Effects of two different anesthesia-analgesia methods on incidence of postoperative delirium in elderly patients undergoing major thoracic and abdominal surgery: study rationale and protocol for a multicenter randomized controlled trial A randomized study of maternal serum cytokine levels following cesarean section under general or neuraxial anesthesia. The Effect of Neuraxial Versus General Anesthesia Techniques on Postoperative Quality of Recovery and Analgesia After Abdominal Hysterectomy: A Prospective, Randomized, Controlled Trial Total Intravenous Anesthesia versus Single Breath Technique and Anesthesia Maintenance with Sevoflurane for Bariatric Operations A Comparison of Psoas Compartment Block and Spinal and General Anesthesia for Outpatient Knee Arthroscopy Isoflurane and Propofol Contribute to Increasing the Antioxidant Status of Patients During Minor Elective Surgery The Effect of Epidural Versus General Anesthesia on Postoperative Pain and Analgesic Requirements in Patients Undergoing Radical Prostatectomy Safety and beneficial effect on body core temperature of a prewarmed plasma substitute—hydroxyethyl starch—during anesthesia Factors Affecting Discharge Time in Adult Outpatients Quality of recovery from two types of general anesthesia for ambulatory dental surgery in children: a double-blind, randomized trial. A Clinical Outcome-Based Prospective Study on Venous Thromboembolism After Cancer Surgery: The @RISTOS Project The effects of timing of prophylaxis, type of anesthesia, and use of mechanical methods on outcome in major orthopedic surgery – subgroup analyses from 17,701 patients in the XAMOS study [Efficacy of spinal anesthesia with small-dose lidocaine in ambulatory prostate biopsy procedures for elderly patients : comparison with propofol anesthesia]. Thoracic Epidural Anesthesia Combined with General Anesthesia: The Preferred Anesthetic Technique for Thoracic Surgery Incidence of regional pain syndrome after carpal tunnel release. Is there a correlation with the anesthetic technique? Anesthetic techniques for pharyngeal flap surgery: effects on postoperative complications. The effects of prayer, relaxation technique during general anesthesia on recovery outcomes following cardiac surgery. Systemic inflammatory response after endoscopic (TEP) vs Shouldice groin hernia repair Nonopioid versus opioid based general anesthesia technique for bariatric surgery: A randomized double-blind study Hip fracture in the elderly: the effect of anesthetic technique. Ondansetron vs. metoclopramide for the prevention of nausea and vomiting after gynecologic surgery. Volatile agents for cardiac protection in noncardiac surgery: a randomized controlled study. Intraoperative blood loss during radical retropubic prostatectomy: epidural versus general anesthesia.
Background Delirium is a common complication in elderly patients after surgery and associated with increased morbidity and mortality . Studies suggest that deep anesthesia and intense pain are important precipitating factors of postoperative delirium . Neuraxial block is frequently used in combination with general anesthesia for patients undergoing major thoracic and abdominal surgery . Compared with general anesthesia alone and postoperative intravenous analgesia , combined epidural-general anesthesia and postoperative epidural analgesia decreases the requirement of general anesthetics during surgery and provided better pain relief after surgery . However , whether combined epidural-general anesthesia plus epidural analgesia is superior to general anesthesia plus intravenous analgesia in decreasing the incidence of postoperative delirium remains unknown . Methods / design This is a multicenter , open-label , r and omized , parallel-controlled clinical trial . One thous and eight hundred elderly patients ( age range 60–90 years ) who are scheduled to undergo major thoracic or abdominal surgery are r and omized to receive either general anesthesia plus postoperative intravenous analgesia or combined epidural-general anesthesia plus postoperative epidural analgesia . The primary outcome is the 7-day incidence of postoperative delirium . Secondary outcomes include the duration of postoperative delirium , the intensity of pain during the first three days after surgery , the 30-day incidences of postoperative non-delirium complications , the length of stay in hospital after surgery and 30-day all-cause mortality . Discussion Results of the present study will provide information to guide clinical practice in choosing appropriate anesthesia-analgesia method for elderly patients undergoing major thoracic and abdominal surgery . Trial registration The study is registered on Clinical Trials.gov NCT01661907 and Chinese Clinical Trial Registry ChiCTR-TRC-12002371 BACKGROUND Cytokines are significant mediators of the immune response to surgery and also play a role in parturition . The aim of the study was to investigate the impact of the anesthetic technique for cesarean section on plasma levels of cytokines IL-6 and TNF-alpha . METHODS Thirty-five parturients scheduled for elective cesarean section were r and omly assigned to  general ( n=18 ) or neuraxial ( n=17 ) anesthesia . The general anesthesia group received thiopental 4 mg/kg , succinylcholine 1 - 1.5 mg/kg and 1 % end-tidal concentration of sevoflurane in nitrous oxide and 50 % oxygen . The neuraxial anesthesia group received intrathecal 0.5 % levobupivacaine 1.8 - 2.2 mL and epidural fentanyl 1 microg/kg . Blood sample s were taken for IL-6 and TNF-alpha immediately after positioning the parturient on the operating table , after uterine incision and before the umbilical cord clamping and 24h after surgery ( T(1 ) , T(2 ) and T(3 ) respectively ) . RESULTS The two groups did not differ in IL-6 ( P=0.15 ) or TNF-alpha ( P=0.73 ) serum concentrations at any time point . In the general and neuraxial anesthesia groups , IL-6 serum concentrations were significantly higher in the third blood sample , T(3 ) ( 12.2+/-5.0 and 15.2+/-4.3 pg/mL ) , than in T(1 ) ( 0.41+/-0.38 and 0.29+/-0.10 pg/mL ) and T(2 ) ( 0.37+/-0.47 and 0.24+/-0.05 ) respectively ( P<0.001 ) . Within each group , serum TNF-alpha concentrations did not differ significantly over time ( P=0.44 ) . CONCLUSIONS Under the present study design anesthetic technique did not affect IL-6 or TNF-alpha concentrations in parturients undergoing elective cesarean section . Serum IL-6 levels increased 24 h postoperatively independently of anesthetic technique BACKGROUND : Patients undergoing abdominal hysterectomy often have significant postoperative pain despite the use of concurrent multimodal pain strategies . Neuraxial anesthesia has opioid-sparing effects and may provide better postoperative recovery to patients when compared with general anesthesia . Our main objective in this study was to compare the effects of neuraxial and general anesthesia on postoperative quality of recovery after abdominal hysterectomy . METHODS : The study was a prospect i ve , r and omized , controlled clinical trial . Seventy healthy females were recruited and r and omized to a general anesthesia or neuraxial technique  as their primary anesthetic regimen . The primary outcome was the global quality of recovery—40 question naire ( QoR–40 ) at 24 hours after the surgical procedure . Other data collected included postoperative pain scores and opioid consumption . Data were analyzed using the Mann – Whitney U test , Fisher 's exact test , and linear regression . A P value < 0.05 was considered statistically significant . RESULTS : The median difference ( 95 % confidence interval [ CI ] ) in the global QoR–40 score at 24 hours between the neuraxial and general anesthesia groups was 17 ( 11 to 21.5 ) ( P < 0.001 ) . Patients in the neuraxial anesthesia group had better quality of recovery scores in all the QoR–40 subcomponents than did the general anesthesia group ( all P < 0.005 ) . The median difference in global QoR–40 scores at 48 hours between the neuraxial anesthesia and the general anesthesia groups was 8 ( 6–10 ) ( P < 0.001 ) . Postoperative opioid consumption and pain scores were higher in the general anesthesia group than in the neuraxial anesthesia group . There was an inverse linear relationship between opioid consumption and postoperative quality of recovery at 24 hours , r 2 = 0.67 ( P < 0.0001 , 95 % CI of 0.77 to 0.51 ) , and at 48 hours , r 2 = 0.58 ( P < 0.0001 , 95 % CI of 0.72 to 0.42 ) . CONCLUSION : Neuraxial anesthesia provides better quality of recovery than does general anesthesia for patients undergoing abdominal hysterectomy . The opioid-sparing effects of neuraxial anesthesia were associated with a better quality of recovery in patients after the surgical procedure . In the absence of contraindications , neuraxial anesthesia seems to be a better anesthetic plan for those patients Background : The choice of anesthetic technique for general anesthesia in morbidly obese patients remains controversial . We aim ed to compare blood gases , recovery and hemodynamic parameters using TIVA and sevoflurane anesthesia in bariatric surgery . Methods : The study was performed with permission of the ethics committee . We studied 40 morbidly obese patients allocated to 2 groups . The total I.V. anesthesia ( TIVA ) group was named Group T , and the sevoflurane group was named Group S. In Group T , anesthesia induction was achieved with propofol . In Group S , anesthesia induction was achieved by sevoflurane with single breath technique , with maintenance provided with 1 - 2 % volume sevoflurane . Student t , Chi square and ANOVA tests were used for data analysis ; p-value < 0.05 was considered statistically significant . Results : There was no significant difference between the 2 groups in demographic data , blood gas values and recovery characteristic . Hemodynamic values were significantly lower in Group T than Group S , during and after the operative period . Conclusion : While sevoflurane induction and maintenance is a suitable anesthetic modality for obese patients , TIVA can be applied easily in those patients possessing no extra risk factors other than morbid obesity The optimal anesthetic technique for outpatient knee arthroscopy remains controversial . In this study , we evaluated surgical operating conditions , patient satisfaction , recovery times , and postoperative analgesic requirements associated with psoas compartment block , general anesthetic , or spinal anesthetic techniques . Sixty patients were r and omized to receive a propofol/nitrous oxide/fentanyl general anesthetic , spinal anesthesia with 6 mg of bupivacaine and 15 & mgr;g of fentanyl , or psoas compartment block with 40 mL of 1.5 % mepivacaine . All patients received IV ketorolac and intraarticular bupivacaine . The frequency of postanesthesia recovery room admission was 13 ( 65 % ) of 20 for patients receiving general anesthesia , compared with 0 of 21 for patients receiving spinal anesthesia and 1 ( 5 % ) of 19 for patients receiving psoas block ( P < 0.001 ) . The median time from the end of surgery to meeting hospital discharge criteria did not differ across groups ( 131 , 129 , and 110 min for general , spinal , and psoas groups , respectively ) . In the hospital , 45 % of general anesthesia patients received opioid analgesics , compared with 14 % of spinal anesthesia and 21 % of psoas block patients ( P = 0.087 ) . There was no difference among groups with respect to the time of first analgesic use or the number of patients requiring opioid analgesia . Pain scores were highest in patients receiving general anesthesia at 30 min ( P = 0.032 ) and at 60 , 90 , and 120 min ( P < 0.001 ) . Patient satisfaction with anesthetic technique ( P = 0.025 ) and pain management ( P = 0.009 ) differed significantly across groups ; patients receiving general anesthesia reported lower satisfaction ratings . We conclude that spinal anesthesia or psoas block is superior to general anesthesia for knee arthroscopy when considering re source utilization , patient satisfaction , and postoperative analgesic management Abstract Isoflurane is a volatile halogenated anesthetic used especially for anesthesia maintenance whereas propofol is a venous anesthetic utilized for anesthesia induction and maintenance , and reportedly an antioxidant . However , there are still controversies related to isoflurane-induced oxidative stress and it remains unanswered whether the antioxidant effects occur in patients under propofol anesthesia .  Taking into account the importance of better underst and ing the role of anesthetics on oxidative stress in anesthetized patients , the present study was design ed to evaluate general anesthesia maintained with isoflurane or propofol on antioxidant status in patients who underwent minimally invasive surgeries .  We conducted a prospect i ve r and omized trial in 30 adult patients without comorbidities who underwent elective minor surgery ( septoplasty ) lasting at least 2 h admitted to a Brazilian tertiary hospital . The patients were r and omly allocated into 2 groups , according to anesthesia maintenance ( isoflurane , n = 15 or propofol , n = 15 ) . Peripheral blood sample s were drawn before anesthesia ( baseline ) and 2-h after anesthesia induction . The primary outcomes were to investigate the effect of either isoflurane or propofol anesthesia on aqueous plasma oxidizability and total antioxidant performance ( TAP ) by fluorometry as well as several individual antioxidants by high-performance liquid chromatography . As secondary outcome , oxidized genetic damage ( 7,8-dihydro-8-oxoguanine , known as 8-oxo-Gua ) was investigated by the comet assay . Both anesthesia techniques ( isoflurane or propofol ) for a 2-h period result ed in a significant decrease of plasma & agr;-tocopherol , but not other antioxidants including uric acid , carotenoids , and retinol ( P > 0.05 ) . Propofol , in contrast to isoflurane anesthesia , significantly increased ( P < 0.001 ) anti-inflammatory/antioxidant plasma & ggr;-tocopherol concentration in patients . Both anesthesia types significantly enhanced hydrophilic antioxidant capacity and TAP , with no significant difference between them , and 8-oxo-Gua remained unchanged during anesthesia in both groups . In addition , both anesthetics showed antioxidant capacity in vitro . This study shows that anesthesia maintained with either propofol or isoflurane increase both hydrophilic and total antioxidant capacity in plasma , but only propofol anesthesia increases plasma & ggr;-tocopherol concentration . Additionally , both types of anesthetics do not lead to oxidative DNA damage in patients without comorbidities undergoing minimally invasive surgery Background Although preemptive analgesia has been shown to decrease postinjury pain in animals , studies in humans have provided controversial results . The authors studied whether surgical epidural anesthesia with local anesthetics could affect postoperative pain and analgesic dem and s , when compared with general anesthesia . Methods Male patients scheduled for radical retropubic prostatectomy were r and omly assigned to receive  epidural anesthesia only ( EA , n = 34 ) , combined epidural and general anesthesia ( EG , n = 32 ) , or general anesthesia only ( GA , n = 30 ) . A lumbar epidural catheter was inserted and tested in all patients . In the EA group , an induction dose of 0.25 ml/kg epidural bupivacaine ( 0.5 % ) was followed during surgery by a continuous infusion of 0.1 ml.kg–1.h–10.125 % bupivacaine . In the EG group , 0.2 ml/kg epidural bupivacaine ( 0.5 % ) was injected after induction of general anesthesia but before surgery , followed by epidural infusion of 0.1 ml.kg–1.h–10.125 % bupivacaine . In the GA group , anesthesia was maintained with morphine , isoflurane , and N2O . Epidural patient-controlled analgesia ( PCA ) was provided with bupivacaine and fentanyl for all patients in the postoperative period . Postoperative pain scores and analgesic requirements were examined and compared between groups every 4–8 h for 3–5 postoperative days . Results Intraoperatively , EA patients received significantly more epidural bupivacaine than EG patients ( 129 ± 6 mg vs. 98 ± 6 mg , respectively . Recovery room median residual sensory level in EA patients ( T6 ± 2 ) was significantly higher than in EG patients ( T10 ± 2 ) . PCA dem and was greater in the GA and EG groups when compared with the EA group in postoperative days 2 ( 126 ± 9 ml , 112 ± 9 ml , 90 ± 6 ml , respectively ; P = 0.01 ) and 3 ( 89 ± 10 ml , 83 ± 9 ml , 48 ± 5 respectively ; P = 0.005 ) . There was no difference in PCA dem and between the GA and EG groups in the postoperative period . No significant clinical differences in postoperative mean pain scores were recorded in the first 5 days after surgery in the three anesthetic groups ( range 0–2/10 ) . Conclusions In patients undergoing lower abdominal surgery , the neuraxial blockade and surgical anesthesia achieved by epidural local anesthetics was associated with decreased postoperative analgesic dem and s. Lower postoperative analgesic requirements in the EA group , when compared with both the EG and GA groups , indicate that : ( 1 ) EA patients had less postoperative pain , and ( 2 ) an efficient intraoperative blockade of noxious afferent signals to the central nervous system is fundamental in reducing postoperative pain Purpose We investigated , first , the safety of use and stability of a plasma substitute — hydroxyethyl starch (HES)—kept in a warming cabinet for a long period , and then the effect on body core temperature of the prewarmed HES in patients during urological surgery . Methods In the first part of the study , HES colloid solutions ( 500 ml per pack ; Hesp and er ) were kept in a warming cabinet ( 40 ° C ) for 3 months and were tested for biological and chemical safety and stability . In the second part of the study , 1000 ml of HES at room temperature ( control group ; n = 10 ) or kept in a warming cabinet for a few days ( warmed group ; n = 10 ) was infused via a central venous catheter for 30 min in patients undergoing urological surgery under general anesthesia with lumbar epidural anesthesia .  Esophageal temperature was monitored as the core temperature . HES fluid temperatures in the pack and at the end of a 1-m intravenous tube connected to the central venous catheter were also measured . Results The test of HES products warmed for 3 months passed all inspections performed during the study period . In the warmed group , the pack and intravenous tube temperatures of HES were still high at 15 min after infusion ( 37.1 ° ± 1.5 ° C [ mean ± SD ] and 34.8 ° ± 2.2 ° C , respectively ) . Core temperature in the warmed group decreased significantly , by 0.34 ° ± 0.06 ° C , but was significantly higher than that in the control group ( by 0.84 ° ± 0.13 ° C ) after 30 min of the infusion . Conclusions The use of HES products kept in a warming cabinet prior to surgery can maintain warm body temperature , easily , safely , and effectively Discharge time ( total recovery time ) is one determinant of the overall cost of outpatient surgery . We performed this study to determine what factors affect discharge time . Details regarding patients , anesthesia , surgery , and recovery were recorded prospect ively for 1088 adult patients undergoing ambulatory surgery over an 8-mo period . The contribution of factors to variability in the discharge time was assessed by using multivariate linear regression analysis . In the last 4 mo of the study , nurses indicated the causes of discharge delays > or = to50 min in Phase 1 or > or = to70 min in Phase 2 recovery . When all anesthetic techniques were included , anesthetic technique was the most important determinant of discharge time ( R2 = 0.10 - 0.15 ; P = 0.001 ) , followed by the Phase 2 nurse . After general anesthesia , the Phase 2 nurse was the most important factor ( R2 = 0.13 ; P = 0.01 - 0.001 ) . In women , the choice of general anesthetic drugs was significant ( R2 = 0.04 ; P = 0.002 ) . The three most common medical causes of delay were pain , drowsiness , and nausea/vomiting . System factors were the foremost cause of Phase 2 delays ( 41 % ) , with lack of immediate availability of an escort accounting for 53 % of system-related delays . We conclude that efforts to shorten discharge time would best be directed at improving nursing efficiency ; ensuring availability of an escort for the patient ; and preventing postoperative pain , drowsiness , and emetic symptoms . The selection of anesthetic technique and anesthetic drug seems to be of selective importance in determining discharge time depending on patient gender and type of surgery . Implication s : The relative importance of anesthetic and nonanesthetic factors were evaluated as determinants of discharge time after ambulatory surgery . Postoperative nursing care was the single most important factor after general anesthesia ; anesthetic drugs , anesthetic technique , and prevention of pain and emetic symptoms were of selective importance depending on patient gender and type of surgery . ( Anesth Analg 1998;87:816 - 26 BACKGROUND Pediatric dental procedures are increasingly performed under general anesthesia because of the inability to cooperate , situational anxiety , or other behavioral problems . Volatile anesthetics have been associated with emergence delirium in children , whereas the use of propofol for anesthetic maintenance has been shown to reduce the incidence of emergence delirium after other types of surgeries . The aim of this study is to compare a sevoflurane-based anesthetic with a propofol-based technique as it relates to the incidence of emergence delirium and the quality of recovery after pediatric dental surgery , in patients who present with risk factors for perioperative behavioral issues . METHODS We prospect ively collected data of 179 pediatric patients scheduled for ambulatory dental surgery using a double-blind and r and omized trial design . Subjects were anesthetized following st and ardized protocol s for either a sevoflurane- or a propofol-based technique . The incidence of emergency delirium , as measured by the Pediatric Anesthesia Emergence Delirium score , was the primary outcome . Secondary outcomes included the incidence of postoperative nausea and vomiting ( PONV ) , number of nursing interventions in the recovery room , time to discharge readiness , and parental satisfaction . RESULTS We found no difference in the incidence of emergence delirium after both types of anesthesia . However , use of sevoflurane significantly increased both the risk of PONV and the number of postoperative nursing interventions . Discharge criteria were met about 10 min earlier in patients anesthetized with sevoflurane .  Parental satisfaction was equally high with both anesthesia regimens . CONCLUSIONS A propofol-based anesthetic technique did not lead to a lower incidence of emergence delirium after dental surgery in children but did result in significantly less PONV and fewer postoperative nursing interventions Summary Background Data : The epidemiology of venous thromboembolism ( VTE ) after cancer surgery is based on clinical trials on VTE prophylaxis that used venography to screen deep vein thrombosis ( DVT ) . However , the clinical relevance of asymptomatic venography-detected DVT is unclear , and the population of these clinical trials is not necessarily representative of the overall cancer surgery population . Objective : The aim of this study was to evaluate the incidence of clinical ly overt VTE in a wide spectrum of consecutive patients undergoing surgery for cancer and to identify risk factors for VTE . Methods : @RISTOS was a prospect i ve observational study in patients undergoing general , urologic , or gynecologic surgery . Patients were assessed for clinical ly overt VTE occurring up to 30 ± 5 days after surgery or more if the hospital stay was longer than 35 days . All outcome events were evaluated by an independent Adjudication Committee . Results : A total of 2373 patients were included in the study : 1238 ( 52 % ) undergoing general , 685 ( 29 % ) urologic , and 450 ( 19 % ) gynecologic surgery . In-hospital prophylaxis was given in 81.6 % and postdischarge prophylaxis in 30.7 % of the patients . Fifty patients ( 2.1 % ) were adjudicated as affected by clinical ly overt VTE ( DVT , 0.42 % ; nonfatal pulmonary embolism , 0.88 % ; death 0.80 % ) . The incidence of VTE was 2.83 % in general surgery , 2.0 % in gynecologic surgery , and 0.87 % in urologic surgery . Forty percent of the events occurred later than 21 days from surgery . The overall death rate was 1.72 % ; in 46.3 % of the cases , death was caused by VTE . In a multivariable analysis , 5 risk factors were identified : age above 60 years ( 2.63 , 95 % confidence interval , 1.21–5.71 ) , previous VTE ( 5.98 , 2.13–16.80 ) , advanced cancer ( 2.68 , 1.37–5.24 ) , anesthesia lasting more than 2 hours ( 4.50 , 1.06–19.04 ) , and bed rest longer than 3 days ( 4.37 , 2.45–7.78 ) . Conclusions : VTE remains a common complication of cancer surgery , with a remarkable proportion of events occurring late after surgery . In patients undergoing cancer surgery , VTE is the most common cause of death at 30 days after surgery Purpose Real-world data on the use of rivaroxaban in the perioperative period in patients undergoing major orthopedic surgery are limited . Subsets of data from the Phase IV , non-interventional XAMOS study were analyzed to explore the potential influence of timing of the first thrombo prophylactic dose , type of anesthesia , and concomitant mechanical prophylaxis on clinical outcomes in patients undergoing major orthopedic surgery in routine clinical practice . Patients and methods In XAMOS , 8,778 patients received rivaroxaban ( 10 mg once daily ) and 8,635 received st and ard-of-care ( SOC ) pharmacological prophylaxis  ( safety population ) . Crude incidences of symptomatic thromboembolic and treatment-emergent bleeding events were analyzed according to timing of the first postoperative thromboprophylactic dose , use of general or neuraxial anesthesia , and use of mechanical prophylaxis with pharmacological thromboprophylaxis . Results In the rivaroxaban group , the incidences of symptomatic thromboembolic events were 0.7 % , 1.0 % , and 0.7 % in patients receiving the first thromboprophylactic dose at ≤6 hours , > 6 hours to ≤10 hours , and > 10 hours to ≤24 hours after surgery , respectively . In the SOC group , the incidence of symptomatic thromboembolic events was slightly higher when the postoperative dose was given at > 10 hours to ≤24 hours ( 1.8 % vs 1.1 % at ≤6 hours and 1.3 % at > 6 hours to ≤10 hours ) . The antithrombotic effect of rivaroxaban was maintained in comparison to the SOC group . The incidence of major bleeding ( RECORD trial definition ) was low and similar between the two treatment groups and was not influenced by timing of the first thromboprophylactic dose . Neuraxial anesthesia was used more than any other form of anesthesia for both hip and knee surgery ; the effectiveness of rivaroxaban was not influenced by the type of anesthesia used . No spinal hematomas were reported in patients receiving neuraxial anesthesia in either treatment group . Use of mechanical thromboprophylaxis in addition to rivaroxaban or SOC pharmacological prophylaxis did not reduce the risk of thromboembolic events further . Conclusion The effectiveness and safety of rivaroxaban in patients undergoing major orthopedic surgery in routine clinical practice were maintained irrespective of timing of the first postoperative dose within 24 hours after surgery , the type of anesthesia , and the additional use of mechanical thromboprophylaxis BACKGROUND Opinions differ as to what is more appropriate anesthetic technique for elderly patients undergoing ambulatory surgery . The objective of this study is to compare the efficacy and safety of spinal anesthesia with small-dose lidocaine and those of propofol general anesthesia in elderly patients undergoing ambulatory prostate biopsy . METHODS Eighty ASA physical status I x II patients aged older than 65 year were r and omized to receive either spinal anesthesia with 1 % hyperbaric lidocaine 1 ml ( 10 mg ) ( group L ) or general anesthesia with 1.0 mg x kg(-1 ) of propofol injected at 180 mg x kg(-1 ) x hr(-1 ) followed by continuous infusion at 8 mg x kg(-1 ) x hr(-1 ) ( group P ) . RESULTS Significantly higher incidences of intraoperative hypotension and respiratory depression were found in the group P compared with the group L ( P < 0.05 ) . There were no major postoperative side effects , including transient neurologic symptoms and delirious sate , in either group . Both anesthetic techniques result ed in a high rate of patient satisfaction . Total perioperative costs were significantly lower in the group L compared with the group P ( P < 0.01 ) . CONCLUSIONS Spinal anesthesia with 10 mg of hyperbaric 1 % lidocaine may be more preferable to propofol anesthesia in elderly patiens undergoing ambulatory prostate biopsy , with respect to safety and costs Thoracic epidural anesthesia ( TEA ) combined with general anesthesia ( GA ) as well as total-IV anesthesia ( TIVA ) are both established anesthetic managements for thoracic surgery . We compared them with respect to hypoxic pulmonary vasoconstriction , shunt fraction and oxygenation during one-lung ventilation . Fifty patients , ASA physical status II-III undergoing pulmonary resection were r and omly allocated to two groups . In the TIVA group , anesthesia was maintained with propofol and fentanyl . In the TEA group , anesthesia was maintained with TEA ( bupivacaine 0.5 % ) combined with low-dose concentration 0.3–0.5 vol% of isoflurane ( end-tidal ) . Changing from two-lung ventilation to one-lung ventilation caused a significant increase in cardiac output ( CO ) in the TIVA group , whereas no change was observed in the TEA group . One-lung ventilation caused significant increases in shunt fraction in both groups which was associated per definition with a significant decrease in Pao2 in both groups but Pao2 remained significantly increased in the TEA group ( P < 0.05 ) . We conclude that both anesthetic regimens are safe intraoperatively . However , TEA in combination with GA did not impair arterial oxygenation to the same extent as TIVA , which might be a result of the changes in CO . Therefore , patients with preexisting cardiopulmonary disease and impaired oxygenation before one-lung ventilation might benefit from TEA combined with GA BACKGROUND AND OBJECTIVES Complex regional pain syndrome ( CRPS ) previously known as reflex sympathetic dystrophy refers to a set of signs and symptoms that include pain , increased sweating , and vasomotor instability . Pain is usually triggered by a noxious stimulus in a peripheral nerve , which is disproportionate to the triggering stimulus . Its development after surgery is not uncommon varying with the type of intervention . An incidence of 2.1 to 5 % has been reported after carpal tunnel release ( CTR ) . Sympathetic blockade may prevent the onset of CRPS . However , there is no study validating this technique to prevent CRPS after CTR . The objective of the present study was to define the incidence of CRPS after CTR and its relationship with four anesthetic techniques . METHODS Patients were r and omly distributed to undergo one of the following techniques : general anesthesia , regional intravenous anesthesia with lidocaine , regional intravenous anesthesia with lidocaine and clonidine , or axillary plexus block .  Postoperatively , they were followed-up by a nurse who was unaware of the anesthetic technique used , and follow-up was done through electronic patient records for up to 6 months after the anesthesia . During this period signs and symptoms typical of CRPS were investigated and , if positive , treatment was instituted . A descriptive evaluation using the chi-square test was performed . RESULTS Three-hundred and one patients were investigated . Twenty-five of them developed CRPS , an incidence of 8.3 % . Predominance was not observed among the anesthetic techniques used . Other factors such as smoking , profession , and other concomitant diseases were also investigated , and none showed a relationship with the development of post-CTR CRPS . CONCLUSIONS Complex regional pain syndrome has an incidence of 8.3 % after CTR surgery without association with the anesthetic techniques investigated OBJECTIVE To assess the effects of 2 different anesthetic techniques on early complications after superior pharyngeal flap surgery . DESIGN R and omized , prospect i ve , single-blind study . SETTING Large referral hospital . PATIENTS One hundred patients undergoing superior pharyngeal flap surgery for the correction of velopharyngeal insufficiency were r and omly divided into 2 equal groups to receive either isoflurane or propofol-based anesthesia . INTERVENTIONS Following induction of anesthesia with fentanyl citrate and propofol , patients were r and omized to receive either isoflurane or propofol for the maintenance of general anesthesia . The inspired isoflurane concentration and propofol infusion rate were adjusted to maintain a stable depth of anesthesia as judged by clinical signs and hemodynamic responses to surgical stimuli . MAIN OUTCOME MEASURES Recovery from anesthesia , recovery from surgery , and early postoperative complications . RESULTS The groups were similar in age , weight , height , induction time , surgery time , extubation time , and anesthetic time . The time ( mean + /- SD ) required to achieve a maximal Steward Recovery Score was 7 + /- 14 minutes in the propofol group compared with 32 + /- 28 minutes in the isoflurane group ( P<.04 ) . No significant differences in postoperative patient satisfaction scores , time to first swallow , drinking time , and time to " home readiness " were noted . Overall , 17 patients ( 17 % ) developed airway-related complications and 2 of the patients ( 2 % ) were accounted as severe . Two patients ( 2 % ) bled from the operation site . However , there was no difference in the incidence of postoperative complications between the groups . CONCLUSIONS When compared with isoflurane administration for maintenance of general anesthesia , propofol-based anesthesia was associated with more rapid mental and psychomotor recovery . However , airway-related complications and " home readiness " were similar between the groups During general anesthesia the possibility of subconscious perception of intraoperative events is a controversial subject . Some studies found that positive verbal suggestions , or music improved intraoperative relaxation and postoperative recovery . The aim of the current study was to evaluate the effect of prayer and relaxation technique applied while patients are under general anesthesia for open-heart surgery . A r and omized , controlled , double-blind trial study included 78 patients who underwent cardiac surgery .  During the surgery the patients used a headphone connected to a CD player . They were r and omly divided into three groups . One group listened to prayer during the surgery , the other listened to relaxation technique and one , placebo . There was only one significant finding : the prayer group is less likely to believe that prayer would assist conventional medical treatments . Although not statistically significant , we discussed the length of stay ( LOS ) after surgery and the incidence of sternal wound infection Endoscopic techniques are commonly used for many different types of surgery . It is cl aim ed that videoendoscopic procedures have the advantage of being less traumatic and of offering higher postoperative patient comfort than conventional open techniques . The extent of tissue trauma can be evaluated on the basis of the inflammatory response observed in the wake of surgery . Available studies that have compared endoscopic and conventional techniques suggest that endoscopic cholecystectomy , laparoscopic colorectal resection , and thoracoscopic pulmonary resection have immunologic advantages over conventional approaches . The objective of this prospect i ve study was to determine whether endoscopic hernia repair techniques are also preferable to conventional procedures and to what extent the anesthetic technique ( local or general anesthesia ) influences the postoperative inflammatory response . For this purpose , biochemical monitoring of cytokine activity [ C-reactive protein ( CRP ) , prostagl and in F1α ( PGF1α ) , neopterin , interleukin-6 ( IL-6 ) ] was done prospect ively in 101 patients [ totally extraperitoneal approach ( TEP ) n=32 , unilateral n=12 , bilateral n=20 ; Shouldice n=69 , local anesthesia ( LA ) n=23 , general anesthesia ( GA ) n=46 ] before and until 3 days after surgery . The parameters IL-6 and PGF1α suggested that the immune trauma immediately after surgery was significantly higher in the group of patients with endoscopic hernia repair than in the group of patients who received a Shouldice repair . No significant differences were observed after the first postoperative day . A comparison between the TEP group and the patients who received conventional surgery under local anesthesia showed that the TEP approach was also associated with a higher postoperative neopterin level . Within the first 3 days after surgical intervention , bilateral endoscopic hernia repair induced no significantly higher inflammatory response than the surgical treatment of unilateral conditions . The anesthetic procedure that was used in the Shouldice operation had no significant effect on inflammatory response . Unlike other types of endoscopic surgery , the repair of groin hernias using an endoscopic technique can not be regarded as a minimally invasive procedure that is less traumatic than conventional approaches . Instead , the conventional Shouldice procedure appears to cause the lowest inflammatory response and to be the least traumatic approach to hernia repair , especially when it is performed under local anesthesia Objective : The objective of this study was to evaluate the efficacy and safety of giving general anesthesia without the use of any opioids either systemic or intraperitoneal in bariatric surgery . Methods : Prospect i ve r and omized controlled trial . Obese patients ( body mass index > 50 Kg/m2 ) undergoing laparoscopic sleeve gastrectomies were recruited and provided an informed signed consent . Patients were r and omized using a computer generated r and omization table to receive either opioid or non-opioid based anesthesia . The patient and the investigator scoring patient outcome after surgery were blinded to the anesthetic protocol . Primary outcomes were hemodynamics in the form of “ heart rate , systolic , diastolic , and mean arterial blood pressure ” on induction and ½ hourly thereafter . Pain monitoring through visual analog scale ( VAS ) 30 min after recovery , hourly for 2 h and every 4 h for 24 h was also recorded . Pain monitoring through VAS and post-operative nausea and vomiting 30 min after recovery were also recorded and finally patient satisfaction and acute pain nurse satisfaction . Results : There was no difference in background characteristics in both groups . There were no statistically significant differences in different outcomes as heart rate , mean blood pressure , O2 saturation in different timings between groups at any of the determined eight time points but pain score and nurse satisfaction showed a trend to better performance with non-opioid treatment . Conclusion : Nonopioid based general anesthesia for Bariatric surgery is as effective as opioid one . There is no need to use opioids for such surgery especially that there was a trend to less pain in non-opioid anesthesia Seven hundred forty-nine community-dwelling , previously ambulatory , elderly patients who sustained a femoral neck or intertrochanteric fracture underwent prospect i ve follow-up to determine whether anesthetic technique ( spinal or general ) had an effect on inpatient morbidity and mortality , or 1-year mortality .  One hundred seven patients were excluded from the study as the anesthetic technique was " predetermined " based on a underlying medical condition . Of the remaining 642 patients , 362 ( 56.4 % ) received general and 280 ( 43.6 % ) received spinal anesthesia . Twenty ( 3.1 % ) patients died during hospitalization ; 73 ( 11.4 % ) patients developed one or more postoperative medical complications . The 1-year mortality rate was 12.1 % . There was no difference in inpatient morbidity and mortality , or 1-year mortality rates between patients receiving general or spinal anesthesia BACKGROUND Postoperative nausea and vomiting ( PONV ) remains a very troublesome concomitant phenomenon after general anesthesia . The present study was design ed to compare the efficacy and safety of ondansetron with metoclopramide for prophylaxis of PONV in patients undergoing major gynecological surgery . MATERIAL AND METHOD A prospect i ve , r and omized , double-blind , 382 female patients received either ondansetron 4 mg or metoclopramide 10 mg intravenous administration immediately before the induction of anesthesia . A st and ard general anesthetic technique was employed throughout . Nausea , vomiting , and safety assessment s were performed continuously during the 24 h postoperative period . RESULTS Of the 380 patients evaluated , significantly fewer ondansetron 4 mg treated patients ( 89/189 ; 47 % ) experienced postoperative nausea and /or vomiting compared with metoclopramide treated patients ( 115/ 191 ; 60 % ) during the study period ( p = 0.007 , 95 % CI : 1.07 , 1.66 ) . Postoperative adverse events were not significantly different between the groups . CONCLUSION Prophylactic use of ondansetron is more effective than metoclopramide for preventing PONV in patients undergoing major gynecological surgery OBJECTIVE Volatile anesthetics reduce the risk of myocardial infa rct ion and mortality in coronary artery surgery . Recently , the American College of Cardiology/American Heart Association Guidelines suggested the use of volatile anesthetic agents for the maintenance of general anesthesia during noncardiac surgery in patients at risk for perioperative myocardial ischemia , but no r and omized experience to document the cardioprotective effects of these agents exists in this setting . Therefore , the authors performed a prospect i ve , r and omized , controlled trial to compare the effects of sevoflurane versus total intravenous anesthesia , in terms of postoperative cardiac troponin I release in patients undergoing noncardiac surgery . DESIGN A r and omized , controlled trial . SETTING A teaching hospital . PARTICIPANTS Eighty-eight consecutive patients undergoing noncardiac surgery . INTERVENTIONS Patients were allocated r and omly to receive either volatile anesthetic ( 44 patients ) as the main anesthetic agent or total intravenous anesthesia ( TIVA ) ( 44 patients ) . MEASUREMENTS Postoperative cardiac troponin I release was measured as a marker of myocardial necrosis . Patients with detectable postoperative troponin I in the sevoflurane group ( 12/44 , 27.3 % ) were similar to those in the propofol group ( 9/44 , 20.5 % ; p = 0.6 ) . There was no significant reduction of postoperative median peak cTnI release ( 0.16 ± 0.71 ng/mL in the sevoflurane group compared with the TIVA group , 0.03 ± 0.08 ng/mL ; p = 0.4 ) . Three patients died at the 1-year follow-up for noncardiac causes ( 2 in the TIVA group ) . CONCLUSIONS In the authors ' experience , patients undergoing noncardiac surgery did not benefit from anesthesia based on halogenated anesthetics . Further studies are necessary to evaluate the cardioprotective effects of volatile agents in noncardiac surgery OBJECTIVES There are conflicting reports on the influence of different anesthetic techniques , such as regional versus general anesthesia , on intraoperative blood loss . The purpose of this study was to eluci date the effects of anesthetic technique on intraoperative blood loss in men undergoing radical retropubic prostatectomy ( RRP ) . METHODS One hundred patients undergoing RRP for prostate cancer were r and omly assigned to receive either epidural anesthesia ( EA ) , combined epidural and general anesthesia ( EG ) , or general anesthesia alone ( GA ) .  Intraoperative blood loss was calculated by using a formula that accounted for the volume and hematocrit of the fluid suctioned from the surgical field , blood absorbed on surgical pads , and the patient 's hematocrit . RESULTS Mean blood loss in the EA group ( 1490 + /- 90 mL ; mean + /- SEM ) was significantly less than mean blood loss in both the EG group ( 1810 + /- 100 mL ) and the GA group ( 1940 + /- 130 mL ) ( P = 0.01 ) . Blood loss was not different between the EG and the GA groups ( P = 0.7 ) . Significantly less blood was transfused during surgery in the EA group ( 730 + /- 50 mL ) compared with the EG ( 960 + /- 60 mL ) and GA ( 950 + /- 70 mL ) groups ( P = 0.02 ) . CONCLUSIONS Similar blood loss in patients receiving general anesthesia , either alone or when combined with epidural anesthesia , implies that epidural anesthesia did not reduce bleeding , but , rather , that general anesthesia increased blood loss
At the moment , the evidence available can not prove that neuraxial anesthesia is more effective and safer than general anesthesia for urological surgery .
There were insufficient data to pool the results relating to mortality , stroke , myocardial infa rct ion , length of hospitalization , quality of life , degree of satisfaction , postoperative cognitive dysfunction and blood transfusion requirements
CONTEXT AND OBJECTIVE Choosing the best anesthetic technique for urological surgery with the aim of mortality reduction remains controversial .
The objective here was to compare the effectiveness and safety of neuraxial anesthesia versus general anesthesia for urological surgery .