Combined General Anesthesia Research Articles

The association between anesthesia type and postoperative outcomes in patients receiving primary total shoulder arthroplasty.

There has been interest to investigate optimal anesthetic techniques for primary total shoulder arthroplasty (TSA). In this study, we investigate if there are differences in postoperative complications in patients receiving (1) regional alone; (2) general alone; and (3) regional plus general anesthesia for primary TSA. Patients undergoing primary TSA from 2014 to 2018 were identified in a national database. Patients were stratified into 3 cohorts: general anesthesia, regional anesthesia, and general anesthesia combined with regional anesthesia. Thirty-day complications were assessed using bivariate and multivariate analyses. Of 13,386 total patients undergoing TSA, 9079 patients (67.8%) had general anesthesia, 212 (1.6%) had regional anesthesia, and 4095 (30.6%) had general anesthesia combined with regional anesthesia. There were no significant differences in postoperative complications between the general anesthesia group and the regional anesthesia group. Following adjustment, an increased risk of extended length of hospital stay was seen in the combined general and regional anesthesia group compared to those who only had general anesthesia (p = 0.001). General versus regional versus general plus regional anesthesia have no difference in postoperative complications in patients receiving primary total shoulder arthroplasty. However, addition of regional anesthesia to general anesthesia is associated with increased length of stay. III.

Continuous femoral nerve block enhances outcome of spinal anaesthesia in preventing perioperative cardiac complications in patients with cardiac risk

ABSTRACT Background Elevated brain natriuretic peptide (BNP) is crucial to detect perioperative adverse cardiovascular events in patients with cardiac risk, even at low elevation of BNP level or when myocardial necrosis has not been already established. This study aims to compare between two anaesthesia methods in preventing perioperative myocardial infarction for patients having cardiac risk undergoing total knee arthroplasty (TKA). Patients and methods Fifty adult patients planned for TKA with risk factors as ischemic heart disease, diabetics, hypertensive, heavy smokers or body mass index ≥ 35 were categorized randomly into two groups. Group (S): received spinal anaesthesia followed by continuous ultrasound guided femoral nerve block once spinal motor blockade had been resolved. Group (G): received combined general and lumber epidural anaesthesia. BNP, cardiac troponins, pain severity, analgesic consumption, patients’ satisfaction and adverse cardiac events were observed preoperatively and extended to 2 days postoperatively. Results Baseline readings of BNP and cardiac troponins were comparable in both members. At 24 and 48 hours postoperatively, it decreased significantly in group S compared to group G. Mean Visual analogue score was significantly lower in group S comparative to group G at all times except at 40 and 48 hours postoperatively. Morphine utilization was significantly lower in group S. Patients in group S were significantly more satisfied than those in group G. Conclusions The use of spinal anaesthesia with continuous femoral nerve block can reduce the prevalence of perioperative myocardial infarction in patients with cardiac risk undergoing TKA.

Robot-assisted simple prostatectomy for treatment of large prostatic adenomas: surgical technique and outcomes from a high-volume robotic centre.

Aim of the present study is to describe our robot-assisted simple prostatectomy technique and to report 6-month surgical and clinical outcomes. Eighty men were consecutively submitted to robot-assisted simple prostatectomy in our institution from October 2019 to October 2020. All procedures were performed by the same surgical team. Diagnostic preoperative assessment was based on history, symptoms evaluation by International Prostate Symptom Score, digital rectal examination, flowmetry with post-void residual volume measurement by abdominal ultrasound, prostatic volume estimation by MRI, PSA dosage. Under combined general and subarachnoid anesthesia, surgery was performed via a transperitoneal approach using a Da Vinci Si system in the four-arm configuration. Operative time, blood loss, hospital stay, catheterization time, intraoperative and postoperative complications were assessed. Clinical postoperative 6months of evaluation was based on physical examination, flowmetry with post-void residual volume measurement, PSA dosage, and International Prostate Symptom Score. Mean operative time was 105.29min, mean hospital staying 5.4days. Blood loss was low in all cases and only 2 patients received transfusion. Catheterization time was 7days. According to the Clavien-Dindo classification, only minor (grade I and grade II) intraoperative and postoperative complications were observed. At 6-month postoperative assessment, a statistically significant increase of urinary flow indexes and bladder capacity was recorded, as a significant reduction of urinary residual volume. No patient experienced stress urinary incontinence and the mean postoperative IPSS score was significantly reduced to 4.3. Two patients were diagnosed with incidental prostatic cancer at the histopathological examination. Data collected in our experience on a large cohort confirm efficacy and safety of Robot-Assisted Simple Prostatectomy. This procedure allows both short operative time and hospital staying, with low incidence of perioperative complications. This surgical technique can therefore be considered a valid alternative to other procedures for the surgical treatment of large volume prostates. Randomized prospective and comparative studies are warranted in the future to assess if different RASP techniques provide similar surgical and functional outcomes.

Comparison of Efficacy of Spontaneous Breathing with Pressure Support and Volume-Controlled Mandatory Ventilation during General Combined Anesthesia without Muscle Relaxants

To compare efficacy of spontaneous breathing with pressure support and volum e-c ontrolled mandatory ventilation during combined general anesthesia using desflurane and without muscle relaxants. Subjects and Methods. 100 patients were included in the study. All underwent lo w-t raumatic operations on the lower limbs under general combined anesthesia using supraglottic air devices without muscle relaxants. Immediately prior to the induction of anesthesia, patients were randomly divided into two groups: Group 1 ( VCV ) where a mandatory volume control mode was used ( n = 50) and Group 2 ( PSV ) where a pressure support mode was used ( n = 50). The following parameters were assessed: hemodynamics, gas exchange, depth of anesthesia before induction, during and after the end of general anesthesia; arterial blood gas composition one hour after induction of anesthesia; indicators of pressure in the respiratory tract during mechanical ventilation, as well as time parameters of awakening. Results. In patients of Group 2 ( PSV ), according to the analysis of arterial blood gases, a higher level of PaO 2 ( p = 0.006), Horowitz index ( p = 0.005), and carbon dioxide level ( p < 0.0001) were noted. In Group 1 ( VCV ), higher mean and peak airway pressures were found one hour after induction and 10 minutes before the end of surgery ( p < 0.05). Also in the groups, there were statistically significant differences in the time parameters of awakening (233 ± 58 sec and 352 ± 83 sec in the PSV and VCV groups, respectively), supraglottic airway device removal time (268 ± 62 sec and 398 ± 84 sec in the PSV and VCV groups, respectively) and transfer to the ward (395 ± 60 sec and 571 ± 66 sec in the PSV and VCV groups, respectively) ( p < 0.0001). There were no significant differences in the main parameters of hemodynamics and depth of anesthesia, the consumption of anesthetics used during induction and maintenance of general anesthesia. Conclusion: The use of spontaneous breathing with pressure support during general combined anesthesia without muscle relaxants has a number of advantages versus mandatory ventilation mode. These include better oxygenation rates, lower airway pressure, faster awakening, supraglottic airway device removal time, and transfer of the patient to the ward. At the same time, acceptable ventilation, stable hemodynamic parameters and depth of anesthesia are maintained.

Towards the efficacy of erector spinae plane block in lumbar spinal fusion

AIM: This study aimed to assess the efficacy and safety of the erector spinae plane block (ESP-block) in lumbar spinal fusion in the perioperative period.
 MATERIALS AND METHODS: This prospective randomized study included 200 patients aged 4565 years undergoing decompression and lumbar spinal fusion. All the patients were divided into three groups depending on the anesthesia method. The first group received general anesthesia in combination with a single bilateral ESP-block; the second group received general anesthesia in combination with a prolonged bilateral ESP-block; the third (or, control) group was given general anesthesia. The parameters of intraoperative hemodynamics, the postoperative pain according to the visual analog scale, the need for opioid analgesics during and after surgery, the incidence of postoperative nausea and vomiting, and other anesthesia-induced adverse reactions were assessed.
 RESULTS: Patients who received the single bilateral ESP-block have exhibited adequate pain relief, leading to minimal opioid analgesic consumption in the early postoperative period. However, prolonged ESP-block with bilateral catheters is the most efficacious postoperatively, and patients hardly needed narcotic analgesics and featured a low incidence of postoperative nausea and vomiting (hazard ratio: 0.32; 95% confidence interval: 0.2130.464; р 0.001).
 CONCLUSION: The bilateral ultrasound-assisted ESP-block in lumbar decompression and spinal fusion ensures adequate pain relief both intra- and postoperatively, resulting in a reduced need for opioid analgesics and minimizing their related incidence of adverse reactions.

Factors Predicting Prolonged Postoperative Ileus in Patients Undergoing Major Gastrointestinal Surgery

Objective: This study aimed to investigate the rate of prolonged postoperative ileus (PPOI) and its predictive factors focusing on age, body mass index, smoking status, postoperative mobilization, and preoperative anxiety and depression among patients undergoing major gastrointestinal surgery.Materials and Methods: This prospective observational study included patients who underwent elective major gastrointestinal surgery in a super tertiary hospital in Thailand. The data were collected using a uniform case record form including the Hospital Anxiety and Depression Scale and Fagerstrom Test for Nicotine Dependence. PPOI was defined using criteria of Vather et al. (2013). Predictive factors for PPOI were determined by multivariate analysis.Results: A total of 123 patients were enrolled, with an average age of 59.8 ± 12.7 years. The most common indication for surgery was gastrointestinal malignancy (96 patients, 78%), followed by an open approach (75 patients, 61%) and a combined general and epidural anesthesia (58 patients, 47%). Approximately 30% of patients had a history of smoking. Preoperative anxiety and depression were equally found in nine patients (7%). Twenty-seven patients (22%) experienced PPOI. The significant predictive factors of PPOI were having preoperative anxiety (OR = 6.26, 95% CI = 1.22–44.41, p = 0.046) and being unable to ambulate on postoperative day 1 (OR = 3.26, 95% CI = 1.25–8.50, p = 0.015).Conclusion: Preoperative anxiety and delayed postoperative ambulation were two predictors for PPOI in this study. Some interventions to reduce preoperative anxiety and encourage early postoperative ambulation should be considered in patients undergoing major elective gastrointestinal surgery.

Comparison of Effectiveness of Pressure Support and Mandatory Ventilation Modes at the End of General Combined Anesthesia

The objective: to compare effectiveness of pressure support and mandatory ventilation modes at the final stage of general anesthesia.Subjects and Methods. 58 patients were included in the study. All patients underwent laparoscopic or open surgery under combined general anesthesia with muscle relaxants and tracheal intubation. At the end of the operation, after suturing the muscle layer, patients were randomly divided into two groups, depending on the further mode of ventilation: the mandatory mode group with dual control until extubation (n = 29) and the spontaneous breathing mode group with pressure support (n = 29). The time of awakening, the severity of post-extubation cough, hemodynamic parameters and oxygenation immediately before and 5 minutes after extubation were assessed.Results. In the groups of patients, statistically significant differences were observed in the time of awakening (252 ± 67 sec and 426 ± 71 sec in PSV and PCV-VG Groups, respectively), extubation (287 ± 55 sec and 464 ± 67 sec in the PSV and PCV-VG groups, respectively), and transfer from the operating room (473 ± 60 sec and 687 ± 77 sec in the PSV and PCV-VG groups, respectively) (p < 0.0001). Also, patients receiving PSV respiratory support had higher saturation levels 5 minutes after extubation (p < 0.0001), and heart rate and mean arterial pressure immediately before extubation were lower than in the mandatory ventilation group (p = 0.013 and p < 0.0001, respectively). In addition, in the mode of spontaneous breathing with pressure support, a lower severity of post-extubation cough was observed (p = 0.003).Conclusion. The use of a spontaneous breathing mode with pressure support at the end of general combined anesthesia has several advantages versus mandatory ventilation mode. These advantages include faster awakening, extubation and transfer of the patient to the ward, lower severity of post-extubation cough, as well as better gas exchange after extubation, lower intensity of hypertension and tachycardia before it.

Effects of general anesthesia with and without thoracic epidural block on length of stay after open spine surgery: a single-blinded randomized controlled trial

BACKGROUND CONTEXTLength of hospital stay (LOS) is an important concern in all types of surgery, and the enhanced recovery after surgery (ERAS) protocol has been developed to improve perioperative management and outcomes, which require multidisciplinary management. In terms of pain control, intraoperative regional anesthesia and postoperative opioid-sparing analgesia are recommended. For open spine surgery, we aimed to combine thoracic epidural analgesia to reduce pain and opioid-related side effects, thereby hastening recovery. PURPOSEThis study aimed to compare the length of hospital stay after open complete laminectomy with fusion between general anesthesia and combined general anesthesia involving a single thoracic epidural injection. DESIGNA randomized single-blinded controlled study. PATIENT SAMPLEThirty-eight patients scheduled for elective open laminectomy with fusion between I and III levels were selected. OUTCOME MEASURESLOS, postoperative pain, patient-controlled morphine consumption at 24 hours, patient satisfaction score, and other opioid-related side effects were recorded. METHODSPatients were randomly selected to receive standard general anesthesia (GA) or GA combined with a single-shot thoracic epidural at T11–T12 or T12–L1, a block with 10 mL of 0.25% bupivacaine, and 4 mg of morphine. RESULTSThere were no significant differences in the demographic variables between groups. LOS was significantly lower in the combined epidural and/or GA than in the control group (3.78±0.81 [mean±standard deviation] and 4.79±1.51 days, respectively; p=.017). Numeric rating score (at rest) at the post-anesthesia care unit, 24 hours postoperative morphine consumption (mg), operating time, and blood loss were significantly lower in the epidural group. Patients who received combined epidural and/or GA were more likely to report higher patient satisfaction (p=.008). However, the incidence of intraoperative hypotension was significantly higher in the epidural group (72.2% vs. 21.1%, p=.003). The incidences of adverse events and surgical field rating scores did not differ between the 2 patient groups. CONCLUSIONSCombined lower thoracic epidural and/or GA in patients undergoing elective lumbar spine surgery was associated with decreased LOS.

Effect of combination of intravenous general anesthesia with propofol and fentanyl on surgery for aortic dissection repair in patients, and its influence on respiratory and circulatory functions

Purpose: To investigate the effect of application of propofol in combination with fentanyl intravenous anesthesia in interventional surgery for aortic dissection repair, and its influence on respiratory and circulatory functions in patients.Methods: 100 patients undergoing interventional surgery for aortic dissection repair in Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang. China from ovember 2018 to May 2020 were assigned equally to control group (CG) and study group (SG). CG received general anesthesia with propofol, while those in SG received combined intravenous general anesthesia with propofol and fentanyl. Time of anesthesia onset, postoperative awakening time, extubation time, respiratory function indicators and circulatory function indicators before operation (T0), and at intraoperative 1 h (T1), intraoperative 2 h (T2) and postoperative 2 h (T3); as well as postoperative VAS pain scores, and Ramsay sedation scores were determined and compared.Results: Compared with CG, SG had shorter anesthesia onset, shorter postoperative awakening and extubation times, and lower postoperative VAS pain and Ramsay sedation scores (p < 0.05). At T1, T2 and T3, indicators of respiratory and circulatory functions were better in SG than in CG (p > 0.05).Conclusion: Combined intravenous general anesthesia using propofol and fentanyl was more effective in interventional surgery for repair of aortic dissection, and it enhanced respiratory and circulatory functions in the patients.

Comparative study between combined general anesthesia with peribulbar block versus traditional general anesthesia in patients undergoing strabismus surgery

Comparative study between combined general anesthesia with peribulbar block versus traditional general anesthesia in patients undergoing strabismus surgery

Celiac Plexus Denudation in Triangle Dissection in Pancreatico Duodenectomy: Perioperative Anesthetic Implications

This is a case report of inadvertent right celiac plexus denudation during triangle dissection during the surgery for carcinoma of pancreas under combined general epidural anaesthesia. Operative removal of the ganglia has its own autonomic effects, which are important to observe for anesthesiologists and perioperative critical care physicians alike.

Paths of thoracic epidural catheters in children undergoing the Nuss procedure for pectus excavatum repair

PurposeTo investigate the paths of thoracic epidural catheters in children, this retrospective study was performed.MethodsWe investigated 73 children aged 4 to 12 (mean ± SD 7.8 ± 2.3) years, who underwent the Nuss procedure for pectus excavatum repair under combined general and epidural anesthesia over a 5-year period at Tokyo Metropolitan Police Hospital. Following induction of general anesthesia, we inserted a radiopaque epidural catheter via the T5/6 or T6/7 interspace and advanced for 5 cm cephalad in the thoracic epidural space. We evaluated the paths of the epidural catheters on plain chest radiographs after surgery.ResultsThe median level for the catheter tip location was T3 (range C6–T7), while the median number of vertebrae crossed by the catheter tips was 2.5. In most children, the catheters advanced straight for the first 2–3 cm (1–1.5 vertebrae) in the thoracic epidural space. However, they continued to advance straight in only 25 children, while they exhibited curved or coiled paths in the remaining 48. The catheter tips were located at higher levels in children with straight epidural catheter paths [median (range) T2 (C6–T4)] than in those with curved or coiled paths after the initial 2–3 cm [median (range) T4 (T2–T7)] (p < 0.0001).ConclusionsOur findings indicate that the course of epidural catheters in children is unpredictable after the first 2–3 cm in the thoracic epidural space. Clinicians should be aware of such findings, although further studies are required for confirmation.

Anesthesia Type and Postoperative Outcomes for Patients Receiving Arthroscopic Rotator Cuff Repairs.

As the indications for and the volume of arthroscopic rotator cuff repair increase, it is important to optimize perioperative care to minimize postoperative complications and health care costs. We sought to investigate if the anesthesia type used affects the rate of postoperative complications in patients undergoing arthroscopic rotator cuff repairs. We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database to identify patients undergoing arthroscopic rotator cuff repair from 2014 to 2018. Patients were divided into 3 cohorts: general anesthesia, regional anesthesia, and combined general plus regional anesthesia. Bivariate and multivariate analyses with stepwise technique were performed on data related to patient demographics, smoking history, functional status, medical comorbidities (ie, bleeding disorders, chronic obstructive pulmonary disease, and dialysis), and postoperative outcomes within 30 days of discharge. To assess the independent risk factors for postoperative complications, demographics and medical comorbidities were included in the multivariate analyses for any variables that derived P values <.20. Of 24,677 total patients undergoing arthroscopic rotator cuff repair, 15,661 (63.5%) had general anesthesia, 889 (3.6%) had regional anesthesia, and 8127 (32.9%) received combined general plus regional anesthesia. Patients who received general anesthesia rather than regional anesthesia were more frequently white (76.8% vs 74.8%, respectively) and had a medical history of hypertension (47.9% vs 41.8%, respectively), smoking (14.9% vs 12.4%, respectively), and chronic obstructive pulmonary disease (3.4% vs 1.6%, respectively). Compared with patients receiving general anesthesia, those receiving combined general plus regional were more likely to have higher American Society of Anesthesiologists class and a smoking history. Following adjustment, patients who underwent regional anesthesia had a decreased risk for postoperative admission compared with patients who had general anesthesia. Patients who underwent combined regional plus general anesthesia had decreased rates of wound complications and readmission compared with those who received general anesthesia. Among patients undergoing arthroscopic rotator cuff repair, this retrospective study found a significantly higher rate of respiratory and cardiac comorbidities with general anesthesia compared with regional anesthesia. When controlling for these confounders, the use of regional anesthesia was still associated with lower rates of postoperative readmission compared with the general and combined subgroups. Patients receiving combined general plus regional anesthesia had decreased rates of wound complications and readmittance compared with general anesthesia. These findings may influence anesthetic choice in minimizing postoperative complications for rotator cuff repairs.

Effect of combined epidural-general anesthesia on long-term survival of patients with colorectal cancer: a meta-analysis of cohort studies.

This study aimed to analyze the long-term survival of patients with colorectal cancer after receiving combined epidural-general anesthesia (EGA) or general anesthesia (GA) alone. The PubMed, MEDLINE, Web of Science, Cochrane Library, and Embase databases were used to search for cohort studies that explored the differences between the effects of EGA and GA on overall survival (OS) and recurrence-free survival (RFS) of patients with colorectal cancer. The hazard ratios (HRs) and their 95% confidence intervals (95%CIs) were used as indicators to evaluate the strength of the effects and were pooled. Nine studies were included in the meta-analysis. EGA improved the OS of patients with colorectal cancer compared with GA (HR = 0.904, 95%CI 0.871-0.938, P < 0.05). In the subgroup analysis, EGA was more protective for OS of patients with colon cancer than GA (HR = 0.840, 95%CI 0.732-0.963, P < 0.05), but not for OS of patients with rectal cancer (HR = 0.764, 95%CI 0.398-1.469, P > 0.05). Additionally, EGA could not further prolong RFS in patients with colorectal cancer (HR = 1.015, 95%CI 0.942-1.093, P > 0.05), which was the same in the subgroup analysis of patients with colon cancer (HR = 0.908, 95%CI 0.760-1.085, P > 0.05). EGA could improve the OS of patients with colorectal cancer, especially those with colon cancer, but it could not improve the OS in the subgroup of patients with rectal cancer. This difference may be due to the immune protective function of the parasympathetic nerve innervating the intestinal tubes above the splenic flexure retained by EGA. Additionally, although EGA has a protective effect on RFS in patients with colorectal cancer, the difference was not significant. The design of this analysis is registered and displayed in the PROSPERO database (CRD42021274864).

The Effect of Intraoperative Diphenhydramine/Morphine on Acute Pain and Opioid Consumption after Spine Surgery

Background: One of the most common problems after spine surgery is very severe pain that usually affects outcome of patients after surgery and duration of hospital stay. Acute postoperative pain has several mechanisms, and multimodal analgesia by different mechanism of action will help control to it. In this study, we intended to investigate the effect of intravenous diphenhydramine injection during induction of anesthesia and morphine before incision on the control of acute pain in postoperative laminectomy. Methods: 130 patients scheduled for spine surgeries were assigned to receive a single pre induction dose of diphenhydramine 0.4mg/kg IV (D group) and morphine 0.15mg/kg before incision in addition acetaminophen 1gr IV at the end of surgery and just morphine 0.15mg/kg and acetaminophen 1gr IV (C group) in a randomized, double-blind trial. Postoperative pain, analgesic requirements in recovery and 24 hr after surgery were assessed. Results: The mean pain intensity in recovery was lower in the diphenhydramine group than in the control group (MD, 2.13; 95% confidence interval (CI), 1.72–2.53; P &lt; .0001) and the need for analgesia was much lower in the diphenhydramine group than in the control group. P &lt; 0.001. The severity of pain and the need for analgesics in the diphenhydramine group had a significant decrease in the ward compared to the control group. Conclusion: Prophylactic diphenhydramine 0.4 mg/kg at induction of general anesthesia in combination with morphine 0.15mg/kg before incision and acetaminophen 1gr at the end of surgery reduced the postoperative severity of acute pain and opioids requirement in the early postoperative period after spine surgeries.

Regional Analgesia Does Not Reduce Cancer Recurrence. Case closed

Regional Analgesia Does Not Reduce Cancer Recurrence. Case closed

Potentials of intravenous laser blood irradiation to correct peroxidation and antioxidant activity as a result of surgical distress

Purpose: to reveal protective effects of intravenous low-level laser blood irradiation (ILBI) during surgical interventions at the gallbladder as well as to study the state of antioxidant activity, lipid peroxidation and endogenous intoxication.Material and methods. In the perioperative period, 40 patients from the main group (I) had traditional treatment which included pharmacological preparations and sessions of intravenous laser blood irradiation. 45 patients from the control group (II) had only traditional (pharmacotherapeutic) treatment. In both groups during surgery, the anesthetic protection consisted of classical neuroleptanalgesia. The age of patients in both groups did not differ significantly. Intravenous laser blood irradiation was done with helium-neon laser “Atoll” 632 nm (Fokon Ltd, St-Petersburg, Russia). During surgery, three irradiation sessions were performed at radiation power of 20 mW and exposure 15 minutes at various stages of surgery: 30 minutes before induction of anesthesia, at the traumatic stage and 30 minutes before the expected finish of the surgery. Ceruloplasmin and transferrin levels in the blood plasma were assessed with the electron paramagnetic resonance technique. The ratio of ceruloplasmin/transferrin which characterizes the level of antioxidant activity was also established. The level of endogenous intoxication was assessed using the previously published technique. The quantitative characteristics of endogenous intoxication by this technique is the value of optical density (D280) and total optical density of components related to high molecular weight and low molecular weight fractions.Results. ILBI sessions in patients neutralize changes in the level of ceruloplasmin and transferrin in blood. The data obtained also confirm ILBI protective effects at protein SH-groups or activation of the restoration of protein SH-groups that were damaged by oxidation as a result of surgical aggression and trauma.Conclusion. The protective effect of intravenous laser blood irradiation in addition to the standard preoperative therapy optimizes pharmacological anesthetic protection during surgery under the existing traditional schemes of combined general anesthesia.

PRIMARY HYPERPARATHYROIDISM: OPTIMIZATION OF ANAESTHESIA

Background and Aims. The majority of cases of primary hyperparathyreosis (PHPT) due to solitary adenoma and require the target surgery. Research of new anesthesia/analgesia methods, which afford to have an opioid-sparing effect, is going. Methods. 127 patients with PHPT were divided into 3 groups: the group STI-BCSPB (n=26) was used combined general anesthesia (GA) with sevoflurane (SEV), the tracheal intubation (TI) with the myorelaxant introduction and bilateral cervical superficial plexus blockade (BCSPB); the group STI (n=82) was used SEV anaesthesia with IT and no BCSPB; the group PLM-BCSPB (n=19) was provided propofol (P) GA with protection air-ways by laryngeal mask (LM) and BCSPB. In both groups (STI-BCSPB and PLM-BCSPB) were used co-analgesics, such as dexamethasone (DXM) 8 mg IV, 2% lidocaine (L) 1,0-1,5 mg/kg IV, metamizole (M) or paracetamol (P) 1 g IV, dexketoprofen (DKTP) 50 mg IV as pre-emptive analgesia 30 min before surgery. Ketamine 25 mg IV was used for induction anaesthesia in these groups. In STI group only opioid with P were used for induction of GA. Duration of surgery (DoS), anaesthesia (DoA), opioid consumption, time from the operation ending until the eyes opening (EyOp), desaturation was measured. All data M±m Results. DoS for STI-BCSPB, STI and PLM-BCSPB was respectively 38.7±2.7, 37.8±1.3 and 35.6±1.7 min (NS), DoA was respectively 63.8±3.1, 59.4±1.4 m and 53,8±2.7 min (p= 0.028 STI vs PLM-BCSPB, p= 0.024 STI-BCSPB vs PLM-BCSPB, the difference is significant (DS). EyOp was 15.4±1.1, 15.6±1.2 and 11.6±0.9 min respectively for STI-BCSPB, STI and PLM-BCSPB (p=0.022 STI vs PLM-BCSPB (DS) and p=0.025 STI-BCSPB vs PLM-BCSPB (DS). Desaturation (SpO2 below 92%) due to residual sedation and the effect of muscles relaxants was observed in 39 (47.6%) and 11 (42,3%) patients in STI and STI-BCSPB during the first 30 min postop compared to 2 cases (10.5%) in PLM-BCSPB (both STI groups were DS vs PLM-BCSPB, chi-square test). The dose of intra-op fentanyl was 334.3±17.1, 256.5±16.9 197.3±15.3 mcg in STI, STI-BCSPB and PLM-BCSPB respectively, (DS for PLM-BCSPB vs other groups, DS between STI groups). Conclusions. Combine methods GA with BCSPB have some benefits over mono GA. Co-analgesics afford to achieve an opioidsparing effect. Under ectomy of single parathyroid adenoma, the use of propofol and BSCPB with the laryngeal mask without muscles relaxants seems more preferable compared to sevoflurane anesthesia with BBSCP and tracheal intubation due to the shorter anesthesia duration, time to eye-opening after surgery, lower desaturation frequency.

Providing one-lung ventilation in posttracheostomic tracheal stenosis for thoracoscopic plastic of the right diaphragm dome

The article is devoted to the consideration of a clinical case of providing artifcial one-lung ventilation for performing thoracoscopic plastic of the right dome of the diaphragm in a patient with grade 3 posttracheostomy cicatricial tracheal stenosis. The patient is presented after a new coronavirus infection COVID-19 from 2020, prolonged mechanical ventilation through a tracheostomy tube (74 days), the development of medium thoracic cicatricial tracheal stenosis of grade 3 (the lumen of the narrowest part of the trachea is 4 mm) after decannulation and the development of relaxation of the right dome of the diaphragm (according to CT data, the dome is located at the level of the IV intercostal space). The frst stage under conditions of combined general anesthesia and high-frequency ventilation of the lungs was performed to restore the lumen of the trachea by bougienage of the stenosis area with tubes of a rigid endoscope under the control of a fberoptic bronchoscope with further nasotracheal intubation with a thermoplastic single-lumen endotracheal tube with a diameter of 8.0 with a cuff. At the second stage, during thoracoscopic plastic of the right dome of the diaphragm, to provide artifcial one-lung ventilation, a bronchial blocker was used, introduced through the same endotracheal tube into the right main bronchus under the control of a fberoptic bronchoscope.

Сравнение эффективности комбинированной анестезии с использованием эпидурального морфина и без него на фоне коррекции окислительно-восстановительного метаболизма у онкобольных с мультиорганными оперативными вмешательствами

Актуальность. На сегодня недостаточно данных о послеоперационном эпидуральном обезболивании с использованием морфина и проведении окислительно-восстановительной терапии у онкобольных с мультиорганными оперативными вмешательствами с оценкой показателей иммунитета. Цель работы: изучение интраоперационного использования эпидурального морфина по сравнению с комбинированной общей эпидуральной анестезией, а также проведение окислительно-восстановительной терапии у онкобольных с мультиорганными оперативными вмешательствами с оценкой показателей иммунитета для обеспечения анестезии с опережающей терапией возможных осложнений и получения более комфортного состояния пациентов. Мате­риалы и методы. В ходе работы было обследовано 117 пациентов с местно-распространенным опухолевым процессом желудочно-кишечного тракта с мультиорганными хирургическими вмешательствами по жизненным показаниям (67,6 ± 3,7 года). Все пациенты были разделены на четыре группы в зависимости от типа анестезии и антиоксидантной терапии. Были выделены группы с интраоперационным использованием эпидурального морфина и без него. В качестве антиоксидантной терапии использовали L-орнитин L-аспартат с комплексом кверцетина с повидоном. Измерялись показатели клеточного и гуморального иммунитета на примере субпопуляционного определения относительного количества лимфоцитов CD3+ и IgA до операции и через 4 и 24 часа после операции. Общее качество жизни, связанное со здоровьем, оценивали с применением стандартного «Краткого опросника оценки статуса здоровья» SF-36 по научно обоснованной методологии. Результаты. Полученные результаты свидетельствуют о том, что в группе с использованием эпидурального морфина степень эффективности обезболивания была достаточной, но были зарегистрированы осложнения, в том числе в виде апноэ при использовании морфина и незначительное ухудшение показателей иммунитета. При применении окислительно-восстановительной терапии мы достигли как улучшения качества жизни, так и более значительного улучшения показателей иммунитета. Выводы. Таким образом, проведение комбинированной эпидуральной анестезии без использования морфина на фоне коррекции окислительно-восстановительного метаболизма у онкобольных с мультиорганными оперативными вмешательствами более комфортно для пациентов, менее опасно из-за отсутствия развития апноэ, психоэмоционально и экономически оправдано, что свидетельствует о ее приоритетном использовании.