动静脉通路建立的麻醉选择：国家麻醉临床结局登记分析。
Anesthetic choice for arteriovenous access creation: A National Anesthesia Clinical Outcomes Registry analysis.
机构信息
Department of Medical Education, West Virginia University School of Medicine, Morgantown, WV, USA.
Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV, USA.
出版信息
J Vasc Access. 2023 Jul;24(4):666-673. doi: 10.1177/11297298211045495. Epub 2021 Sep 21.
BACKGROUND
We sought to evaluate differences in primary anesthetic type used in arteriovenous access creation with the hypothesis that administration of regional anesthesia and monitored anesthesia care (MAC) with local anesthesia as the primary anesthetic has increased over time.
METHODS
National Anesthesia Clinical Outcomes Registry data were retrospectively evaluated. Covariates were selected a priori within multivariate models to determine predictors of anesthetic type in adults who underwent elective arteriovenous access creation between 2010 and 2018.
RESULTS
A total of 144,392 patients met criteria; 90,741 (62.8%) received general anesthesia. The use of regional anesthesia and MAC decreased over time (8.0%-6.8%, 36.8%-27.8%, respectively; both < 0.0001). Patients who underwent regional anesthesia were more likely to have ASA physical status >III and to reside in rural areas (52.3% and 12.9%, respectively; both < 0.0001). Patients who underwent MAC were more likely to be older, male, receive care outside the South, and reside in urban areas (median age 65, 56.8%, 68.1%, and 70.8%, respectively; all < 0.0001). Multivariate analysis revealed that being male, having an ASA physical status >III, and each 5-year increase in age resulted in increased odds of receiving alternatives to general anesthesia (regional anesthesia adjusted odds ratios (AORs) 1.06, 1.12, and 1.26, MAC AORs 1.09, 1.2, and 1.1, respectively; all < 0.0001). Treatment in the Midwest, South, or West was associated with decreased odds of receiving alternatives to general anesthesia compared to the Northeast (regional anesthesia AORs 0.28, 0.38, and 0.03, all < 0.0001; MAC 0.76, 0.13, and 0.43, respectively; all < 0.05).
CONCLUSIONS
Use of regional anesthesia and MAC with local anesthesia for arteriovenous access creation has decreased over time with general anesthesia remaining the primary anesthetic type. Anesthetic choice, however, varies with patient characteristics and geography.
背景
我们评估了动静脉通路创建中使用的主要麻醉类型的差异，假设随着时间的推移，局部麻醉下的区域麻醉和监测麻醉护理（MAC）作为主要麻醉方式有所增加。
方法
回顾性评估国家麻醉临床结果登记数据。在多变量模型中，我们预先选择协变量，以确定 2010 年至 2018 年间接受择期动静脉通路创建的成年人中麻醉类型的预测因素。
结果
共有 144392 名患者符合标准；90741 名（62.8%）接受全身麻醉。区域麻醉和 MAC 的使用率随时间推移而下降（分别为 8.0%-6.8%和 36.8%-27.8%；均<0.0001）。接受区域麻醉的患者更可能有 ASA 身体状况>III 级和居住在农村地区（分别为 52.3%和 12.9%；均<0.0001）。接受 MAC 的患者更可能年龄较大、男性、在南部以外接受治疗且居住在城市地区（中位年龄 65 岁、56.8%、68.1%和 70.8%；均<0.0001）。多变量分析显示，男性、ASA 身体状况>III 级和年龄每增加 5 岁，接受全身麻醉替代方法的几率增加（区域麻醉调整优势比（AOR）分别为 1.06、1.12 和 1.26，MAC AOR 分别为 1.09、1.2 和 1.1；均<0.0001）。与东北部相比，中西部、南部和西部的治疗与接受全身麻醉替代方法的几率降低相关（区域麻醉 AOR 分别为 0.28、0.38 和 0.03；均<0.0001；MAC 分别为 0.76、0.13 和 0.43；均<0.05）。
结论
随着时间的推移，局部麻醉下的区域麻醉和 MAC 用于动静脉通路创建的使用减少，而全身麻醉仍然是主要的麻醉类型。然而，麻醉选择因患者特征和地理位置而异。
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