Articles: general-anesthesia.
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Journal of neurosurgery · Jan 2025
Comparative StudyPipeline embolization device placement under local versus general anesthesia: a propensity score-matched study.
Pipeline embolization device (PED) placement for the treatment of intracranial aneurysms is safe and effective under general anesthesia (GA). However, GA is associated with certain risks, longer procedural time, and higher hospital cost. The authors aimed to compare clinical outcomes and hospital cost between GA and local anesthesia (LA) procedures in patients who underwent PED placement for intracranial aneurysm treatment. ⋯ PED placement under LA can achieve satisfactory outcomes similar to those of PED placement under GA; however, the use of LA reduces procedural time and hospital cost.
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The wide-awake local anesthesia no tourniquet (WALANT) technique, which is based on the local infiltration of lidocaine and epinephrine, is widely used in hand and wrist surgery. However, few studies have been conducted on the cost-benefit analysis of phalanx fracture surgery using the WALANT technique. This study aimed to investigate the clinical condition, as well as the time spent for anesthesia and operation. We also performed an economic analysis to compare general anesthesia, local anesthesia with a tourniquet, and the WALANT technique for plate fixation of phalanx fractures. ⋯ Open reduction with plate fixation of phalanx fractures using the WALANT technique or local anesthesia was cost-effective compared with general anesthesia. Patients who underwent phalanx fracture surgery using the WALANT technique experienced less pain on the first postoperative day because of the adequate tumescent technique and not using a tourniquet during surgery.
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Anesthesia and analgesia · Jan 2025
Optimal Maternal Ventilation During Laparotomy with General Anesthesia in Pregnancy in the Ovine Model.
General anesthesia during pregnancy is not uncommon, for example, for trauma surgery, cerclage, or cesarean delivery. Current recommendations are to maintain maternal partial pressure of carbon dioxide in arterial blood (paCO2) at 30 mm Hg, which is based solely on the average maternal paCO2 in awake pregnant women. However, there is no evidence that this target, compared to other targets, would enable optimal conditions for the fetus during general anesthesia. Maternal paCO2 can affect uterine blood flow, affinity of hemoglobin for oxygen, and fetal CO2 elimination. In this study, a range of potential targets of maternal paCO2 was investigated in the ovine model, aiming to determine which target is most conducive to physiological fetal blood gas values during laparotomy with general anesthesia. ⋯ This study provides experimental support for the clinical recommendation to maintain maternal paCO2 close to the physiologic value of 30 mm Hg during general anesthesia for maternal laparotomy in pregnancy as it is conducive to physiological fetal blood gas values. Given the lower bound of the 95% confidence interval, the possibility that a lower maternal paCO2 would improve fetal gas exchange cannot be excluded.