Effects Of Different Anesthetic Techniques Research Articles

The impact of inhalation versus total intravenous anesthesia on the immune status in patients undergoing breast cancer surgery: a double-blind randomized clinical trial (TeMP).

Breast cancer (BC) mortality primarily stems from metastases rather than the primary tumor itself. Perioperative stress, encompassing both surgical and anesthetic factors, profoundly impacts the immune system, leading to alterations in neuroendocrine pathways and immune functions, potentially facilitating tumor progression and metastasis. Understanding the immunomodulatory effects of different anesthesia techniques is crucial for optimizing perioperative care in patients with BC. The neutrophil-to-lymphocyte ratio (NLR) serves as one of the key indicators of perioperative immune response. To compare the effects of inhalation anesthesia (IA) and total intravenous anesthesia (TIVA) on perioperative immune response in BC surgery patients. In this randomized, double-blind clinical trial, BC surgery patients were randomized to receive either TIVA with propofol or IA with sevoflurane. The primary endpoint was NLR assessment. Secondary immune parameters measured included natural killer cells, various T cell subsets, B cells, the immuno-regulatory index [T-helpers (CD3+CD4+)/cytotoxic T-cells (CD3+CD8+)], matrix metallopeptidases (MMP-9), complement components, and immunoglobulins, preoperatively and at 1 and 24 hours postoperatively. The study included 98 patients (IA: 48, TIVA: 50). The baseline characteristics exhibited remarkable similarity across the groups. No significant difference in absolute NLR values was found between IA and TIVA groups at any time point (1 hour: p = 0.519, 24 hours: p = 0.333). Decreased IgA and IgM levels post-surgery suggested potential negative impacts of IA on humoral immunity compared to TIVA. CRP levels increased more by 24 hours (p = 0.044) in IA compared to TIVA. No significant differences were observed in natural killer cells, T cell subsets, B cells, MMP-9 levels or complement components between groups. Significant differences in the immuno-regulatory index between the TIVA and IA groups at one hour postoperatively (p = 0.033) were not maintained at 24 hours. While there were no notable differences in NLR among the types of anesthesia, the observed disparities in immunoglobulin content and C-reactive protein levels between groups suggest that we cannot dismiss the potential immunosuppressive effects of inhalational anesthesia in breast cancer surgeries. Further investigation needed to clarify the impact of various anesthesia methods on immune function and their implications for long-term cancer outcomes.

The Impact of Various Anesthetic Techniques on Cerebral Oxygenation during Spinal Surgery Performed in a Prone Position with Controlled Hypotension

Background: While prone positioning during anesthesia is necessary for certain surgical procedures, it also increases the risk of postoperative neurological complications. This risk is exacerbated by controlled hypotension used to minimize blood loss during spinal surgeries. Monitoring regional cerebral oxygen saturation (rScO2 ) is essential for maintaining cerebral oxygenation and preventing adverse outcomes like cognitive dysfunction and organ failure. This study aimed to evaluate the effect of different anesthetic techniques on cerebral oxygenation in patients undergoing spinal surgery in the prone position with controlled hypotension. Methods: Fifty-four patients scheduled for spinal surgery in a prone position with controlled hypotension were randomly assigned into two equal groups, to receive sevoflurane or propofol anesthesia. Data were collected at various intervals: before and after anesthesia induction, post-induction in the prone position, during surgery, and before awakening in the supine position. Parameters recorded included rScO2 , peripheral oxygen saturation (SpO2), heart rate (HR), patient state index (PSI), end-tidal carbon dioxide tension (ETCO2 ), and mean arterial pressure (MAP). Results: rScO2 levels decreased in both patient groups once positioned in the prone position. However, the rScO2 values were significantly lower in the propofol group compared to the other group (p = 0.025, 0.032 respectively). Conclusion: The study suggests that propofol as the anesthetic agent may have exacerbated the decline in cerebral oxygenation associated with the transition to prone positioning. Sevoflurane might thus be preferable for patients at risk of compromised cerebral oxygenation.

Perioperative outcomes in different anesthesia techniques for patients undergoing hip fracture surgery: a systematic review and meta-analysis

BackgroundPrevious studies of the perioperative effects of general and regional anesthesia in adult patients undergoing effects of different anesthesia techniques on patients undergoing hip fracture surgery have not produced consistent results. The aim of this systematic review and meta-analysis was to compare the hip fracture surgery.MethodsWe performed a systematic review and meta-analysis to compare the effects of general anesthesia with regional anesthesia on in-hospital mortality, 30-day mortality, postoperative pneumonia, and delirium in adult hip fracture patients (≥ 18 years). Between January 1, 2022, and March 31, 2023, a systematic search was performed for retrospective observational and prospective randomized controlled studies in PubMed, Ovid Medline, Cochrane Library, and Scopus.ResultsTwenty-one studies including 363,470 patients showed higher in-hospital mortality in the general anesthesia group compared with regional anesthesia (OR = 1.21; 95% CI 1.13–1.29; P < 0.001, n = 191,511). The 30-day mortality (OR = 1.00; 95% CI 0.96–1.05; P = 0.95, n = 163,811), the incidence of postoperative pneumonia (OR = 0.93; 95% CI 0.82–1.06; P = 0.28, n = 36,743) and the occurrence of postoperative delirium in the two groups (OR = 0.94; 95% CI 0.74–1.20; P = 0.61, n = 2861) had no significant difference.ConclusionRegional anesthesia is associated with reduced in-hospital mortality. However, the type of anesthesia did not affect the occurrence of 30-day mortality, postoperative pneumonia, and delirium. A large number of randomized studies are needed in the future to examine the relationship between type of anesthesia, postoperative complications, and mortality.

The Effect of Different Anesthetic Techniques on Proliferation, Apoptosis, and Gene Expression in Colon Cancer Cells: A Pilot In Vitro Study.

Colorectal cancer is highly common and causes high mortality rates. Treatment for colorectal cancer is multidisciplinary, but in most cases the main option remains surgery. Intriguingly, in recent years, a number of studies have shown that a patient's postoperative outcome may be influenced by certain anesthetic drugs. Our main objective was to compare the effect of propofol-total intravenous anesthesia (TIVA) with sevoflurane anesthesia and to investigate the potential role of intravenous lidocaine on colon cancer cell functions. We tested the effects of serum from colorectal cancer patients undergoing TIVA vs. sevoflurane anesthesia with or without lidocaine on HCT 116 cell lines; on proliferation, apoptosis, migration, and cell cycles; and on cancer-related gene expressions. 60 patients who were scheduled for colorectal cancer surgery were randomized into four different groups (two groups with TIVA and two groups with sevoflurane anesthesia with or without intravenous lidocaine). Blood samples were collected at the start and at the end of surgery. HCT 116 cells were exposed to the patients' serum. 15 patients were included in each of the study groups. We did not find any significant difference on cell viability or apoptosis between the study groups. However, there was an increased apoptosis in propofol groups, but this result was not statistically significant. A significant increase in the expression profile of the TP53 gene in the propofol group was registered (p = 0.029), while in the other study groups, no significant differences were reported. BCL2 and CASP3 expressions increased in the sevoflurane-lidocaine group without statistical significance. In our study, serum from patients receiving different anesthetic techniques did not significantly influence the apoptosis, migration, and cell cycle of HCT-116 colorectal carcinoma cells. Viability was also not significantly influenced by the anesthetic technique, except the sevoflurane-lidocaine group where it was increased. The gene expression of TP53 was significantly increased in the propofol group, which is consistent with the results of similar in vitro studies and may be one of the mechanisms by which anesthetic agents may influence the biology of cancer cells. Further studies that investigate the effects of propofol and lidocaine in different plasma concentrations on different colon cancer cell lines and assess the impacts of these findings on the clinical outcome are much needed.

Comment on: Effects of different anesthetic techniques on neutrophil lymphocyte ratio and monocyte lymphocyte ratio in patients undergoing major non-cardiac surgery: A prospective, single-blind, randomized study

Comment on: Effects of different anesthetic techniques on neutrophil lymphocyte ratio and monocyte lymphocyte ratio in patients undergoing major non-cardiac surgery: A prospective, single-blind, randomized study

Effects of different anesthetic techniques on neutrophil lymphocyte ratio and monocyte lymphocyte ratio in patients undergoing major non-cardiac surgery: A prospective, single-blind, randomized study

Effects of different anesthetic techniques on neutrophil lymphocyte ratio and monocyte lymphocyte ratio in patients undergoing major non-cardiac surgery: A prospective, single-blind, randomized study

Effect of Different Anesthetic Techniques on Cytokine Gene Expression in Patients who Underwent Elective Cesarean Section.

Cesarean section (CS) is an important challenge for a pregnant woman and her newborn. The most common anesthesia techniques used for CS are general anesthesia (GA) and spinal anesthesia (SA). This study was designed to compare the modulation of genes whose expression level is indicative of the immune system following exposure to GA and SA. The present study was performed on 40 women who were scheduled for elective CS receiving GA or SA. The expression levels of the relative mRNA of Interleukin (IL)-4, IL-6, IL-10, IL-17, Interferon (IFN)-γ, and tumor growth factor (TGF)-β before anesthesia (T0) and 24 hours post-anesthesia (T1) were analyzed by real-time polymerase chain reaction (RT-PCR) technique. Twenty-four hours post-anesthesia, the expression levels of IL-10, IL-17, and IFN-γ genes were decreased while the expressions of IL-4, IL-6, and TGF-β genes were upregulated in two groups, however, the differences were not significant. The mRNA level of IL-4 was increased in the SA group significantly. The post-CS mRNA levels of IL-4 in the SA group may indicate that SA is more appropriate than GA for the initiation of tissue repair pathways.

Effects of different anesthetic techniques on the incidence of phantom limb pain after limb amputation: a population-based retrospective cohort study.

BackgroundGeneral anesthesia (GA) has been considered the anesthetic technique which most frequent leads to phantom limb pain (PLP) after a limb amputation. However, these prior reports were limited by small sample sizes. The aims of this study were to evaluate the incidence of PLP according to the various anesthetic techniques used for limb amputation and also to compare the occurrence of PLP according to amputation etiology using the Korean Health Insurance Review and Assessment Service for large-scale demographic information.MethodsThe claims of patients who underwent limb amputation were reviewed by analyzing the codes used to classify standardized medical behaviors. The patients were categorized into three groups—GA, neuraxial anesthesia (NA), and peripheral nerve block (PNB)—in accordance with the anesthetic technique. The recorded diagnosis was confirmed using the diagnostic codes for PLP registered within one year after the limb amputation.ResultsFinally, 7,613 individuals were analyzed. According to the recorded diagnoses, 362 patients (4.8%) developed PLP after amputation. Among the 2,992 patients exposed to GA, 191 (6.4%) were diagnosed with PLP, whereas 121 (4.3%) of the 2,840 patients anesthetized with NA, and 50 (2.8%) of the 1,781 patients anesthetized under PNB developed PLP. The relative risks were 0.67 (95% confidence interval [CI], 0.53–0.84; P < 0.001) for NA and 0.43 (95% CI, 0.32–0.59; P < 0.001) for PNB.ConclusionsIn this retrospective cohort study, using large-scale population-based databases, the incidence rates of PLP after limb amputations were, in the order of frequency, GA, NA, and PNB.

Near-infrared spectroscopy for assessing microcirculation during laparoscopic gynaecological surgery under combined spinal-general anaesthesia or general anaesthesia alone: a randomised controlled trial.

While pneumoperitoneum causes negative macrohaemodynamic effects, much less is known about microcirculatory effects of different anaesthetic techniques and laparoscopy. Therefore, we aimed to explore microcirculatory effects of combined spinal-general anaesthesia and laparoscopy, as measured by near-infrared spectroscopy over forearm and calf muscles utilising a 3-min ischemic challenge. Patients (n = 102) undergoing elective laparoscopic gynaecological surgery were randomised to receive general anaesthesia alone or in combination with high-dose or low-dose spinal analgesia (levobupivacaine 7.5mg or 3.75mg, respectively, plus sufentanil 2.5μg). Primary outcomes were near-infrared spectroscopy derived parameters before general anaesthesia induction, 5min after tracheal intubation, and 15min after pneumoperitoneum commencement. General anaesthesia resulted in impaired post-ischaemic recovery rate in the forearm (p < 0.001, within all groups), which improved during laparoscopy. For the calf, before general anaesthesia induction, high and low dose spinal analgesia significantly slowed the post-ischaemic recovery compared to control (34 ± 16%min-1 and 36 ± 13%min-1 vs. 52 ± 27%min-1, respectively; p = 0.002 and p = 0.006). General anaesthesia abolished differences between the groups (24 ± 14%min-1 and 25 ± 12%min-1 vs. 27 ± 18%min-1), while during laparoscopy high-dose spinal analgesia further reduced the post-ischaemic recovery compared to low-dose spinal and control groups (p = 0.023 and p = 0.040, respectively). During gynaecological laparoscopy patients show impaired calf but maintain forearm microcirculatory function, regardless of the anaesthetic technique. Reduction in post-ischaemic recovery with high-dose spinal analgesia is explained by its sympatholytic effects: number of perfused capillaries is increased, leading to a haemodynamically more favourable state. Blood pressure is positively correlated with the post-ischaemic recovery rate in vascular beds not affected by spinal analgesia.

Comparison of Anesthesia Techniques Used in Cesarean Deliveries on the Neonate - Anesthesia Techniques and Neonate?

Background: Though there are many studies on the effects of anesthesia methods used for cesarean section on the newborn, research on this topic still continues. In our prospective observational study, we investigated the effects of different anesthesia techniques used in routine cesarean deliveries on early neonatal outcomes in our hospital. Methods: This prospective, observational, randomized study included a total of 222 ASA II risk group pregnant women undergoing elective cesarean section at term (38-41 weeks’ gestation) without fetal distress. The women were randomized into three groups. In the general anesthesia with propofol group (Group P, n = 74), anesthesia was induced with 2 mg∙kg-1 propofol and 0.6-0.9 mg∙kg-1 rocuronium. In the general anesthesia with thiopental sodium group (Group T, n = 74), anesthesia was induced with 5 mg∙kg-1 thiopental sodium and 0.6-0.9 mg∙kg-1 rocuronium. Women in the spinal anesthesia group (Group SA, n = 74) were administered 0.5% (10 mg) hypertonic bupivacaine and 10 mcg fentanyl. Results: There were no significant differences between Group SA, Group P, and Group T in terms of delivery time; neonatal 1- and 5-min Apgar scores; neonatal jaundice rates; neonatal systolic, diastolic, or mean blood pressure or peak heart rate; neonatal intensive care requirement; pH, PCO2, PO2 values in cord blood gas; or neonatal glucose and lactate values. The rate of ephedrine use was significantly higher in Group SA than in Group P and Group T. Maternal satisfaction score was higher in Group SA at postoperative 4 hours and in Group P at 24 hours. The number of newborns taken into intensive care unit in Group T was significantly higher in the 1st hour, 4th hour, 5th hour and total. Respectively p value (0.006, 0,048, 0,048, and 0,005). Pain on injection was present in 55% of patients (n = 81), mild in 36% (n = 54), and severe in 18% (n = 27). Myoclonies occurred in 4% of patients (n = 7) and local rash in 6% of patients (n = 10). Differences between formulations did not reach statistical significance. Conclusion: None of the three anesthesia methods showed superiority after elective cesarean delivery. However, spinal anesthesia and general anesthesia with propofol are more appropriate for pregnant women in terms of effects on the neonate.

Neuraxial anesthesia is less harmful to the endothelial glycocalyx during elective joint surgery compared to general anesthesia.

Damage of the endothelial glycocalyx (EG) has been described during surgery, but the effect of different anesthesia techniques remains unknown. Perfused boundary region (PBR) evaluated by side-stream dark field (SDF) imaging of the sublingual microcirculation enables in vivo EG assessment. PBR values are inversely related to the EG thickness. The aim of the observational study was to evaluate the changes of PBR in patients undergoing elective joint surgery under general (GA) vs. neuraxial anesthesia (NA). Our hypothesis was that PBR will be lower in patients in NA. Sixty consecutive patients (ASA 1-3) undergoing elective total knee or hip replacement under GA or NA were included in this prospective observational cohort study. PBR in the sublingual microcirculation was recorded in each patient using SDF at two time points - before surgery and 2 hours after surgery. Before surgery, there was no significant difference in baseline PBR between groups (NA: 1.95 μm (±0.24); GA: 2.02 μm (±0.26); p = 0.098). Postoperatively (2 hours after surgery) PBR was significantly increased in both groups with respect to baseline values (NA: 2.09 μm (±0.19), GA: 2.20 μm (±0.25); p < 0.001). In the GA group, postoperative PBR values were significantly higher than in the NA group (p = 0.006). Joint surgery led to significant increases of PBR. Patients in the GA group had significantly higher PBR values 2 hours after surgery compared to NA group. This might implicate that NA is associated with less EG damage then GA in elective hip/knee surgery.

Effects of different anesthesia techniques on intraoperative blood loss in acetabular fractures undergoing the Modified Stoppa approach.

This study aims to evaluate the effects of the anesthesia technique on the intraoperative blood loss in acetabular fracture patients undergoing the Modified Stoppa approach. We retrospectively identified 63 patients who underwent a Modified Stoppa approach for acetabular fracture from January 2014 to July 2018. A total of 20 patients were excluded from this study for the following reasons: bilateral acetabular fractures (n=6), undergoing antiaggregant treatment (n=3), incomplete anesthesia records (n=3), emergency pelvic surgery due to hemodynamic instability (n=5), splenic rupture (n=2), and liver laceration (n=1). The patients were divided into two groups as follows: patients undergoing general anesthesia (GA) (n=22) and patients undergoing combined epidural-general anesthesia (CEGA) (n=21). The main outcome measurements studied were the intraoperative blood loss and the need for intraoperative and/or postoperative blood transfusions. No statistically significant differences were found between the groups concerning the age, gender, type of fracture, mechanism of injury, time from injury to surgery, Injury Severity Score, associated injuries, and comorbidities (p>0.05). The mean intraoperative blood losses were 717.27 ml (300-1.600 ml) in the GA group and 473.81 ml (150-1.020 ml) in the CEGA group (p<0.001). In the cases with only an isolated acetabular fracture, the intraoperative blood transfusion means were 2.43 units (1-5 units) in 14 patients in the GA group and 1.27 units (1-4 units) in 15 patients in the CEGA group (p<0.001). Less intraoperative bleeding was seen in those patients undergoing CEGA when compared to those undergoing GA. This is a significant advantage for acetabular surgery, which has a long learning curve and a high risk of bleeding.

Comparison of different anesthesia techniques on early prognosis in patients undergoing hip joint replacement

Objective To compare the effects of different anesthesia techniques on early prognosis in patients undergoing hip joint replacement. Methods The demographic, preoperative and postoperative data of 478 patients, aged 18-95 yr, of American Society of Anesthesiologists physical statusⅠ-Ⅳ, who underwent elective unilateral hip joint replacement in Tongji Hospital from May 2014 to December 2016, were retrospectively analyzed.Patients were divided into general anesthesia group (group GA, n=197), peripheral nerve block group (group PNB, n=147) and peripheral nerve block combined with general anesthesia group (group PNB+ GA, n=134). The amount of crystalloid solution and colloid solution infused, consumption of sufentanil and requirement for vasoactive agents were recorded during operation.The duration of anesthetic recovery room stay, length of hospital stay before and after operation and total length of hospital stay were recorded.The development of complications within 48 h after operation, therapy after admission to intensive care unit and in-hospital fatality were also recorded. Results Compared with group GA, the intraoperative consumption of sufentanil was significantly decreased in group PNB+ GA, and the amount of crystalloid solution infused, urine output, consumption of sufentanil, requirement for vasoactive agents and incidence of postoperative hypoxemia, pulmonary infection and acute cerebral infarction were significantly decreased in group PNB+ GA (P<0.05). Compared with group PNB+ GA, the consumption of sufentanil, requirement for vasoactive agents and incidence of postoperative hypoxemia, pulmonary infection and acute cerebral infarction were significantly decreased in group PNB (P<0.05). Conclusion Compared with general anesthesia or with peripheral nerve block-general anesthesia, peripheral nerve block is more helpful in improving early prognosis in patients undergoing hip joint replacement. Key words: Arthroplasty, replacement, hip; Nerve block; Lumbosacral plexus

Effect of different anesthetic techniques on the prognosis of hepatocellular carcinoma after hepatectomy

Objective: To investigate the influence of different anesthetic techniques on the prognosis of hepatocellular carcinoma (HCC)after hepatectomy. Methods: A total of 185 consecutive patients with HCC confirmed underwent surgery in Cancer Hospital, Chinese Academy of Medical Sciences were recruited from January 2006 to January 2008. The patients were assessed as American Society of Anesthesiologists (ASA)Ⅰ-Ⅲ, with body mass index (BMI) (22.8±4.6)kg/m(2). There were 169 males, with an average age of 56 years old and 16 females, with an average age of 53 years old. According to the different anesthesia methods, 185 patients were divided into two groups: total intravenous anesthesia group (TIVA) (n=53) and intravenous-inhalation combined anesthesia group (n=132). Postoperative pain and adverse reactions were compared in recent follow-up, prognosis were compared in long-term follow-up. Results: Recent follow-up showed that the NRS scores 2 hours after operation in TIVA group was 2.0 (0-2.0), whereas those in intravenous-inhalation combined anesthesia group was 3.0 (1.0-3.0). The pain in TIVA groups was significantly lower than that in intravenous-inhalation combined anesthesia group (Z=-3.261, P=0.001). But for 24 hours after operation, the NRS scores in these two groups were 3.0 (2.0-5.0) and 3.0 (3.0-4.0), respectively. There was no significant difference in the two groups (Z=-0.035, P=0.972). In addition, there was no significant difference between the two groups in the incidence of sedation, nausea/vomiting, restlessness and other adverse reactions (all P>0.05). Long-term follow-up indicated that anesthetic techniques have no correlation with HCC prognosis in Kaplan-Meier analysis and Cox's regression analysis. Conclusion: There is no significant effect of two anesthesia methods on the long-term prognosis of HCC.

Atan Kalpte Koroner Arter Baypas Greft Cerrahisi Yapılan Yaşlılarda Farklı Anestezi Tekniklerinin Zihin Üzerindeki Sonuçları

Atan Kalpte Koroner Arter Baypas Greft Cerrahisi Yapılan Yaşlılarda Farklı Anestezi Tekniklerinin Zihin Üzerindeki Sonuçları

The Effects of Different Anaesthetic Techniques on Surgical Stress Response During Inguinal Hernia Operations.

The aim of this study is to compare the effects of 3 different kinds of anaesthesia on stress response induced by surgery. Sixty patients aged between 25-70 American Society of Anesthesiologists (ASA) I-II group to undergo inguinal herniography were included in this study. Patients were randomly divided into 3 groups of 20. Group 1 received general anaesthesia with sevoflurane/air/remifentanil, patients in Group 2 received total intravenous anaesthesia (TIVA) with propofol/air/remifentanil and Group 3 received spinal anaesthesia induced by hyperbaric bupivacaine, adjoined by remifentanil sedation. Mean arterial pressure (MAP), heart rate and SpO2 values were recorded preoperatively, intraoperatively and postoperatively at certain periods. Cortisol, leptin and glucose levels were preoperatively detected. Intervals were as; 15 minutes prior to the induction of anaesthesia, at intraoperative first hour and at the postoperative third and twenty-forth hours. MAP and heart rate values were similar in the inhalational anaesthesia and TIVA groups but relatively higher in the spinal anaesthesia group. Blood glucose levels were elevated, insulin levels were decreased in all groups, at the intraoperative first hour. Biphasic variation in blood leptin levels was observed in all groups, as the levels were lower than the preoperative control values at the intraoperative first and postoperative third hours and significantly higher at the postoperative twenty-forth hour. There was a significant decrease in cortisol level percentage change in the TIVA group at the intraoperative 1st hour, increasing in the other groups. We concluded that TIVA supresses the stress response induced by surgery better by lowering cortisol levels, leading to a lower increase in blood glucose levels and a lower decrease in blood insulin levels when compared to others. Furthermore, leptin levels were increased at the postoperative twenty-forth hour. The lower increase at the postoperative twenty-forth hour in the TIVA group can be correlated with the anaesthetic agent.

Effects of different anesthetic techniques on neurologic and adaptation capacity in newborn with elective cesarean section.

Background:Neurologic and Adaptive Capacity Scoring (NACS) has been introduced as a screening test for diagnosis of central nervous system depression due to intrapartum drugs on the neonate. This test can show neurological and behavioral changes even in the presence of a normal Apgar score. NACS has 20 indicators, each indicator allocating to itself the score zero, one or two. The aim of this study was to compare the effects of different anesthetic techniques on the NACS values.Materials and Methods:This study was performed as a randomized, single-blind clinical trial on 75 infants born with elective cesarean in Shahid Beheshti Hospital, Isfahan. Simple Sampling method was carried out and the information was gathered by questionnaires. Anesthetic techniques included general, spinal or epidural anesthesia. NACS score was assessed at 15th min, 2 and 24 h after birth and then the anesthesia technique was recorded in the questionnaire. NACS score 35 or above was considered normal and 34 or less was abnormal.Results:In the present study, no significant correlation was found between the anesthesia techniques and NACS score. The mean NACS at 15 min after birthin the general, spinal and epidural groups were 33.5 ± 2.2, 33.0 ± 4.4 and 33.7 ± 1.6 respectively (P = 0.703).Conclusion:All three anesthetic techniques have identical effects on neurological and compatibility capacity of neonates born with elective cesarean; so, this could necessarily be a base to recommend the three methods equally.

Anesthesia Related Toxic Effects on In Vitro Fertilization Outcome: Burden of Proof.

Management of pain and anxiety during oocyte retrieval makes anesthesia an important part of the in vitro fertilization (IVF) procedures. There are many studies investigating the influence of anesthesia on IVF success. This review article provides an overview of published data regarding the potential toxic effects of different anesthetic techniques (Loco-regional, general anesthesia (GA), and monitored anesthesia care (MAC)), different anesthetic agents, and alternative medicine approach (principally acupuncture) on the IVF outcome. From our analysis, evidence of serious toxicity in humans is not well established. Trials regarding different anesthetic techniques ended up without clear conclusions. Studies about GA came up with conflicting results. A few trials relate GA with lower pregnancy rates, although some others failed to prove this conclusion. Furthermore, detectable amounts of some anesthetic agents are measurable in the follicular fluid but these findings are not strongly associated with toxicity. MAC and Loco-regional anesthesia appear as safe alternative choices and there is evidence of improved outcome. Whereas acupuncture may provide assistance increasing IVF success according to some trials, some others could not obtain these effects. Questions about the appropriate time of application and the underlying mechanism of action are not answered yet, so further investigation should be done.

The additional effect of granisteron over propofol and sevoflurane on prophylaxis of vomiting after pediatric adenotonsillectomy

IntroductionPostoperative vomiting (POV) after adenotonsillectomy in children is a common problem with an incidence as high as 40–80%. Only few studies in the literature compared the effect of different anesthetic techniques concerning postoperative vomiting in children. ObjectivesTo compare the effect of granisteron over propofol and sevoflurane in prevention of POV after adenotonsillectomy in children. Patients and methodsThis cohort, double blind study included 80 children with age between 4 and 12years, undergoing tonsillectomy±adenoidectomy, they were divided into 4 equal groups, in groups (I, II) the induction and maintenance of anesthesia were done by propofol, granisteron was given 5min before extubation to group II. In groups (III, IV) induction and maintenance were done by sevoflurane, granisteron was given 5min before extubation to group IV. ResultsThe incidence of vomiting 24h after surgery was 30% among all patients, with lower incidence in groups I and II than groups III and IV. Groups II and IV had the lowest incidence of postoperative vomiting ConclusionsOn performing adenotonsillectomy in children, the incidence of postoperative vomiting is lower with (i.v. anesthetics) propofol than (volatile anesthetics) sevoflurane. Use of granisteron significantly reduces the incidence of postoperative vomiting in children undergoing this procedure.

Evaluation of the Effects of Different Anesthetic Techniques on Neonatal Bilirubin Levels

Objectives: The aim of the present study was to determine whether different anesthetic techniques applied for vaginal delivery and cesarean section affect neonatal bilirubin levels in the first 24 hours of life. Materials and Methods: A total of 511 neonates delivered by vaginal route or cesarean section were included in the study. The neonates were classified according to method of delivery and anesthetic agents as group A (cesarean section / general anesthesia with sevoflurane), group B (cesarean section / spinal anesthesia with bupivacaine hydrochloride), group C (vaginal delivery with episiotomy / local anesthesia with prilocaine hydrochloride) and group D (vaginal delivery/ no anesthesia). The levels of neonatal serum bilirubin in the groups were compared. Results: There was no difference between group A and group B in terms of neonatal bilirubin levels (p = 0.98). Depending on the use of prilocaine hydrochloride as local anesthetic agent in the vaginal delivery, there was no significant difference between the groups C and D, in terms of the neonatal bilirubin levels (p = 0.99). The serum levels of bilirubin in cesarean section groups were significantly higher than those of the vaginal delivery groups (p<0.001). Conclusion: Prilocaine hydrochloride used for episiotomy did not exert any effects on neonatal hyperbilirubinemia. However, cesarean section with sevoflurane and bupivacaine hydrochloride seemed to result in increased bilirubin levels.