Anesthesia Control Group Research Articles

Correction of the Elevated Blood Pressure in Patients Undergoing Robot-Assisted Radical Prostatectomy

The aim of the study was to evaluate the role of urapidil hydrochloride for the management of abnormal cardiovascular response in patients undergoing robot-assisted radical prostatectomy (RARP).Material and methods. The total of 93 prostate cancer patients scheduled for elective RARP were included and randomized in two groups: urapidil (n=44) and standard anesthesia control group (n=49). Urapidil was used to control the elevated blood pressure intraoperatively. Central hemodynamic monitoring was performed at 5 steps of the surgery.Results. In the control group, the step 2 of the procedure was associated with elevated mean blood pressure (by 24.3%, P=0.045) and increased total peripheral vascular resistance (by 46.6%, P=0.011) compared with step 1, while in the urapidil group no significant changes in these parameters were found. In the urapidil group, the blood pressure was lower by 20.2% (P=0.047), afterload by 36.9% (P=0.02) vs the control group values, whereas the cardiac output was higher by 22.2% (P=0.043). Placing patient in the steep Trendelenburg position (step 3) resulted in a 22.4% increase in stroke volume (P=0.38) in the control group and a 19.2% increase in stroke volume (P=0.049) in the urapidil group compared with the previous step. Cardiac output in the urapidil group was higher by 34% (P=0.002) and blood pressure and vascular resistance were lower by 24.4% (P=0.031) and 45.7% (P=0.001), respectively, vs the control group. At steps 4 and 5, gradual stabilization of the hemodynamic parameters and peripheral vascular tone with significantly smaller differences between the groups were revealed.Conclusion. Urapidil was effective for maintaining central hemodynamic parameters in patients during robotic-assisted radical prostatectomy at step 2 of the procedure, avoiding blood pressure elevation at step 3 and significantly reducing the total peripheral vascular resistance compared with the control group.

Observation on nursing effect of nebulization inhalation in patients with vocal cord polypectomy under tracheal intubation and general anesthesia

Objective To observe the nursing effect of 2% lidocaine and dexamethasone mixture in patients with vocal polyp extirpation under tracheal intubation. Methods From September 2017 to March 2018, 68 patients who were selected to perform vocal cord polyp resection under supportive laryngoscope in the hospital were randomly divided into 4 ml of 2% lidocaine before surgery and 2 ml of 0.5% dexamethasone after atomization inhalation with tracheal intubation under general anesthesia (observation group) and conventional tracheal intubation with general anesthesia (control group), 34 cases of each group.The hemodynamic indexes of endotracheal intubation and operation , the Self-rating Anxiety Scale (SAS) of Ricker at trachea extubation, BCS comfort score and wake time 15 minutes after endotracheal tube extubation were observed. Results The hemodynamics of the observation group was more stable than that of the control group, and the difference was statistically significant(P 0.05). Conclusions The atomization inhalation of 2% lidocaine 4ml and 0.5% dexamethasone mixture before operation as an important preventive nursing intervention can reduce the hemodynamic fluctuation and improve the postoperative comfort. Key words: Atomization inhalation; Nursing effect; Vocal cord polyp extirpation; Lidocaine; Dexamethasone

Effects of ultrasound-guided paravertebral nerve block combined with general anesthesia on hemodynamics and recovery in thoracic surgery

Objective To compare the effects of combined paravertebral nerve block and general anesthesia on hemodynamics and recovery period in thoracic surgery. Methods Eighty patients undergoing elective thoracic surgery with American Society of Anesthesiologists(ASA) Ⅱ or Ⅲ were randomly divided into 2 groups with 40 cases in each group. Paravertebral nerve block combined general anesthesia group (TPVB group) and traditional general anesthesia control group (C group). Two groups of patients were induced with the same procedure. Sevoflurane inhalation, propofol, and remifentanil were administered intravenously to maintain anesthesia. Hemodynamic parameters before surgery (T0), after induction (T1), 3 min after the operation (T2), after the end of surgery (T3) and the number of interventions requiring vasoactive drugs and dosage of analgesic drugs were measured. The time of anesthesia, operation time, and recovery time, extubation time and pain score were recorded. The recovery of consciousness was assessed by using Observer′s Assessment of Alertness/Sedation Scale (OAA/S) score. Results Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate were significantly lower in TPVB group than in group C at the T2 timepoint. SBP and DBP were significantly higher, and heart rate was significantly lower in TPVB group than in group C at the T3 timepoint (P<0.05). The number of 4 vasoactive drugs and remifentanil dosage were significantly less in TPVB group than in group C (P<0.05). The time of blinking, extubating time and pain score of TPVB group were significantly better than those of group C (P<0.05). Postoperative opening the eyes by prompting time, extubating time, and pains cores were significantly better in TPVB group than in group C (P<0.05). The OAA/S scores before and after extubating were significantly higher in TPVB group than in group C (P<0.05). Conclusions Combination of paravertebral nerve block with general anesthesia leads to more stable hemodynamics, earlier time for extubation, and less postoperative pain scores in patients undergoing thoracic surgery. Key words: Paravertebral nerve block; Anesthesia, general; Hemodynamics

Effect of transcutaneous electrical acupoint stimulation combined with general anesthesia on intraoperative and postoperative recovery in patients undergoing carotid artery stenting

Objective To investigate the effect of transcutaneous electrical acupoint stimulation (TEAS) combined with general anesthesia on intraoperative medication and postoperative recovery in patients undergoing carotid artery stenting (CAS). Methods Eighty-two patients with CAS under general anesthesia were randomly divided into the transcutaneous electrical acupoint stimulation combined with general anesthesia group (group T, n=40) and the traditional general anesthesia control group (group C, n=42). The surgical side acupoints of the body for acupuncture were selected as, Shuigou and Baihui, Hegu and Waiguan. For patients in group T, the electrodes were pateched pasted at the corresponding locations and were stimulated by HANS. For the patients in group C, the electrodes were placed at the same location but not stimulated by HANS. The blood pressure and heart rate are maintained within in the (1±20)% range of the baseline. The hemodynamic changes during the operation, the use of vasoactive drugs and the postoperative recovery of the patients were recorded. Results After 30 min of the transcutaneous electrical acupoint stimulation, the blood pressure in the group T was lower than the level of baseline (P 0.05). At 5 min before extubation and 5 min after extubation, the heart rate of patients in group T was lower than that of patients in group C (P 0.05). There was no statistical difference in among the number of cases and total amount of dopamine, atropine and urapidil in the two groups (P>0.05). The amount of remifentanil used in group T was less than that in group C (P 0.05). The time of respiration recovery, wake-up time and extubation time in the group T were less than those in group C (P 0.05). The numbers of patients with postoperative moderate pain (VAS score more than 4 points above) were analyzed at 9 am and 4 pm at one day after the operation. The incidence of postoperative moderate pain in group T was significantly lower than the incidence in group C (P<0.05). Conclusions TEAS combined with general anesthesia for CAS surgery can stabilize hemodynamics changes, reduce analgesic remifentanil consumption, shorten the wake-up time and extubation time after surgery, reduce the incidence of postoperative pain, and improve the patients′ satisfaction with anesthesia. Key words: Transcutaneous electrical acupoint stimulation; Carotid artery stenting; Anesthesia, general; Postoperative recovery

Selective Early Glial Reactivity in the Visual Pathway Precedes Axonal Loss, Following Short-Term Cerebrospinal Fluid Pressure Reduction.

To examine the early glial reactivity and neuron damage in response to short-term cerebrospinal fluid pressure (CSFp) reduction, as compared with intraocular pressure (IOP) elevation. The experiment included 54 male Sprague-Dawley rats with elevated translaminar cribrosa pressure difference (TLPD), defined as IOP minus CSFp. These rats underwent either continuous CSF drainage for 6 hours (n = 18), or unilateral IOP elevation to 40 mm Hg for 6 hours (n = 18). For control, 18 normal rats were anesthetized for 6 hours. Orthograde axonal transport was examined by intravitreal injection of 3% rhodamine-β-isothiocyanate. We also used transmission electron microscopy to display the ultrastructural features of retinal ganglion cell axons in the optic nerve head. Early glial reactivity in the retina, lateral geniculate nucleus (LGN), and superior colliculus (SC) was detected by immunostaining and Western blot for the glial fibrillary acidic protein (GFAP) and glutamine synthetase (GS). We also observed the glial reactivity in the inferior colliculus and hippocampus to rule out possible influences of CSF dynamics and composition. Anterograde staining with 3% rhodamine-β-isothiocyanate revealed decreased fluorescence intensity of the SC and LGN projected from both lower CSFp and higher IOP eyes. Transmission electron microscopy showed loss of axons from the optic nerve head in the high-IOP group, but not in the low-CSFp group. Compared with the anesthesia control group, GFAP expression was significantly increased in the retina, LGN, and SC, whereas GS expression was only increased in the retina following CSFp reduction. However, their expressions were not significantly elevated in the inferior colliculus and hippocampus. In the high-IOP group, expressions of GFAP and GS were significantly increased in the retina, LGN, and SC. Visual system neurons may be much more sensitive than other nervous tissues. Following short-term CSFp reduction, early glial reactivity may precede axonal loss. Changes of translaminar cribrosa pressure difference in both experimental low-CSFp and high-IOP groups induce selective early glial reactivity. The neuron damage from abnormally low CSFp may be pathogenetically similar to high IOP.

Analgesic Effects of Pre-induction Low-dose Ketamine on Post-tonsillectomy Patients

Background: Post-operative pain management aims to decrease pain intensity with patient comfort and to improve post-operative outcome. Multimodal analgesia is currently recommended for effective post-operative pain control with lower total doses of analgesics and fewer side effects.Objective: To compare the analgesic effect of pre-induction low-dose ketamine against conventional general anaesthesia.Materials and Methods: This prospective comparative study was conducted over a period of 12 months at Combined Military Hospital, Dhaka. Two hundred and forty patients of either sex requiring tonsillectomy were divided into two groups: conventional general anaesthesia (control group) and general anaesthesia with low-dose ketamine (ketamine group). Non-invasive blood pressure, heart rate and SpO2 were recorded at regular intervals throughout the anaesthetic period. Post-operative analgesia was provided for both the groups using pethidine intramuscularly. Time to complete operation, pain intensity, time to request for first analgesia were noted and total opioid consumption and complications, if any occurred in 24 hours post-operatively, were also recorded and addressed accordingly.Results: The demographic data and mean operation time were similar in both the groups (p&gt;0.05).Time to request for first analgesia was longer in lowdose ketamine group (mean ± SD 5.36±3.21 hours) than in control group (mean ± SD 2.49±1.53 hours) (p&lt;0.05). Total dosage of pethidine consumption over 24 hours period was less in ketamine group with satisfactory pain relief (mean ± SD 98.73±2.60 mg) than in control group (mean ± SD 142.52±3.48 mg) (p&lt;0.05). Post-operative complications were also less in ketamine group than control group (p&lt;0.05).Conclusion: The result of this study suggests that pre-induction low-dose ketamine has pre-emptive analgesic effect and reduces overall post-operative opioid requirements.J Enam Med Col 2018; 8(2): 74-79

Improved costs and outcomes with conscious sedation vs general anesthesia in TAVR patients: Time to wake up?

BackgroundTranscatheter aortic valve replacement (TAVR) has become a commonplace procedure for the treatment of aortic stenosis in higher risk surgical patients. With the high cost and steadily increasing number of patients receiving TAVR, emphasis has been placed on optimizing outcomes as well as resource utilization. Recently, studies have demonstrated the feasibility of conscious sedation in lieu of general anesthesia for TAVR. This study aimed to investigate the clinical as well as cost outcomes associated with conscious sedation in comparison to general anesthesia in TAVR.MethodsRecords for all adult patients undergoing TAVR at our institution between August 2012 and June 2016 were included using our institutional Society of Thoracic Surgeons (STS) and American College of Cardiology (ACC) registries. Cost data was gathered using the BIOME database. Patients were stratified into two groups according to whether they received general anesthesia (GA) or conscious sedation (CS) during the procedure. No-replacement propensity score matching was done using the validated STS predicted risk of mortality (PROM) as a propensity score. Primary outcome measure with survival to discharge and several secondary outcome measures were also included in analysis. According to our institution's data reporting guidelines, all cost data is presented as a percentage of the general anesthesia control group cost.ResultsOf the 231 patients initially identified, 225 (157 GA, 68 CS) were included for analysis. After no-replacement propensity score matching, 196 patients (147 GA, 49 CS) remained. Overall mortality was 1.5% in the matched population with a trend towards lower mortality in the CS group. Conscious sedation was associated with significantly fewer ICU hours (30 vs 96 hours, p = <0.001) and total hospital days (4.9 vs 10.4, p<0.001). Additionally, there was a 28% decrease in direct cost (p<0.001) as well as significant decreases in all individual all cost categories associated with the use of conscious sedation. There was no difference in composite major adverse events between groups. These trends remained on all subsequent subgroup analyses.ConclusionConscious sedation is emerging as a safe and viable option for anesthesia in patients undergoing transcatheter aortic valve replacement. The use of conscious sedation was not only associated with similar rates of adverse events, but also shortened ICU and overall hospital stays. Finally, there were significant decreases in all cost categories when compared to a propensity matched cohort receiving general anesthesia.

PECS Block Provides Effective Postoperative Pain Management for Breast Cancer Surgery—A Retrospective Study

We investigated the efficacy of ultrasound-guided pectoral nerves (PECS) block for modified radical mastectomy surgery retrospectively. Methods: We measured that pain scores and the use of additional analgesic drugs were recorded in the postoperative care unit within 24 hours after the operation. Postoperative complications (i.e., nausea and vomiting) were noted. Results: Patients who received the PECS block under general anesthesia (PECS group) reported lower visual analog scale pain scores at 0, 1, 2, 4, 6, 12, 24 hours after the operation than patients who did not receive PECS block under general anesthesia (control group). Moreover, the use of additional analgesic drugs during the first 24 hours after surgery was lower in the PECS group than in the control group. While in the postoperative care unit, the PECS group had less nausea and vomiting than the control group. Conclusion: The PECS block provides effective postoperative analgesia within the first 24 hours after breast cancer surgery.

Effects of a combined nerve block on intraoperative stress and postoperative immune function in elderly patients subjected to total hip replacement: study protocol for a randomized controlled trial

Background: Anesthesia, surgery, and other nociceptive stimuli affect stress and hemorheological indices, impact physiological function, decrease immune function, and thereby influence recovery of hip joint function in elderly patients who undergo total hip replacement. Previous anesthesia methods for hip replacement in elderly patients include general, lumbar puncture, or epidural anesthesia alone. A combined nerve block is more suitable for total hip replacement in the elderly because of the safety and reliability of the method. In this study, we hypothesized that a combined nerve block is superior to any previous anesthesia method alone for total hip replacement in the elderly. Specifically, we hypothesized that intraoperative stress, hemorheological indices, postoperative immune function, and incidence of postoperative complications would be more favorable using a combined nerve block compared with previous anesthesia methods. Methods/Design: This is a prospective, single-center, randomized controlled, open-label trial, which will be performed at Qinghai University Affiliated Hospital, China. A total of 120 elderly patients scheduled to undergo total hip replacement will be randomly assigned to undergo a combined nerve block (involving lower lumbar plexus, sciatic nerve, and paraspinal nerve L 1-2 ) (experimental group, n = 60), or general anesthesia (control group, n = 60). All patients will be followed up at 3 months. The primary outcome is serum cortisol concentration during surgery, as a measure of intraoperative stress. Secondary outcomes include serum cortisol concentration prior to anesthesia, and prior to and immediately after surgery; blood glucose level prior to anesthesia, and prior to, during, and after surgery, used to evaluate stress during different times. In addition, immune function-related indices including absolute leukocyte count, absolute neutrophil count, interleukin-1, interleukin-6, tumor necrosis factor-α, and T-lymphocyte subset levels prior to anesthesia, immediately after surgery, 1, 3, 7 days, and 3 months after surgery, will be used to evaluate patients' immune function after surgery. Hemorheological indices including electrocardiogram, pulse, systolic pressure, diastolic pressure, heart rate, blood gas analysis prior to anesthesia, and during and after surgery will be used to investigate changes in blood-related indices. Lastly, incidence of adverse events 1, 3, 7 days, and 3 months after surgery will be used to evaluate postoperative complications. Discussion: This study will investigate the effects of a combined nerve block versus general anesthesia on intraoperative stress and postoperative immune function in elderly patients who undergo total hip replacement. This study will provide objective evidence for selection of anesthesia method for total hip replacement in the elderly, with the aim of reducing intraoperative risks and postoperative complications. Trial registration: ClinicalTrial.gov identifier: NCT02884388; registered on 19 August 2016. Ethics: This trial has been approved by Ethics Committee, Qinghai University Affiliated Hospital, China (approval number QHY1017D) and will be performed in accordance with the Declaration of Helsinki, formulated by the World Medical Association. Informed consent: Signed informed consent will be obtained from the patients or their relatives.

Impact of Bilateral St36 and Pc6 Electroacupuncture on the Depth of Sedation in General Anaesthesia

To investigate the impact of electroacupuncture (EA) at bilateral acupuncture points ST36 and PC6 on the level of sedation in general anaesthesia. 40 patients undergoing abdominal surgery were randomly divided into two groups: EA combined with general anaesthesia (EA group, n=20) and general anaesthesia control group (n=20). The bilateral acupuncture points ST36 and PC6 were selected in both groups. Target-controlled infusion (TCI) of propofol was used for the induction and maintenance of general anaesthesia to reach an equilibrium state of Narcotrend Index (NT index). In the EA group, EA was performed with a Hans EA device. In the control group, general anaesthesia was performed without EA stimulation. In both groups, heart rate (HR), mean blood pressure (MAP) and NT index were recorded at corresponding time points up to 30 min after the end of acupuncture. The NT indices of the EA group showed a downward trend after EA stimulation (p=0.01). From 15 min after the start of EA stimulation the NT indices of the EA group were significantly lower than those of the control group (p<0.05). HR and MAP of the two groups showed no significant differences at any time points (p≥0.05). EA stimulation at bilateral ST36 and PC6 significantly deepens the sedation level of general anaesthesia in patients with propofol TCI, has little impact on haemodynamics and provides significant delayed sedation effects.

Different stimulant intensity of abdominal operation on the expression of tumor necrosis factor α and surfactant protein-A in lung of the rats

To determine the influence of different stimulation of abdominal operation on lung. We randomly divided 100 SD male rats into 5 groups(n=20): An anesthesia control group (Group A), an abdominal skin 2 cm incision group (Group B), an abdominal skin+ muscle 2 cm incision group (Group C ), an abdominal skin+muscle+peritoneum 2 cm incision group (Group D), and an abdominal skin+muscle+peritoneum 2 cm incision+2 min laparoscopy in abdomen+pull exploration bowel group (Group E). Propofol was used for induction of anaesthesia by rat tail vein with 10 mg/kg, with 35-45 mg/(kg.h) during the operation. Anesthesia depth was maintained during moderate sedation without obvious analgesia action level. According to the postoperative specimens at different time, each group was divided into 4 sub groups, including 6-hour group, 1-day group, 3-day group, and 7-day group(n=5). Immunohistochemical method was used to examine tumor necrosis factor (TNF-α) and lung tissue lung surface active substances related proteins A (SP-A) of rats at different points after surgery. There was no significant differences in the expression of TNF-α at 6 hours, 3 days, and 7 days after surgery in the 5 groups (P>0.05). The expression of TNF-α in Group D, and E was significantly higher than that in Group A at 1 day after surgery (P<0.05). Although the expression of TNF-α was Group E > Group D > Group C > Group B at 1 day, 3 days after surgery, there was no significant difference among the 4 groups. There was no significant differences in the expression of SP-A at 6 hours, 3 days, and 7 days after surgery in the 5 groups (P>0.05). The expression of SP-A in Group D and E was significantly higher than that in Group A at 1 day after surgery (P<0.05). There was no significant difference between Group D and E (P>0.05). The greater the stimulant intensity of abdominal operation on rats, the more impact on postoperative lung. The postoperative pulmonary effect of intraperitoneal operation is greater than non-intraperitoneal operation, but in the compensation.

Clinical observation of anesthesia combined with epidural block for patients with COPD surgery

Objective To observation the clinical effect of anesthesia combined with epidural block for patients with COPD surgery.Methods 262 cases with COPD needed to line the chest and abdominal surgery and urology surgery patients.Patients were divided into control group and observation group according to the time sequence,underwent general anesthesia and anesthesia combined with epidural anesthesia,contrast observed in patients with operative time,postoperative extubation time,wake time and the analgesic effect of anesthesia (VAS score) was measured in patients with FVC,FEV1/FVC and FEF25％ to 27％ lung function,clinical efficacy and complication rate of two anesthesia methods.Results The patients extubation time,recovery time and VAS scores were significantly lower than those of control group,the differences were statistically significant(all P ＜0.05).Group of postoperative patients with FVC,FEV1/FVC and FEF25％ to 27％,such as lung function test results were significantly better than those of control group,and the difference was statistically significant (all P ＜0.05).Anesthesia control group total effective rate of 87.0％ observed in patients anesthesia total effective rate was 96.9％.Compared with the control group,the anesthesia clinical effect of the observation group was statistically significant (P ＜0.05).Operative time and postoperative complication rate of the two groups of patients showed no significant difference(P ＞0.05).Conclusion Anesthesia combined with epidural anesthesia used in surgery in patients with COPD can effectively improve the clinical effects of anesthesia,to enhance the safety of anesthesia,which will help the rehabilitation of patients and worth of clinical practice. Key words: Anesthesia, general; Anesthesia, epidural; Pulmonary disease, chronic obstructive

Effect of Low-dose Radiation on Cognitive Function of Rats at Different Ages

Purpose/Objective(s): It is known that radiation can induce cognitive dysfunction, but we still know little about the threshold of radiation dose. It turns out that 0.1 Gy radiation can modulate the expression of gene pathways involved in cognitive function. However, it isn’t clear whether 0.1 Gy whole brain irradiation can induce cognitive impairments. In this study, the relationship between 0.1 Gy exposure and cognitive function was investigated in rats at different ages. Materials/Methods: Thirty-two 1-month-old male Sprague-Dawley rats and thirty two six-month-old male Sprague-Dawley rats were divided randomly into 0.1Gy irradiated group and anesthesia control group. The rats were anesthetized, and then the whole brains were irradiated using 4MeV electron beams delivered by a linear accelerator. Behavioral tests were performed 3 months after irradiation in the order of open field, Morris water maze and passive avoidance test. The tests were used to evaluate the anxiety level, hippocampal dependent spatial learning and memory, and nonspatial learning and memory respectively. In Morris water maze, the place navigation test was conducted on the 1st to 4th day; while on the 5th day, the spatial probe test was done. Results: In the place navigation test of Morris water maze, six-month-old rats exhibited age dependent impairments in latency to find the hidden platform compared with the one-month-old rats. But radiation did not affect the six-month-old rats’ spatial learning and memory. Irradiated group (one month old) had significantly longer latency time than control group. Radiation did not have the effect on the anxiety level in the open field test, and there was no significant difference between groups in the latency of the passive avoidance. Conclusions: In present study, the hippocampal dependent spatial learning and memory capacity of the one-month-old rats was impaired by 0.1Gy whole brain irradiation, but it did not have the same effect on the six-month-old rats. These findings strongly suggest that low dose radiation is sensitive to induce cognitive impairments in younger rats. Author Disclosure: R. Sun: E. Research Grant; NSFC 81172128, NSFC 81102077, NSFC 30870740, Project of Postgraduate’s Innovation of Jiangsu Province cx10b-055z. L.Y. Zhang: E. Research Grant; NSFC 81172128, NSFC 81102077, NSFC 30870740, Project of Postgraduate’s Innovation of Jiangsu Province cx10b-055z. L.S. Chen: E. Research Grant; NSFC 81172128, NSFC 81102077, NSFC 30870740, Project of Postgraduate’s Innovation of Jiangsu Province cx10b-055z. Y. Tian: E. Research Grant; NSFC 81172128, NSFC 81102077, NSFC 30870740, Project of Postgraduate’s Innovation of Jiangsu Province cx10b-055z.

Does periprostatic local anesthesia for prostate biopsy affect the operative difficulty of open radical prostatectomy? A prospective randomized trial

Periprostatic local anesthesia for transrectal ultrasound (TRUS)-guided prostate biopsy requires additional needle punctures and injection of local anesthetics into the periprostatic area. This study sought to determine the influence of periprostatic local anesthesia on the surgical difficulty of open radical prostatectomy (RP). A total of 241 consecutive patients who underwent TRUS-guided prostate needle biopsy were randomized to receive either periprostatic nerve block (Anesthesia group; n=120) or no anesthesia (Control group; n=121). After diagnosing localized prostate cancer, patients who underwent open RP without neoadjuvant androgen deprivation therapy were evaluated as to whether perioperative nerve block affected operative duration, estimated blood loss (EBL), positive margin rate or complications. Twenty-one patients in the Anesthesia group and 19 patients in the Control group were investigated in the current study. In assessing the patients who underwent open RP with or without periprostatic nerve block, no significant differences in operative duration, EBL, positive margin rate or complications were seen between groups. Periprostatic nerve block does not appear to affect perioperative outcomes after open RP.

The effect of multimodal balanced anaesthesia and long term gabapentin on neuropathic pain, nitric oxide and interleukin-1β following breast surgery

ObjectivesTo evaluate the effect of multimodal balanced anaesthesia and gabapentin (6 months) on neuropathic pain qualities, nitric oxide (NO) and interleukin 1-beta (IL-1β).MethodologyThis randomized study was conducted on 50 women scheduled for conservative breast surgery for cancer followed by chemotherapy and/or radiotherapy. Women enrolled into two groups; either to receive balanced general anaesthesia (GA) (control group) or ultrasound guided thoracic paravertebral with GA, multimodal balanced anaesthesia, (intervention group). Nociceptive pain was evaluated for 24 h. Neuropathic pain was evaluated using pain questionnaire 1 month postoperatively and neuropathic pain scale at 1, 3, 6 and 9 months. Gabapentin was prescribed to women reporting neuropathic pain 1 month postoperatively and for 6 months. NO and IL-1β were measured before operation, 1, 3, 6 & 9 months, postoperatively. Their relationship with neuropathic pain was assessed.ResultsNociceptive pain was less in intervention group than control group immediately post operative, 4 h after surgery at rest and 8 h with movement. Neuropathic pain started few days postoperatively, in both groups. Its onset, sites, duration and precipitating factors did not differ between the groups. Sensitive, hot pain and unpleasantness reduced significantly 1 month postoperatively, in intervention group. Two months later, itchy, dull and sharp pain was significantly less in intervention group. At 6 months, most of neuropathic pain items except sharp and deep pain lowered significantly in intervention group. At 9 months, hot and superficial pain was still less in intervention group. NO decreased significantly 1 and 3 months postoperatively, while IL-1β was significantly lower through different times, in intervention group. IL-1β correlated well with neuropathic pain intensity and unpleasantness.ConclusionBreast surgery for cancer was associated with neuropathic pain that continued for 9 months after surgery. Multimodal balanced GA had positive impact on acute nociceptive and neuropathic pain. Gabapentin reduced almost all neuropathic pain qualities.

Laser application enables awake thoracoscopic resection of pulmonary nodules with minimal access

Thoracoscopic resection of indeterminate pulmonary nodules is most commonly performed through three trocars using an endoscopic stapler. We assessed the safety, feasibility, and results of laser resection via minimal access under only local anesthesia. Between September 2009 and June 2010, excision of subpleural nodules using laser application under only local anesthesia was performed in 28 patients (Laser group). A 2-mm trocar (minigrasper) and an 11-mm trocar (operating scope) were used. Anesthesia time, surgery time, global operating room time, chest tube time, piritramid dose, and hospital stay were assessed and compared with data from a patient group (n = 28) that required nodule resection through three trocars using an endoscopic stapler under general anesthesia (Control group). There was no mortality or major morbidity. There was no difference in technical feasibility between the groups. Two patients in the Laser group and one patient in the Control group required conversion to thoracotomy due to severe adhesions. The mean nodule size was 0.9 ± 0.2 cm in the Laser group and 1.0 ± 0.3 cm in the Control group (P = 0.05). Comparisons of Laser group results with Control group results showed that in the Laser group, anesthesia time (3 ± 0.7 vs. 42 ± 6.3 min, P < 0.001), global operating room time (51 ± 4.8 vs. 88 ± 10.8 min, P < 0.001), piritramid dose (65.9 ± 30.5 vs. 109.1 ± 21.9 mg, P < 0.001), and hospital stay (2.3 ± 0.9 vs. 3.2 ± 0.6 days, P < 0.001) were significantly reduced. Patients' satisfaction was high. Ninety-eight percent of patients said they would undergo this surgery again. Awake thoracoscopic laser resection of subpleural pulmonary nodules proved safe and feasible. This technique may enable further reduction of invasiveness, length of hospital stay, and costs in selected patients.

Analgesic effects of tramadol, carprofen or multimodal analgesia in rats undergoing ventral laparotomy.

In this study, the authors evaluated the analgesic efficacy of tramadol (an opioid-like analgesic), carprofen (a nonsteroidal anti-inflammatory drug) and a combination of both drugs (multimodal therapy) in a rat laparotomy model. The authors randomly assigned rats to undergo either surgery (abdominal laparotomy with visceral manipulation and anesthesia) or anesthesia only. Rats in each group were treated with tramadol (12.5 mg per kg body weight), carprofen (5 mg per kg body weight), a combination of tramadol and carprofen (12.5 mg per kg body weight and 5 mg per kg body weight, respectively) or saline (anesthesia control group only; 5 mg per kg body weight). The authors administered analgesia 10 min before anesthesia, 4 h after surgery or (for the rats that received anesthesia only) anesthesia and 24 h after surgery or anesthesia. They measured locomotor activity, running wheel activity, feed and water consumption, body weight and fecal corticosterone concentration of each animal before and after surgery. Clinical observations were made after surgery or anesthesia to evaluate signs of pain and distress. The authors found that carprofen, tramadol and a combination of carprofen and tramadol were all acceptable analgesia regimens for a rat laparotomy model.

The efficacy of sacral block plus propofol for urinary surgery in children

Objective To observe the efficacy and complications of sacral block plus propofol for urinary surgery in children. Methods 80 ASAIpatients aged 3 months to 3 years undergoing urinary surgery were randomly assigned to receive sacral block plus propofol for continuous sedation (study group,n = 40) or intravenous injections of ketamine plus propofol for general anesthesia (control group,n = 40). Peranaesthesia,skin incision,intraoperative and postoperative systolic pressure (SBP),diastolic pressure (DBP),heart rate (HR),respiration (R),blood oxygen saturation (SPO2),time to consciousness recovery,surgical duration,and postoperative adverse reactions within 8 hours were noted. Results SBP,DBP,and R after induction and during surgery were significantly lower in the study group than in the control group (P＜0.05);and time to consciousness recovery was shorter in the study group(P＜0.0l).Conclusions Sacral block plus propofol is safe and effective in urinary surgery for children and has fewer complications. Key words: Children; Urinary surgery; Sacral block; Propofol; Efficacy

Inclusion of a Nitric Oxide Congener in the Insufflation Gas Repletes S‐Nitrosohemoglobin and Stabilizes Physiologic Status During Prolonged Carbon Dioxide Pneumoperitoneum

A method to maintain organ blood flow during laparoscopic surgery has not been developed. Here we determined if ethyl nitrite, an S-nitrosylating agent that would maintain nitric oxide bioactivity (the major regulator of tissue perfusion), might be an effective intervention to preserve physiologic status during prolonged pneumoperitoneum. The study was conducted on appropriately anesthetized adult swine; the period of pneumoperitoneum was 240 minutes. Cohorts consisted of an anesthesia control group and groups insufflated with CO2 alone or CO2 containing fixed amounts of ethyl nitrite (1-300 ppm). Insufflation with CO2 alone produced declines in splanchnic organ blood flows and it reduced circulating levels of S-nitrosohemoglobin (i.e., nitric oxide bioactivity); these reductions were obviated by ethyl nitrite. In a specific example, preservation of kidney blood flow with ethyl nitrite kept serum creatinine and blood urea nitrogen concentrations constant whereas in the CO2 alone group both increased as kidney blood flow declined. The data indicate ethyl nitrite can effectively attenuate insufflation-induced decreases in organ blood flow and nitric oxide bioactivity leading to reductions in markers of acute tissue injury. This simple intervention provides a method for controlling a major source of laparoscopic-related morbidity and mortality: tissue ischemia and altered postoperative organ function.

64: Outpatient Versus Day-case Endometrial Ablation Using the NovaSure Impedance Controlled Ablative System

The objective of this paper was to assess the feasibility and efficacy of the NovaSure™ endometrial ablation system in the outpatient setting using local anaesthesia and to compare this with the standard day-case procedure under general anaesthesia. A prospective cohort-controlled study was undertaken at a university teaching hospital. The patient cohort was made up of 38 women with heavy menstrual bleeding refractory to medical therapy where endometrial ablation was indicated. Endometrial ablation using the NovaSure™ impedance-controlled ablative system was undertaken to compare outpatient treatment using local cervical anaesthetic (experimental group, n=18) with inpatient treatment under general anaesthesia (control group, n=20). The subjective self-assessment of uterine bleeding symptoms, patient satisfaction and health-related quality of life (HRQL; multi-attribute utility assessment) measures at six months following treatment were noted. Participants were also asked as to whether they would subsequently recommend the treatment, based on their experience. All procedures were successfully accomplished. Completed outcome questionnaires were returned by 17/18 (94%) women treated as outpatients and by 13/20 (65%) as inpatients. Overall, 27/30 (90%) women reported an improvement in menstrual bleeding symptoms, with an amenorrhoea rate of 37% (95% CI 20–56%) and a combined amenorrhoea/spotting rate of 53% (95% CI 34–72%). There was no significant difference between the outpatient and inpatient treatment groups in terms of improvement in menstrual blood loss (94% vs. 84%, P=0.6), amenorrhoea (29% vs. 46%, P=0.5), amenorrhoea/spotting (47% vs. 62%, P=0.5), satisfaction (82% vs. 85%, P=1.0), improvement in HRQL (P=0.3) and treatment setting recommendation (88% vs. 77%, P=0.7). From our results, we conclude that NovaSure™ impedance-controlled endometrial ablation is an effective, safe and feasible treatment for heavy menstrual bleeding in both the outpatient and traditional inpatient settings. A choice of treatment settings should be offered to women suitable for this procedure.