Articles: general-anesthesia.
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Randomized Controlled Trial Multicenter Study
The MAGIC trial: a pragmatic, multicentre, parallel, noninferiority, randomised trial of melatonin versus midazolam in the premedication of anxious children attending for elective surgery under general anaesthesia.
Child anxiety before general anaesthesia and surgery is common. Midazolam is a commonly used premedication to address this. Melatonin is an alternative anxiolytic, however trials evaluating its efficacy in children have delivered conflicting results. ⋯ ISRCTN registry: ISRCTN18296119.
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J Neurosurg Anesthesiol · Jan 2024
The Effect of Anesthetic Agent and Mean Arterial Pressure on Functional Outcome After General Anesthesia for Endovascular Thrombectomy.
The optimal general anesthetic (GA) technique for stroke patients undergoing endovascular thrombectomy (ET) is unclear. We compared favorable outcomes and mortality in patients receiving propofol or volatile GA during ET and assessed associations between mean arterial pressure (MAP) and outcome. ⋯ Favorable outcome rates were similar in stroke patients receiving propofol or volatile GA during ET. Propofol was associated with lower mortality, an effect magnified in patients that did not receive intravenous thrombolysis. MAP time/exposure thresholds were associated with outcome but independent of the anesthetic agent. Our data suggest that a difference in outcome related to an anesthetic agent may exist; this hypothesis needs to be tested in a prospective study.
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Review Meta Analysis Comparative Study
Comparison of Safety and Efficacy of Anesthesia Methods in Percutaneous Endoscopic Lumbar Discectomy: A Network Meta-Analysis.
Background: The objective of this study was to systematically evaluate the safety and efficacy of local anesthesia, general anesthesia, and epidural anesthesia in percutaneous endoscopic lumbar discectomy (PELD). Methods: We searched PubMed, EMBASE, and OVID databases for all relevant studies. All statistical analysis was performed using STATA 17.0. ⋯ Epidural anesthesia is most advantageous in anesthesia satisfaction and postoperative VAS scores. General anesthesia is most advantageous in postoperative ODI. In the future, more multicenter RCTs are needed to further compare the safety and effectiveness of different anesthesia methods in PELD.
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Review Meta Analysis
The effect of sugammadex on patient morbidity and quality of recovery after general anaesthesia: a systematic review and meta-analysis.
Residual neuromuscular block is associated with increased patient morbidity. Therefore prevention of residual neuromuscular block is an important component of general anaesthesia where neuromuscular blocking agents are used. Whereas sugammadex improves reversal based on neuromuscular twitch monitoring parameters, there have been no prospective, adequately powered definitive studies demonstrating that sugammadex is also associated with less patient morbidity. ⋯ PROSPERO database (CRD42022325858).
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Review Meta Analysis
General anesthesia versus conscious sedation for acute ischemic stroke endovascular therapy: A Meta Analysis of Randomized Controlled Trials.
Endovascular thrombectomy (E.V.T.) is the primary treatment for acute ischemic stroke (AIS). Nevertheless, the optimal choice of anesthetic modality during E.V.T. remains uncertain. This systematic review and meta-analysis aim to summarize existing literature from randomized controlled trials (RCTs) to guide the selection of the most appropriate anesthetic modality for AIS patients undergoing E.V.T. ⋯ G.A. had superior recanalization rates in AIS patients undergoing endovascular therapy, but functional outcomes, mortality, and NIHSS scores were similar. Secondary outcomes showed no significant differences, except for a higher risk of hypotension with G.A. More trials are required to determine the optimal anesthesia approach for thrombectomy in AIS patients.