Balanced Anesthesia Research Articles

Expert opinion: Using of antiplatelet agents in surgery with external fixators

Expert opinion: Using of antiplatelet agents in surgery with external fixators

Effects of the ultra-short-acting beta-blocker Esmolol infusion on cardiovascular parameters and quality of postoperative recovery in patients scheduled for elective plastic surgery

Background/Aim: Esmolol is an ultra-short-acting, easily titratable b-adrenergic receptor antagonist used for urgent treatment of hypertension and tachycardia in non-surgical and surgical settings. Aim of this clinical study was to investigate its cardiovascular effects and quality of the emergence from anaesthesia in patients scheduled for elective plastic surgery under general balanced anaesthesia. Methods: A total of 30 ASA I/II patients were randomised in two groups of similar demographic characteristics and baseline values of cardiovascular parameters. Esmolol group received esmolol dissolved in glucose 5 % as an intravenous infusion, 0.3 mg/kg/min during the first 5 min and at a rate of 0.1 mg/kg/ min thereafter. Control patients received the solvent only, at the same rate and volume. General balanced anaesthesia was induced with thiopentone sodium and fentanyl and maintained with nitrous oxide and oxygen. Neuromuscular relaxation was assured with pancuronium bromide and was antagonised at the end of operation with atropine and neostigmine. Systolic and diastolic blood pressure and heart rate were registered at all critical phases: (1) immediately prior to the induction (baseline value), (2) induction to anaesthesia, (3) tracheal intubation, (4) first skin incision, (5) surgical manipulation with organs, (6) suture of the surgical wound and (7) tracheal extubation. Drug consumption and quality of postoperative recovery were monitored. Results: In most of the critical phases of anaesthesia and operation, patients from the Esmolol group had significantly lower values of cardiovascular parameters than the patients from the Control group. Esmolol-treated patients needed less fentanyl, droperidol and pancuronium and had faster and smoother emergence from anaesthesia than the control patients. Conclusion: Esmolol improved haemodynamics and post-anaesthesia recovery in patients undergoing elective plastic surgery under general balanced anaesthesia.

Enhanced recovery program in thoracoabdominal surgery

To improve medical rehabilitation outcomes in patients after extensive surgery for benign and malignant diseases of the esophagus by implementing an enhanced recovery program. Patients with benign and malignant esophageal diseases underwent radical surgical repair under general balanced anesthesia with mechanical ventilation. With the collaboration of surgery, anesthesiology, and intensive care staff, a proprietary day-by-day enhanced recovery program was developed based on existing guidelines for patient management and systematic reviews on the enhanced recovery protocol after surgical esophageal repair. The developed patient management program was effective due to the reduction of intensive care unit stay and the total postoperative stay in all main group patients. The use of minimally invasive video-endoscopic techniques contributed to the reduction of intensive care unit stay. A less severe surgical stress response was observed in patients in the group of thoracoscopic subtotal esophageal resections. The introduction of the enhanced recovery program promotes the reduction of hospital stay and ICU stay in surgical esophageal repair patients. Also, it allows optimizing the postoperative management of patients with complicated and uncomplicated postoperative periods.

Measurement of coronary sinus blood flow using transesophageal echocardiography to estimate the adequacy of revascularization in patients undergoing off-pump coronary artery bypass grafting

Introduction Revascularization of coronary artery increases the blood flow in the coronary sinus (CS) too. The study aimed to measure the CS blood flow using transesophageal echocardiography (TEE) to estimate the adequacy of revascularization in patients undergoing off-pump coronary artery bypass grafting. Patients and methods After ethical committee approval, 100 patients scheduled for elective coronary artery bypass grafting were included in this study. After induction of balanced anesthesia according to institutional protocol, a 5-Hz multiplane phased-array TEE probe was inserted into patients’ esophagus, and the following parameters were calculated at pre-revascularization and post-revascularization periods: velocity time integral of CS, coronary sinus diameter, coronary sinus cross-section area, and coronary sinus blood flow (CSBF) per beat and per minute. Results Our study showed a statistically significant increase in velocity time integral in the post-revascularization period as compared with the pre-revascularization period (P Conclusion TEE is a superior modality to evaluate CSBF before and after coronary artery bypass revascularization to determine the adequacy of surgical revascularization in real time during off-pump coronary artery bypass revascularization.

Effects of esmolol infusion on cardiovascular parameters and quality of general anaesthesia in younger and older patients

Background: Esmolol is a cardioselective b-adrenergic antagonist that is used during general anaesthesia to blunt the sympathetic reflex tachycardia and hypertension. The aim of the study was to investigate whether the potential beneficial and adverse effects of esmolol differ depending on the patient age. Methods: A total of 50 ASA I/II patients scheduled for elective upper abdominal surgery were divided in two groups: younger (patients aged up to 35 years) and older (patients older than 65). After premedication with Diazepam, they were infused with esmolol during the first 5 min at a rate of 0.3 mg/kg/min and 0.1 mg/kg/min thereafter. Anaesthesia was induced with thiopental sodium 3-5 mg/kg intravenously (iv) and fentanyl 1.5 µg/kg IV. Tracheal intubation was facilitated with suxamethonium 1-2 mg/kg IV. Long-term neuromuscular blockade was induced with pancuronium bromide 0.07 mg/kg IV bolus and maintained with incremental IV boluses of 0.01 mg/ kg. Inhalational anaesthesia was maintained with a mixture of oxygen and nitrous oxide (O2 /N2 O) 2 : 1. Results: The systolic blood pressure remained constant during the intubation phase in the group of older patients, at the same time being around 89 % of the pre-induction values, while in younger patients it rose up to 100 %. During the same phase of anaesthesia, the diastolic blood pressure in older patients remained at about 91 %, while in younger patients it rose up to 107 % of the pre-induction values. The consumption of drugs and the speed and quality of the recovery from anaesthesia did not differ between the two groups of patients. Conclusion: Infusion of esmolol contributes to the concept of general balanced anaesthesia in elective patients scheduled for upper abdominal surgery equally in younger and older patients.

Ion Channels in Anesthesia.

Ion channels play a pivotal role in anesthesia, including general and regional anesthesia. Two main classes of general anesthetics (GAs) are inhalational anesthetics, such as isoflurane, sevoflurane, and nitrous oxide; injectable anesthetics, such as propofol, etomidate, and ketamine. Besides hypnotic agents, muscle relaxants for immobility and opioids for analgesia are needed to achieve balanced anesthesia. Although our understanding of anesthesia is far from complete, recent studies have revealed the molecular interactions between anesthetic drugs and ion channels, particularly, the ligand-gated ion channels (LGICs). Ionotropic GABAA receptors (GABAARs), the main mediators of the inhibitory signals in the central nervous system (CNS), are the key to hypnosis by general anesthetics. Ionotropic cholinergic receptors (nAChRs), expressed at the neuromuscular junction and the nervous system, are the molecular targets of muscle relaxants. GABAARs and nAChRs belong to the same family of pentameric LGICs. With a completely different architecture, ionotropic glutamate receptors (iGluRs) carry the excitatory signals in the CNS and are targeted by inhalational anesthetics and ketamine. Another distinct family of ion channels, two-pore-domain K+ (K2P) channels, can be activated by inhalational anesthetics and cause neuron hyperpolarization. In this chapter, we will discuss the recent advance in understanding the molecular mechanisms underlying anesthesia through the molecular structures of these ion channels.

OPTIMIZED SCHEME OF DIAZEPAM USAGE DURING CORONARY ARTERY STENTING

During invasive procedures in the X-ray operating room, sedation and analgesia have been used throughout its history. For sedation and anxiolytic effects, benzodiazepines, namely diazepam, were one of the drugs of choice. However, when using this drug, undesirable side effects have been identified, such as drowsiness, fatigue, amnesia, headache, tremors, cognitive impairments, and others.Objective. To establish the optimal scheme of analgosedation using diazepam for coronary artery stenting.Materials and research methods. The study included 60 patients with coronary artery disease who underwent a planned stenting of the coronary arteries. Analgosedation (AS) during stenting of the coronary arteries was performed routinely, and the patients were evenly divided into two study groups. The comparison group consisted of patients who underwent analgosedation based on diazepam and fentanyl. Patients in this group of AC were administered 10 mg of diazepam and 100 μg of fentanyl for induction, and repeated administration of drugs at the same dosage to maintain anesthesia during surgery. The study group consisted of patients with balanced usage of diazepam, namely, at the induction stage, we slowly intravenously injected 5 mg of diazepam solution and fentanyl solution at a dose of 1.5 mg / kg and 1.5 mg / kg / h to maintain the level analgesia. Intraoperatively, to maintain the level of sedation III on the RAMSEY scale (surface sedation), we used propofol solution.Conclusions. During the main stage, when sampling blood gases, we noted a difference in the level of oxygen, which was 6% higher in the study group (p = 0.044) and carbon dioxide, which was 11% higher (p = 0.018). This indicates the best rates of gas exchange in the balanced anesthesia group. During AS, based on the balanced usage of a combination of fentanyl and propofol solution, was better analgesic profile and fewer episodes of excessive sedation.

ANESTHESIA FOR RENAL TRANSPLANT SURGERY IN ADULTS

Renal transplant surgery may be associated with important perioperative complications. In this scenario, the anesthetic technique should provide optimal conditions for the surgical team, guarantee hemodynamic stability and kidney perfusion, and adequate analgesia. Preoperative evaluation should always be performed. In the intraoperative period, standard monitoring is sufficient in most cases. General balanced anesthesia, alone or in combination with spinal anesthesia or peripheral block, is the technique of choice. Management of blood pressure during the surgery is crucial. Before reperfusion, a mean arterial blood pressure of 65 mmHg is recommended, increasing to 80–90 mmHg when reperfusion is imminent until the end of surgery. Vasopressors, such as ephedrine, may be necessary to achieve blood pressure targets. Mannitol and furosemide are commonly used to increase urine output. In the postoperative period, analgesia should be ensured.

To compare intravenous paracetamol with tramadol given pre-emptively for intraoperative and postoperative analgesia- A randomized controlled trial

Introduction: The recommended approach for postoperative pain management is to initiate the treatment with analgesics such as paracetamol, NSAIDS, and aspirin followed by adjunctive use of opioids to treat more acute pain symptoms. However, the adverse effects associated with opioids and NSAIDS are well established. Aim: To study the efficacy of paracetamol in comparison to Tramadol when used as analgesic component of balanced anesthesia, pre-emptively for intraoperative and postoperative purpose. To study their side effects. To find out which of these two drugs is better in providing intraoperative and postoperative analgesia with minimum side effects. Materials and Methods: 60 patients of either sex, divided using computer generated random number table into 2 equal groups. Group T: (n 30): Tramadol hydrochloride group, Group P: (n 30): Paracetamol group. The dose of paracetamol and tramadol hydrochloride was 15mg/kg and 2mg/ kg body weight respectively. Statistical analysis: analysis was done by SPSS software version 11 by using Z test, chi-square test, proportion test (Z). P value less than 0.05 was considered as significant and less than 0.0001 as highly significant. Results: Both the groups were comparable with respect to their demographic profile, ASA status, and surgical procedures. Both paracetamol and tramadol have a good analgesic action and fewer side effects. The mean score of VAS Scale in group P (1.86 i‚± 2.40) and group T (3.03 i‚± 2.42) was similar and difference was not statistically significant. Also the side effects were comparable in both groups. Total number of rescue analgesics required by the group P (1.6) was significantly less as compared to the group T (3.7) with Z value = 4.00, p < 0.0001. Conclusion: Paracetamol has a better efficacy than tramadol hydrochloride in providing intra-operative and post-operative analgesia, when used pre-emptively with reduced number of doses of analgesic and almost no side effects. Keywords: Analgesi

Re: Attribution of Delayed Poor Lung Function to Desflurane-Based Balanced Anaesthesia Might be Inappropriate: Our Reply to Sharma et al.'s article.

Re: Attribution of Delayed Poor Lung Function to Desflurane-Based Balanced Anaesthesia Might be Inappropriate: Our Reply to Sharma et al.'s article.

Differences Between Natural Sleep and the Anesthetic State

The anesthetic state and natural sleep share many neurobiological features and yet are two distinct states. The hallmarks of general anesthesia include hypnosis, analgesia, akinesia and anxiolysis. These are the principal parameters by which the anesthetic state differs from natural sleep. These properties are mediated by systemic administration of a combination of agents producing balanced anesthesia. The exact nature of anesthetic narcosis is dose dependent and agent specific. It exhibits a relative lack of nociceptive response and active suppression of motor and autonomic reflexes. Surgical anesthesia displays a signature electroencephalogram pattern of burst suppression that differs from rapid eye movement sleep, representing more widespread disruption of thalamocortical connectivity, impairing information integration and processing. These differences underpin successful anesthetic action. This review explores the differences between natural sleep and anesthetic-induced unconsciousness as induced by balanced anesthesia.

Attribution of Delayed Poor Lung Function to Desflurane-Based Balanced Anaesthesia Might be Inappropriate: Our Reply to Sharma et al.'s Article.

Attribution of Delayed Poor Lung Function to Desflurane-Based Balanced Anaesthesia Might be Inappropriate: Our Reply to Sharma et al.'s Article.

Systemic effects and clinical application of dexmedetomidine

Dexmedetomidine is a most potent α-2 adrenergic selective agonist. It is one of the components of the racemic mixture of two enantiomers of medetomidine. It has a selectivity ratio of 1620/1(α 2/ α1), which is 5–10 times higher than that for detomidine (260/1) and xylazine (160/1. Dexmedetomidine produces consistent sedation, anxiolysis and muscle relaxation, which makes it a popular sedative agent in veterinary medicine. In veterinary practice, it is used for premedication and as an adjunct to general anaesthesia in several species. Similar to other alpha-2 agonists it exerts its effect through the action on alpha-2 adrenergic receptors. The sedative and anxiolytic effects of α-2 agonists are mediated by agonism of supraspinal autoreceptors situated in the pons, whereas analgesic effects are mediated by agonism of heteroreceptors located in the dorsal horn of the spinal cord. Dexmedetomidine causes a dose-dependent redistribution of blood flow and preserves blood flow to the most vital organs at the expense of organs like skin and pancreases and this distribution of blood flow is not affected by the type of anaesthesia. The pattern of cardiovascular changes may be affected by the dose used and the type of anaesthetic combined with dexmedetomidine. Most anaesthetic drugs, such as propofol, thiopental, isoflurane and halothane have cardiovascular and respiratory side effects that are dose-dependent. Dexmedetomidine is a good anaesthetic adjuvant for general anaesthesia which reduces intra-operative isoflurane consumption provides analgesic-sparing effect without affecting postoperative recovery profile and improved cardiovascular stability and contributes to the provision of balanced anaesthesia.

Remifentanil-based propofol-supplemented vs. balanced sevoflurane-sufentanil anesthesia regimens on bispectral index recovery after cardiac surgery: a randomized controlled study.

BackgroundThe present study was to compare the potential impact of remifentanil-based propofol-supplemented anesthesia regimen vs. conventional sevoflurane-sufentanil balanced anesthesia on postoperative recovery of consciousness indicated by bispectral index (BIS) values in patients undergoing cardiac surgery.MethodsPatients undergoing cardiac surgery were randomly allocated to get the remifentanil-based propofol-supplemented anesthesia employing target-controlled infusion (TCI) of remifentanil and propofol (Group-PR, n = 15) or a balanced-anesthesia employing sevoflurane-inhalation and TCI-sufentanil (Group-C, n = 19). In Group-PR, plasma concentration (Cp) of TCI-remifentanil was fixed at 20 ng/ml, and the effect-site concentration of TCI-propofol was adjusted within 0.8–2.0 μg/ml to maintain BIS value of 40–60. In Group-C, sevoflurane dosage was adjusted within 1–1.5 minimum alveolar concentration to maintain BIS of 40–60, and Cp of TCI-sufentanil was fixed at 0.4 ng/ml. The inter-group difference in the time for achieving postoperative BIS > 80 (T-BIS80) in the intensive care unit was determined as the primary outcome. The inter-group difference in the extubation time was determined as the secondary outcome.ResultsT-BIS80, was shorter in Group-PR than Group-C (121.4 ± 64.9 min vs. 182.9 ± 85.1 min, respectively; the difference of means –61.5 min; 95% CI –115.7 to –7.4 min; effect size 0.812; P = 0.027). The extubation time was shorter in Group-PR than in Group-C (434.7 ± 131.3 min vs. 946.6 ± 393.3 min, respectively, P < 0.001).ConclusionsCompared with the conventional sevoflurane-sufentanil balanced anesthesia, the remifentanil-based propofol-supplemented anesthesia showed significantly faster postoperative conscious recovery in patients undergoing cardiac surgery.

Inhaled anesthesia in neurosurgery: Still a role?

In patients undergoing craniotomy, general anesthesia should be addressed to warrant good hypnosis, immobility, and analgesia, to ensure systemic and cerebral physiological status and provide the best possible surgical field. Regarding craniotomies, it is unclear if there are substantial differences in providing general anesthesia using total intravenous anesthesia (TIVA) or balanced anesthesia (BA) accomplished using the third generation halogenates. New evidence highlighted that the last generation of halogenated agents has possible advantages compared with intravenous drugs: rapid induction, minimal absorption and metabolization, reproducible pharmacokinetic, faster recovery, cardioprotective effect, and opioid spare analgesia. This review aims to report evidence related to the use of the latest halogenated agents in patients undergoing craniotomy and to present available clinical evidence on their effects: cerebral and systemic hemodynamic, neurophysiological monitoring, and timing and quality of recovery after anesthesia.

Comparative randomized study of continuous serratus anterior plane block versus continuous paravertebral block in post-mastectomy pain

BackgroundMany analgesic methods have been used to control post-mastectomy pain. Both thoracic paravertebral and serratus anterior blocks are recent regional techniques with promising results. The aim of this study was to compare safety and analgesic efficacy of both techniques in controlling post-mastectomy pain.MethodsThe study was conducted from January 1, 2019, till January 10, 2019, on 60 female patients ASA class ≤ 2 undergoing modified radical mastectomy. After induction of balanced general anesthesia patients received either continuous thoracic paravertebral block (group P) or continuous serratus anterior block (group S). Twenty milliliters of levobupivacaine 0.25% were injected in each technique under ultrasound guidance followed by continuous infusion of 5 ml/h levobupivacaine 0.125% through a 22-gage catheter. IV morphine was given postoperatively by patient-controlled analgesia. In both groups, we measured time to first dose morphine, total 24 and 48 h morphine consumption, vital signs, visual analog scale, and side effects of each technique.ResultsThe demographic data (age, body mass index, and duration of surgery) were comparable in both groups. The time for first dose of morphine was significantly longer in group P (368 ± 36 min) than group S (270 ± 37.65 min) with P value < 0.001. Total morphine consumption in milligram at both 24 and 48 h were significantly less in group P (8.1 ± 0.8, and 11.5 ± 1 respectively) than in group S (10.1 ± 1.3 and 14.2 ± 1.4), with limited side effects in both groups.ConclusionBoth continuous paravertebral and serratus anterior plane blocks are safe good alternatives to control post-mastectomy pain. However continuous paravertebral block provides better analgesic profile.

In Response.

We thank Dr A. K. Jha1 for his valuable comments regarding our article.2 Although there is a correlation between the relative perfusion to the operative lung as assessed by lung scans and the partial pressure of oxygen in arterial blood (Pao2), it is unclear whether this variable is clinically relevant for patients undergoing thoracic surgery.3 Because not all the patients enrolled in our trial underwent lung perfusion scans, we did not perform a between-group comparison. We also did not measure Pao2 levels by arterial blood gas analysis during 2-lung ventilation (TLV). Because the Pao2 level during 1-lung ventilation (OLV) strongly and positively correlates with Pao2 during TLV, we were able to predict hypoxemia during OLV for patients in both groups that presented with an average room air saturation of 93% before general anesthesia. Nonetheless, we acknowledge that the TLV parameters and preoperative perfusion scans may give more insight on the impact of OLV, peak inspiratory pressure (PIP) and Pao2/fractional inspiration of oxygen (Fio2) (P/F) ratio. Hypoxic pulmonary vasoconstriction (HPV) during OLV mitigates the shunt fraction. HPV is blunted by sevoflurane and suppressed by the pathologic effects of chronic obstructive pulmonary disease (COPD). Although we did measure sevoflurane concentrations, we administered balanced anesthesia that included a remifentanil infusion. Thus, the actual concentration of sevoflurane was probably less than 1 minimum alveolar concentration (MAC), a concentration thought to have limited impact on HPV.4 Also, the treatment of OLV-induced increase in pulmonary hypertension may have been beneficial, as Dr A. K. Jha1 commented in the letter. Unfortunately, as we mentioned in the limitation section, we can only speculate there was an OLV-induced rise in pulmonary artery pressure because it was not possible to obtain accurate measurements of pulmonary arterial pressure in our clinical practice. We agree with the view that iloprost-induced pulmonary arteriolar vasodilation in the ventilated lung resulted in blood diversion from nonventilated lung to the ventilated lung with physiological dead space reduction and P/F ratio augmentation. Indeed, as our study results indicate, inhaled iloprost improves oxygenation and dead space ventilation during OLV in COPD patients with poor lung oxygenation. Considering that atelectasis in the operated lung persists in the postoperative period,5 it can be deduced that the difference in P/F ratio in the postanesthetic care unit in both groups may be due to the residual intrapulmonary shunt fraction and the residual effects of iloprost inhalation, which ameliorates the ventilation/perfusion matching. In this regard, we speculate that the beneficial effects of iloprost during OLV may persist even after TLV or spontaneous ventilation is restored, but this needs to be clarified. We think that the comments provided by Dr A. K. Jha1 are valuable and should be considered when planning further studies. Namo Kim, MD, PhDDepartment of Anesthesiology and Pain MedicineAnesthesia and Pain Research InstituteYonsei University College of MedicineSeoul, Republic of Korea Su Hyun Lee, MDDepartment of Anesthesiology and Pain MedicineYonsei Sarang HospitalSeoul, Republic of Korea Young Jun Oh, MD, PhDDepartment of Anesthesiology and Pain MedicineAnesthesia and Pain Research InstituteYonsei University College of MedicineSeoul, Republic of Korea[email protected]

Factors affecting the incidence of chronic pain following breast cancer surgery: Preoperative history, anesthetic management, and surgical technique.

Breast cancer is the most frequent cancer in women. Chronic pain following mastectomy remains a significant problem. This study aimed to evaluate risk factors associated with postoperative chronic pain. Medical records were analyzed retrospectively for 147 consecutive patients with breast cancer who underwent mastectomy between July 2016 and February 2018 with one-year follow-up. All patients received a paravertebral block pre-operatively and then general anesthesia for the surgery. The median postoperative pain score was 1.3 on the verbal analgesic score. The average total dose of opioids administered postoperatively was 10.4 mg, expressed in morphine milligram equivalents. The incidence of chronic pain after mastectomy was 16.7% at 6 months and 13.3% at 1 year. The satisfaction rate for anesthesia and surgery was 95.7%. The data suggested that preoperative paravertebral nerve blocks, appropriate adjuvants, and a balanced general anesthetic may contribute to better postoperative pain control and decreased the incidence of chronic pain. A history of preoperative use of opioids and/or a history of alcohol consumption were both associated with significant increased levels of postoperative pain, and this subgroup warrants attention to diminish the risk of developing chronic pain.

Effects of Spinal and Epidural Anaesthesia on Brain Oxygenation in Lumbar Disc Surgery

Aim: Due to the sympathetic blockage in spinal and epidural anesthesia applied in lumbar disc surgery, hemodynamic effects are different from each other and these effects may cause changes in cerebral oxygenation. In our study, we aimed to compare the effects of spinal and epidural anesthesia on brain oxygenation in patients undergoing elective LDS. Material and Methods: ASA I-II, 50 patients were included in our study. Group S: (n = 25) 15mg(3ml) 5% isobaric bupivacaine intrathecal and Group E: (n = 25) 40mg(8ml) isobaric bupivacaine (5%), 70mg(3.5ml) lidocaine hydrochloride (2%), 75 µg(1.5ml) fentanyl and 3 ml saline were applied to lomber epidural gap. The hemodynamic variables and bilateral regional cerebral oxygen saturation (rScO2) of the patients were recorded with the Near-Infrared Spectroscopy (NIRS) method in the basal, supine position in the 5th, 10th minutes after the central block, 10th minute in the prone position and the patient was placed in the supine position again. Results: In demographic data, hemodynamic parameters and periodic measurements in Group S and Group E, brain right and left hemisphere rScO2 values (Group S: right hemisphere rScO2 (basal) 69.7 ± 5.5, (60 minutes) 64 ± 7; left hemisphere rScO2 (basal) 70.2 ± 5.1, (60 minutes) 64 ± 8, Group E: right hemisphere rScO2 (basal) 71.6 ± 7.2, (60 minutes) 66.6 ± 5; left hemisphere rScO2 (basal) 71.7 ± 7.3, (60 minutes) 66.8 ± 5), no statistically significant difference was found (p&gt; 0.05). Conclusion: Spinal and Epidural anesthesia affect rScO2 in a similar way. Since epidural anesthesia causes a more balanced anesthesia, it can balance cerebral blood volume and oxygenation. This study may be a guide for studies evaluating the effects of spinal and epidural anesthesia on brain oxygenation, especially in geriatric patient groups. Keywords: Lumbar disc surgery, Spinal anaesthesia, Epidural anaesthesia, Near-Infrared Spectroscopy (NIRS), Regional Brain Oxygenation Saturation(rScO2) DOI: 10.7176/JHMN/79-09 Publication date: August 31 st 2020

Variability of anesthetic depth in total intravenous anesthesia vs balanced anesthesia using entropy indices: a randomized, crossover, controlled clinical trial

Introduction: Total intravenous anesthesia (TIVA) and balanced anesthesia (BA) are the most commonly used anesthetic techniques. The differences are the variability of the depth of anesthesia between these techniques that might predict which one is safer for patients and presents a lower risk of intraoperative awakening.&#x0D; Objective: To determine whether a difference exists in the variability of depth of anesthesia obtained by response entropy (RE). &#x0D; Methods: A crossover clinical trial was conducted on 20 healthy patients receiving upper or lower limb ambulatory orthopedic surgery. Patients were randomly assigned to (a) target-controlled infusion of propofol using the Schnider model at a target concentration of 2.5mg/mL for 15minutes and a 10-minute washout, followed by sevoflurane administration at 0.8 minimal alveolar concentration (MAC) for the reminder of the surgery, or (b) the reverse sequence. Differences in the variability of the depth of anesthesia using RE were evaluated using paired t test.&#x0D; Results: The treatment effect showed no significant difference in the average values of RE, during TIVA=97.23 vs BA 97.04 (P=0.39). Carry Over (-4.98 vs 4.08) and Period (100.3 vs 94.68) effects were not significantly different.&#x0D; Conclusion: The present study suggests that both anesthetic techniques are equivalent in terms of the stability of the depth of anesthesia. It is important to keep testing the determinants of the efficacy of different populations because the individual behaviors of patients might ultimately tip the scale.