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 .
Post-operative recovery after inguinal herniotomy in ex-premature infants: comparison between sevoflurane and spinal anaesthesia.
We prospect ively studied the post-operative recovery profile of 28 ex-premature infants undergoing inguinal herniotomy . All infants had a post-conceptual age of less than 46 weeks at the time of surgery and were r and omized to receive either sevoflurane ( group 1 , 14 patients ) or spinal anaesthesia ( group 2 , 14 patients ) . All patients received supplemental caudal analgesia before skin incision . Cardiorespiratory function was continuously recorded in all patients before and after surgery . A blinded observer analysed each paired recording for predefined episodes of apnoea , hypoxaemia or bradycardia and the reports were used to compare the two groups . Spinal anaesthesia was attempted unsuccessfully in four patients in group 2 . Five patients in group 1 demonstrated an ' excess ' number of episodes ( median 4 , range 3 - 12 ) of clinical ly silent post-operative cardiorespiratory complications . ( ' Excess ' in our study was defined as a 3-fold or greater increase in the number of post-operative episodes of bradycardia or apnoea relative to pre-operative occurrence ) . Three of these patients had pre-existing abnormal respiratory function and accounted for 80 % of the episodes ( 26/32 ) of post-operative bradycardia and all five episodes of post-operative apnoea identified . All episodes of bradycardia and apnoea were temporally unrelated . None of the remaining patients in group 2 demonstrated an unacceptable number of post-operative cardiorespiratory complications . Our limited study suggests that general anaesthesia with an inhalational agent such as sevoflurane may induce or unmask abnormalities of cardiopulmonary function in predisposed infants . Spinal anaesthesia may be preferable but it is potentially stressful for the infant and associated with a clinical ly significant failure rate
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 .