1. Spinal or General Anesthesia? COPYRIGHT © 2014, ALL RIGHTS RESERVED From the Publishers of

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3. Copyright © 2014 @corncobgeneral Help settle a debate. I remember that the less anesthesia my pt needs the better. Hv always thought spinal btr than general if pt cld tolerate. A colleague disagrees and says no diff re outcome. Whose side are U 2 on ? :) NeedHlp@corncobhosp.org @corncobgeneral Help settle a debate. I remember that the less anesthesia my pt needs the better. Hv always thought spinal btr than general if pt cld tolerate. A colleague disagrees and says no diff re outcome. Whose side are U 2 on ? :) NeedHlp@corncobhosp.org

4. Anesthesia

5. Anesthesia: General vs Regional No difference morbidity - mortality Advantages of regional:  Less myocardial, respiratory depression  Avoid endotracheal intubation (autonomic stimulation) Disadvantages of regional:  Anxiety catecholamine release MVO2  Spinal vasodilation BP Copyright © 2014

6. Meta analysis (141 trials, 9559 patients) Studies are heterogeneous: Meta analysis validity ?Meta analysis overestimates “treatment effect” (positive trial publication bias) No patient randomization Postop management has changed making benefit of neuraxial anesthesia less important Rodgers A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000; 321: 7275. Copyright © 2014

7. Ballantyne, Jane C. et al. Does the evidence support the use of spinal and epidural anesthesia for surgery? Journal of Clinical Anesthesia. 2005;17: 382 - 391 Benefits of spinal and epidural anesthesia and analgesia:  Less blood loss  Superior pain control  Decreased ileus  Fewer pulmonary complications  Decreased ileus No mortality benefit No definite improvement in cardiac outcome No fewer thromboembolic events when DVT prophylaxis used Copyright © 2014

8. The Guys reply text General vs. Spinal / epidural anesthesia : no difference in cardiac mortality Spinal / epidural may have fewer non- cardiac complications: pulmonary, pain control Copyright © 2014

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