胸部手术的外周麻醉与区域麻醉的利用和结果:ACS-NSQIP分析
Kayla M Knuf1, Matthew D Smith1, Raymond B Kroma2
1Department of Anesthesiology, Brooke Army Medical Center, Fort Sam Houston, TX; Departments Anesthesiology, Uniformed Services University, Bethesda, MD.
Journal of cardiothoracic and vascular anesthesia
|January 7, 2025
概括
外围神经阻塞在胸部手术中越来越多地使用,与外周麻醉相比,它们与更好的患者结果有关,包括更短的住院时间和减少发病率和死亡率.
科学领域:
- 麻醉学 麻醉学
- 胸部外科手术 胸部外科手术
- 区域麻醉地区麻醉
背景情况:
- 外周麻醉一直是胸部外科手术中全身麻醉的常见补充剂.
- 区域麻醉技术,特别是外围神经阻塞,已经获得了吸引力.
- 这些麻醉辅助剂之间的比较结果需要持续评估.
研究的目的:
- 分析外周麻醉与区域麻醉在胸部手术中作为全身麻醉的附加剂的使用时间趋势.
- 为了比较这些麻醉方法之间的停留时间,整体发病率,严重发病率和死亡率.
主要方法:
- 2014年至2022年美国外科医生学院国家外科质量改进项目 (NSQIP) 数据库的回顾性分析.
- 包括18433名在800多家美国医院接受胸部手术的成年患者.
- 倾向分数加权的通用线性模型被用于比较分析.
主要成果:
- 在研究期间,外围神经阻断的利用率显著增加,特别是在带切除和肺切除方面.
- 接受外周神经阻塞的患者与外周麻醉 (5.48天) 相比,住院时间更短 (3.91天).
- 外围神经阻塞与较低的严重发病率 (OR 0.81) 和死亡率 (OR 0.74) 相关.
结论:
- 随着时间的推移,外围神经阻塞作为胸部外科手术的辅助工具的使用量有所增加.
- 周围神经阻塞在这个群体中,与外周麻醉相比,显示出优异的患者结果.
- 需要进一步的研究来证实这些发现,考虑到外科手术方法和机构变化等混因素.
相关概念视频
Local Anesthetics: Clinical Application as Epidural Anesthesia
409
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
409
Local Anesthetics: Clinical Application as Spinal Anesthesia
576
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
576
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
355
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
One of the advantages of...
355
General Anesthesia: Overview
190
Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
190
Endoscopic Studies II: Thoracocentesis
199
Thoracentesis(Thoracocentesis), commonly known as pleural tap, is a medical procedure where a 22 gauge needle is inserted into the pleural space, the area between the lung and chest wall. This procedure is commonly performed to diagnose or treat various respiratory disorders.
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
199


