A randomised trial comparing local versus general anaesthesia for microwave endometrial ablation. [Comparative study of general and spinal anesthesia in elderly women in hip surgery]. Comparison of general and regional anesthesia for cesarean section: success rate, blood loss and satisfaction from a randomized trial. Day-case anaesthesia for termination of pregnancy. Evaluation of a total intravenous anaesthetic technique. Anxiety, relaxation and anaesthesia for day-case surgery. The effect of local anaesthetic spray on the pain associated with local anaesthetic injection, prior to biopsy or loop diathermy to the cervix in the outpatient colposcopy clinic. Topical anaesthesia for diagnostic hysteroscopy and endometrial biopsy in postmenopausal women: a randomised placebo-controlled double-blind study. A randomized comparison of medical abortion and surgical vacuum aspiration at 10-13 weeks gestation. Combined epidural and general anaesthesia versus general anaesthesia for abdominal aortic surgery: a prospective randomised trial.
To compare the acceptability of microwave endometrial ablation using a local anaesthesia/sedation regime or general anaesthesia. To compare recovery following treatment with each type of anaesthetic.
                Prospective randomised controlled trial with follow up of women who declined randomisation.
                The gynaecology department of a large teaching hospital in the UK.
                All women referred for microwave endometrial ablation at the Aberdeen Royal Infirmary between July 1999 and September 2000 without a medical reason to favour one or other type of anaesthetic.
                191 women were equally randomised to undergo microwave endometrial ablation under general or local anaesthesia. Details were also collected for women not randomised because of an anaesthetic preference. All procedures were undertaken in an operating theatre.
                Data collected by questionnaire including the woman's view of treatment acceptability, operative details and post-operative recovery.
                Sixty-nine percent of eligible women would consider treatment under local anaesthesia. Ninety-one percent of microwave endometrial ablation procedures that started under local anaesthesia were completed without conversion to general anaesthesia. Anaesthetic type and allocation by randomisation or preference made no significant difference to the proportion of women describing treatment as totally or generally acceptable at two weeks. Neither parity nor cavity size predicted acceptability. Women allocated general anaesthesia were more likely to describe the procedure as totally acceptable and to choose the same anaesthetic again. There was no significant difference between anaesthetic groups regarding post-operative pain, nausea or recovery time.
                Microwave endometrial ablation under local anaesthesia was acceptable to the majority of women referred for treatment. There was no recovery advantage from local anaesthesia and almost 1 in 10 women who starting treatment under local anaesthesia needed a general anaesthetic because of discomfort. The incidence of post-operative pain and nausea means that treatment with this local anaesthetic/sedation regime remains a day case rather than an outpatient procedure. The choice between regional versus general anaesthesia for elderly patients undergoing hip surgery is debated. It is vitally important to see if the type of anaesthetic administered affects per- and postoperative morbidity and mortality. Seventy women more than 75 yr old suitable for spinal anaesthesia were included in this study. They were randomly divided into two groups: in one (n = 35), general anaesthesia was given with sodium thiopentone, fentanyl, enflurane and vecuronium; in the other (n = 35), spinal anaesthesia was performed with 3 ml 0.5% bupivacaine in isobaric solution. During the anaesthetic period, there were no statistically significant differences between both groups in systolic arterial pressure falls or in increases in the heart rate X systolic arterial pressure product. No serious cardiovascular collapse was encountered. Seven patients (20%) receiving general anaesthesia had mental changes against four only (14.2%) in the spinal group. In patients having general anaesthesia, 22.9% developed bronchopneumonia as opposed to 8.6% in the spinal anaesthesia group (p less than 0.05). The mortality rate at three months was rather similar in the two groups. It was concluded that, in order to reduce the incidence of postoperative central dysfunction and bronchopneumonia, spinal anaesthesia should be preferred in geriatric patients for lower limb surgery. A prospective randomized trial was organized to compare the effectiveness of general and regional anesthesia for cesarean section (C/S).
                Three hundred and forty-one patients were randomized into the general anesthesia group (GA), epidural anesthesia group (EA) and spinal anesthesia group (SA). The effectiveness of interest was success rate, blood loss and patient satisfaction.
                We found that the success rates of EA and SA were lower than GA. Success in EA should be improved by using an epidural catheter to add more local anesthetic drug instead of a single shot; and the surgeon should allow more time for the block to work adequately. Success in SA should be improved by using bupivacaine instead of lidocaine. GA resulted in significantly more blood loss, lower postoperative hematocrit, and higher proportion of patients who had postoperative hematocrit < 30 per cent than EA and SA. The patients' satisfaction scores were not different among the 3 techniques. This meant that, given adequate explanation and perioperative care, Thai women were satisfied with regional anesthesia.
                Regional anesthesia is a better choice of anesthesia for C/S than general anesthesia. However, the availability of different techniques and ability to change the technique when needed were very useful and important. If GA is chosen, all safety procedures must be followed. Oxygen supplement and endotracheal intubation facilities must be available in all techniques. Guidelines of anesthesia for C/S at a national level should be agreed upon, including the type of personnel, monitoring equipment and postoperative care. An investigation was undertaken to assess the use of a total intravenous anaesthetic technique of fentanyl and methohexitone for outpatient vaginal termination of pregnancy. When compared with a technique of fentanyl, methohexitone, nitrous oxide and trichloroethylene the total intravenous method caused swifter recovery, minimal side-effects and no cardiovascular depression. However, both anaesthetic techniques produced significant postoperative reduction of memory for new facts when compared with a control group receiving no general anaesthesia. There is a need to continue the search for anaesthetic methods appropriate for day cases. It is recognized that pre-operative anxiety can have adverse effects on the course and outcome of surgery and there is a considerable amount of research into the influences of interventions for pre-operative anxiety on a number of post-operative variables. However, little attention has been paid to the potential influences of treatments on intra-operative variables, most notably on the facilitation of anaesthesia. The present study examined the impact of a brief relaxation procedure on anaesthesia in comparison to attention-control and no-treatment control procedures. A sample of 21 patients about to undergo anaesthesia for day-case surgery were randomly assigned to one of the three conditions. It was found that the relaxation treatment significantly reduced pre-operative anxiety as measured by the state scale of the State-Trait Anxiety Inventory (Spielberger, 1983). This reduction was reflected in physiological indicators of anxiety. Both the relaxation group and the attention-control group required significantly less time to induce anaesthesia and less of the anaesthetic agent used to maintain anaesthesia. The relaxation group also scored significantly lower than the no-treatment control group on an anaesthetist's rating of difficulty of maintenance of anaesthesia. Whilst the relaxation treatment appeared to have no advantages over the attention-control procedure in terms of anaesthetic requirements, the latter treatment did not reduce anxiety and showed no benefit over the no-treatment control condition in terms of an anaesthetist's rating of difficulty of maintenance of anaesthesia. In addition, following recovery the relaxation subjects reported more favourable perceptions of their treatment than the attention-control subjects. We evaluated the effectiveness of local anaesthetic spray prior to injection of local anaesthetic before biopsy or large loop excision of the transformation zone of the cervix at colposcopy. This was a prospective, randomised, double-blind placebo-controlled study involving 51 women. Pain or discomfort was measured using a four-point categorical scale and a visual analogue score. Our results show that the use of local anaesthetic spray has no effect on the pain or discomfort experienced by patients having local anaesthetic injections to the cervix, and cannot be recommended. To evaluate the efficacy and safety of topical anaesthesia in reducing pain and incidence of vasovagal reactions during diagnostic hysteroscopy with endometrial biopsy in postmenopausal women.
                Randomised placebo-controlled double-blind study.
                University hospital.
                Eighty postmenopausal women undergoing diagnostic hysteroscopy and endometrial biopsy.
                Two millilitres of 2% mepivacaine or saline solution were injected transcervically into the uterine cavity before performing the procedures.
                Evaluation of pain reduction on a visual analogue scale and continuous monitoring of heart rate and blood pressure.
                The use of the anaesthetic significantly reduced the pain experienced at hysteroscopy and endometrial biopsy. The occurrence of vasovagal reactions was significantly lower in the anaesthetised group.
                Topical anaesthesia attenuated pain and effectively prevented the occurrence of vasovagal reactions during hysteroscopy and endometrial biopsy in postmenopausal women. Since 1991, mifepristone in combination with a prostaglandin analogue has been licensed for termination of pregnancy in the UK at up to 9 weeks amenorrhoea, and since 1995, beyond 13 weeks. Surgical methods are used almost exclusively at 10-13 weeks amenorrhoea.
                A patient-centred, partially randomized, controlled trial was carried out. Those who expressed a strong preference for either medical (n = 15) or surgical (n = 62) abortion were allocated to that method. The remainder agreed to be randomized. The medical method (n = 188) was mifepristone 200 mg followed by misoprostol up to 3 doses, and surgery (n = 180) was by vacuum aspiration under general anaesthesia. Outcome measures included efficacy rates, medical complications within 8 weeks of the procedure, patient preferences and acceptability.
                Among women who underwent medical abortion, 5.4% required a second procedure compared with 2.1% who had surgery, although this difference was not statistically significant. Side effects experienced were higher in women who underwent medical abortion compared with those who underwent surgery. There were no significant differences in the rates of major complications up to 8 weeks. Prior to termination, 80% of women had a preference for a method, with 72% preferring medical and 28% preferring surgical abortion. Following abortion, 70% of those who underwent medical termination and 79% who underwent surgery would opt for the same method in the future.
                Medical abortion is safe and effective at 10-13 weeks gestation and should be considered an option for those women who wish to avoid surgery and anaesthesia. Fifty patients undergoing elective abdominal aortic surgery were randomised to receive either combined epidural and general anaesthesia and postoperative epidural analgesia (CEGA) or general anaesthesia and postoperative intravenous morphine infusion (GA). Prospective data was collected in order to compare the two groups. This included intraoperative cardiovascular changes and postoperative complications. The use of intraoperative vasopressors was significantly higher in the CEGA group (P < 0.01) but the use of intravenous glyceryl trinitrate was significantly lower (P < 0.01). There was no significant difference between groups in regard to blood loss, volume replacement or in the number of patients requiring postoperative ventilation. Two patients in the CEGA group died postoperatively compared to one in the GA group (not significant). There was no significant difference between groups in the total number or type of postoperative complications. Combining epidural anaesthesia with general anaesthesia altered intraoperative cardiovascular management but did not affect postoperative outcome.
Particular considerations that influence the choice of anaesthesia for this procedure such as availability, effectiveness, safety, side effects, practitioner's choice, costs and woman's preferences of each technique should continue to be used until more evidence supporting the use of one technique or another.