Regional Versus General Anesthesia in Surgical Patients with课件.pptVIP

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2016-03-20 发布于广东
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Regional Versus General Anesthesia in Surgical Patients with课件.ppt

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Regional Versus General Anesthesia in Surgical Patients with Chronic Obstructive Pulmonary Disease: Does Avoiding General Anesthesia Reduce the Risk of Postoperative Complications? Mark S. Hausman, Jr., MD, Elizabeth S. Jewell, MS, and Milo Engoren, MD Department of Anesthesiology, Division of Critical Care Medicine University of Michigan Health Systems, Ann Arbor, Michigan. Anesth Analg 2015;120:1405–12 Surgical patients with chronic obstructive pulmonary disease (COPD) are at increased risk of perioperative complications. These patients are more likely to require unplanned postoperative intubation, have a higher incidence of postoperative pulmonary infection, and have increased length of hospital stay compared with patients without COPD. Postoperative epidural analgesia for patients with COPD undergoing major abdominal surgery under general anesthesia has been shown to be beneficial in some patient populations. Epidural analgesia promoted better postoperative pulmonary function, reduced the risk of postoperative pulmonary infection, and improved 30-day mortality in patients with COPD. A review of 141 prospective, randomized trials comparing neuraxial versus general anesthesia demonstrated decreased mortality and decreased incidence of postoperative pulmonary and cardiac complications, renal failure, and deep venous thrombosis in the patients receiving neuraxial anesthesia. However, 3 more recent trials found modest to no benefit to epidural anesthesia and analgesia, and a very recent post hoc subgroup analysis of a large prospective trial of β-blockers found that neuraxial anesthesia was associated with increased adverse cardiovascular outcomes. Therefore, whether using regional (spinal, epidural, or peripheral nerve block) anesthesia and thus avoiding operative endotracheal intubation and mechanical ventilation improves outcomes in surgical patients with COPD remains unknown. We hypothesized that avoiding general anesthesia in patients with COPD would