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1.
The aim of our study was to determine the subjective sensation of caesarean section under regional anaesthesia. We performed a prospective, observational study of 205 patients undergoing caesarean section under regional anaesthesia in a UK district general hospital. Patients were asked open and closed questions relating to their physical and emotional experience during the operation. Seventy-three percent of patients chose the phrase "pulling and pushing" to describe the physical sensation of the operation, 75% described the experience as pleasant, and only 4% described it as unpleasant, the rest saying it was neither pleasant nor unpleasant. Ninety-six percent said they would by choice have any future caesarean section under regional anaesthesia, 3% were undecided and 1% said they would prefer a general anaesthetic next time. This study provides important precise information that may be given to patients before caesarean section under regional anaesthesia. We believe it will help minimise preoperative fears and increase patients' ability to make informed decisions about their care. 相似文献
2.
Paraskevi Mavridou Varvara Dimitriou Adamantia Manataki Elena Arnaoutoglou Georgios Papadopoulos 《Journal of anesthesia》2013,27(1):104-108
Purpose
Patients express high anxiety preoperatively, because of fears related to anesthesia and its implications. The purpose of this survey was to gain insight into these fears and to study whether they are affected by patients’ sex, age, education, or previous experience of anesthesia.Methods
Questionnaires with fixed questions were distributed to consenting, consecutive surgical patients before the pre-anesthetic visit. The questionnaires included patients’ demographics and questions related to their fears about anesthesia.Results
Four-hundred questionnaires were collected and analyzed. Eighty-one percent of patients experience preoperative anxiety. The main sources of their anxiety were fear of postoperative pain (84 %), of not waking up after surgery (64.8 %), of being nauseous or vomiting (60.2 %), and of drains and needles (59.5 %). Patients are less concerned about being paralyzed because of anesthesia (33.5 %) or of revealing personal issues (18.8 %). Gender seems to affect patients fears, with women being more afraid (85.3 vs. 75.6 % of men, p = 0.014). The effects of patients’ age, level of education, and previous experience of anesthesia are minor, except for individual questions. Sixty-three percent of our patients (mostly women 67.4 vs. 57.4 % of men, p = 0.039) talk about these fears with their relatives, although a vast majority of 95.5 % would prefer to talk with the anesthesiologist and be reassured by him.Conclusion
All patients, mostly women, express fears about anesthesia; this fear leads to preoperative anxiety. Slight differences are observed for some individual questions among patients of different sex, education level, and previous experience of anesthesia. 相似文献3.
J.S. Lavado D. Gonçalves L. Gonçalves C. Sendino E. Valente 《Revista espa?ola de anestesiología y reanimación》2019,66(4):199-205
Introduction and objectives
Regional anaesthesia (RA) has gained popularity due to its numerous benefits and increasing safety. Yet, often patients refuse this procedure and prefer general anaesthesia (GA). This study aimed to investigate variables (demographic factors, safety perception of GA and RA, patients’ fears, anxiety, and knowledge) related to patients’ anaesthetic preference.Material and methods
Participants were patients aged 18 years or more proposed to an anaesthesia appointment for preoperative assessment. Patients completed a written questionnaire before meeting the anaesthesiologist. The questionnaire asked about their preferences, fears and perceptions about RA.Results
One hundred and 2 patients agreed to participate. Mean age was 52.6 ± 13.5 years, 57.8% were female and 44.5% had at least 12 years of education. Given the choice, 54.0% would prefer GA and 20.7% said they would refuse RA if proposed by the anaesthesiologist. Among patients who already experienced neuroaxial anaesthesia, 40.0% said they did not wish to repeat it. Patients who preferred GA over RA perceived GA to be safer than RA and expressed more anxiety towards being awake during surgery and more fear of feeling pain during surgery, of having back pain, and of needle puncture. Results also suggested that patients are unaware of RA's real risks and benefits.Conclusions
Knowing patients’ fears is essential for the anaesthesiologist address their patients’ needs. Anaesthesiologists should work on improving general population perspective and knowledge about RA. 相似文献4.
Preoperative parental anxiety predicts behavioural and emotional responses to induction of anaesthesia in children 总被引:5,自引:0,他引:5
Joan C. Bevan Celeste Johnston Margaret J. Haig Guy Tousignant Simon Lucy Vanessa Kirnon Irene K. Assimes Ruben Carranza 《Journal canadien d'anesthésie》1990,37(2):177-182
Parental presence at induction of anaesthesia is desirable if it makes the child happier and more cooperative. This study evaluated the emotional and behavioural responses of children to being accompanied by a parent at induction of anaesthesia in a paediatric day-care surgical centre. One hundred and thirty-four patients (aged 2-10 yr, ASA physical status I or II) were divided into two groups by day of surgery, to have a parent present at induction of anaesthesia (treatment group), or to be unaccompanied (control group). Before, and at one week after surgery, the child's fears and behaviour were scored by the Hospital Fears Inventory (HFI) and Behavioural Questionnaire (BQ), and parental anxiety by the Parents' Questionnaire (PQ) before and at one week after surgery. The Global Mood Scale (GMS) was used to assess the child's behaviour and the Visual Analogue Scale (VAS) to assess the parent's anxiety on arrival for surgery and at induction of anaesthesia. All patients and parents were disturbed by the experience, but to the same degree in the treatment and control groups. Subgroups of "calm" and "anxious" parents were identified by a median split of their preoperative VAS scores. Children in the "calm-treatment," "calm-control" and "anxious-control" subgroups were similarly upset at induction. Children in the "anxious-treatment" subgroup were the most disturbed at induction, and significantly more than those in the "anxious-control" subgroup. Preoperative parental anxiety levels also correlated with the child's fears and behaviour one week after surgery.(ABSTRACT TRUNCATED AT 250 WORDS) 相似文献
5.
Background
Increasing attention to psychological determinants may be useful in identifying patients undergoing total knee arthroplasty who may be at risk for poor postoperative outcome. However, little is known about the relationship between personality as a comprehensive reflection of stable psychological states and outcome after total knee arthroplasty. The purpose of this study was to describe the relationship between patients’ diverse personalities and clinical outcomes.Methods
We recruited 387 patients undergoing primary total knee arthroplasty to complete the Eysenck Personality Questionnaire (EPQ) and collected demographic information before surgery. Prior to and 6 months after surgery, we used two validated functional instruments to assess satisfaction rate—the Short Form Health Survey of 36 questions (SF-36), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).Results
Neuroticism, especially the classic type, tended to be displayed more frequently by women and younger patients. A statistically significant positive relationship was seen between outcome scores and extraversion levels in rating scales; there was a negative relationship between outcome scores especially from the SF-36 Mental Component Summary (MCS), WOMAC pain scores, and neuroticism subscales scores. Among four types of personality, sanguine patients displayed the best clinical outcomes and melancholic patients the worst. Despite good clinical outcomes, including in pain relief and functional improvement for choleric patients, satisfaction rate was unexpectedly the lowest.Conclusions
Our results may help clinicians identify patients at risk for poor postoperative clinical outcomes and thus proceed with better communication with patients. Also, our results may indicate conducting individual attention during the perioperative period based on patient personality determined according to the EPQ in order to help attain better recovery. 相似文献6.
Transurethral resection (TUR) is a surgical operation generally performed in elderly patients, afflicted with polymorbidity and a high risk for anaesthesia. We studied 1351 transurethral resections during the years 1974-1984: 840 of these procedures were done under regional block--spinal as well as epidural--and 511 in general anaesthesia. Results and complications were related to the applied technique of anaesthesia. Considering that especially the very old patients belong to the regional anaesthesia group where general anaesthesia is known to be dangerous, the results of this study confirm definitely that regional anaesthesia is at present the most appropriate technique for TUR surgery. 相似文献
7.
Many anaesthetists consider neurological disorders of all kinds as a contraindication for regional anaesthesia particularly for neuraxial techniques. This hesitation is partly rooted in fears of medicolegal problems but also in the heterogeneous literature. Therefore, the present topical review is an attempt to describe the feasibility and the risks of neuraxial techniques in patients with spinal injury, anatomical compromise, chronic back pain or previous spinal interventions, ranging from 'minor' types like epidural blood patches to major surgery such as Harrington fusions. Most reviews and case reports were describing experiences in obstetrics as these patients are more likely to insist on neuraxial blocks. In the acute phase of new neurologic injury, general anaesthesia may be the technique of choice to prevent further haemodynamic and respiratory deterioration. After the acute phase, current evidence is mostly reassuring with respect to the risks of neuraxial blocks as they may even be recommendable in some conditions. Ultrasound technology may be of additional help to increase the success rate. A careful pre-operative examination remains mandatory, while patients should be sufficiently informed about technical aspects and possible relapses or progression of their disease. When necessary, patients should have additional technical and clinical examinations as close as possible to surgery to establish the actual pre-operative status. Most patients may benefit more from spinal techniques rather than from less reliable epidural ones. High concentrations and volumes of local anaesthetics should be avoided at all times, especially in patients with nerve compression, large disc herniation or spinal stenosis. 相似文献
8.
Anaesthetic practice and postoperative pulmonary complications 总被引:7,自引:0,他引:7
T. Pedersen MD. J. Viby-Mogensen C. Ringsted 《Acta anaesthesiologica Scandinavica》1992,36(8):812-818
The aim of this study was to identify risk factors associated with postoperative pulmonary complications. The influence of the anaesthetic technique was evaluated (i.e. general contra regional anaesthesia and long contra intermediately acting muscle relaxants (pancuronium and atracurium)) taking into account the patient's age, the presence or absence of chronic obstructive lung disease (preoperative risk factors), the type of surgery and the duration of anaesthesia (perioperative risk factors). Seven thousand and twenty-nine patients undergoing abdominal, urological, gynaecological or orthopaedic surgery were included in the study. A total of 290 patients (4.1%) suffered from one or more postoperative pulmonary complications. Six thousand and sixty-two patients received general anaesthesia and 4.5% of these had postoperative pulmonary complications. Of the patients admitted to major surgery receiving pancuronium, 12.7% (135/1062) developed postoperative pulmonary complications, compared to only 5.1% (23/449) receiving atracurium (P < 0.05). When stratified for type of surgery and duration of anaesthesia, conventional statistics showed no difference between pancuronium and atracurium as regard postoperative pulmonary complications. However, a logistic regression analysis indicated that long-lasting procedures involving pancuronium entailed a higher risk of postoperative pulmonary complications than did other procedures. In patients having regional anaesthesia, only 1.9% (18/967) developed postoperative pulmonary complications (P < 0.05 compared to general anaesthesia). However, when stratified for type of surgery there was a significantly higher incidence of postoperative pulmonary complications only in patients undergoing major orthopaedic surgery under general anaesthesia, 11.5% compared to 3.6% in patients given a regional anaesthesia.(ABSTRACT TRUNCATED AT 250 WORDS) 相似文献
9.
Objective Postoperative length of stay (LOS) is an important outcome after colorectal cancer surgery. The aim of this study was to evaluate the putative effects of personality, mood, coping and quality of life on LOS. Method A consecutive series of 110 eligible patients undergoing elective resection for colorectal cancer were invited to participate in the study. A battery of psychometric questionnaires including the Hospital Anxiety and Depression Scale, the Functional Assessment of Cancer Therapy (colorectal), the Courtauld Emotional Control Scale, the Positive and Negative Affectivity Scale and the Eysenck Personality Questionnaire (EPQ) were administered 5–12 days before surgery. Nonparametric correlations were computed for psychometric scores, demographic variables and the LOS. Factors found to be significantly correlated on this analysis were entered into a multiple regression model to determine the independent predictors of LOS. Results One hundred and four patients with colorectal cancer participated. Seventy were male (67%) and the mean age was 68 years (range 39–86). The median LOS was 10 days (range 4–108). LOS was negatively correlated with pre- and postoperative albumin levels, PANAS +ve affect, Functional Assessment of Cancer Therapy questionnaire with the colorectal module functional well-being score and EPQ extroversion score. LOS was strongly positively correlated with postoperative morbidity. LOS was positively correlated with CECS anger score, age and being male. Postoperative morbidity (β = 0.379, P = 0.007) and extroversion (β = −0.318, P = 0.05) were independent predictors of LOS. Conclusion Personality as measured by EPQ predicts postoperative LOS in patients with colorectal cancer. Extroverts have a higher pain threshold and this may be part of the explanation. 相似文献
10.
Cost-effectiveness analysis of local, regional and general anaesthesia for inguinal hernia repair using data from a randomized clinical trial 总被引:7,自引:0,他引:7
BACKGROUND: Inguinal hernia repair is a common operation in general surgery and can be performed under local, regional or general anaesthesia. This multicentre randomized trial was undertaken to compare the costs of the three anaesthetic methods in general surgical practice. METHODS: Between January 1999 and December 2001, 616 patients at ten hospitals who underwent primary inguinal hernia repair were randomized to local, regional or general anaesthesia. The primary endpoints were direct costs. Secondary endpoints were indirect costs and recurrence rates. RESULTS: Total intraoperative, as well as total early postoperative, data showed local anaesthesia to have significant cost advantages over regional and general anaesthesia (P < 0.001). The advantage was also significant for total hospital and total healthcare costs (P < 0.001), whereas there was no significant difference between regional and general anaesthesia. CONCLUSION: The use of local anaesthesia for inguinal hernia repair was significantly less expensive than regional or general anaesthesia. 相似文献
11.
BACKGROUND AND OBJECTIVES: The public is not well informed about matters relating to regional anesthesia. Previous studies concerning regional anesthesia have involved patients, surgeons, and anesthesiologists. This study is the first in-depth survey of the attitudes of the general public toward a number of commonly perceived fears about regional anesthesia. METHODS: A province-wide telephone survey was conducted in Alberta, Canada. The sample surveyed was representative of the adult population of the province and included an equal balance of urban and rural participants. General and regional anesthesia were defined, a scenario involving major knee surgery was described, and participants were asked to choose between regional and general anesthesia. Respondents were then questioned so their attitudes toward commonly perceived fears associated with regional anesthesia could be assessed. RESULTS: A total of 1,216 people were surveyed. A preference for regional or general anesthesia was not expressed in this scenario. Approximately 27% of respondents were very concerned about permanent paralysis, back injury, perioperative pain, seeing the surgical procedure, and the prospect of a needle in the back. Only 6% of individuals were concerned about headaches. CONCLUSIONS: The public's fears and conceptions about regional anesthesia are greatly distorted. The anesthesia community has not been successful in keeping the public informed about regional anesthesia. Future anesthesia-related educational programs should address the concerns of the public about anesthesia matters, particularly regional anesthesia. 相似文献
12.
Platelet activation in major surgical stress: influence of combined epidural and general anaesthesia 总被引:1,自引:0,他引:1
O. NAESH I. HINDBERG J. FRIIS C. CHRISTIANSEN T. PEDERSEN J. TRAP–JENSEN J. O. LUND 《Acta anaesthesiologica Scandinavica》1994,38(8):820-825
Platelets are activated in surgery releasing vasoactive substances such as serotonin and thromboxane. Platelets become temporarily hypoaggregable during surgery followed by a postoperative hyperaggregability. Local anaesthetics are known to inhibit platelet function but earlier reports are conflicting. In order to study the impact of the combined use of general and regional anaesthesia on platelet function during major surgery 16 otherwise healthy patients were randomised to either general anaesthesia (GA) (n = 8) or GA combined with epidural anaesthesia (GA + EPI) (n = 8) for elective upper abdominal surgery. Cyclic 3'5'adenosine monophosphate, plasma glucose, plasma Cortisol and the rate pressure product (RPP) were markers of the stress response. ADP–induced platelet aggregation and the release products β-thromboglobulin, serotonin and thromboxane 2 were measured in plasma before and during as well as for 3 days after surgery. 相似文献
13.
Tan CS Kumar CM Fanning GL Lai YC Au Eong KG 《European journal of anaesthesiology》2006,23(4):276-281
BACKGROUND AND OBJECTIVE: To assess the knowledge, beliefs and attitudes of anaesthesia providers on the patients' possible intraoperative visual experiences during cataract surgery under local anaesthesia. METHODS: Anaesthesia providers from the Ophthalmic Anaesthesia Society (USA); British Ophthalmic Anaesthesia Society (UK); Alexandra Hospital, National University Hospital, Tan Tock Seng Hospital, Singapore General Hospital and Changi General Hospital (Singapore) were surveyed using a structured questionnaire. RESULTS: A total of 146 anaesthesiologists (81.6%), 10 ophthalmologists (5.6%) and 23 nurse anaesthetists (12.8%) responded to the survey. Most respondents believed that patients would experience light perception and many also felt that patients might encounter other visual sensations such as movements, flashes, colours, surgical instruments, hands/fingers and the surgeon during the surgery. A significantly higher proportion of anaesthesia providers with previous experience of monitoring patients under topical anaesthesia believed that patients might experience the various visual sensations compared to those who have not previously monitored. For both topical and regional anaesthesia, anaesthesia providers who routinely counsel their patients are (1) more likely to believe that preoperative counselling helps or (2) were previously told by patients that they could see intraoperatively and/or that they were frightened by their visual sensations. These findings were statistically significant. CONCLUSIONS: The majority of anaesthesia providers in the USA, UK and Singapore are aware that patients may experience a variety of visual sensations during cataract surgery under regional or topical anaesthesia. Those who have previously managed patients undergoing cataract surgery under topical anaesthesia are more likely to believe this compared to those who have not. 相似文献
14.
Fifteen patients with bilateral carpal tunnel syndrome underwent surgery using intravenous regional anaesthesia (IVRA) on one hand and local infiltration anaesthesia (LA) on the other. All 30 carpal tunnel releases were performed without complication. Patient tolerance for IVRA and LA was similar. Six patients preferred the LA, eight preferred IVRA and one had no preference. Tourniquet time averaged 16 minutes when LA was used and 24 minutes with IVRA (P<0.05). Use of local anaesthesia allows more expeditious surgery and limits costs, but intravenous regional anaesthesia is recommended if epineurotomy, internal neurolysis or flexor tenosynovectomy are planned. 相似文献
15.
Summary The treatment of inguinal hernias using laparoscopy can be performed without violating the peritoneal cavity using the totally extraperitoneal technique (TEP). This procedure is usually done with general anaesthesia. The objective of this article is to evaluate the general and regional anaesthesia techniques in extraperitoneal laparoscopic surgery for treating inguinal hernias in an outpatient surgery unit. A prospective clinical study of 131 patients with uncomplicated inguinal hernia undergoing surgery using extraperitoneal laparoscopy was completed. Two study groups were established according to the anaesthesia technique used: general (n = 90) and regional (n = 41). We analyzed clinical data (age, sex, associated diseases, prior abdominal surgery, site and hernia type), intra-operative complications (bleeding, peritoneal rupture, subcutaneous emphysema, reconversion rate, haemodynamic stability, respiratory problems and degree of satisfaction), postoperative complications (haematomas, urinary retention, post lumbar puncture headaches, nausea, vomiting and postoperative pain) and recurrence rate. General anaesthesia was used significantly more in the cases of prior infra-umbilical surgery and bilateral hernias (p < 0.05). Statistically significant differences were not shown for intra- or post-operative complications. The rate of conversion was higher for general (5.5%) than for regional anaesthesia (2.4%). Recurrence was detected only in the regional anaesthesia group. In conclusion, general anaesthesia is not required for the performance of extraperitoneal laparoscopic inguinal hernia repair; regional anaesthesia is a safe and efficient alternative. 相似文献
16.
Objective
This study addresses two questions concerning open inguinal hernia repair patients: (1) are there differences in psychological traits between patients opting for local vs. general anaesthesia and (2) assuming comparable operations, are there any differences between the two groups during surgery and postoperative recovery?Methods
A total of 69 male patients aged between 18 and 80 took part in the study. After having been briefed about anaesthesia, they opted for either local (n=40) or general anaesthesia (n=29). In order to determine psychological traits, patients filled out questionnaires before the operation [NEO Five-Factor-Inventory (NEO-FFI) and the Stress Coping Questionnaire (SVF)] and the Anaesthesiological Questionnaire (ANP) after the operation. Data about the surgery (duration of anaesthesia and operation, blood pressure and heart rate) and the convalescence period (time spent in recovery room, length of stay in hospital) were also recorded. The patients’ information processing skills were measured preoperatively and postoperatively using the “Trail Making Test”.Results
Patients preferring local anaesthesia were significantly older than those who chose general anaesthesia. Therefore two similar age groups were formed by using the method of matched samples (n=2×26). Between these groups no significant differences were found with reference to psychological traits, but markedly extraverted patients favoured local anaesthesia. There were no differences in the duration of anaesthesia and surgery. Local anaesthesia patients spent less time in the recovery room and in hospital than general anaesthesia patients. Postoperatively, the cognitive state and the satisfaction with the anaesthesia were comparable between both groups.Conclusion
Psychological traits do not have a significant impact on the choice of either local or general anaesthesia. However, highly extraverted patients prefer local anaesthesia while extreme introverts prefer general anaesthesia. Our findings suggest that local anaesthesia will become more widely adopted for the repair of groin hernia. Future studies should focus on optimising the perioperative care for patients who choose local anaesthesia. 相似文献17.
We conducted a postal survey of 221 anaesthetists in the Oxford region to determine their views and actual clinical practice regarding regional anaesthesia in adult patients undergoing limb surgery, when a combined regional and general anaesthetic was planned. Of the 162 respondents (73.3%), 142 (87.6%) regularly practised regional blocks for limb surgery in adult patients. For all the regional anaesthetic techniques in question, more anaesthetists felt it was safer to perform these blocks before induction of general anaesthesia than after induction. However, their actual practice varied markedly from their views, with more anaesthetists performing these blocks after general anaesthesia. Overall, trainees performed blocks before induction of general anaesthesia more often than consultants (p = 0.047). 相似文献
18.
Does anaesthesia cause postoperative cognitive dysfunction? A randomised study of regional versus general anaesthesia in 438 elderly patients 总被引:19,自引:0,他引:19
Rasmussen LS Johnson T Kuipers HM Kristensen D Siersma VD Vila P Jolles J Papaioannou A Abildstrom H Silverstein JH Bonal JA Raeder J Nielsen IK Korttila K Munoz L Dodds C Hanning CD Moller JT;ISPOCD 《Acta anaesthesiologica Scandinavica》2003,47(3):260-266
BACKGROUND: Postoperative cognitive dysfunction (POCD) is a common complication after cardiac and major non-cardiac surgery with general anaesthesia in the elderly. We hypothesized that the incidence of POCD would be less with regional anaesthesia rather than general. METHODS: We included patients aged over 60 years undergoing major non-cardiac surgery. After giving written informed consent, patients were randomly allocated to general or regional anaesthesia. Cognitive function was assessed using four neuropsychological tests undertaken preoperatively and at 7 days and 3 months postoperatively. POCD was defined as a combined Z score >1.96 or a Z score >1.96 in two or more test parameters. RESULTS: At 7 days, POCD was found in 37/188 patients (19.7%, [14.3-26.1%]) after general anaesthesia and in 22/176 (12.5%, [8.0-18.3%]) after regional anaesthesia, P = 0.06. After 3 months, POCD was present in 25/175 patients (14.3%, [9.5-20.4%]) after general anaesthesia vs. 23/165 (13.9%, [9.0-20.2%]) after regional anaesthesia, P = 0.93. The incidence of POCD after 1 week was significantly greater after general anaesthesia when we excluded patients who did not receive the allocated anaesthetic: 33/156 (21.2%[15.0-28.4%]) vs. 20/158 (12.7%[7.9-18.9%]) (P = 0.04). Mortality was significantly greater after general anaesthesia (4/217 vs. 0/211 (P < 0.05)). CONCLUSION: No significant difference was found in the incidence of cognitive dysfunction 3 months after either general or regional anaesthesia in elderly patients. Thus, there seems to be no causative relationship between general anaesthesia and long-term POCD. Regional anaesthesia may decrease mortality and the incidence of POCD early after surgery. 相似文献
19.
Tsuchiya M Asada A Ryo K Noda K Hashino T Sato Y Sato EF Inoue M 《Acta anaesthesiologica Scandinavica》2003,47(8):939-943
BACKGROUND: It is known that auditory input, such as comforting music or sound, blunts the human response to surgical stress in conscious patients under regional anaesthesia. As auditory perception has been demonstrated to remain active under general anaesthesia, playing comforting sounds to patients under general anaesthesia might also modulate the response of these patients to surgical stress. METHODS: Fifty-nine patients scheduled for laparoscopic cholecystectomy were anaesthetized with propofol general anaesthesia in combination with epidural anaesthesia. Natural sounds, chosen preoperatively by each patient as being comforting, were played to 29 patients using headphones during surgery (S group) and the remainder of the patients (n = 30) were fitted with dummy open-type headphones (N group). We compared the haemodynamic change during anaesthesia and the acceptability of anaesthetic practice between the two groups in a randomized double-blind design. RESULTS: There were no differences in haemodynamics between the S and N groups during surgery. During the emergence from anaesthesia, the mean blood pressure and heart rate gradually increased; both parameters were significantly higher in the N group than in the S group. Postoperatively, patients in the S group perceived the experience of anaesthesia as significantly more acceptable than did those in the N group. CONCLUSION: These findings indicate that allowing patients comforting background sounds during general anaesthesia may blunt haemodynamic changes upon emergence from general anaesthesia and increase the acceptability of the experience of anaesthesia. 相似文献
20.
Gulur P Nishimori M Ballantyne JC 《Best Practice & Research: Clinical Anaesthesiology》2006,20(2):249-263
The regional versus general anaesthesia debate is an age-old debate that has brought about few clear answers. Most concur that multiple factors including the patient, the surgery, the method of regional and general anaesthesia, and the quality of perioperative care, all influence surgical outcome. In this age of evidence-based medicine, the heterogenous data available need to be reconciled with the advances in perioperative care and the significant decline in complications associated with the surgical process as a whole. This review considers general issues such as the type of available evidence, and its limitations, particularly with regard to the relatively broad question of neuraxial versus general anaesthesia. It then assesses current evidence on regional versus general anaesthesia for specific scenarios such as hip fracture surgery, carotid endarterectomy, Caesarean section, ambulatory orthopaedic surgery, and postoperative cognitive dysfunction in elderly patients after non-cardiac surgery. 相似文献