spinal or general anesthesia? copyright © 2014, all rights reserved from the publishers of
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Spinal or General Anesthesia?
COPYRIGHT © 2014, ALL RIGHTS RESERVED
From the Publishers of
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@corncobgeneral
Help settle a debate.I remember that the less anesthesia my pt needs the better. Hv always thoughtspinal btr than general if pt cld tolerate. A colleague disagrees and says no diff re outcome. Whose side are U 2 on ?
@corncobgeneral
Help settle a debate.I remember that the less anesthesia my pt needs the better. Hv always thoughtspinal btr than general if pt cld tolerate. A colleague disagrees and says no diff re outcome. Whose side are U 2 on ?
Anesthesia
Anesthesia: General vs Regional
No difference morbidity - mortalityAdvantages of regional:
Less myocardial, respiratory depression Avoid endotracheal intubation (autonomic stimulation)
Disadvantages of regional: Anxiety catecholamine release MVO2 Spinal vasodilation BP
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Meta analysis (141 trials, 9559 patients)Studies are heterogeneous: Meta analysis validity?Meta analysis overestimates “treatment effect” (positive
trial publication bias)No patient randomizationPostop management has changed making benefit of
neuraxial anesthesia less important
Rodgers A, et al. Reduction of postoperative mortality and morbidity withepidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000;
321: 7275.
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Ballantyne, Jane C. et al. Does the evidence support the use of spinal and epidural anesthesia for surgery? Journal of Clinical Anesthesia. 2005;17: 382 - 391
Benefits of spinal and epidural anesthesia and analgesia: Less blood loss Superior pain control Decreased ileus Fewer pulmonary complications Decreased ileus
No mortality benefitNo definite improvement in cardiac outcomeNo fewer thromboembolic events when DVT prophylaxis
used
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The Guys reply text
General vs. Spinal / epidural anesthesia : no difference in cardiac mortality
Spinal / epidural may have fewer non-cardiac complications: pulmonary, pain control
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