General Anesthesia For Laparoscopic Cholecystectomy Research Articles

The Effect of Recruitment Maneuver on Static Lung Compliance in Patients Undergoing General Anesthesia for Laparoscopic Cholecystectomy: A Single-Centre Prospective Clinical Intervention Study.

Background and Objectives: The aim of this study was to examine whether the use of an alveolar recruitment maneuver (RM) leads to a significant increase in static lung compliance (Cstat) and an improvement in gas exchange in patients undergoing laparoscopic cholecystectomy. Material and Methods: A clinical prospective intervention study was conducted. Patients were divided into two groups according to their body mass index (BMI): normal-weight (group I) and pre-obese and obese grade I (group II). Lung mechanics were monitored (Cstat, dynamic compliance-Cdin, peak pressure-Ppeak, plateau pressure-Pplat, driving pressure-DP) alongside gas exchange, and hemodynamic changes (heart rate-HR, mean arterial pressure-MAP) at six time points: T1 (induction of anesthesia), T2 (formation of pneumoperitoneum), T3 (RM with a PEEP of 5 cm H2O), T4 (RM with a PEEP of 7 cm H2O), T5 (desufflation), and T6 (RM at the end). The RM was performed by increasing the peak pressure by +5 cm of H2O at an equal inspiration-to-expiration ratio (I/E = 1:1) and applying a PEEP of 5 and 7 cm of H2O. Results: Out of 96 patients, 33 belonged to group I and 63 to group II. An increase in Cstat values occurred after all three RMs. At each time point, the Cstat value was measured higher in group I than in group II. A higher increase in Cstat was observed in group II after the second and third RM. Cstat values were higher at the end of the surgical procedure compared to values after the induction of anesthesia. The RM led to a significant increase in PaO2 in both groups without changes in HR or MAP. Conclusions: During laparoscopic cholecystectomy, the application of RM leads to a significant increase in Cstat and an improvement in gas exchange. The prevention of atelectasis during anesthesia should be initiated immediately after the induction of anesthesia, using protective mechanical ventilation and RM.

A Comparative Study on Spinal Anesthesia verses General Anesthesia for Laparoscopic Cholecystectomy

Background: The main goal of anesthetic management in patients undergoing surgical procedures of laparoscopy includes the management of pneumoperitoneum. Generally, laparoscopic cholecystectomy is done under general anesthesia, but a large number of patients with major medical problems sometimes cannot tolerate such anesthesia where thoracic spinal anesthesia may be suitable. Aim of the Study: The aim of this study was to compare spinal anesthesia verses general anesthesia for laparoscopic cholecystectomy regarding the efficacy and outcomes. Methods: This prospective comparative study was conducted in the Department of Anaesthesia & ICU, Mugda Medical College & Hospital, Dhaka, Bangladesh during the period from January 2021 to December 2021. A total 60 patients were enrolled in this study as study population. Patients with physical status ASA I and II were selected as the study population and randomly divided to undergo laparoscopic cholecystectomy with low-tension pneumoperitoneum with CO2 under general anesthesia (n=30) or spinal anesthesia (n=30). Propofol, rocuronium, fentanyl, sevoflurane and tracheal intubation were used for general anesthesia. On the other hand, to achieve a sensorial level of T3, hyperbaric bupivacaine (15 mg) and fentanyl (20 µg) were used for the spinal anesthesia. Data regarding intraoperative parameters, postoperative pain, complications and recovery cost were compared between both groups. Results: In this study, in analyzing the perioperative comparison of mean ±SD VAS scores in both the general and spinal anesthesia groups we observed that in group 1 after 4, 8, 12 and 24 hours VAS (Visual analogue score) scores were found as 1.21±1.02, 1.62±1.35, 1.59±1.38 and 1.02±0.54 respectively which were found as 2.24±1.15, 3.29±1.62, 3.61±1.28 and 2.33±1.49 respectively in group 2. Between both the groups, in all the reading of VAS scores (4, 8, 12 and 24 hours) we found significant correlations between the groups where the P values ...........

Intraoperative Target-Controlled Infusion of Etomidate versus Propofol for General Anesthesia in Laparoscopic Cholecystectomy

To investigate the safety and changes of hemodynamic profiles when using etomidate for general anesthesia in laparoscopic cholecystectomy compared to propofol was the objective of the study. Adult patients who received laparoscopic cholecystectomy were retrospectively categorized as etomidate and propofol group. Time to extubation, time to eye opening, pain scores at rest, postoperative nausea, vomiting and lengths of hospital stay were studied as safety outcomes. Changes in hemodynamic profiles are evaluated by coefficients of variation of systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rates were compared between groups. 291 patients were categorized as the etomidate group and 388 patients as the propofol group. There was no significant difference in age, sex, body mass index and hemodynamic profiles at baseline between the two groups (p all>0.05). Compared to propofol, the etomidate group showed similar safety outcomes (p all>0.05). Similar change patterns in the hemodynamic profiles over time were observed between the two groups, but the coefficients of variation of systolic blood pressure, diastolic blood pressure and mean arterial pressure in the etomidate group were significantly lower than that in the propofol group (p<0.05). There was no difference in safety outcomes but a more stable hemodynamic profile when comparing intraoperative target-controlled infusion of etomidate to propofol used for general anesthesia in laparoscopic cholecystectomy.

Abstract No. : ABS2056: To compare time and intraoperative haemodynamic changes of spinal anaesthesia with general anaesthesia for laparoscopic cholecystectomy

Background &Aims:Laparoscopic cholecystectomy (LC) is conventionally performed under general anaesthesia (GA). As with any day care procedure, LC requires an anaesthetic technique which provides rapid recovery and fewer side effects. Neuraxial techniques resulted in decreased morbidity and mortality. Theaimofthestudywasto comparethe time and haemodynamic changes of spinal with GA.Methods:Following approval by the institutional ethical committee, registering in CTRI (CTRI/2021/04/032586 ) and after taking patient consent ,a controlled ,prospective, randomised trial of 70 patients with symptomatic gallstone disease and American Society of Anesthesiologists status I or II were operated for LC under spinal (n=35) or GA (n=35)between the academic years 2020 and 2021. Statistical analysis was done using SPSS version 25.0. Time taken for both groups were compared. Haemodynamic parameters were recorded to find theincidence of hypotension and bradycardia.Results:All the procedures were completed by the allocated method of anaesthesia and there were no conversions from spinal to GA. The incidences of hypotension(p=0.742) and bradycardia (P=0.163) were 17% and 11.4% in SA group and 14% and 2.8% in GA group respectively and no significant difference were observed. The total time taken in SA group was significantly less than in GA group; 38.9 9.64 versus 46.79.487 respectively (P=0.0011).Conclusion:LC done under spinal anaesthesia is safe and less time consuming. Spinal anaesthesia can berecommended as the technique of choice for LC in developing countries where time and cost can be saved.

Author’s Response to Letter to the Editor: Is Opioid-Free General Anesthesia More Superior for Postoperative Pain Versus Opioid General Anesthesia in Laparoscopic Cholecystectomy?

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Thoracic Epidural Versus General Anaesthesia For Laparoscopic Cholecystectomy: A Randomized Controlled Trial.

Laparoscopic cholecystectomy is one of the most commonly performed surgeries worldwide. Aim of our study was to compare the effectiveness of thoracic epidural anaesthesia with general anaesthesia for Laparoscopic cholecystectomy in terms of changes in blood pressure during surgery, postoperative pain, respiratory complications and average length of hospital stay. It was a randomized controlled trial conducted from 1stOctober 2018 to 31st October 2019. Eightytwo patients planned to undergo elective laparoscopic cholecystectomy were randomly divided into two groups, T and G. In Group T all patients underwent laparoscopic cholecystectomy under thoracic epidural anaesthesia with 12 ml of 0.25% bupivacaine and 1% lignocaine plain whereas in group G all patients underwent surgery under general anaesthesia. Intra-operative mean arterial pressure (MAP) and postoperative opioid consumption in first 24hrs were recorded as primary outcomes whereas presence or absence of respiratory complication and duration of hospital stay as secondary outcome.. Out of 82 patients, 41 patients underwent laparoscopic cholecystectomy under thoracic epidural anaesthesia and 41 patients had surgery under general anaesthesia. Mean arterial pressure was lower in Group T and the difference was statistically significant. The average time of first complaint of postoperative pain in Group T was 5.4±1.26 hours as compared to less than 0.79±0.25 hours in Group G. Patients in group T required lower doses of opioid analgesia in first twenty-four hours as compared to patients in group G. Mean hospital stay in group T was 1 day as compared to 3 days in group G. Thoracic epidural anaesthesia provides a better alternative to general anaesthesia for Laparoscopic cholecystectomy with lower intraoperative mean arterial blood pressure, 24 hours postoperative consumption of opioids, respiratory complications and length of hospital stay.

Mean Temperature Loss During General Anesthesia for Laparoscopic Cholecystectomy: Comparison of Males and Females.

IntroductionMild hypothermia is common after general anesthesia. It is associated with discomfort and shivering. Greater fall of temperature is associated with more devastating complications. Data regarding the effect of gender on perioperative hypothermia is scanty.Objectives of the studyTo determine and compare mean core temperature loss in males and females undergoing laparoscopic cholecystectomy under general anesthesia.Setting and designDescriptive cross-sectional study in a tertiary care teaching hospital.Subjects and methodsNinety-seven elective laparoscopy patients were included through non-probability consecutive sampling. Intraoperatively, there was standardization of monitoring equipment, drapes, operation room temperature (21-22 °C), humidity (50%), irrigation fluid temperature (37 °C), peritoneal CO2 temperature (21-22 °C), anesthetic fresh gas flow rates at induction and maintenance. Temperature recording equipment (nasopharyngeal probe) and temperature recording interval (10 minutes) were also standardized from induction till the end of surgery. Final temperature was recorded at the end of surgery before emergence.ResultsMean temperature loss was 0.73 ⁰C ± 0.47⁰C. Mean loss was significant in males compared to females with a mean difference of 0.28°C ± 0.93⁰C; P-value= 0.003.ConclusionMean temperature decreases significantly in laparoscopic cholecystectomy patients under general anesthesia. We recommend that more care is needed to prevent hypothermia in male patients because of their higher susceptibility to hypothermia.

Spinal Anaesthesia and General Anaesthesia for Laparoscopic Cholecystectomy: Study in a Private Hospital, Dhaka, Bangladesh

Spinal Anaesthesia and General Anaesthesia for Laparoscopic Cholecystectomy: Study in a Private Hospital, Dhaka, Bangladesh

Dexmedetomidine as a Single Bolus Dose in Laparoscopic Cholecystectomy under General Anesthesia – A Comparison of Different Doses

Introduction: Dexmedetomidine has an ideal pharmacodynamic profile for attenuation of stress response during general anesthesia for laparoscopic cholecystectomy. Since, the value of dexmedetomidine as a single premedication dose remains largely unexplored, this study compared dexmedetomidine in 0.5μg/kg and 1μg/kg dose for laparoscopic cholecystectomy under general anesthesia. &#x0D; Objectives: The primary objective of this study was to compare dexmedetomidine in a single premedication dose of 0.5μg/kg and 1μg/kg in terms of hemodynamic (heart rate and mean arterial pressure) changes to critical incidences such as laryngoscopy, endotracheal intubation, pneumoperitoneum and extubation. The secondary objectives were to compare induction dose of propofol required, sedation scores in the immediate post anesthesia period and adverse events such as bradycardia and hypotension. &#x0D; Methodology: This was a prospective double blind study. Ninety-two patients aged 18-55 years of either gender of American Society of Anesthesiologists physical status I-II were randomly allocated into two groups to receive either Dexmedetomidine 1μg/kg or 0.5μg/kg slowly IV over 10 minutes as a premedication before induction. Heart rate, Mean arterial pressure, induction dose of propofol, sedation scores, and adverse events were compared. &#x0D; Results: The patient characteristics, Fentanyl consumption, duration of surgery and anesthesia in both groups were comparable. There was comparable attenuation of hemodynamics in both groups during laryngoscopy and intubation. Dexmedetomidine in 1μg/kg compared to 0.5μg/kg had significantly better attenuation of hemodynamics from 1 minute to 40 minutes of pneumoperitoneum. After 40 minutes, there was no attenuation in either group. The post anesthesia sedation scores were comparable. The induction dose of propofol was significantly less and the incidence of bradycardia was significantly higher with dexmedetomidine 1μg/kg. &#x0D; Conclusion This study demonstrates that a premedication dose of Dexmedetomidine in 1μg/kg compared to 0.5μg/kg has significantly betier attenuation of hemodynamics from 1 minute to 40 minutes of pneumoperitoneum.

High-Frequency Heart Rate Variability Index: A Prospective, Observational Trial Assessing Utility as a Marker for the Balance Between Analgesia and Nociception Under General Anesthesia.

Maintaining a balance between nociception and analgesia perioperatively reduces morbidity and improves outcomes. Current intraoperative analgesic strategies are based on subjective and nonspecific parameters. The high-frequency heart rate (HR) variability index is purported to assess the balance between nociception and analgesia in patients under general anesthesia. This prospective observational study investigated whether intraoperative changes in the high-frequency HR variability index correlate with clinically relevant nociceptive stimulation and the addition of analgesics. Instantaneous and mean high-frequency HR variability indexes were measured continuously in 79 adult subjects undergoing general anesthesia for laparoscopic cholecystectomy. The indexes were compared just before and 2 minutes after direct laryngoscopy, orogastric tube placement, first skin incision, and abdominal insufflation and just before and 6 minutes after the administration of IV hydromorphone. Data from 65 subjects were included in the final analysis. The instantaneous index decreased after skin incision ([SEM], 58.7 [2.0] vs 47.5 [2.0]; P < .001) and abdominal insufflation (54.0 [2.0] vs 46.3 [2.0]; P = .002). There was no change in the instantaneous index after laryngoscopy (47.2 [2.2] vs 40.3 [2.3]; P = .026) and orogastric tube placement (49.8 [2.3] vs 45.4 [2.0]; P = .109). The instantaneous index increased after hydromorphone administration (58.2 [1.9] vs 64.8 [1.8]; P = .003). In adult subjects under general anesthesia for laparoscopic cholecystectomy, changes in the high-frequency HR variability index reflect alterations in the balance between nociception and analgesia. This index might be used intraoperatively to titrate analgesia for individual patients. Further testing is necessary to determine whether the intraoperative use of the index affects patient outcomes.

Comparative Evaluation of Efficacy of Preventive Analgesia with Diclofenac and Buprenorphine Patch versus Single Diclofenac Patch for Postoperative Pain following General Anesthesia for Laparoscopic Cholecystectomy.

Background:Acute postoperative pain is managed with parenteral and oral medications requiring skilled personnel for administration and vigilance. Previous studies have been done either with transdermal buprenorphine or diclofenac patch separately in mitigating postoperative pain.Aims:The primary aim was to compare pain scores and rescue analgesia requirement. The secondary aims were comparison of side effects, time to mobilization and oral intake start, sedation scores, and satisfaction scores of surgeons and patients receiving transdermal patches of buprenorphine and diclofenac versus placebo and diclofenac patches following laparoscopic cholecystectomy.Settings and Design:This is a randomized double-blinded (1:1), case–control study.Materials and Methods:One hundred patients undergoing laparoscopic cholecystectomies were enrolled for the study. Patients were allocated into two groups by computer-generated randomization: those receiving dual patch of buprenorphine and diclofenac (DP) and those receiving patches of diclofenac and placebo (SP). Outcomes were measured after extubation and at 4, 8, 12, 24, 36, and 48 h after surgery.Statistics:Analysis was done using the Statistical Package for the Social Sciences version 22.0, R environment 3.2.2 for data analysis, and Microsoft Excel to generate graphs and tables.Results:The pain scores and rescue analgesia requirements were significantly higher in group SP compared to group DP. Patient satisfaction scores were better with group DP. No significant difference was found in both the groups concerning sedation scores, side effects, and time to patient mobilization and start of oral intake.Conclusions:Concomitant use of transdermal patches of buprenorphine and diclofenac for postoperative pain in laparoscopic cholecystectomy provides adequate analgesia and patient satisfaction without compromising postoperative recovery.

Comparision of Dexmedetomidine and Propofol in Patients Undergoing Laparoscopic Cholecystectomy Under Spinal Anesthesia.

Background:Spinal anesthesia (SA) with sedation is considered to be an alternative to general anesthesia for laparoscopic cholecystectomy (LC) in high-risk patients. Ketamine in analgesic dose with propofol or dexmedetomidine infusion provides titratable sedation, hemodynamic stability, and minimum respiratory depression without psychomimetic effects.Aim:To compare the efficacy of ketamine–dexmedetomidine and ketamine-propofol combination in relation to sedation, analgesia, hemodynamic effects, and perioperative side effects.Settings and Design:This was a prospective, randomized single-blind comparative study comprising 100 American Society of Anesthesiologists I, II, and III patients posted for LC.Materials and Methods:Patients were randomized into two groups of 50 patients each. Group KP (ketamine + propofol) received intravenous (i.v.) bolus of injection ketamine 0.5 mg.kg −1 and propofol infusion at 3 mg.kg −1.h −1. Group KD (ketamine + dexmedetomidine) received i.v. bolus of injection ketamine 0.5 mg.kg −1 and dexmedetomidine infusion at 0.4 μg.kg −1.h −1. Parameters observed were vitals, perioperative side effects, time to first rescue analgesia, and return of consciousness.Statistical Analysis:Student's independent t-test was employed for comparing continuous variables. Chi-square test or Fisher's exact test, whichever appropriate, was applied for comparing categorical variables.Results:Duration of analgesia was longer in KD Group (191.2 vs. 173.5 min), and time to regain consciousness was faster in KP Group (14.9 vs. 20.4 min).Conclusion:Both the techniques of sedation are feasible, safe, and comparable, except the duration of analgesia and time to regain consciousness which was longer in KD Group.

Anaphylaxis occurred immediately after prophylactic antibiotics injection with negative intradermal skin test during laparoscopic cholecystectomy

Prophylactic antibiotics that are used to prevent post-operative infection can commonly cause anaphylactic reactions during anesthesia. It is therefore necessary to perform a skin test before antibiotics are administered in order to diagnose and prevent anaphylactic reactions. However, the results of the antibiotic skin test can differ according to the drug, dose, and reagent concentration. We report a case of anaphylactic shock with bronchospasm and cardiovascular collapse immediately following administration of the prophylactic cefazedone after induction of general anesthesia for laparoscopic cholecystectomy.

Effects of preoperative oral carbohydrates on quality of recovery in laparoscopic cholecystectomy: a randomized, double blind, placebo-controlled trial

While carbohydrate loading is an important component of enhanced patient recovery after surgery, no study has evaluated the effects of preoperative carbohydrate loading after laparoscopic cholecystectomy (LC) on patient satisfaction and overall recovery. Thus, we aimed to investigate the impact of preoperative oral carbohydrates on scores from the quality of recovery 40-item (QoR-40) questionnaire after LC. A total of 153 adults who underwent LC were randomized into three groups. Group MN-NPO was fasted from midnight until surgery. Group No-NPO received 400 mL of a carbohydrate beverage on the evening before surgery, and a morning dose of 400 mL was ingested at least 2 h before surgery. Group Placebo received the same quantity of flavored water as for group No-NPO. The quality of recovery after general anesthesia was evaluated using QoR-40 questionnaire. Intraoperative hemodynamics were also evaluated. There were no significant differences among the groups in terms of the pre- and postoperative global QoR-40 scores (P = 0.257). Group MN-NPO had an elevated heart rate compared to patients who ingested a preoperative beverage (groups No-NPO and Placebo; P = 0.0412). The preoperative carbohydrate beverage did not improve quality of recovery using the QoR-40 questionnaire after general anesthesia for laparoscopic cholecystectomy compared to placebo or conventional fasting. However, the preoperative fasting group had a consistently increased heart rate during changes in body position that induced hypotension, which is likely a result of depletion of effective intravascular volume caused by traditional fasting over 8 h. Clinical trial.gov identifier: NCT02555020.

Effects of Preoperative Oral Carbohydrates on Quality of Recovery in Laparoscopic Cholecystectomy: A Randomized, Double Blind, Placebo-Controlled Trial.

While carbohydrate loading is an important component of enhanced patient recovery after surgery, no study has evaluated the effects of preoperative carbohydrate loading after laparoscopic cholecystectomy (LC) on patient satisfaction and overall recovery. Thus, we aimed to investigate the impact of preoperative oral carbohydrates on scores from the quality of recovery 40-item (QoR-40) questionnaire after LC. A total of 153 adults who underwent LC were randomized into three groups. Group MN-NPO was fasted from midnight until surgery. Group No-NPO received 400mL of a carbohydrate beverage on the evening before surgery, and a morning dose of 400mL was ingested at least 2h before surgery. Group Placebo received the same quantity of flavored water as for group No-NPO. The quality of recovery after general anesthesia was evaluated using QoR-40 questionnaire. Intraoperative hemodynamics were also evaluated. There were no significant differences among the groups in terms of the pre- and postoperative global QoR-40 scores (P = 0.257). Group MN-NPO had an elevated heart rate compared to patients who ingested a preoperative beverage (groups No-NPO and Placebo; P = 0.0412). The preoperative carbohydrate beverage did not improve quality of recovery using the QoR-40 questionnaire after general anesthesia for laparoscopic cholecystectomy compared to placebo or conventional fasting. However, the preoperative fasting group had a consistently increased heart rate during changes in body position that induced hypotension, which is likely a result of depletion of effective intravascular volume caused by traditional fasting over 8h. Clinical trial.gov identifier: NCT02555020.

A prospective observational study to compare the efficacy and safety of spinal Vs general anesthesia for laparoscopic cholecystectomy

A prospective observational study to compare the efficacy and safety of spinal Vs general anesthesia for laparoscopic cholecystectomy

A comparative study between combined spinal anesthesia with bilateral thoracic paravertebral block and general anesthesia in laparoscopic cholecystectomy

Background Paravertebral block is a common regional anesthetic technique such as intraoperative anesthesia and perioperative analgesia used in multiple surgical procedures. Many studies have demonstrated that laparoscopic cholecystectomy (LC) with the patient under spinal anesthesia (SA) was feasible and safe and was associated with stable hemodynamics and better postoperative pain control. Aim The aim is to compare the anesthetic effect of combined SA with bilateral thoracic paravertebral block and general anesthesia in LC. Patients and methods Sixty patients undergoing LC were randomized into two groups: group I receiving general anesthesia and group II receiving SA with bilateral thoracic paravertebral block at the level of T7 with a catheter on the right side, and then injecting 10 ml plain bupivacaine 0.5% on the left side through the epidural needle without catheter as a single shot. Patients were still in the sitting position, and then SA was performed using a 25 G spinal needle at L2–L3 intervertebral space. 2 ml=10 mg of hyperbaric bupivacaine hydrochloride (0.5%) was injected intrathecally. Results Intraoperatively, there was significant increase in stress response including mean arterial blood pressure and heart rate in group I than in group II at 30 min and at the end of operation. Significant decrease in intraoperative opioid requirement as fentanyl in group II than in group I was observed. The time of first analgesic requirement within 8 h in the postoperative period if the Visual Analogue Scale more than 3 was significantly increased in group II than in group I. As regards intraoperative end tidal CO2, oxygen saturation, operative time, nausea, vomiting, headache and patient satisfaction, there was insignificant difference between the two groups. Conclusion LC can be performed under SA and bilateral thoracic paravertebral block at low pressure pneumoperitoneum, providing hemodynamic stability and with no respiratory complications.

Transcranial Cerebral Oxymetric Monitoring Reduces Brain Hypoxia in Obese and Elderly Patients Undergoing General Anesthesia for Laparoscopic Cholecystectomy.

The aims of this prospective, observational study were to evaluate the changes of the regional cerebral saturation (rSO2) measured by near-infrared spectroscopy during elective laparoscopic cholecystectomy under total intravenous anesthesia and the association between patient's characteristics and critical decline of rSO2. Hemodynamics, rSO2, and oxygen saturation were recorded in different time points: before the anesthesia (Tbas), 2 minutes after the induction (supine position) (Tind), 2 minutes after CO2 insufflation (supine) (TCO2), 10 minutes after CO2 insufflation (reverse Trendelenburg) (TrevT), and 2 minutes after deflation (supine) (Tpost). Average age was 53±13 (range: 22 to 79 y). In 12 of a total of 62 patients (19.4%) the rSO2 decreased >20% (20.5% to 28.4%) in TCO2 or TrevT times. Significantly higher decrease of the rSO2 was found in patients older than 65 years and those with body mass index >30 kg/m (P<0.05). Noninvasive monitoring of cerebral oxygenation could be an important part of perioperative care in obese and older patients.

Sevoflurane preserves regional cerebral oxygen saturation better than propofol: Randomized controlled trial

Study objectiveTo investigate possible effects of volatile induction and maintenance anesthesia with sevoflurane (VIMA) and total intravenous anesthesia with propofol (TIVA) on regional cerebral oxygen saturation (rcSo2) during laparoscopic cholecystectomy. DesignRandomized, prospective and single-blinded study. SettingAcademic hospital. PatientsASA physical status of I and II surgical patients, scheduled for elective laparoscopic cholecystectomy from March 2013 to October 2014. MeasurementsChanges of regional cerebral oxygen saturation were measured by near-infrared spectroscopy on the left and right sides of forehead at different time points: before anesthesia induction (Tbas), immediately after induction (Tind), after applaying a pneumoperitoneum (TCo2), 10 minutes after positioning the patient into reverse Trendelenburg's position (TrtCo2), immediately after desufflation of gas (Tpost) and 30 (Trec30) and 60 (Trec60) minutes after emergence from anesthesia. Main resultsStudy population included 124 patients, 62 in each group. There was no significant difference between these groups according to demographic characteristics, surgery and anesthesia times as well as in the basal rcSo2 values. Statistically higher rSco2 values were noted in the VIMA group when compared to the TIVA group in all time points Tind, TCo2, TrtCo2, Tpost, Trec30 and Trec60 and incidence of critical rcSo2 decreases was statistically lower in VIMA group (P<.05). There were no serious perioperative complications. ConclusionsVIMA technique provides significantly (4%-11%) higher rcSO2 values during general anesthesia for laparoscopic cholecystectomy, when compared with TIVA and also provides significantly less number of critical rcSO2 decreases.

Randomized Comparison Of Tramadol, Nalbuphine And Fentanyl Used As Premedication In Attenuation Of Hemodynamic Response To Laryngoscopy And Postoperative Pain In Laparoscopic Cholecystecyomy

Background: Stress response to laryngoscopy during endotracheal intubation and pain after surgeries under General Anesthesia are one of the major concern and challenge for anesthetists. A number of methods have been used to modify the laryngoscopy and endotracheal intubation response, including different intubation devices, beta blockers, vasodilators and opioids. Opioids are good analgesics and have role in attenuation of stress response to laryngoscopy when used in premedication prior to laryngoscopy. Our aim of study is to compare the efficacy and safety of three opioids ie; Tramadol, Nalbuphine and Fentanyl as stress buster and analgesic when used in single dose as premedication in General Anaesthesia for Laparoscopic Cholecystectomy. Methods: One twenty patients of ASA grade I&II were randomly selected with forty patients in each group. Drug was given 10 min before starting the anaesthesia. Patients were assessed for change in hemodynamic parameter from baseline in Immediate post intubation (IPI), 1, 2 and 5min post intubation to note the stress response to laryngoscopy. Intra operative vitals were recorded for every 15min till end of surgery and in immediate and 5min post extubation period. VAS was recorded after awakening from anaesthesia. Any adverse reaction like nausea vomiting, respiratory depression and sedation were also recorded. Results: Nalbuphine and Fentanyl were found to be better drug compared to Tramadol for attenuation of hemodynamic response to Laryngoscopy (p<0.0001). No significant difference in hemodynamics was found intraoperatively in all the three drugs. Nalbuphine and Tramadol were having good analgesia in immediate post operative period. Mild respiratory depression and sedation was reported with Nalbuphine. Nausea vomiting was significantly high with Tramadol (p<0.001). Conclusion: Nalbuphine is one of the better choices for relieving stress to laryngoscopy and intubation, maintaining good hemodynamics intraoperatively and providing pain relief in immediate postoperative period.