PDF(Pubmed)
Abstract：
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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 p < 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 p < 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 p < 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 p < 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 p < 0.0001; MAC 0.76, 0.13, and 0.43, respectively; all p < 0.05).
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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 p < 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 p < 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 p < 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 p < 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 p < 0.0001; MAC 0.76, 0.13, and 0.43, respectively; all p < 0.05).
UNASSIGNED: 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.
摘要：
背景：我们试图评估动静脉通路创建中使用的主要麻醉剂类型的差异，假设区域麻醉和以局部麻醉作为主要麻醉剂的监测麻醉护理（MAC）的管理随着时间的推移而增加。
方法：对全国麻醉临床结果登记数据进行回顾性评估。在多变量模型中先验选择协变量，以确定在2010年至2018年期间进行选择性动静脉通路创建的成年人的麻醉类型的预测因素。
结果：共有144,392例患者符合标准；90,741例（62.8％）接受了全身麻醉。区域麻醉和MAC的使用随着时间的推移而下降(8.0%-6.8%，36.8%-27.8%，分别；两者p<0.0001)。接受区域麻醉的患者更有可能有ASA身体状况>III和居住在农村地区（52.3％和12.9％，分别；两者p<0.0001)。接受MAC的患者更有可能年龄较大，男性,在南方以外接受护理，并居住在城市地区(中位年龄65岁，56.8%，68.1%,70.8%,分别；所有p<0.0001)。多变量分析表明，作为男性，具有ASA物理状态>III，年龄每增加5岁导致接受全身麻醉替代治疗的几率增加(区域麻醉调整比值比(AORs)分别为1.06,1.12和1.26,MACAORs分别为1.09,1.2和1.1;所有p<0.0001).在中西部的治疗，南,与东北相比,或西部与接受全身麻醉替代方案的几率降低相关(区域麻醉AORs0.28,0.38和0.03,均p<0.0001;MAC分别为0.76,0.13和0.43;均p<0.05).
结论：随着时间的推移，全身麻醉仍然是主要的麻醉类型，区域麻醉和局部麻醉用于建立动静脉通路的MAC的使用减少了。麻醉选择,然而,因患者特征和地理位置而异。
方法：对全国麻醉临床结果登记数据进行回顾性评估。在多变量模型中先验选择协变量，以确定在2010年至2018年期间进行选择性动静脉通路创建的成年人的麻醉类型的预测因素。
结果：共有144,392例患者符合标准；90,741例（62.8％）接受了全身麻醉。区域麻醉和MAC的使用随着时间的推移而下降(8.0%-6.8%，36.8%-27.8%，分别；两者p<0.0001)。接受区域麻醉的患者更有可能有ASA身体状况>III和居住在农村地区（52.3％和12.9％，分别；两者p<0.0001)。接受MAC的患者更有可能年龄较大，男性,在南方以外接受护理，并居住在城市地区(中位年龄65岁，56.8%，68.1%,70.8%,分别；所有p<0.0001)。多变量分析表明，作为男性，具有ASA物理状态>III，年龄每增加5岁导致接受全身麻醉替代治疗的几率增加(区域麻醉调整比值比(AORs)分别为1.06,1.12和1.26,MACAORs分别为1.09,1.2和1.1;所有p<0.0001).在中西部的治疗，南,与东北相比,或西部与接受全身麻醉替代方案的几率降低相关(区域麻醉AORs0.28,0.38和0.03,均p<0.0001;MAC分别为0.76,0.13和0.43;均p<0.05).
结论：随着时间的推移，全身麻醉仍然是主要的麻醉类型，区域麻醉和局部麻醉用于建立动静脉通路的MAC的使用减少了。麻醉选择,然而,因患者特征和地理位置而异。
