Different Types Of Anesthesia Research Articles

Effect of anaesthetic and choice of neuromuscular blocker on vagal control of heart rate under laboratory animal experimental conditions.

Neuromuscular-blocking agents are commonly used in laboratory animal research settings. Due to actions of cholinergic receptors at locations other than the motor end-plate, these agents have a strong propensity to modulate autonomic outflow and may therefore not be desirable in studies examining autonomic function. This study aimed to compare the effect of two non-depolarizing neuromuscular-blocking agents, pancuronium and cisatracurium, on blood pressure, heart rate and non-invasive indices of autonomic function (heart rate variability, systolic blood pressure variability and baroreflex sensitivity) under two different types of anaesthesia in Lewis rats. Pancuronium produced a profound vagolytic response characterized by tachycardia, reduction in heart rate variability and baroreflex sensitivity under urethane anaesthesia, and with minimal effect under isoflurane anaesthesia. Conversely, cisatracurium produced no evidence of vagolytic action under either urethane or isoflurane anaesthesia. Therefore, for studies interested in examining autonomic function, particularly baroreflex or vagal function, neuromuscular blockade would be best achieved using cisatracurium.

Increase of plasma S100B and neuron-specific enolase in children following adenotonsillectomy: a prospective clinical trial.

S100B protein and neuron-specific enolase (NSE) can be considered the markers of cerebral injury. To our knowledge the association of general anesthesia for elective non-cardiac surgery in children with these markers has not been studied before. The goalof this study was to find out whether these markers change after adenotonsillectomy with general anesthesia. The secondary goal was to determine whether different types of anesthesia, gender, age and body mass index are associated with the change of S100B and NSE after adenotonsillectomy with general anesthesia. This study was designed as a prospective clinical trial. We did a simple pre-post experiment with no control group. In 59 children (aged 6-13, ASA I-II) undergoing adenotonsillectomy and randomized to TIVA or inhalational general anesthesia, plasma S100B and NSE were measured during anesthesia before and after the surgery which lasted a median (interquartile range) of 16.5 (13.0-20.0)min. S100B and NSE assays were performed using the electrochemiluminescence immunoassay. Significance of the differences was assessed by two-tailed asymptotic Wilcoxon signed rank test. Main outcome measures were differences in the levels of S100B and NSE before and after the general anesthesia and surgery. There were significant increases in S100B and NSE levels after the surgery. S100B was increased by 38% (P<0.001) and NSE was increased by 10% (P<0.001). Increase of S100B was significantly negatively associated with age (P=0.023). We have not found significant association of S100B and NSE with any other of the monitored variables. The values of neurological biomarkers S100B and NSE were significantly increased after general anesthesia for elective adenotonsillectomy in children.

Operating unit time use is associated with anaesthesia type in below-knee surgery in adults.

Peripheral nerve blocks could reduce the operating unit and theatre time spent on high-risk patients who are particularly vulnerable to complications of general anaesthesia or have medications that prevent application of central neuraxial blocks. Medical record data of 617 and 254 elderly adults undergoing below-knee surgery in Jorvi and Meilahti hospitals (Helsinki University Hospital) between January 2010 and December 2012 were used to investigate the influence of anaesthetic technique on operating theatre times and on operating unit times using flexible parametric survival models. We report operating theatre and unit exit ratios (i.e. hazard ratios but using ratios of exit rates) for different types of anaesthesia. Adjusted analyses: In Jorvi Hospital, anaesthesia type was associated with large initial differentials in operating theatre times. The theatre exit ratios remained lower for general anaesthesia and central neuraxial blocks compared to peripheral nerve blocks until 30 min. In Meilahti Hospital, anaesthesia type did not influence theatre time, but was the best predictor of operating unit times. Compared to peripheral nerve blocks, the exit ratio remained lower for general anaesthesia until five operating unit hours in both hospitals and for central neuraxial blocks until 1 h in Meilahti Hospital and until 3 h in Jorvi Hospital. Holding area was used more in Jorvi Hospital compared to Meilahti Hospital. Peripheral nerve block anaesthesia reduces time spent in the operating unit and can reduce time spent in the operating theatre if induced in holding area outside of theatre.

Evaluation of the Role of Induced Uterine Contraction on Blood Loss during Caesarean Section under Different Types of Anesthesia: A Double Blind Controlled Study

Background: Delivery by Caesarean section (CS) can cause more complications than normal vaginal delivery and one of its common complications is postpartum bleeding which can be life threatening. To reduce maternal mortality and morbidity caused by bleeding, it is important to reduce the extent of bleeding during and after CS. Objectives: To compare between the efficacy of using prostaglandin F2α under spinal or general anesthesia on decreasing the amount of blood loss during elective caesarean section. Settings and design: A prospective, double blind controlled randomized and comparative study. Methods: 60 patients undergoing elective lower segment caesarean section were divided into two groups: Group A received general anesthesia with subtypes A1 (general anesthesia=control group), and A2 (general anesthesia +prostaglandin F2α) and Group B received spinal anesthesia with subtypes B1 (spinal anesthesia=control group), and B2 (spinal anesthesia+prostaglandin F2α), hemodynamics, total blood loss , Hemoglobin Hb (gm/dl) and hematocrit Hct (%) values were recorded before and after the operation. Results: There was significant difference in total blood loss (ml) between general and spinal anesthesia groups which was 772.333 ± 144.287 in group A and 623.667 ± 119.779 in group B and significant increase in total blood loss in group A1 when compared with other three groups, significant increase in group A2 when compared with B2, insignificant changes between A2 and B1 and significant increase in total blood loss in group B1 when compared with group B2. Also the same manner present in MAP and HR where there was significant difference in MAP and HR in group A1 when compared with other three groups, significant difference in group A2 when compared with B2, insignificant changes between A2 and B1 and significant difference in MAP and HR in group B1 when compared with group B2 at 10 and 20 min but there was insignificant changes at preoperative and immediately postoperative measurements between 4 subgroups. Conclusion: PGF2α under spinal anesthesia decreases the amount of blood loss during cesarean section.

The Effect of Different Regional Blocks: Combined Femoral-Sciatic, Spinal and Epidural Blocks on the Different Side Effects of Arterial Tourniquet in Patients Undergoing Lower Limb Orthopedic Surgeries —A Randomized Controlled Trail

Background: Pneumatic arterial tourniquet is a very commonly used technique in limb surgeries to provide bloodless field to facilitate dissection and decrease blood loss. However, arterial tourniquet has many deleterious effects including hemodynamic changes, serum lactate and potassium level changes and tourniquet-induced pain which sometimes can be severe and intolerable. Aim of the study: To evaluate the effect of different regional blocks: femoral-sciatic, spinal and epidural blocks on serum lactate and potassium levels and the degree of arterial tourniquet-induced pain in patients undergoing lower limb orthopedic surgeries. Methods: 60 patients underwent lower limb orthopedic surgery with application of tourniquet for duration not more than 90 minutes. Patients were assigned randomly to one of three groups (20 each) Group I had sciatic-femoral block, Group II: patients had spinal anesthesia and Group III: patients had epidural anesthesia. Intraoperative hemodynamics, changes in serum potassium and lactate levels and tourniquet pain after tourniquet inflation & deflation, were recorded. Results: There was no statistically significant difference among the three groups regarding tourniquet pain after tourniquet inflation (p = 0.872) and deflation (p = 0.902), and regarding serum levels changes of potassium (p = 0.067) and lactate (p = 0.051). However, each group showed statistically significant increase in post deflation tourniquet pain (p = 0.003, 0.002, 0.003, in groups F, S, E respectively) and serum potassium (p = 0.004, 0.006, 0.000, in groups F, S, E respectively) and lactate levels (p = 0.004, 0.000, 0.000, in groups F, S, E respectively) when compared to the pre-deflation values, and the increase was directly proportional to the duration of tourniquet. Conclusion: the three different types of anesthesia (femoral-sciatic, spinal and epidural block) have the same effect on serum lactate and potassium levels and the degree of tourniquet pain, which were related to the duration of tourniquet inflation.

Tailored anterior tension-free repair for the treatment of recurrent inguinal hernia previously repaired by anterior approach.

The purpose of this study is to describe our policy in selecting different types of anaesthesia and anterior tension-free techniques for the repair of recurrent inguinal hernias previously treated by anterior approach and to evaluate early and late outcomes. The medical records of 111 patients who underwent recurrent inguinal hernia repair by anterior approach in the period 2000-2013 were reviewed. Fifty patients (45%) were over 70years old and 63 (56.7%) had one or more co-morbidities. Hernias with large defects were the most frequently observed (59.5%), and no-mesh techniques were the most frequent failed repair (75.7%). Different anterior tension-free techniques and types of anaesthesia were used, depending on hernia and patient characteristics. Seventy-three patients (65.8%) were operated on an outpatient basis. Mean follow-up period was 89months (range 10-183). No perioperative deaths, medical events, or visceral injuries were recorded. Early postoperative complications occurred in 11 patients: 4 haematomas (3.6%), 5 seromas (4.5%), 1 superficial wound infection (0.9%) and 1 ischemic orchitis (0.9%). Late complications consisted in 3 cases of chronic moderate pain (3.2%) and 2 re-recurrences (2.1%). Recurrent inguinal hernia previously treated by open anterior technique can be repaired using the same approach, often on an outpatient basis, with a low rate of recurrence and postoperative complications. To be safe and effective, the repair should be performed by appropriately trained surgeons, well versed in the use of different types of anaesthesia and surgical techniques depending on patient and hernia characteristics.

Assessment of selected cognitive processes in elderly patients after urologic surgery

IntroductionThe issue of postoperative disorders of cognitive functions is a highly topical problem as more and more elderly people undergo medical treatments. Patients may lose the ability of assimilating information and their linguistic functions may deteriorate. Cognitive disorders may result in the temporary exclusion of the patient from social activity. AimThe purpose of the paper was to assess the incidence of certain cognitive disorders in the elderly after urological surgeries. Material and methodsThe study was conducted in a group of 218 patients aged over 65, male and female, after an urological surgery under different types of anesthesia. Standardized neuropsychological tests of cognitive functions were employed in the study. ResultsAnalysis of the data showed that in the control group were obtained similar results in the study of the first and second. However, in the test group demonstrated a reduction cognitive function in all the tests in a second study. ConclusionsThe reduction of cognitive functions in the study group was observed in all the domains but it was the most marked in visual memory tests. Postoperative reduction of cognitive functions is correlated with the patient's age, education and mood. Postoperative reduction of cognitive functions is not correlated with the type of surgery, anesthesia and its duration.

Significant effects of sex, strain, and anesthesia in the intrahippocampal kainate mouse model of mesial temporal lobe epilepsy.

The intrahippocampal kainate mouse model of mesial temporal lobe epilepsy is increasingly being used for studies on epileptogenesis and antiepileptogenesis. Almost all previous studies used male mice for this purpose, and no study is available in this or other models of acquired epilepsy that directly compared epileptogenesis in female and male rodents. Epidemiological studies suggest that gender may affect susceptibility to epilepsy and its prognosis; therefore, one goal of this study was to investigate whether sex has an influence on latent period and epileptogenesis in the intrahippocampal kainate model in mice. Another aspect that was examined in the present study was whether mouse strain differences in epileptogenesis exist. Finally, we examined the effects of different types of anesthesia (chloral hydrate, isoflurane) on kainate-induced status epilepticus (SE) and epileptogenesis. Continuous (24/7) video-EEG monitoring was used during SE and the 2 weeks following SE as well as 4-6 weeks after SE. In male NMRI mice with chloral hydrate anesthesia during kainate injection, SE was followed by a seizure-free latent period of 10-14 days if hippocampal paroxysmal discharges (HPDs) recorded from the kainate focus were considered the onset of epilepsy. Anesthesia with isoflurane led to a more rapid onset and higher severity of SE, and not all male NMRI mice exhibited a seizure-free latent period. Female NMRI mice differed from male animals in the lack of any clear latent period, independently of anesthesia type. Furthermore, HPDs were only rarely observed. These problems were not resolved by decreasing the dose of kainate or using other strains (C57BL/6, FVB/N) of female mice. The present data are the first to demonstrate marked sex-related differences in the latent period following brain injury in a rodent model of acquired epilepsy. Furthermore, our data demonstrate that the choice of anesthestic agent during kainate administration affects SE severity and as a consequence, the latent period, which may explain some of the differences reported for this model in the literature.

Does regional anaesthesia improve outcome?

This review examines the recent evidence of an impact of regional anaesthesia on important clinical outcomes. Evidence was obtained from a variety of studies, with increasing numbers of analyses of large databases being prominent. The benefits and limitations of these approaches are considered in order to provide a context for interpretation of the data they generate. There should be little argument that correctly performed and appropriately used regional anaesthetic techniques can provide the most effective postoperative analgesia for the duration of the block, but the majority of studies suggest that this does not translate into improved longer-term surgical outcomes. The evidence for reduced incidence of major complications when regional anaesthesia is compared with, or added to, general anaesthesia is mixed. There appears to be a small effect in reducing blood loss during major joint arthroplasty. Some, but not all, studies demonstrate a reduced incidence of respiratory and infective complications with regional anaesthesia, but the effect on cardiovascular complications is variable. There are even some data consistent with a hypothesis that general anaesthesia may be protective against postoperative cognitive dysfunction. In conclusion, there is probably no generally applicable benefit in long-term outcomes with regional anaesthesia. More likely is an interaction between patient factors, the surgical procedure, and the relative capability of the anaesthetist to manage different types of anaesthesia.

Influence of Preoperative Antioxidant-Antihypoxant Infusion on the Indices of Central Hemodynamics in Elderly Patients during Anesthesia and Surgical Intervention for Femur Fracture

The problem of the safety of elderly patients at surgical intervention for femur fracture is broached. Different types of anesthesia (regional and general) exert both direct and indirect influence on hemodynamics parameters. Ninety patients (mean age 68±4.2 years) were divided into 2 groups depending on the type of anesthesia: epidural and general anesthesia based on proforol and sevoflurane with caudal block. In every group different infusion solutions (Ringer’s solution, 10% Refortan, Mafusol, Cardioxipin) were used prior to anesthesia. The following parameters of central hemodynamics were studied: mean arterial pressure, heart rate, cardiac output and cardiac index, stroke volume index, total vascular resistance. The least changes in hemodynamics were observed when general anesthesia based on proforol and sevoflurane in combination with ropovicain caudal block and cardioxipin preinfusion were used.

Influence of Preoperative Antioxidant-Antihypoxant Infusion on the Indices of Central Hemodynamics in Elderly Patients during Anesthesia and Surgical Intervention for Femur Fracture

The problem of the safety of elderly patients at surgical intervention for femur fracture is broached. Different types of anesthesia (regional and general) exert both direct and indirect influence on hemodynamics parameters. Ninety patients (mean age 68±4.2 years) were divided into 2 groups depending on the type of anesthesia: epidural and general anesthesia based on proforol and sevoflurane with caudal block. In every group different infusion solutions (Ringer’s solution, 10% Refortan, Mafusol, Cardioxipin) were used prior to anesthesia. The following parameters of central hemodynamics were studied: mean arterial pressure, heart rate, cardiac output and cardiac index, stroke volume index, total vascular resistance. The least changes in hemodynamics were observed when general anesthesia based on proforol and sevoflurane in combination with ropovicain caudal block and cardioxipin preinfusion were used.

Postoperative Pulmonary Complications among Patients Undergone Percutaneous Nephrolithotomy

Background: Post-operative pulmonary complications (PPC) are not unusual following anesthesia and surgery in PCNL as the incidence is being higher. Complication rates vary according to different procedures and different types of anesthesia and may be affected by the patient condition. Objective: To assess postoperative pulmonary complications among the patients who had undergone PCNL. Methodology: This was a prospective observational study of 111 consecutive adult patients over a period of one year who underwent PCNL surgery. The data of the patient, surgery and anesthesia was collected and analyzed to find association with PPC. Results: Seven patients (6.3%) had developed pulmonary complications postoperatively, six of them had pneumothorax and one had atelectasis who, died at the 15 th postoperative day due to respiratory failure. All the 6 patients with pneumothorax were managed by inserting a chest drain. The other non pulmonary complications among the patients were shivering (40%), blood loss (15%), hyperthermia (9%). It is seen that patients who had a history of smoking and the patients who were operated on the left kidney had shown more incidence of developing pneumothorax and the difference was found to be statistically significant (p<.05). Conclusions: From the present study it can be concluded that the most common type of post-operative complication following PCNL is pulmonary, with pneumothorax. A close working relationship between the surgeon and anesthetist is essential to coordinate the access puncture with deflation of lung and ventilator standstill to minimize the chances of pleural injury.

Analysis of the relationship of stress markers, pain intensity and cognitive performance in young patients, operated on limb injuries in different types of anesthesia

Aim. Analysis of the dependence of stress markers, pain intensity and cognitive performance in young patients, operated on limb injuries in different types of anesthesia.Methods. The study included 102 patients (33,5±0,7 years), who underwent osteosynthesis operations due to traumas of the limbs. The patients were divided into 3 groups: I group (n=32) included the patients, who were operated under regional anesthesia without sedation, II group (n=44) included the patients, who were operated under regional anesthesia with sedation, III group (n=26) included the patients who were operated under intravenous anesthesia.Results. The status of short-term memory at the first day after the operation was evidently improved in patients of І-ІІ groups. The status of short-term memory and attention evidently improved at the fifth day after the operation in patients of all groups. The level of glycemia, cortysolemiа and insulinemia is not exceeding the laboratory rate in all groups of patients at traumatic stage and at the end of the operation. There were no differences by the number of correlations and directions in groups.Conclusions. The status of cognitive functions in traumatological patients of young age after regional anesthesia, regional anesthesia with sedation (propofolum) and intravenous (propofolum, phentanylum) anesthesia is not deteriorated. The level of stress markers indicates adequate antinociceptive protection during the operation

Neutrophil chemotaxis in cord blood of term and preterm neonates is reduced in preterm neonates and influenced by the mode of delivery and anaesthesia.

Bacterial infections, even without any perinatal risk factors, are common in newborns, especially in preterm neonates. The aim of this study was to evaluate possible impairment of neutrophil chemotaxis in term and preterm neonates compared with adults as well as neonates with different modes of delivery and anaesthesia. We analysed the expression of the adhesion molecule L-Selectin as well as shape change, spontaneous and N-formyl-methionyl-leucyl-phenylalanine (fMLP)-induced transmigration of neutrophils in a flow cytometric assay of chemotaxis after spontaneous delivery with Cesarian Section (CS) under spinal anaesthesia (mepivacaine, sufentanil), epidural anaesthesia (ropivacaine or bupivacaine, sufentanil) or general anaesthesia (ketamine, thiopental, succinylcholine). Chemokinesis was higher (p=0.008) in cord blood neutrophils than in the adult ones, whereas those could be more stimulated by fMLP (p=0.02). After vaginal delivery neutrophils showed a higher spontaneous and fMLP-stimulated chemotactic response compared to neonates after CS without labor. Comparing different types of anaesthesia for CS, spinal anaesthesia resulted in less impairment on chemotaxis than general anaesthesia or epidural anaesthesia. The new flow cytometric assay of neutrophil chemotaxis is an appropriate and objective method to analyse functional differences even in very small volumes of blood, essential in neonatology. Term neonates do not show reduced chemotaxis compared to adults. Preterm neonates present with reduced chemotaxis and chemokinesis, confirming the well known deficits in their neutrophil function. The side effects of maternal drugs on the neonatal immune system have to be considered especially when the immune response is already impaired, as in preterm infants.

Status of hemodynamics and estimation of level of pain in young patients at the operations of metaloosteosynthesis under different types of anesthesia

Objective – to study of status of hemodynamics and to estimate of level of pain in traumatological patients under different types of anesthesia. Materials and methods. In the research was involved 62 patients at the age from 20 to 45 years, who underwent osteosynthesis operations due to traumas of the limbs. The patients were divided into 3 groups: the 1st group (n=12) included the patients who were operated under regional anesthesia without sedation, the 2nd group (n=30) – the patients who were operated under regional anesthesia with sedation, the 3rd group (n=20) – the patients who were operated under intravenous anesthesia. Results. Mean blood pressure (MBP) in the 1st and the 2nd groups was stable are revealed, but heart rate (HR) showed a trend to growing, however fluctuation of saturation (SpO2) there were no differences in comparison with normal rates. The level of pain according visual analogue scale (VAS) was a little reduction in these groups at the 1st day after the operation in comparison with 3rd group, and was minimal in the 2nd group at the 5th day after the operation. There was anevident reduction of MBP level in the 3rd group during the surgery, and HR was at the level pre-operative period at the traumatic stage, however was an evident reduction at the end of the operation, and did not exceed normal values. HR and level of pain according VAS were the most high in the 3rd group at the 1st day after the operation, and the level of SpO2 was stable in this group. Conclusion. More expressed antistress properties of intravenous anesthesia (propofol, fentanyl) are revealed at the traumatic stage of the operation, however regional anesthesia provided a significant protection against pain at the early postoperative period.

Effects of anesthetics on the renal sympathetic response to anaphylactic hypotension in rats.

The autonomic nervous system plays an important role in rat anaphylactic hypotension. It is well known that sympathetic nerve activity and cardiovascular function are affected by anesthetics. However, the effects of different types of anesthesia on the efferent renal sympathetic nerve activity (RSNA) during anaphylactic hypotension remain unknown. Therefore, we determined the renal sympathetic responses to anaphylactic hypotension in anesthetized and conscious rats and the roles of baroreceptors in these responses. Sprague-Dawley rats were randomly allocated to anesthetic groups that were given pentobarbital, urethane, or ketamine-xylazine and to a conscious group. The rats were sensitized using subcutaneously injected ovalbumin. The systemic arterial pressure (SAP), RSNA and heart rate (HR) were measured. The effects of sinoaortic baroreceptor denervation on RSNA during anaphylaxis were determined in pentobarbital-anesthetized and conscious rats. In all of the sensitized rats, the RSNA increased and SAP decreased after antigen injection. At the early phase within 35 min of the antigen injection, the antigen-induced sympathoexcitation in the conscious rats was significantly greater than that in the anesthetized rats. Anaphylactic hypotension was attenuated in the conscious rats compared to the anesthetized rats. The anesthetic-induced suppression of SAP and RSNA was greater in the order ketamine-xylazine >urethane = pentobarbital. Indeed, in the rats treated with ketamine-xylazine, RSNA did not increase until 40 min, and SAP remained at low levels after the antigen injection. The baroreceptor reflex, as evaluated by increases in RSNA and HR in response to the decrease in SAP induced by sodium nitroprusside (SNP), was suppressed in the anesthetized rats compared with the conscious rats. Consistent with this finding, baroreceptor denervation attenuated the excitatory responses of RSNA to anaphylaxis in the conscious rats but not in the pentobarbital-anesthetized rats. RSNA was increased markedly in conscious rats during anaphylactic hypotension. Anesthetics attenuated this antigen-induced renal sympathoexcitation through the suppression of baroreceptor function.

Effects of different types of anesthesia on lower respiratory tract infections in elderly patients of orthopedic surgery

Objective To investigate the effects of different types of anesthesia on the incidence rates of low-er respiratory tract infections of elderly patients in orthopedic department.Methods Clinical data from 445 elderly patients in orthopedic department were collected and retrospectively analyzed.We also investigated the relationship be-tween the types of anesthesia and the lower respiratory tract infections.Results The incidence rates of lower respira-tory tract infections were 23.08%in 169 cases,12.14%in 173 cases,and 4.85%in 103 cases after general anesthe-sia with tracheal intubation,intraspinal anesthesia,and nerve blocking anesthesia,respectively.There was statistically significant difference in the infection rates among the three groups （χ^2=13.784,P=0.001）.Conclusion Different ways of anesthesia is critically correlated with the incidence of the lower respiratory tract infections in elderly patients. Key words: Anesthesia; Respiratory tract infections; Eldy

Endovascular repair of a large ruptured abdominal aortic aneurysm using monitored anesthesia care and local anesthesia.

Over the last decade, there has been a paradigm shift in the treatment of ruptured abdominal aortic aneurysm (AAA) from open repair to endovascular aneurysm repair (EVAR). Regardless of the method used during emergent rupture, open verses endovascular repair, the overall mortality remains high. Recent studies have compared patient outcomes using different types of anesthesia during elective EVAR procedures. The data show that during an elective EVAR, monitored anesthesia care (MAC) with local anesthesia is not only just as safe as general anesthesia, but it offers other potential benefits as well. There is limited data in regards to patient outcomes using MAC and local anesthesia during cases of large ruptured aneurysms that are treated with EVAR. This case report discusses the treatment of a patient who presented with a large 13 cm ruptured AAA which was successfully repaired using EVAR with MAC and local anesthesia.

Early Postpartum Breast‐Feeding Outcomes and Breast‐Feeding Self‐Efficacy in Turkish Mothers Undergoing Vaginal Birth or Cesarean Birth With Different Types of Anesthesia

To compare the breast-feeding outcomes and breast-feeding self-efficacy, in the first 24 postpartum hours, of mothers who underwent vaginal birth, cesarean birth with epidural anesthesia, and cesarean birth with general anesthesia. A comparative study was conducted in Turkey. A total of 334 mothers participated. Data were evaluated through descriptive data form, breast-feeding outcomes form, and the Breastfeeding Self-Efficacy Scale. It was observed that the mothers who had cesarean birth with general anesthesia experienced more breast-feeding problems. With regard to breast-feeding self-efficacy, all the groups were similar. For reducing breast-feeding problems, nurses should provide more care and support to mothers undergoing cesarean birth. Therefore, the fact that the breast-feeding self-efficacy was similar among the groups might be related to culture.

The impact of general anaesthesia for elective adenotonsillectomy in children aged 6-12 years on biomarkers of cerebral injury S100B and NSE

Background and Goal of Study: S100B protein and NSE (neuron specific enolase) can be considered as early markers of cerebral injury. The impact of general anesthesia for elective noncardiac surgery in children on these markers has not been studied before. The goal was to find out whether these markers can be used to access the short term neurological outcome after general anesthesia. The secondary goal was to determine whether different types of anesthesia influence the levels of S100B and NSE. Materials and methods: Prospective study was conducted at the University Hospital on 64 children (aged 6-12, ASA I-II) undergoing elective adenotonsillectomy. The children were randomized into 2 groups:TIVA (n=32) and sevoflurane(S) (n=32). In TIVA group anesthesia was induced with propofol, fentanyl and vecuronium and maintained with continuous infusion of propofol. In S group, anesthesia was induced with fentanyl, sevoflurane and vecuronium and maintained with sevoflurane. S100B and NSE were measured before and after the surgery. S100B and NSE assays were performed using the electrochemiluminiscence immunoassay “ECLIA” used on Roche Cobas e601 immunoassay analyzer (Roche Diagnostics GmbH, Mannheim, Germany). Statistical significance of the differences was accessed by two-tailed asymptotic Wilcoxon Signed Rank test. The 95% CI for median difference was calculated by bootstrapping on 1000 samples in IBM SPSS Statistics version 21. Results and discussion: There was statistically significant increase of S100B median value after surgery with regard to preoperative values (P< 0.001). Median(interquartile range) values of S100B before and after surgery were 0.08 (0.064-0.102) and 0.1 (0.072-0.179), respectively. There was no statistically significant change of NSE median value af ter surgery regarding preoperative values (P=0.567). The prevalence of elevated S100B (≥0.105 ug/l) after the surgery was statistically significantly higher than before (McNemar test, two sided exact P=0.003). There were 12/60 children (20.0% ; 95% CI=(10.5%-29.8%)) with elevated S100 B before and 28/60 (46.7% ; 95% CI=33.3%-59.6%)) after surgery. Conclusion(s): The values of neurological biomarker S100B, but not of NSE, were significantly increased af ter general anesthesia for elective adenotonsillectomy in children, indicating possible cerebral injury.There were no differences regarding 2 types of anaesthesia, TIVA or inhalational.