Numerous abstracts were presented at the 2014 American Society of Anesthesiologists Annual Meeting in New Orleans, LA. Because of space limitations, we could only highlight a few of the numerous safety abstracts presented. We encourage readers to visit the ASA abstract website at http://www.asaabstracts.com/.
Comparative Safety of Anesthetic Type for Hip Fracture Surgery in Adults (A3011)
(Based on subsequently published retrospective cohort study with same title).BMJ. 2014;348:g4022.
Patorno E, Neuman MD, Schneeweiss S, Mogun H, Bateman BT.
Few interventions have been directly related to reducing mortality among patients with hip fracture. Patorno et al. conducted a retrospective cohort study to evaluate the risk for postoperative mortality comparing hip fracture patients treated with regional, general, and combined regional/general anesthesia using the Premier Perspective Comparative Database. Over 73,000 patients with hip fracture undergoing surgical repair over a 4-year period were included. After adjusting for over 60 covariates, the authors found no statistically significant difference in mortality risk associated with the use of either regional (risk ratio [RR] = 0.93, 95% confidence interval (CI) 0.78 to 1.11) or combined regional/general (RR 1.00, 95% CI 0.82 to 1.22) compared to general anesthesia. These findings suggest that the beneficial effect of regional anesthesia on short-term mortality is not nearly as robust as previously reported.
Somatosensory Deficits from Steep Trendelenburg Position During Gynecologic Robotic Surgery (A5021)
David Glatt DO, Joseph Danto PhD, John DiCapua MD, Frank J Overdyk MSEE, MD
Robotic surgery in the steep Trendelenburg position (STP) may result in brachial plexopathy, lower extremity compartment syndrome and other neurologic sequelae. Glatt et al. studied the effect of robotic surgery in the STP on the integrity of somatosensory evoked potentials (SSEP). Fifteen patients received a general anesthetic for their robotic assisted laparoscopic gynecologic procedure in STP (-25 to -30 degree from horizontal). Ten patients demonstrated a clinically significant loss of SSEP amplitude, and three patients developed latency changes, 20-45 minutes after STP. Although patients did not report postoperative symptoms or deficits with the SSEP changes seen in this small cohort, changes in SSEP of this magnitude in spine surgery can prompt changes in surgical technique, including modifying blood pressure, retraction, etc. The authors note that an adequately powered study employing real time SSEP monitoring by a surgical neurophysiologist is forthcoming.
Dr. Greenberg is Clinical Associate Professor, Department of Anesthesiology/Critical Care University of Chicago, Pritzker School of Medicine and Director of Critical Care Services, Evanston Hospital NorthShore University HealthSystem. Dr. Greenberg is also the Assistant Editor of the APSF Newsletter.