side effects. Accordingly, we studied 12 patients during 48 h after thoracotomy (three pneumonect...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199311000-00011
更新日期:1993-11-01 00:00:00
abstract::Morphine given intracerebroventricularly releases spinal dynorphin A (Dyn) in mice. The present study was undertaken to determine whether morphine given intrathecally (IT) released Dyn. We demonstrated that the antinociceptive action of morphine was enhanced by procedures that are known to attenuate Dyn action. First,...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199312000-00015
更新日期:1993-12-01 00:00:00
abstract::This study was designed to compare the efficacy of 6% hetastarch to that of crystalloid administration in reducing the incidence and severity of hypotension during spinal anesthesia. Forty ASA grade I patients scheduled for postpartum tubal ligations under spinal anesthesia were randomly allocated to receive either 50...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-199701000-00021
更新日期:1997-01-01 00:00:00
abstract::Laser Doppler flowmetry was used to further investigate the role of nitric oxide (NO) in CO2-induced cerebrocortical hyperemia in rats. A second objective was to elucidate the source(s) of the NO involved in the response to hypercapnia. We used the L-arginine analogue N omega-nitro-L-arginine methyl ester (L-NAME) to ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199702000-00023
更新日期:1997-02-01 00:00:00
abstract::The potency of conventional inhaled anesthetics increases with increasing age: the 50% effective dose (minimum alveolar anesthetic concentration [MAC]) for anesthesia in the neonatal animal or human exceeds MAC in the young adult by approximately 30% to 60%. We tested whether this relationship also applies to the alka...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199704000-00028
更新日期:1997-04-01 00:00:00
abstract::The extent and magnitude of sympathetic blockade during epidural anesthesia have previously been assessed only by indirect methods. In this study, direct intraneural recordings of muscle sympathetic activity (MSA) in the peroneal nerve was performed to determine the profundity of blockade of sympathetic fibers to the ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1989-12-01 00:00:00