Combined Epidural Anesthesia Research Articles

Combined anesthesia shows better curative effect and less perioperative neuroendocrine disorder than general anesthesia in early stage NSCLC patients.

ObjectivesWe aimed to compare the effects of general anesthesia with combined epidural and general anesthesia in patients with early-stage non-small cell lung carcinoma (NSCLC).MethodsPatients scheduled to undergo tumor resection with adjuvant chemoradiotherapy were eligible. Patients in the control group received general anesthesia during surgery, and those in the observation group received combined epidural and general anesthesia. The hemodynamic factors mean arterial pressure (MAP), heart rate, end-tidal carbon dioxide, and oxygen saturation were measured. Serum levels of pro-inflammatory cytokines interleukin (IL)-1, IL-8, high-sensitivity C-reactive protein (hs-CRP), and tumor necrosis factor (TNF)-α as well as β-endorphin were measured by enzyme-linked immunosorbent assay. Serum malondialdehyde (MDA) was measured using the thiobarbituric acid method.ResultsThe incidence of specific adverse events was reduced and overall and disease-free survival were improved in the observation group compared with the control group. MAP was generally lower in the observation group compared with the control group, as were the serum levels of IL-1, IL-8, hs-CRP, TNF-α, and MDA.ConclusionsCompared with general anesthesia, combined epidural and general anesthesia may inhibit the occurrence of short-term adverse events and improve long-term outcomes by inhibiting inflammatory responses in patients with early-stage NSCLC after tumor resection.

Relationship among anesthesia technique, surgical stress, and cognitive dysfunction following spinal surgery: a randomized trial.

Surgical trauma is known to result in systemic inflammatory changes that can lead to postoperative cognitive dysfunction. In the present study, the authors compared the effects of an epidural anesthesia protocol to those of traditional anesthesia with regard to postoperative inflammatory changes, cellular immunity, and cognitive dysfunction. Forty-eight patients, ages 45-60 years, underwent multilevel thoracolumbar decompression and fusion and were randomly assigned to one of two groups: group 1 (27 patients) had combined epidural and general anesthesia, followed by epidural analgesia for 48 hours after surgery, and group 2 (21 patients) had general anesthesia, followed by traditional opioid pain management after surgery. At multiple time points, data on pain control, cognitive function, cellular immunity, and inflammatory markers were collected. Group 1 patients demonstrated lower pain levels, less systemic inflammation, less cellular immune dysfunction, and less postoperative cognitive dysfunction than group 2 patients. The use of combined epidural and general anesthesia followed by postoperative epidural analgesia during the first 48 hours after multilevel thoracolumbar decompression and fusion surgery had a significant positive effect on pain management, cellular immune function, systemic inflammation, and postoperative cognitive function.Clinical trial registration no.: 115080510080 (http://rosrid.ru).

Measurement of cardiac biomarkers in open lobectomies: comparison of combined thoracic epidural anesthesia with general anesthesia to general anesthesia alone

Introduction Troponin is a sensitive biomarker for cardiovascular injury. In lobectomies, perioperative analgesia can be performed with either a combination of thoracic epidural anesthesia and general anesthesia or general anesthesia alone. We wish to demonstrate that patients who receive the former tend to have lower levels of troponin. Methods In this prospective observational study, we included patients who underwent open lobectomy. Cardiovascular markers were recorded postoperatively, in order to correlate the fluctuation of these markers with the application or not of thoracic epidural anesthesia. Results Forty-eight (48) patients were enrolled, 15 (31.3%) received a combination of thoracic epidural anesthesia with general anesthesia, while 33 (68.7%) received general anesthesia alone. Patients with epidural anesthesia were found to have significantly lower levels of troponin 12-24 hours after surgery (8.9 ± 4.1 versus 16.8 ± 10.5, p Discussion Patients who undergo open lobectomy receiving a combination of general and thoracic epidural anesthesia appear to maintain lower troponin levels in the immediate postoperative period than patients receiving general anesthesia alone.

Combined General and Epidural Anesthesia is Associated With Decreased Opioid Consumption and Enhanced Pain Control After Penile Inversion Vaginoplasty in Transwomen.

Penile skin inversion vaginoplasty is a gender-affirming surgical procedure for transwomen with limited surgical analgesic protocol. This study compares the postoperative pain and opioid use in patients managed for surgery with general anesthesia (GA) with patients who were given combined epidural and general anesthesia (E/GA) with continuing postoperative epidural analgesia. All patients who underwent penile inversion vaginoplasty between May of 2016 and May of 2018 under the care of single surgeon were identified retrospectively, 18 patients of which met the inclusion criteria. A retrospective chart review was conducted. Outcome measures were postoperative pain using visual analog scale, type and dosage of postoperatively administered intravenous or oral opioids (converted to morphine milligram equivalents, duration of inpatient admission, and time to ambulation. Patients who received combined E/GA reported significantly less pain and used less opioids during the first 4 postoperative days in comparison with patients who received GA alone. The reduction in mean pain associated with the use of an epidural was found to be statistically significant (P < 0.0005) as was the difference in opioid used in the 2 groups (P < 0.005) over the first 4 days postoperatively. Differences in day 5 pain suggest that postoperative pain is significantly lower even after the epidural has been removed (P < 0.005). There was no significant difference in length of hospital stay and time to ambulation (P > 0.05). Combined E/GA was associated with decreased inpatient opioid consumption after surgery and provided superior pain control than administration of GA alone. Based on these findings, combined E/GA should be strongly considered for patients undergoing penile inversion vaginoplasty.

To compare the efficacy of ropivacaine with fentanyl v/s levobupivacaine with fentanyl in post-operative epidural analgesia in lower limb and lower abdominal surgeries

Aims: To compare the efficacy of ropivacaine V/S levobuivacaine with fenatnyl as adjuvant for post operative analgesia in below umbilicus surgeries under combined spinal and epidural anaesthesia. Settings and Design: A prospective randomized double blind study was planned on 60 ASA grade I and II patients, admitted for elective surgeries. Materials and Methods: Patients were randomly divided into two Groups, Group I (n=30) received ropivacaine 0.1% (10ml of 0.2% ropivacaine) with 2µgm/ml of fentanyl (0.8 ml of fentanyl) & 9.2 ml of normal saline making a total volume of 20 ml, Group II (n=30) received 0.1% levobuivacaine (4 ml of 0.5% levobuivacaine) with 2µgm / ml of fentanyl (0.8 ml of fentanyl) & 15.2 ml of normal saline making a total volume of 20 ml. In both the groups, VAS score at different intervals of time, onset and duration of sensory block, and hemodynamic parameters and complications were assessed. Statistical Analysis Used: Data was expressed as either mean + standard deviation or numbers and percentages and analyses were performed using “Microsoft Excel 2007” for windows. The parameters were analyzed using Student’s Paired and Unpaired t-test. Results: The average duration of sensory block was 276±30.80 and 259±20.95 min for Group I and Group II respectively which were comparable for both Groups (p >0.05). The hemodynamic changes and complications have no significant differences between two groups, (p > 0.05). Conclusions: The combination of ropivacaine and levobupivacine with fentanyl as common adjuvant is equipotent for post-operative epidural anesthesia. Keywords: Ropivacaine, Levobupivacaine, Fentanyl, Epidural.

IMPROVEMENT OF COMBINED MULTIMODAL ANESTHESIA FOR ABDOMINAL SURGICAL INTERVENTIONS IN CHILDREN

The aim of the study was to enhance the efficiency and safety of the combined methods of anesthesia using propofol and epidural anesthesia for the abdominal surgery in children by assessing the hemodynamic regulation of the heart rhythm and the clinical course of anesthesia. Materials and methods. We studied children aged of 1 to 14 years operated for diseases and malformations of the abdominal cavity. To ensure the anesthetic protection in 57% of affected children there was used combined epidural anesthesia by bupivacaine combined with propofol and fentanyl in cases from the 1 (main) group and in 43% of affected children there was applied the combined anesthesia by fentanyl and droperidol with lidocaine epidural anesthesia - 2 (control) groups. Results The results showed the relative stability of the patients providing adequate pain relief after the surgery in children. Use of a combination of drugs: early fentanyl analgesic effect develops, whereas propofol implements its action later, and provides a prolongation of analgesia. Propofol, fentanyl with epidural analgesia bupivacaine for analgesic effect appeared to be several times higher than methods of neuroleptanalgesia.

Effects of combined intravenous anesthesia and epidural anesthesia on the perioperative stress response and immune function in elderly patients with hepatectomy

目的 探讨静脉复合麻醉联合硬膜外麻醉对老年人肝癌切除术围术期应激反应、免疫功能的影响。 方法 选择2016年7月至2017年7月在浙江金华广福肿瘤医院择期行肝癌切除术的老年原发性肝癌患者82例，采用随机数字表法分为观察组和对照组，每组41例。对照组采取静脉复合麻醉，观察组采取静脉复合麻醉联合硬膜外麻醉，比较两组患者围术期血流动力学指标、血糖、肾上腺素水平以及T细胞免疫功能。 结果 切皮时、切皮后1 h两组患者平均动脉压(MAP)、心率(HR)均较麻醉前显著降低[对照组MAP切皮时(80.52±7.44)mmHg、切皮后1 h(78.52±6.49)mmHg，均高于麻醉前的(91.28±7.20)mmHg(t＝6.655、8.429，均P<0.05)；对照组HR切皮时(60.37±2.04)次/min、切皮后1 h(58.47±1.95)次/min，均高于麻醉前的(66.72±6.12)次/min(t＝6.303、8.224，均P<0.05)；观察组MAP切皮时(85.21±8.49)mmHg、切皮后1 h(86.21±7.63)mmHg，均高于麻醉前的(92.31±6.47)mmHg(t＝4.259、3.904，均P<0.05)；观察组HR切皮时(63.85±2.31)次/min、切皮后1 h(64.21±2.51)次/min，均高于麻醉前的(67.42±5.94)次/min(t＝3.587、3.187，均P<0.05)]，且对照组降低程度明显高于观察组(P<0.05)。术后1 h、术后6 h两组患者肾上腺素、皮质醇以及血糖水平均较麻醉前显著升高[对照组肾上腺素术后1 h(69.48±9.27)μg/L、术后6 h(60.12±8.43)μg/L，均高于麻醉前的(36.47±6.83)μg/L(t＝18.357、13.958，均P<0.05)；对照组皮质醇术后1 h(0.91±0.18)×103 mmol/L、术后6 h(0.84±0.25)×103 mmol/L，均高于麻醉前的(0.59±0.26)×103 mmol/L(t＝6.480、4.438，均P<0.05)；对照组血糖术后1 h(7.64±0.93)mmol/L、术后6 h(7.21±0.83)mmol/L，均高于麻醉前的(4.63±0.56)mmol/L(t＝17.754、16.499，均P<0.05)；观察组肾上腺素术后1 h(57.46±7.82)μg/L、术后6 h(49.32±8.39)μg/L，均高于麻醉前的(35.26±5.82)μg/L(t＝14.582、8.817，均P<0.05)；观察组皮质醇术后1 h(0.71±0.21)×103 mmol/L、术后6 h(0.68±0.19)×103 mmol/L，均高于麻醉前的(0.58±0.22)×103 mmol/L(t＝2.737、2.203，均P<0.05)；观察组血糖术后1 h(6.18±0.79)mmol/L、术后6 h(5.72±0.82)mmol/L，均高于麻醉前的(4.87±0.48)mmol/L(t＝9.074、5.728，均P<0.05)]，且对照组升高程度均明显高于观察组(均P<0.05)。术后1 h、术后1 d、术后3 d两组患者外周血CD3＋、CD4＋、CD4＋/CD8＋水平均较麻醉前显著降低(均P<0.05)，而术后3 d观察组患者外周血CD3＋、CD4＋、CD4＋/CD8＋水平均明显高于对照组(均P<0.05)。 结论 静脉复合麻醉联合硬膜外麻醉可有效降低老年肝癌切除术患者围术期应激反应，加快患者术后免疫功能的恢复，是一种较为理想的麻醉方式。

Efficacy of combined spinal and epidural anesthesia vs epidural anesthesia alone in total hysterectomy: Impact on serum motilin and gastrin

Efficacy of combined spinal and epidural anesthesia <i>vs</i> epidural anesthesia alone in total hysterectomy: Impact on serum motilin and gastrin

Effects of general anesthesia with combined epidural anesthesia on inflammatory response in patients with early-stage gastric cancer undergoing tumor resection.

The present study aimed to investigate the effects of combined epidural and general anesthesia on gastric cancer patients undergoing tumor resection. A total of 107 patients with early-stage gastric cancer who underwent surgery between January 2014 and January 2017 were enrolled in the present study. All patients in the control group (n=54) were treated with general anesthesia, while patients in the observation group (n=53) were treated with combined epidural and general anesthesia. The percentages of viable T lymphocyte subsets and the levels of carcinoembryonic antigen in the serum were measured. Furthermore, the pro-inflammatory cytokines interleukin (IL)-1, IL-8, high-sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor (TNF)-α were measured. Compared with those in the control group, the percentages of CD3+ and CD4+ T lymphocytes and the CD4+/CD8+ ratio in the observation group were increased, while the population of CD8+ cells was decreased. Furthermore, the serum levels of the pro-inflammatory cytokines IL-1, IL-8, hs-CRP and TNF-α in the observation group were reduced compared with those in the control group. In addition, the incidence of nausea and vomiting, as well as post-operative agitation were lower in the observation group compared with those in the control group. In conclusion, compared with general anesthesia, combined anesthesia inhibits the inflammatory response and improves immune function in early-stage gastric cancer patients undergoing tumor resection.

Effect of anesthetic methods on postoperative CD3+, CD4+ and CD4+CD25+ in patients with lung cancer undergoing radical operation.

Effects of anesthesia methods on immune function in patients with lung cancer undergoing radical operation were investigated. A total of 122 patients undergoing radical resection of lung cancer who were treated in Zhejiang Cancer Hospital from September 2013 to April 2016 were randomly divided into the combined anesthesia group and the intravenous anesthesia group, with 61 cases in each group. The patients in the combined anesthesia group were given intravenous combined epidural anesthesia. Patients in the intravenous anesthesia group were given intravenous anesthesia. The change of CD3+, CD4+ and CD4+CD25+ at time-point T0 (before anesthesia), T1 (the time of anesthesia), T2 (after operation), T3 (24 h after operation), T4 (72 h after operation) were compared between the two groups. The levels of CD3+, CD4+ and CD4+CD25+ at T1, T2, T3 and T4 in the combined anesthesia group were higher than that in the intravenous anesthesia group (P<0.05). Αfter starting anesthesia, the levels of CD3+, CD4+ and CD4+CD25+ began to decrease in both groups. The levels of CD3+, CD4+ and CD4+CD25+ at T2 and T1 were lower than those at T0 (P<0.05). The levels of CD3+, CD4+ and CD4+CD25+ at T2 were lower than T1 (P<0.05). After T3, the levels of CD3+, CD4+ and CD4+CD25+ began to increase in both groups. Τhe levels of CD3+, CD4+ and CD4+CD25+ at T3 and T4 were higher in both groups than those at T2 and T1 (P<0.05), and the levels of CD3+, CD4+ and CD4+CD25+ at T4 were higher in both groups than those at T3, but the levels of CD3+, CD4+ and CD4+CD25+ at T3 and T4 were lower than those at T0 (P<0.05). Intravenous combined epidural anesthesia can maintain a relatively stable immune function compared with simple intravenous anesthesia patients.

Bolus administration of ephedrine and etilefrine induces transient vasodilation just after injection in combined epidural and general anesthesia patients: A randomized clinical study.

Hypotension commonly accompanies combined epidural and general anesthesia, and intravenous bolus ephedrine and etilefrine are widely used to correct hypotension. We have noticed that systemic vascular resistance (SVR) transiently decreases just after intravenous bolus administration of these drugs. The goal of the present study was to investigate whether bolus administration of these drugs decrease SVR just after intravenous administration in combined epidural and general anesthesia patients. We investigated 40 patients who were scheduled for elective abdominal surgery. Patients were chosen as subjects if their systolic arterial pressure decreased by 20% or to <100 mmHg at 30 min after the induction of general anesthesia. Baseline hemodynamic values were recorded, and after ephedrine 10 mg injection or etilefrine 2 mg injection (equipotent), the parameters were recorded again at 0.5 min and once each min for the next 5 min thereafter. The 40 patients were enrolled into the ephedrine (n = 20) or etilefrine (n = 20) treatment groups. Patient characteristics were comparable in both groups. After ephedrine injection, SVR decreased significantly at the 1-min time point, whereas after etilefrine injection, SVR decreased significantly at the 0.5- to 2-min time points compared with baseline values. SVR at the 0.5- to 1-min time points was lower in the etilefrine versus the ephedrine group. Both drugs transiently decreased SVR after intravenous injection, but etilefrine decreased SVR much more than ephedrine, indicating that more vasodilation occurred after the injection of etilefrine than after ephedrine. It is thus important to recognize the different characteristics of these drugs.

Effect of different thoracic anesthesia on postoperative cough.

The objective of the study is to retrospectively analyze the cough status after double lumen tube (DLT) and spontaneous respiration thoracic anesthesia, to compare the degree of influence of anesthesia and surgical factors, and to investigate whether spontaneous respiration anesthesia can reduce the incidence of cough. Postoperative follow-ups were performed on 1,162 patients from July 2011 to December 2015 who meet the selected conditions, whose surgical approach is limited to VAST bullectomy, wedge resection, segmentectomy, or lobectomy. Patients' probability of cough in 1st day (T1), 2nd days (T2), 3rd days (T3), 1st month (T4), 3rd months (T5), 6th months (T6) and 12th months (T7) after thoracoscopic surgery were recorded, as well as the Leicester cough questionnaire (LCQ) survey results, visual cough score (VAS), and cough symptom scores. All cases were divided into double-lumen endotracheal tubes anesthesia group (group T, n=925 cases) and spontaneous respiratory anesthesia group (group S, n=456 cases), and group S was further divided into intravenous composite intercostal nerve block anesthesia group (group SB, n=157 cases) and intravenous combined epidural anesthesia group (group SE, n=299 cases). The probability of cough decreases with the increasing of postoperative time (P<0.05). The probability of cough is similar between group SE and group SB (P>0.05). The probability of cough in group T is significantly higher than other groups at any time point (P<0.05). In group T, the symptom of cough is the most severe, the scores of physiological, psychological, and social parts of LCQ are the lowest, and the VAS score is the highest (P<0.05), but all these are similar in group SE and group SB (P>0.05). The duration of antibiotic application, the days of chest drainage tube indwelling, and the days of hospital stay are all lower in group S than in group T (P<0.05). There is a correlation between pulmonary surgery and postoperative cough. The probability of postoperative cough is higher in the more invasive patients. The probability of coughing is approximately 27% to 36% at 3 months after surgery, and approximately 2.6% to 7.9% in one year after surgery. The combination of surgery and anesthesia methods increases the probability of cough from 48.9% to 65.1% at 3 months after surgery, and about 20.5% to 22.8% in 1 year after surgery. Spontaneous respiration anesthesia can significantly reduce the probability of cough, improve postoperative recovery, and improve postoperative quality of life.

Comparison of barbotage and single injection applied to combined spinal and epidural anesthesia in cesarean section

Objective Comparing the outcome of barbotage(Bbt) and single injection applied to combined spinal and epidural anesthesia(CSEA) in cesarean section, including sensation block effect, motor block effect, changes of maternal hemodynamics, neonatal Apgar scores. Methods One hundred ASA Ⅱ parturients of 20-40 years with full-term pregnancy were scheduled for cesarean delivery under L2-L3 CSEA were included. They were randomly divided into 2 groups with 50 cases each group. 0.5% ropivacaine 2.2 ml(11 mg) were used in all patients. A Bbt technique was carried out in group B: 1st step, inject 1.1 ml of 2.2 ml total solution and withdrawing back to 2.1 ml, 2nd step, inject 1.1 ml of 2.1 ml solution and withdrawing back to 1.6 ml, 3rd step, inject 1.1 ml of 1.6 ml solution and withdrawing back to 1.1 ml, 4th step, inject the rest solution into subarachnoid space. The total injection time of group B is 44 s with an average speed of 0.1 ml/s. Single injection is carried out in group S within 22 s and same average speed. Dopamine and phenylephrine were used to stabilize maternal circlatory system. Record maternal blood pressure, heart rate, level of sensory block, Bromage score, usage of vasoactive drugs and local anesthetics at time of resting(t0) and 4 min(t1), 6 min(t2), 8 min(t3), 10 min(t4) min after injection. Record perioperative adverse reaction and condition of newborns. Results The speeds of block sensory level rising: group B>group S(P group S(P group S(P 0.05). Conclusions In the spinal anesthesia of cesarean section, Bbt provides wider distribution of local anesthetics in subarachnoid space, which leads to faster nerve block and higher block level with more stable blood pressure and HR. Key words: Barbotage; Ropivacaine; Combined spinal and epidural anesthesia; Cesarean section

Postoperative analgesia efficacy of quadratus lumborum block versus transversus abdominis plane block in patients undergoing caesarean section

Objective To compare the postoperative analgesic effect of ultrasound-guided quadratus lumborum block(QLB) and transversus abdominis plane block(TAPB) block in caesarean delivery with median incision in the lower abdomen. Methods Eighty patients undergoing caesarean delivery with the median incision of the lower abdomen, classified as ASA Ⅰ or Ⅱ, were randomly divided into QLB group(group Q, n=40) and TAPB group (group T, n=40). Puerperants were scheduled for caesarean delivery under combined spinal and epidural anesthesia with median incision in the lower abdomen. After surgery, patients in group Q received ultrasound-guided QLB with bilateral ropivacaine(20 ml of 0.375%) injection into thoracolumbar fascia behind quadratus lumborum. Patients in group T received ultrasound-guided TAPB with ropivacaine(20 ml of 0.375%) bilaterally. The resting and exercise VAS scores and the consumption of sufentanil 4, 8, 12, 24, 48 h after operation were recorded. The incidences of postoperative adverse reactions and patients' satisfaction with postoperative analgesia were also documented. Results There was no significant difference in postoperative resting VAS scores between the two groups(P>0.05). The exercise VAS scores 8, 12, 24, 48 h after operation and the consumption of sufentanil in group Q were significantly lower than those in group T(P<0.05). Patients in group Q had lower incidence of adverse reactions(P<0.05). Conclusions Ultrasound-guided bilateral QLB with ropivacaine can reduce the consumption of opioid drugs after caesarean delivery, reduce the exercise VAS score, and improve patients' satisfaction. Key words: Quadratus lumborum block; Caesarean section; Postoperative analgesia

Association of hemodynamics during caesarean section, outcomes after caesarean section and hormone changes with different anesthesia in pregnant women with severe pulmonary arterial hypertension.

In the present study we aimed to analyze the effects of different anesthesia methods on the hemodynamics of caesarean section, outcomes after caesarean section and hormone changes in pregnancy complicated with severe pulmonary arterial hypertension (PAH). A total of 75 pregnancy complicated with severe PAH that were treated in Jining First People's Hospital from January 2016 to January 2017 were selected. Three groups were set according to the anesthesia methods, including the subarachnoid combined epidural anesthesia group (group I, n=25), the epidural anesthesia group (group II, n=25) and the general anesthesia group (group III, n=25). Effects on the outcomes of caesarean section of pregnancy complicated with PAH were observed. Sex hormone levels before and 24, 48 and 72 h after the operation were measured. There were remarkable changes in the postoperative hemodynamics compared with those before anesthesia, but changes in groups I and II were significantly smaller than those in group III (P<0.05). No significant differences in maternal mortality rate, neonatal mortality rate and neonatal asphyxia rate among the three groups were found (P>0.05). Time of postoperative mechanical ventilation, ICU residence and hospitalization in groups I and II were shorter than those in group III, the differences were statistically significant (P<0.05). Postoperative levels of sex hormones, including estradiol (E2), human chorionic gonadotrophin (HCG), prolactin (PRL) and plasma total testosterone (TT) decreased, while postoperative levels of sex hormones follicle stimulating hormone (FSH), luteinizing hormone (LH) and progestogen increased, and differences in the decreased E2 and TT at each time-point were statistically significant (P<0.05). In conclusion, there is no remarkable difference in the effects of three anesthesia methods on pregnancy outcomes. However, compared with general anesthesia, intravertebral anesthesia achieve shorter time of postoperative mechanical ventilation, ICU residence and hospitalization in pregnancy complicated with severe PAH, which is preferred in pregnancy without contraindication of the anesthesia.

Evaluation of levobupivacaine and bupivacaine cardiotoxicities by correlation of Brain Natriuretic Peptide protein values and arterial pressures

Objectives: The aim of the present study was to determine the cardiotoxic effects of the intrathecal and epidural administration of bupivacaine and levobupivacaine by investigating whether there is a correlation between the brain natriuretic peptide (BNP) protein levels and the arterial pressure.&#x0D; Methods: In this prospective, randomized, double-blinded, 30 patients aged 25-70 years, who were undergo total knee arthroplasty surgery, were randomized into 2 groups. In Group 1 (n=15): levobupivacaine was applied and Group 2 (n = 15) bupivacaine was applied. Primary outcome measures includes BNP protein levels (at after injection 10th minute and postoperative 24th hour), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP) (at preoperative, after injection 10th minute and postoperative 24th hour) was examined.&#x0D; Results: In both groups, there was no statistically significant correlation between the BNP levels and the SAP, DAP and MAP value 10 minutes after the administration of combined spinal-epidural anesthesia and at the 24th hour (p&gt;0.05)&#x0D; Conclusions: We think that the cardiac effects associated with the hypotensive effects of local anesthetics cannot be revealed with the BNP. Moreover, our study results suggest that both drugs are not cardiotoxic when administered with combined epidural spinal anesthesia.

Effect of combined epidural anaesthesia on tumor-infiltrating lymphocytes in lung adenocarcinoma: a prospective exploratory sub-analysis.

Regional anaesthesia may have advantages in preserving immune function. Tumor-infiltrating lymphocytes (TILs) are considered indicators of immune response in the tumor microenvironment and used as a prognostic marker in patients after cancer surgery. This study investigated the effects of combined epidural anaesthesia on the number of TILs in patients undergoing surgery for lung adenocarcinoma. Patients undergoing radical resection for primary lung cancer were randomized to receive either combined epidural-general anaesthesia (Epi-GA) or general anaesthesia (GA) in an ongoing randomized controlled trial (ChiCTR-TRC-14004136). Excised adenocarcinoma specimens from patients enrolled between 1 June 2015 and 30 November 2015 were selected for immunohistochemical staining of CD8 and FOXP3 molecules. The numbers of positive lymphocytes were counted and expressed as the number of cells per mm2 tumor area. One hundred and twenty-eight patients were recruited and randomized; 64 patients were included in immunohistochemistry analysis (37 received Epi-GA vs. 27 received GA). The number of CD8+ T cells was higher in the Epi-GA group than in the GA group (median [interquartile range]: 292.8 [198.0-418.3] vs. 204.7 [131.1-305.8], P = 0.036); whereas the number of FOXP3+ T cells was less in the Epi-GA group than in the GA group (37.6 [14.7-92.3] vs. 99.8 [68.9-168.3], P < 0.001). For patients undergoing surgery for lung adenocarcinoma under general anesthesia, use of epidural anaesthesia increased CD8+ T cells infiltration but decreased FOXP3+ T cells accumulation in tumor tissues. Epidural anaesthesia may affect TILs in a manner that preserves immune function.

USG Guided Combined Spinal Epidural: A Boon in an Achondroplasic Dwarf undergoing an Orthopaedic Procedure

Achondroplasia is one of the commonest forms of dwarfism. A 26-year-old achondroplasic dwarf with vitamin D deficiency was posted for an elective shaft of femur fixation. Owing to her difficult airway and past history of tuberculosis, it was decided upon to operate her under combined spinal and epidural anaesthesia. This case report highlights on the need for real time ultrasound guidance in locating the epidural space and hence aiding in successful placement of the Quincke’s needle and the epidural catheter. The ultrasound is an effective and reliable tool to ascertain the most feasible inter-vertebral space in cases of a difficult spine anatomy.

COMBINED SPINAL AND EPIDURAL ANESTHESIA FOR HIP REPLACEMENT

Objectives: To describe the technique features evaluate the efficacy of combined spinal and epidural anesthesia in hip replacement surgery. Materials and methods: In a prospective, descriptive study of 50 patients indicated hip replacement underwent combined spinal and epidural anesthesia. Technical parameters and successful rate and efficacy were recorded. Results: The duration of catheter placement was 4.20 ± 0.70 minutes, the distance between the skin and the NMC was 3.72 ± 0.73 cm, the success rate of the technique of puncture in one intervertebral space was 96%, two different intervertebral space 4%, success for the first insertion was 80%. Total motor block of the lower limb was 92%, requirement of suplemental dose through the catheter to achieve anesthesia for surgery was 2%. The rate of hypotension is 6.6%. Conclusion: Combined spinal and epidural anesthesia provided effective anesthesia for hip replacement surgery with high success rates in one vertebrae technique, shorter duration of technique, lower hypotension. Additional dose through the epidural catheters may be used if the spinal anesthesia was incomplete or prolonged surgery. Key words: Combined spinal and epidural anesthesia, hip replacement

Prospects of minimally invasive methods of anesthesia for laparoscopic bariatric interventions in patients with morbid obesity, according to the principle of accelerated rehabilitation

This clinical article presents clinical examples of the successful implementation of the program for accelerated management of the postoperative period in patients with morbid obesity after laparoscopic stomach longitudinal resection , using combined anesthesia based on intravenous administration of propofol, inhalation low flow anesthesia with sevoflurane, and peri operative multimodal analgesia.The objective. Was optimization of methods of general anesthesia of bariatric surgical interventions in patients with morbid obesity.Patients and methods. 26 patients with a BMI of 36-45 took part in the study, who underwent laparoscopic stomach longitudinal resection with the use of combined low flow anesthesia with sevoflurane and multimodal analgesia. All patients underwent the concept of minimally invasive intraoperative anesthetic monitoring and an accelerated postoperative rehabilitation program.Results. The dynamics of the values of central hemodynamics showed a high hemodynamic stability at all stages of the operation, with a tendency towards normalization of initially elevated blood pressure. The indices of the adequacy of oxygenation and ventilation (SpO2 and EtCO2) corresponded to normal values and did not differ from the level of stress norm. In all patients, recovery of spontaneous breathing occurred on average 8 minutes after the end of the operation. Extubation was performed on the operating table in 8±2 minutes (p=0,05), therefore, prolonged artificial ventilation was not required. At that, the level of postoperative pain on the operating table by VAS was minimal – 0–2 points. In the early postoperative period, the pain level according to the VAS in patients was on average 3±2 points (p=0.05). Accordingly, there was no need for narcotic analgesics. All patients were activated within the first 24 hours after the operation. Patients were discharged on 2,9±0,25 days after the operation (p=0,05).Conclusion. Inhalation low flow anesthesia based on sevoflurane with the use of multimodal analgesia during laparoscopic stomach longitudinal resection in patients with morbid obesity does not require prolonged ventilation and is a worthy alternative to combined epidural anesthesia. Rejection of invasive monitoring allows early activation of patients and a shortened stay in the hospital.