Shoulder surgery using combined regional and general anesthesia versus regional anesthesia and deep sedation with a non-invasive positive pressure system: A retrospective cohort study
There are benefits to choosing deep sedation over general anesthesia as an intraoperative anesthetic for shoulder surgery. Deep sedation, however, may be challenging in patients with risk factors for hypoxemia. We conducted a retrospective case control study comparing patients who underwent shoulder...
Saved in:
| Published in: | Trends in anaesthesia & critical care Vol. 37; pp. 23 - 29 |
|---|---|
| Main Authors: | , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Elsevier Ltd
01-04-2021
|
| Subjects: | |
| Online Access: | Get full text |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | There are benefits to choosing deep sedation over general anesthesia as an intraoperative anesthetic for shoulder surgery. Deep sedation, however, may be challenging in patients with risk factors for hypoxemia.
We conducted a retrospective case control study comparing patients who underwent shoulder surgery using deep sedation and interscalene block versus general anesthesia and cervical paravertebral or interscalene block. A non-invasive positive pressure system (SuperNO2VA mask; Vyaire Medical, Mettawa, IL, USA) was utilized as an airway adjunct in patients undergoing deep sedation.
Sixty patients were included in the study (20 patients with block with sedation and 40 patients with general anesthesia). No patient who received deep sedation required conversion to general anesthesia or additional airway support measures. Induction- and emergence-related anesthesia times were lower for those who received deep sedation than those who received general anesthesia (39 [CI 31–48] vs 17 [CI 8–27] minutes; p < 0.0001). No differences were detected in post-anesthesia care unit times, operative times, or estimated blood loss between the two groups. Intravenous fluid administration was lower in patients receiving deep sedation. Sixty percent of patients under general anesthesia had a urinary catheter placed versus zero in the deep sedation group. Vasopressor administration was more common in the general anesthesia group, while antihypertensive medications were utilized more frequently in the deep sedation group.
This retrospective study showed that non-invasive positive pressure ventilation facilitated the performance of deep sedation for shoulder surgery with an interscalene block for both shoulder arthroscopic procedures and shoulder arthroplasty. This technique was associated with avoidance of mechanical ventilation, decreased anesthesia time, use of vasopressors, and need for urinary catheter placement.
•Utilizing deep sedation as an alternative to general anesthesia for shoulder surgery can be a challenging endeavor.•Patients, particularly with obesity or obstructive sleep apnea, who receive deep sedation are at risk for hypoxemia.•A non-invasive positive pressure system (SuperNO2VA mask; Vyaire Medical) was used in patients undergoing deep sedation.•Doing so resulted in decreased total anesthesia time, avoidance of general anesthesia, and other clinical benefits.•Use of this device should be considered for patients undergoing shoulder surgery to facilitate deep sedation. |
|---|---|
| ISSN: | 2210-8440 |
| DOI: | 10.1016/j.tacc.2021.01.003 |