2 research outputs found
Awareness with Recall During General Anesthesia: A Cross-Sectional Study
No full textBackground: Accidental awareness and recall a well-known complication of anesthesia and sedation despite advancements in monitoring, drugs, and techniques. This study aimed to determine the prevalence and factors of awareness with recall (AWR) during general anesthesia in a tertiary care hospital.
Methods: A cross-sectional study was conducted at Maqsood Medical Center Peshawar from April to October 2022, with a total of 383 patients ≥18 years, in good neurological health, and having ASA Physical Status I, II, III, IV undergoing elective general anesthesia-based procedures were included through a convenience sampling technique. Data was collected by administering the Brice questionnaire for structured interviews one hour after admission in PACU after assessing responsiveness. Data was analyzed using SPSS 26 with p<0.05 considered significant.
Results: The mean age of the study participants was 40.93+05.2 years. The Incidence of awareness was found 7(1.8%) out of which 8(2.1%) experienced pain, 7(1.8%), being touched, 7(1.8%), hearing sounds, 8(2.1%), unable to speak 8(2.1%), feeling of paralysis, 6(1.6%) experienced tube being inside the throat, 17(4.4%) experienced an abrupt increase in blood pressure, 7(1.8%) experienced sweating, and tear production and 5(1.3%) observed movement and grimacing. No specific association was found between awareness of gender and surgery type. There was a significant association between awareness and ASA classification(p=0.000) and with intraoperative pain(p=0.00), and hemodynamic changes (p=0.04).
Conclusion: In conclusion, there was an unexpectedly high prevalence of anesthetic awareness with recall. During surgery, patients typically experience pain, difficulty in communication, and paralysis.
Keywords: Analgesia, Anesthesia, Operative Surgical Procedure, Metacognition
Safety and efficacy of adjunctive intra-arterial antithrombotic therapy during endovascular thrombectomy for acute ischemic stroke: A systematic review and meta-analysis
No full textAvailable to read on the publisher's website here: https://doi.org/10.1136/jnis-2023-021244.Background Half of patients who achieve successful recanalization following endovascular thrombectomy (EVT) for acute ischemic stroke experience poor functional outcome. We aim to investigate whether the use of adjunctive intra-arterial antithrombotic therapy (AAT) during EVT is safe and efficacious compared with standard therapy (ST) of EVT with or without prior intravenous thrombolysis. Methods Electronic databases were searched (PubMed/MEDLINE, Embase, Cochrane Library) from 2010 until October 2023. Data were pooled using a random-effects model and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was assessed using ROBINS-I and ROB-2. The primary outcome was functional independence (modified Rankin Scale (mRS) 0-2) at 3 months. Secondary outcomes were successful recanalization (modified Thrombolysis In Cerebral Infarction (TICI) 2b-3), symptomatic intracranial hemorrhage (sICH), and 90-day mortality. Results 41 randomized and non-randomized studies met the eligibility criteria. Overall, 15 316 patients were included; 3296 patients were treated with AAT during EVT and 12 020 were treated with ST alone. Compared with ST, patients treated with AAT demonstrated higher odds of functional independence (46.5% AAT vs 42.6% ST; OR 1.22, 95% CI 1.07 to 1.40, P=0.004, I2=48%) and a lower likelihood of 90-day mortality (OR 0.71, 95% CI 0.61 to 0.83, P=48%) and a lower likelihood of 90-day mortality (OR 0.71, 95% CI 0.61 to 0.83, P2=20%). The rates of sICH (OR 1.00, 95% CI 0.82 to 1.22,P=0.97, I2=13%) and successful recanalization (OR 1.09, 95% CI 0.84 to 1.42, P=0.52, I2=76%) were not significantly different. Conclusion The use of AAT during EVT may improve functional outcomes and reduce mortality rates compared with ST alone, without an increased risk of sICH. These findings should be interpreted with caution pending the results from ongoing phase III trials to establish the efficacy and safety of AAT during EVT.Copyright © Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.https://doi.org/10.1136/jnis-2023-02124
