Compared with general anaesthesia , a central neuraxial block may reduce the zero to 30-day mortality for patients undergoing surgery with intermediate to high cardiac risk ( level of evidence , moderate ) .
BACKGROUND Various beneficial effects derived from neuraxial blocks have been reported .
However , it is unclear whether these effects have an influence on perioperative mortality and major pulmonary/cardiovascular complications .
OBJECTIVES Our primary objective was to summarize Cochrane systematic review s that assess the effects of neuraxial blockade on perioperative rates of death , chest infection and myocardial infa rct ion by integrating the evidence from all such review s that have compared neuraxial blockade with or without general anaesthesia versus general anaesthesia alone for different types of surgery in various population s. Our secondary objective was to summarize the evidence on adverse effects ( an adverse event for which a causal relation between the intervention and the event is at least a reasonable possibility ) of neuraxial blockade .
Reducing Perioperative Blood Loss in Patients Undergoing Total Hip Arthroplasty
In this prospect i ve , r and omised , double-blind study , we investigated the effect of epidural anaesthesia and an antifibrinolytic agent , Aprotinin ( 500,000 KIU in bolus before surgery and 500,000 KIU h-1 in drip form during surgery ) , on intra and postoperative blood loss and transfusion requirements in total hip arthroplasty . Sixty patients were allocated r and omly to four groups ( A : epidural + general anesthesia + Aprotinin , B : epidural + general anesthesia + placebo ( equal volume ) , C : general anaesthesia + Aprotinin , D : general anaesthesia + placebo ) . Postoperative analgesia : epidural analgesia in groups A and B , systemic analgesia with opiates in groups C and D. Blood loss during surgery was monitored and salvaged with the Compact-A Dideco , and postoperative blood loss with the BT 797 Recovery Dideco for the first 24 hours . Perioperative blood loss , frequency and quantity of transfusions were significantly higher in group D ( p < 0.0001 ) . Total blood loss was reduced by 31.3 % by epidural anaesthesia , 20.4 % by Aprotinin and 51.4 % using a combination of the two techiniques
Compared with general anaesthesia , a central neuraxial block may reduce the zero to 30-day mortality for patients undergoing surgery with intermediate to high cardiac risk ( level of evidence , moderate ) .
BACKGROUND Various beneficial effects derived from neuraxial blocks have been reported .
However , it is unclear whether these effects have an influence on perioperative mortality and major pulmonary/cardiovascular complications .
OBJECTIVES Our primary objective was to summarize Cochrane systematic review s that assess the effects of neuraxial blockade on perioperative rates of death , chest infection and myocardial infa rct ion by integrating the evidence from all such review s that have compared neuraxial blockade with or without general anaesthesia versus general anaesthesia alone for different types of surgery in various population s. Our secondary objective was to summarize the evidence on adverse effects ( an adverse event for which a causal relation between the intervention and the event is at least a reasonable possibility ) of neuraxial blockade .