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Results for “Anesthesia, General”

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At least 181 records · Page 10Linked to original sources
PubMed1997

Laparoscopic tubal ligation in a minimally invasive surgical unit under local anesthesia compared to a conventional operating room approach under general anesthesia.

OBJECTIVE: This study was done to compare costs, operating and recovery times, safety, and patient acceptance between (a) minimally invasive laparoscopic tubal ligation under sedation and local anesthesia and (b) conventional laparoscopic operating-room-based tubal ligations under general anesthesia. METHODS: Fourteen women desiring sterilization were randomized between tubal ligation under sedation/local analgesia versus general anesthesia. Procedures were performed by supervised residents previously unfamiliar with the minimally invasive technique. Hospital charges were used as a surrogate for cost. Operating or procedure room times, surgical complications, and recovery times were recorded. Patient acceptance was assessed using satisfaction surveys administered in the recovery room and again 1 week postoperatively. RESULTS: The cost of minimally invasive tubal ligation was significantly lower than for the conventional technique ($1,615+/-$134 vs $2,820+/-$110, p < 0.001). Surgical times were not different between the two procedures: 40.4+/-15 min for the conventional technique versus 32.9+/-10 min for minimally invasive surgery. However, the total in-room time required in the operating room significantly exceeded that for the procedure room technique (84+/-10 min vs 60+/-2 min, p < 0.05). Likewise, recovery time for the general anesthesia technique was longer (48+/-6 min vs 14+/-7 min, p < 0.03). No complications were encountered with either surgical method. Patient satisfaction for pain, fatigue, and days of missed work was similar between the two groups. CONCLUSIONS: The use of minimally invasive surgery to perform tubal ligation is advantageous over conventional laparoscopic tubal ligation under general anesthesia with regard to cost and time utilization. The minimally invasive technique appears to be easy to learn, safe, and well tolerated.

Adult↗
PubMed2006

Differences in the leukocyte response to incision during upper abdominal surgery with epidural versus general anesthesia.

Epidural anesthesia attenuates surgical stress responses, such as the immune reaction and the pituitary hormone response. In the present study, we investigated the leukocyte response to initial surgical stimulation during upper abdominal surgery. Twenty adult patients (American Society of Anesthesiologists physical status I approximately II) undergoing elective upper abdominal surgery were randomly assigned to an epidural anesthesia group or a general anesthesia group. An epidural catheter for postoperative pain relief was inserted into all patients before induction. In the epidural anesthesia group, patients obtained preemptive analgesia from Th4 to Th12 with 2% mepivacaine, whereas general anesthesia was maintained with 2 L of oxygen, 4 L of nitrous oxide, and 1% to 3% isoflurane. Changes in the leukocyte count and leukocyte subset distribution were determined before induction (baseline), immediately after induction, 5 minutes after induction, 5 minutes after skin incision, and 5 minutes after peritoneal incision. The changes were significantly different between the groups throughout the observation period (p<0.0001). The general anesthesia group demonstrated an increase in the leukocyte count compared with the baseline data 5 minutes after skin incision and 5 minutes after peritoneal incision (p<0.01). Moreover, these counts were significantly higher in the general anesthesia group than in the epidural anesthesia group (p<0.05). The subset distributions were also significantly different between the groups throughout the observation period (p<0.0001). In the general anesthesia group, neutrophils decreased and lymphocytes increased significantly compared with baseline (p<0.05). Moreover, lymphocyte distribution was significantly higher in the general anesthesia group than in the epidural anesthesia group 5 minutes after peritoneal incision. Thus, anesthesia modifies the early response of leukocytes to surgical stress. The link between the early leukocyte response to surgery and postoperative outcome is the next subject of investigation.

Abdomen↗
PubMed2005

Continuous infusion propofol general anesthesia for dental treatment in patients with progressive muscular dystrophy.

Progressive muscular dystrophy may produce abnormal reactions to several drugs. There is no consensus of opinion regarding the continuous infusion of propofol in patients with progressive muscular dystrophy. We successfully treated 2 patients with progressive muscular dystrophy who were anesthetized with a continuous infusion of propofol. In case 1, a 19-year-old, 59-kg man with Becker muscular dystrophy and mental retardation was scheduled for dental treatment under general anesthesia. General anesthesia was maintained by a continuous infusion of 6-10 mg/kg propofol per hour and an inhalational mixture of 67% nitrous oxide and 33% oxygen. No complications were observed during or after the operation. In case 2, a 5-year-old, 11-kg boy with Fukuyama type congenital muscular dystrophy and slight mental retardation was scheduled for dental treatment under general anesthesia. General anesthesia was maintained with a continuous infusion of 6-12 mg/kg propofol per hour and an inhalational mixture of 0.5-1.5% sevoflurane in 67% nitrous oxide and 33% oxygen. No complications were observed during or after the operation. It is speculated that a continuous infusion of propofol in progressive muscular dystrophy does not cause malignant hyperthermia because serum levels of creatine phosphokinase and myoglobin decreased after our anesthetic management. Furthermore, our observations suggest that sevoflurane may have some advantages in patients with progressive type muscular dystrophies other than Duchenne muscular dystrophy and Becker muscular dystrophy. In conclusion, our cases suggest that a continuous infusion of propofol for the patients with progressive muscular dystrophy is a safe component of our anesthetic strategy.

Adult↗
PubMed2026

Microglial modulation in general anesthesia: molecular.

General anesthetics profoundly alter brain function and consciousness, yet the mechanisms underlying these effects remain incompletely understood. Although traditional studies have primarily focused on neuronal targets, accumulating evidence suggests that microglia dynamically respond to anesthetic exposure and may participate in anesthesia-associated neurophysiological changes. Beyond their established immune functions, microglia are increasingly implicated in synaptic remodeling, metabolic regulation, neuronal activity surveillance, and neuron-glia communication. Recent studies indicate that different classes of anesthetic agents modulate microglial activity through diverse and context-dependent mechanisms involving inflammatory signaling, purinergic pathways, calcium dynamics, mitochondrial metabolism, and neural circuit interactions. These responses are associated with postoperative neurocognitive disorders, altered synaptic plasticity, and anesthesia-related changes in brain states. In this review, we summarize current evidence regarding the effects of volatile anesthetics, intravenous anesthetics, and analgesics on microglial function and discuss the molecular, functional, and circuit-level mechanisms underlying anesthesia-associated neuron-microglia interactions. We further highlight the dynamic and heterogeneous nature of microglial responses during anesthesia and discuss current limitations in the field, including the lack of temporally resolved and cell-specific approaches. Understanding these processes may provide insights into anesthesia-associated neurocognitive dysfunction and support the development of neuroimmune-targeted strategies in anesthesiology.

General anesthesia↗
PubMed1994

The effect of lumbar epidural and general anesthesia on plasma catecholamines and hemodynamics during abdominal aortic aneurysm repair.

Twenty-four patients undergoing abdominal aortic aneurysm (AAA) repair were studied to compare the effects of lumbar epidural anesthesia (LEA) and general anesthesia (GA) on plasma catecholamine levels and hemodynamics before and during infrarenal aortic cross-clamping. Patients received either a high dose of opioid anesthetic (GA group, n = 12), or lumbar epidural anesthesia to T4 sensory level with a light general anesthetic (LEA group, n = 12). Systemic vascular resistance (SVR) and norepinephrine (NE) and epinephrine (E) levels were measured before anesthetic induction (before epidural activation in the LEA group, and before general anesthesia induction in the GA group), 15 min before cross-clamping, and 1,5, and 10 min after cross-clamping. There was a large (P < 0.05) increase in NE and E in the GA group by 15 min before aortic cross-clamping, but NE and E levels in the LEA group did not increase. The GA group had significantly higher levels of NE and E than the LEA group 15 min before cross-clamping and also after clamping. NE levels in the LEA group increased after cross-clamping, and NE levels in the GA group remained constant. E levels remained stable in both groups after cross-clamping. After clamping, SVR increased in both groups, but the increase occurred after 1 min in the GA group and took 5 min to become significant in the LEA group. There was no significant correlation between changes in NE or E and changes in SVR in either group. This study shows that epidural anesthesia to T4 prevents NE and E increases in response to abdominal surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Epidural↗
PubMed1996

Parathyroid surgery using monitored anesthesia care as an alternative to general anesthesia.

BACKGROUND: Although there have been several reports in the literature describing a renewed interest in performing thyroid surgery under local anesthesia (LA), there has been little information regarding parathyroid surgery under local anesthesia. METHODS: We retrospectively reviewed our experience of 49 LA parathyroid patients over a 9-year period at a single institution. A bilateral cervical block (C2-C3) was administered by a single surgeon using lidocaine and bupivacaine. RESULTS: The study included 39 females and 10 males with an average age of 62 years (range, 35-89 years). Every surgery was curative and the final pathology revealed 46 parathyroid adenomas and 3 cases of parathyroid hyperplasia. Forty-seven percent of the patients were discharged within 6 hours of operation and the remaining patients had a 1.4-day average length of hospital stay. A group of age- and sex-matched controls who underwent parathyroid surgery using general anesthesia (GA) served as a control group with 27% of operations performed as outpatients and an average length of stay of 1.6 days. Return to work averaged 6 days for the LA group versus 8 days for the GA. In the LA group, there was one instance of postoperative hemorrhage requiring reoperation and one instance of conversion to GA secondary to an inability to tolerate LA. There were no instances of recurrent laryngeal nerve injury or permanent hypoparathyroidism in either group. CONCLUSIONS: These data suggest that experienced surgeons can perform parathyroid surgery safely and effectively using LA as an alternative to GA.

Adult↗
PubMedDate not supplied

A comparison of epidural versus general anesthesia for outpatient endoscopic preperitoneal herniorrhaphy.

OBJECTIVES: To study the efficacy of epidural versus general anesthesia on length of stay, patient recovery and anesthetic-related complications in patients undergoing endoscopic preperitoneal herniorrhaphy. METHODS: One hundred sixty-seven consecutive patients undergoing endoscopic preperitoneal herniorrhaphy from July, 1994, to August, 1995, were retrospectively studied. A total of 243 herniorrhaphies were performed. Four patients required conversion of epidural anesthesia to general anesthesia because of inadequate sensory blockade (67/71; 94% success rate). One-hundred-forty-eight patients were available for review. Sixty-seven patients underwent successful epidural anesthesia during the case, while 81 patients were managed with general anesthesia. RESULTS: Thirty patients (37%) receiving general anesthesia required interventions for nausea compared to only six patients (9.0%) in the epidural anesthesia group (p < 0.001). Thirty patients (37%) in the general anesthesia group required intervention because of complaints of pain, compared to 13 (19.4%) in the epidural group (p < 0.05). There were no differences between the two groups for length of stay in OR, PACU, or total hospital times. CONCLUSIONS: The use of epidural anesthesia during the performance of endoscopic preperitoneal herniorrhaphy was associated with a decrease in the incidence of postoperative pain and nausea. The technique was successful in 94% of the cases in which it was used. Epidural anesthesia is recommended as an effective alternative to general anesthesia for the performance of outpatient endoscopic preperitoneal herniorrhaphy.

Adult↗