Intraoperative Hemodynamic Stability Research Articles

Effectiveness of Ultrasound-Guided Retrolaminar Block and Erector Spinae Plane Block in Retroperitoneal Laparoscopic Surgery: A Randomized Controlled Trial.

PurposeRetrolaminar block (RLB) and erector spine plane block (ESPB) share a similar block site, but their analgesia principle may differ. This study compared the postoperative analgesic effects of ultrasound-guided RLB and ESPB for retroperitoneal laparoscopic surgery.Patients and MethodsThe study included patients who scheduled for laparoscopic nephrectomy from July 2020 to January 2021. Patients in RLB group received a three-point block at the posterior surface of T8-T10 lamina, and those in ESPB group received at the T9 level. The primary result was the score of visual analogue scale (VAS). Secondary results included information on intraoperative and postoperative analgesia consumption and rescue analgesia usage, skin temperature, serum interleukin (IL)-1β, prostaglandin E2 (PGE2) level and the occurrence of safety events.ResultsThere was no significant difference between the two groups in the postoperative VAS scores at both the rest and cough state (All P>0.05). The skin surface temperature of the affected side and the healthy side in ESPB group was higher than that in the RLB group at the end of the surgery (P=0.002) and after surgery (P=0.016). The RLB group had a higher ephedrine usage than the ESPB group (P=0.027). Compared with the ESPB group, the RLB group had a shorter time to exhaust (P=0.045) and lower serum IL-1β level (P=0.049). Patients in neither group developed severe adverse event.ConclusionUltrasound-guided RLB and ESPB can provide safe and effective postoperative analgesia for retroperitoneal laparoscopic surgery. ESPB has more stable intraoperative hemodynamics, while RLB has more potential research value for patients’ rapid recovery.

A Comparison of Two Peripheral Nerve Blocks Combined With General Anesthesia in Elderly Patients Undergoing Arthroplasty for Hip Fractures: A Pilot Randomized Controlled Trial.

BackgroundCombined anesthesia can be a promising option for hip surgery when neuraxial anesthesia is contraindicated. Lumbar and sacral plexus blocks, and femoral nerve and lateral femoral cutaneous (LFC) nerve blocks in combination with general anesthesia (GA) are commonly used in elderly patients undergoing arthroplasty for hip fracture surgery. However, no study has compared these two anesthetic strategies in the perioperative period.MethodsA total of 41 elderly patients scheduled for arthroplasty for hip fracture surgery were randomized into group A (n = 20) and group B (n = 21). Group A received femoral nerve block, LFC nerve blocks, and GA, and group B received lumbar plexus block, sacral plexus block, and GA. Primary outcomes were incidences of hemodynamic events and changes in blood pressure (BP) and heart rate (HR). Secondary outcomes included time and drug consumption, infusion and bleeding volume, eyes opening time after surgery, and postoperative quality recovery rate.ResultsCompared with group B, group A showed a lower incidence of intraoperative hypotension (p < 0.001), higher BP [including mean arterial pressure (MAP), systolic BP (SBP), and diastolic BP (DBP)] following induction (IN), and higher HR from mid-surgery. Time required for nerve blockade (p < 0.001) and ephedrine consumption was significantly shorter in group A (p < 0.001), while sufentanil consumption was higher as compared to group B (p = 0.002). No significant differences in other intraoperative parameters and postoperative quality recovery rate were reported during the observation.ConclusionOur pilot data indicate that compared with lumbar and sacral plexus blocks, femoral nerve and LFC nerve blocks may provide more stable intraoperative hemodynamics and a comparable postoperative recovery for elderly patients undergoing arthroplasty for hip fracture under GA. Further studies with a larger sample size are needed to derive stronger evidence.

Comparative study between the characteristics of unilateral spinal and paravertebral neuraxial blockade in patients undergoing inguinal herniorrhaphy

Background: A Comparative study between the characteristics of unilateral and paravertebral neuraxial blockade in patients undergoing inguinal herniorraphy.Materials and Methods: This is a prospective, randomised study conducted on 120 patients of either sex, aged 18-60 years, ASA grade I and II scheduled for elective unilateral herniorraphy using unilateral spinal anaesthesia or paravertebral neuraxial blockade.Results: Spinal anaesthesia group had shown significantly lesser requirement of postop analgesia, good quality of recovery and attainment of early ambulation and cost significantly less compare to TIVA group. All the results were significant statistically and have correlated well with the studies in reference.Conclusion: We concluded that the paravertebral block can be the choice of anaesthesia as a far superior and safe anaesthesia option to unilateral spinal anaesthesia for open unilateral inguinal hernia repair, as it yields unilateral and segmental anaesthesia, extended postoperative analgesia and decreased rescue analgesia demand postoperatively. Paravertebral block also helps in early ambulation, early readiness for discharge from hospital (bypass PACU), stable intra-operative hemodynamics, and minimal adverse effects.

Effect of Entropy Index-Targeted Dextromeetomidine on Postoperative Neurocognitive Function in Elderly Patients with Gastrointestinal Tumors

Objective: To investigate the effect of entropy index targeted monitoring combined with dexmedetomidine infusion on cognitive function after thoracic and abdominal surgery in elderly patients. Methods: 60 elderly patients undergoing abdominal surgery in our hospital on October ~2017 and October 2019 were selected, ASAⅡ~ grade III, and the random digital table method was divided into 3 groups ,20 cases in each group. entropy index monitoring combined with dexmedetomidine group (D1 group), entropy index monitoring combined with dexmedetomidine group (D2 group) and dexmedetomidine monitoring combined with saline group (D0 group). All patients were subjected to sequential rapid induction of endotracheal intubation general anesthesia. D1, D2, the group was injected with 0.5μg/kg dexmedetomidine hydrochloride intravenously in the first 15 min of induction, followed by a 0.3μg•kg-1•h-1, 0.6μg•kg-1•h-1 maintenance pump until 30 minutes before the end of operation, respectively. The D0 group was injected with the same amount of saline intravenously before induction, and then maintained with the same amount of saline. D1 and D2 groups were calibrated at 40~60. preoperative (T1), tracheal intubation immediate (T2),30 min after operation (T3) and extubation immediate (T4) M after operation were compared in 3 groups AP (mmhg), hr (sub/ min), blood oxygen saturation (SpO2) and intraoperative anesthetic dosage, vasoactive drug use, and postoperative recovery status; simple intelligent mental state examination scale (MMSE) test was completed 1 day before ,1 day after ,3 days after and 7 days after operation to record the incidence of perioperative neurocognitive disorders (PND). To detect the necrosis factor-α(TNF-α) and C-reactive protein (CRP) of the above-mentioned concurrent serum tumors; Results Compared with D0 group, the MAP of D1 group and D2 group decreased significantly and the HR slowed down significantly (P&lt;0.05), The MAP, HR of T3, T4 in D2 group was significantly decreased compared with that in the D1 group (P&lt;0.05), but the difference was not significant at all time points (0.05);The respiratory recovery time (min), dialling time (min) and restoring directional force time (min) were significantly shortened compared with the D0 group and the D2 group, and the consumption of propofol and sufentanil during the operation was significantly decreased. Compared with the D2 group, the use of vasoactive drugs in the D1 group was significantly decreased (P&lt;0.05). The TNF-α, CRP of patients in the first day and the third day were higher than those in the first day of operation, but the TNF-α, CRP of D1 group and D2 group were lower than those in the D0 group (0.05). The MMSE scores of l days and 3 days after operation in D1 and D2 groups were higher than those in D0 groups. Significantly decreased (P&lt;0.05), and there was no significant difference between the groups 7 days after operation (P&gt;0.05): Conclusion entropy index targeted monitoring combined with dexmedetomidine infusion (0.3μg/kg/h) in the elderly patients during surgery can improve the intraoperative and postoperative hemodynamic stability, can improve the perioperative neurocognitive disorders of patients, worthy of clinical promotion.

Evaluation of the effect of preoperative anxiety on intraoperative hemodynamic stability and drug consumption in patients who underwent BIS-guided total intravenous anesthesia (TIVA) for neurophysiological monitoring in spine surgery

In our study, the aim was to evaluate the effects of preoperative anxiety measured by Spielberger’s State-Trait Anxiety Inventory-State (STAI-S) and State-Trait Inventory-Trait (STAI-T) scores on intraoperative hemodynamic stability, drug consumption and recovery in patients who underwent spinal surgery with neurophysiological monitoring and total intravenous anesthesia with bispectral index (BIS) monitoring, without the use of muscle relaxants. Eighty patients with planned spinal surgery and neurophysiological monitoring were included in this prospective observational study. Anxiety scores were recorded by applying Spielberger’s STAI-T and STAI-S scoring questionnaires to all patients included in the study 1 hour before the operation. Age, gender and American Society of Anesthesiologists (ASA) scores of the patients who were taken to the operating table without premedication were recorded. Before anesthesia induction, standard monitoring including electrocardiography (ECG), noninvasive blood pressure, peripheral oxygen saturation (SpO2), BIS was applied. The correlation between STAI-T and STAI-S scores with demographic characteristics of patients, preoperative, post-induction, 5th minute, 10th minute, 30th minute, 50th minute, 70th minute, 90th minute heart rate (HR), mean arterial pressure (MAP), SpO2, operation time, recovery time, and total amount of propofol and remifentanil used during the operation were evaluated statistically. A significant negative correlation was observed between STAI-S anxiety scoring and age (p &lt; 0.05). A significant positive correlation was found between the total amount of remifentanil and propofol used with the STAI-S score (p &lt; 0.05). Significant positive correlations were observed between the STAI-S score and the HR value preoperatively, and in the 5th, 30th, 50th, 70th, and 90th minutes (p &lt; 0.05). Our study showed that preoperative anxiety increases intraoperative drug consumption and heart rate. It is of great importance to keep the amount of intraoperative medication at optimal levels, to measure preoperative anxiety, and to eliminate it with multimodal treatments, especially for the accurate detection of neurological damage in patients with neurophysiological monitoring.

Ultrasound navigation during retrobulbar blockade in children with retinoblastoma and enucleation of the eyeball

BACKGROUND: The retrobulbar block in children is used to enucleate analgesia in the intra- and postoperative period and prevent oculocardiac reflex (OCD), postoperative nausea, and vomiting. However, when the block is performed blindly, it results in serious complications.&#x0D; AIM: This study aimed to evaluate the efficacy and safety of a retrobulbar block performed under ultrasound guidance compared with a retrobulbar block performed blindly during enucleation of the eyeball in children with retinoblastoma.&#x0D; MATERIALS AND METHODS: A prospective randomized controlled trial was performed. The study included 40 patients who met the inclusion criteria. The patients were divided into two groups: 20 patients who underwent ultrasound-guided retrobulbar blockade (RBВ + ultrasound) and 20 patients who underwent blindly retrobulbar blockade (RBВ).&#x0D; RESULTS: There was an insignificant decrease in intraoperative opioid requirements in the RBB + ultrasound group, where the average dose of fentanyl was 41.4 g/kg, and in the RBB group, 4.70.8 g/kg (p 0.05).&#x0D; The time before the administration of the first dose of analgesic in the postoperative period was 4.70.8 h in the RBB group and 11.73.3 h in the RBB + ultrasound group (p 0.05). VAS and CHIPPS scores obtained 6 h after the end of surgery in the RBB + ultrasound and RBB groups were 1.8 (1.2; 2) and 2.5 (3.8; 4.5) points (p 0.05), respectively.&#x0D; CONCLUSION: There was no statistically significant difference between the time of the retrobulbar blockade under ultrasound guidance and the retrobulbar regional block performed blindly. Retrobulbar blockade performed under ultrasound guidance provides a decrease in intraoperative opioid requirements, stable intraoperative hemodynamics, and longer postoperative analgesia.

Effects of Fentanyl and Remifentanil on intraoperative hemodynamics and postoperative recovery in percutaneous nephrolithotomy cases

Objective: To compare the effects of fentanyl or remifentanil on intraoperative hemodynamic effects and postoperative recovery in patients undergoing percutaneous nephrolithotomy (PCNL).Material and Methods: Randomized and prospective study was conducted. Forty patients who underwent PCNL with the American Society of Anaesthesiologists (ASA) I-II enrolled into the study. All patients were divided into 2 groups according to administered anaesthesiology technique and drugs, which are remifentanil and fentanyl. Induction of anesthesia was same in both groups. Induction of anesthesia was obtained with a bolus dose of propofol (1-2 mg/kg), maintenance was achieved with sevoflurane (MAC2). Muscle relaxation was achieved with rocuronium. Group 1 was consisted of patients who were administered remifentanil and they received 1 μgr/kg of remifentanil as a single dose during the induction of anaesthesia Group 2 was received fentanyl 2 μg/kg as a single dose during the induction of anaesthesia. Group 1 received remifentanil 0.05 μgr/kg per minute as an infusion throughout the procedure for providing intraoperative hemodynamic stability, in group 2 fentanyl was given at a dose of 0.5 μg/kg iv bolus every 45 minutes. Intraoperative hemodynamic parameters and recovery data were recorded. Aldrete score, Ramsay sedation scale 15, 60, 360 minutes were noted after surgery. Visual analogue scale (VAS0-10) was used for pain evaluation.Results: Intraoperative hemodynamic measurements were more stable in Group 1. The need for nitro-glycerine was significantly increased in Group 2 (p&amp;lt;0.05). The Aldrete scores, Ramsay sedation scales and VAS did not differ significantly between the groups. Immediate recovery was significiantly earlier in Group 1 than Group 2 (p&amp;lt;0.05).Conclusion: Stable hemodynamic status and safer recovery can be provided with remifentanil compared to fentanyl during PCNL.

Effect of Dexmedetomidine on Hemodynamics in Thoracic Surgery - A Randomized Controlled Study

Background: Thoracotomy is associated with various hemodynamics consequences that are influenced by the position of the patient’s body on the operation Table and metabolic functions of lungs. Dexmedetomidine is an alpha-2 agonist sedative-analgesic that inhibits endogenous norepinephrine release and has been used in various studies to maintain intraoperative hemodynamic stability. Aim: To evaluate the effect of Dexmedetomidine infusion on hemodynamics during thoracic surgery. Methods: The selected patients were randomly allocated to the two groups (39 patients in each group) using a computer-generated random number table. Group D patients received initial bolus of Dexmedetomidine 1 μgm/kg in 100 ml normal saline over 15 min before induction followed by intravenous infusion of dexmedetomidine @ 0.5 μgm/kg/hr intraoperatively. Group P received initial 100 ml normal saline over 15 min given prior to induction followed by infusion of Propofol @ 200 μgm/kg/min intraoperatively. Statistics: All analysis was performed on SPSS (Windows version 16). Results: In this study, it was observed that use of dexmedetomidine result in less rise in MAP and heart rate at the time of intubation as well as at the time of extubation in comparison to propofol (p&lt;0.05). Episodes of bradycardia was more in D Group as 12.8% patients required atropine for bradycardia compared to only 2.5% in group P. As well as more patients in Group D received mephentermine for hypotension. The intraoperative requirement of fentanyl was also more in group P. Conclusion: Initial bolus of Dexmedetomidine 1 μg/kg 15 min before induction followed by intravenous infusion of Dexmedetomidine @ 0.5 μg/kg/hr decreases the stress response during DLT intubation and extubation but more patients in dexmedetomidine group required atropine or mephentermine for bradycardia and hypotension.

The effect of splash block on the need for analgesia in dogs subjected to video-assisted ovariectomy.

ObjectivesThe present study aimed to demonstrate the efficacy of splash block using lidocaine to provide additional analgesia during ovariectomy in bitches. To identify an acute intraoperative nociceptive response, three clinical parameters were used: increased blood pressure, heart rate and respiratory rate.Material and MethodsForty healthy bitches were randomly assigned to receive 2% lidocaine (L group) topical application (splash block) on both ovaries (2 mg/kg each), or an equal volume of NaCl 0.9% at the same sites (C group). A fentanyl bolus (2 µg/kg) was administered intraoperatively in response to an increase in blood pressure, heart rate or respiratory rate during surgery (> 30% compared with the pre‐incisional values).ResultsLocal lidocaine administration significantly reduced the need for supplementary fentanyl. Dogs in the L group showed greater intraoperative hemodynamic stability and lower surgical pain than those in the C group. In addition to the routine anaesthetic protocol, the local anaesthesia used in the present study was safe and caused no cardiopulmonary suppression. In addition, it significantly reduced the need for mandatory systemic or rescue analgesia.Clinical SignificanceOvariectomy is a common surgical procedure in bitches. Analgesia during this procedure is important because intraoperative pain can cause negative effects that prevent patient recovery. This study aimed to demonstrate the analgesic efficacy of lidocaine splash block in video‐assisted ovariectomy in dogs. The results showed that splash block improved surgical analgesia during canine laparoscopic ovariectomy. Considering its relative simplicity, low cost, and safety, splash block could be used in daily clinical practice.

Comparative evaluation of haemodynamic parameters intra operatively during desflurane or sevoflurane anaesthesia

Background and Aim: Sevoflurane and Desflurane are the inhalation anaesthetic agents are the most frequently used drugs for giving general anaesthesia to the patients. The purpose of this study was to evaluate desflurane and compare it with sevoflurane in terms of intraoperative haemodynamic stability and any other side effects noted in elective laparoscopic surgeries. Methods: A prospective randomized controlled study was conducted over 60 ASA I-III patients posted for laparoscopic surgeries. Basal HR, SBP, DBP, Oxygen saturation were noted. Patients were pre-medicated and induced and were maintained on inhalation agents according to the group allocated. Haemodynamic parameters were recorded at 1, 5, 10 minutes after intubation and then every 15 minutes throughout the operative period. After extubation, patients were monitored and treated for complications such as hypo/ hypertension, tachy/bradycardia. Incidence of cough, nausea, vomiting, sore throat, laryngospasm, blood on device, lip and dental trauma were noted. Haemodynamic parameters and side effects were compared amongst both groups. Results: We observed no statistically significant difference in heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure between the groups at any time interval (p>0.05). All the patients were observed for side effects and adverse effects during perioperative period. None of the patients in either group had side effects like hypotension, bradycardia, nausea, vomiting, arrhythmias, shivering, cough, sore throat. Conclusion: Desflurane and sevoflurane when compared as a maintainance agent during laparoscopic surgery were comparable with respect to intraoperative haemodynamics parameters and perioperative complications.

Effect of intrathecal buprenorphine on the haemodynamic response in patients undergoing laparoscopic appendicectomy under general anaesthesia

: Combined regional and general anaesthesia for laparoscopic appendicectomy offers better intraoperative haemodynamic stability. Buprenorphine is a long acting opioid which can be administered intrathecally and provides excellent analgesia intraoperatively and post operatively while allowing early ambulation without prolonged motor block. The study aimed to compare the haemodynamic response during laparoscopic appendicectomy using combined general anaesthesia with intrathecal buprenorphine and general anaesthesia alone. In this observational study 80 patients who underwent laparoscopic appendicectomy were divided into two groups of 40 each by random sampling. The patients in the GA group received general anaesthesia whereas patients in the GA+SAB group received intrathecal buprenorphine along with general anaesthesia. The heart rate, systolic and diastolic blood pressures and SpOwere noted after induction of general anaesthesia, immediately after endotracheal intubation, after creating pneumoperitonium and post extubation. Student’s t test was used for comparing the haemodynamic variables There were no statistically significant differences between GA and GA+SAB group in the heart rate, systolic and diastolic blood pressure after pneumoperitonium was created. When compared to general anaesthesia alone, addition of intrathecal burenorphine provides little advantage in preventing stress response during laparoscopic appendicectomy.

Anesthesia Clinical Outcome and Management in Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy: A Retrospective Analysis

Background: Anesthetic technique and outcome of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is not well established. Objective: To evaluate the anesthetic management of CRS with HIPEC and to analyze whether supplement epidural anesthesia will provide any benefit on the outcomes. Materials and Methods: All patients that underwent CRS with HIPEC between January 2008 and December 2017 at King Chulalongkorn Memorial Hospital were retrospective reviewed. Patients were divided into two groups, 1) received a combination of epidural and general anesthesia (EGA), and 2) received general anesthesia (GA) to compare intraoperative hemodynamic stability, postoperative pain control, time to tracheal extubation, and postoperative complications between groups. Results: Twenty patients had EGA, and 14 patients had GA. EGA group had significant more incidences of intraoperative hypotension at 70% versus 21.4%, which required more use of vasopressor at 65% versus 21.4% (p&lt;0.05). There was no statistical difference between groups in total blood loss, time to extubation, and ICU length of stay. There were no significant differences in the pain score at 12 and 24 hours postoperative. Epidural complications were not detected. There was no mortality within 30 days. Conclusion: Adding epidural analgesia to GA in CRS with HIPEC increased the incidence of hypotension and did not reduce the pain or duration of extubation. Keywords: Anesthesia; Epidural; HIPEC; Outcome

A Comparative Study of Ropivacaine and Ropivacaine with Dexmedetomidine during Interscalene Brachial Plexus Block in Upper Arm Surgeries

Pain is a complex multidimensional human perception. It is divine to allay pain, Says Galen. In treatise on gout and rheumatism English physician Thomas Sydenham in 17th century wrote-“Among the remedies, which it has pleased Almighty God to give man to relieve his suffering none is so universal and as efficacious as opium.” Specifically, we tested the hypothesis that adding dexmedetomidine significantly prolongs the duration of analgesia. Another objective of the study was to assess the extent to which the duration of analgesia and Anaesthesia is prolonged with the addition of Dexmedetomidine. Ropivacaine 0.50% used in brachial plexus block is well tolerated and provides effective surgical Anaesthesia as well as relief of postoperative pain. Dexmedetomidine as an adjuvant to ropivacaine enhances the quality of ISB block by faster onset of sensory and motor block. Dexmedetomidie increases the duration of both sensory and motor blockade. Duration of analgesia was significantly increased by dexmedetomidine when added to ropivacaine in brachial plexus block. Though statistically insignificant, addition of dexmedetomidine results in more intraoperative hemodynamic stability. Both dexmedetomidine and ropivacaine do not cause any major side effects in anaesthesia techniques. Thus, this study shows that dexmedetomidine 150 μg added to ropivacaine 0.50% in an appropriate technique has low side effect profile with considerable therapeutic benefit and enhances the quality of ISB block.

General versus general anaesthesia combined with caudal block in laparoscopic-assisted Soave pull-through of Hirschsprung disease: a retrospective study

BackgroundCaudal block is one of the most preferred regional anesthesia for sub-umbilical region surgeries in the pediatric population. However, few studies are available on caudal block performed in laparoscopic-assisted Soave pull-through of Hirschsprung disease (HD). We aimed to compare general anesthesia (GA) and general anesthesia combined with caudal block (GA + CA) in laparoscopic-assisted Soave pull-through of HD.MethodsA retrospective review was performed in children with HD operated in our hospital between 2017 and 2020. Patients were divided into the GA and GA + CA group. The primary outcome was the duration of operation, and secondary outcomes included intraoperative hemodynamic changes, the Face, Legs, Activity, Cry, Consolability (FLACC) scale, dose of anesthetics, and incidence of side effects.ResultsA total of 47 children with HD were included in the study, including 20 in the GA group and 27 in the GA + CA Group. The two groups were similar in age, gender, weight and type of HD (P > 0.05). The GA + CA group had significantly shorter duration of operation (especially the transanal operation time) (median 1.20 h vs. 0.83 h, P < 0.01) and recovery time (mean 18.05 min vs. 11.89 min, P < 0.01). The mean doses of sufentanil and rocuronium bromide during the procedure and FLACC scores at 1 h and 6 h after surgery were also lower in the GA + CA group (p < 0.01). The hemodynamic changes in the GA + CA group were more stable at time of t2 (during transanal operation) and t3 (10 min after transanal operation), but there was no significant difference in the incidence of postoperative side effects between the two groups (P = 1.000).ConclusionGeneral anesthesia combined with caudal block can shorten the duration of operation, and provide more stable intraoperative hemodynamics and better postoperative analgesia.

A Comparison of Success Rate in Off-Pump Coronary Artery Bypass Grafting Surgery among Patients with Varying Preoperative Left Ventricular Ejection Fractions: Retrospective Observational Study

Background: Off-pump coronary artery bypass grafting (OPCAB) is an alternative to coronary artery revascularization and avoids the complications of cardiopulmonary bypass (CPB). The procedure’s success, however, depends on intraoperative hemodynamic stability. Preoperative cardiac function can predict the tolerance to compromised hemodynamics during cardiac surgery. Inability to manage hypotension and low cardiac output while manipulating the heart is the most frequent cause of intraoperative conversion to CPB. Objective: The authors investigated the effects of the preoperative left ventricular ejection fraction (LVEF) on the success of OPCAB surgery and the relation of intraoperative factors to the success of OPCAB surgery. Material and Methods: Medical records of 284 patients who underwent OPCAB surgery in Ramathibodi Hospital between January 2015 and December 2017 were retrospectively reviewed. Preoperatively, the patients were classified into groups 1 to 4 based on LVEFs of 50% to 70%, 40% to 49%, 30% to 39%, and &lt;30%, respectively. Preoperative characteristics were collected. Intraoperative success of OPCAB surgery, application of inotropes, vasopressor, fluid, and intra-aortic balloon pump (IABP), and post-operative outcomes were analyzed and compared among the four LVEF groups. Results: No significant differences in success of OPCAB surgery emerged among the four groups (p=0.430). Intraoperative requirements of IABP were significantly higher for LVEF &lt;30% patients (p=0.001). In addition, the time to extubation was significantly delayed (p=0.001) and the LVEF &lt;30% patients stayed longer in intensive care unit (ICU) (p=0.002) when compared with the good LVEF patients. There were no significant differences in the operative time, amount of intravenous fluid, blood transfusion requirement, or blood loss among the groups. There were no significant differences in major postoperative morbidities. Conclusion: OPCAB surgery can be performed successfully in patients with severe cardiac dysfunction (LVEF &lt;30%) without significant differences from LVEF ≥30% patients, although the need for an intraoperative IABP device and inotropic drugs for hemodynamic support were greater and the extubation times and ICU stays were longer. Keywords: Coronary artery bypass graft; Left ventricular ejection fraction; Off-pump CABG; OPCAB; Poor cardiac function

Efficacy of Carotid Artery Stenting Performed under General Anesthesia with Somatosensory Evoked Potential Monitoring

ObjectivesDuring carotid artery stenting (CAS), hemodynamics may be affected by the carotid sinus reflex in some cases. Although general anesthesia has been reported to stabilize intraoperative hemodynamics, the patient's neurological condition must be assessed indirectly. Therefore, we investigated the changes in intraoperative hemodynamics and perioperative complications of CAS under general anesthesia and evaluated the efficacy of somatosensory evoked potential (SEP) monitoring in detecting a reduction in perfusion during CAS. Materials and methodsFrom April 2011 to August 2016,57 consecutive patients who underwent CAS under general anesthesia were evaluated. The follow-up period ranged from 3 to 8 years. During CAS, anesthesiologists monitored and managed the hemodynamics. SEP monitoring was performed during the CAS procedure in all patients. ResultsIntraoperative hypotension (systolic blood pressure ≤ 100 mmHg) was evident in 16 patients (28.1%), and 13 patients (22.8%) experienced intraoperative bradycardia; however, all of these cases were promptly managed under general anesthesia. None of the patients showed systolic blood pressure < 50 mmHg from baseline. Regarding perioperative complications, none of the patients exhibited myocardial infarction or postoperative hyperperfusion symptoms, and there was no mortality. Among 21 patients (36.8%) with a decrease in the intraoperative SEP, 3 (5.3%) exhibited transient ischemic symptoms and 1 (1.8%) had postoperative infarction. ConclusionsCAS under general anesthesia is a safe and effective management option in terms of intraoperative hemodynamic stability. In addition, our findings indicate that SEP monitoring could be helpful in evaluating transient postoperative cerebral ischemia or cerebral infarction after CAS.

Effectiveness of intravenous dexmedetomidine compared to intercostal nerve blocks in patients undergoing simple mastectomy with axillary dissection under general anaesthesia.

Background: General anaesthesia is used for breast cancer surgery. The downside of generalanaesthesia includes inadequate pain control and a high incidence of nausea and vomiting. Generalanaesthesia with intravenous dexmedetomidine or intercostal nerve block reduce the incidence ofpostoperative pain. Objective: To evaluate the effectiveness of intravenous dexmedetomidine compared to intercostal nerveblocks in patients undergoing simple mastectomy with axillary dissection under general anaesthesia.Methods:It was a single-blinded prospective randomized comparative study. This study was conductedat the Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh MujibMedical University (BSMMU), Dhaka from March 2018 to March 2019. A total of 60 patients sufferingfrom breast cancer admitted in the Department of General Surgery of BSMMU Dhaka and scheduledfor simple mastectomy with axillary dissection, were enrolled in this study. Results: Age ,height andweight were almost identical between two groups. Duration of anaesthesia and surgery were almostsimilar between two groups. The mean heart rate, systolic blood pressure, diastolic blood pressure ,mean arterial pressure did not significantly fluctuate in subsequent baseline follow up and 15 minuteand at 160 minutes parameters were almost similar within two groups.Mean time to achieve adequateAldrete recovery score after extubation was almost similar between two groups. Postoperative sedationlevel was also similar between two groups. Majorty of the surgeon were satisfied about anaesthesiatechnique in both group A and group B. Mean time of rescue analgesic requirement in postoperativeperiod was satistically significant (p&lt;0.05) between two group but it was clinically less significant(groupA= 112 minutes and groupB=141minutes. Conclusion: Intravenous dexmedetomidine may be an alternative to intercostal nerve blocks inpatients undergoing simple mastectomy with axillary dissection under general anaesthesia as itprovided stable intraoperative haemodynamics, reduced blood loss and analgesic requirement, smoothrecovery, postoperative sedation level and surgeon satisfaction as well as intercostal nerve blocks. JBSA 2021; 34 (2) : 24-35

Ретробульбарная блокада при энуклеации глазного яблока у детей с ретинобластомой

Introduction. Retinoblastoma (RB) is a malignant tumor of the embryonic nerve retina. Purpose. To determine the effectiveness of retrobulbar blockade (RbB) with ropivacaine 0.5% for intra- and postoperative analgesia, as well as for the prevention of oculocardial reflex (OCR), postoperative nausea and vomiting (PONV) during enucleation. Material and methods. A prospective, randomized, controlled clinical trial was performed. Eighty patients aged 0 to 10 years were included, who were randomly assigned to the RbB group (retrobulbar blockade with ropivacaine 0.5% with general anesthesia) N = 40 and the GA control group (general anesthesia) N = 40. Results. There were no complications in the RbB group caused by the methodology. In the intraoperative period, the average dose of fentanyl in the RbB group was 4.7 ± 0.7 μg / kg, which is significantly lower than in the OA group of 10.1 ± 1.9 μg / kg (P &lt;0.05). OCR in the RbB group was observed in 5% of cases versus 100% in the GA group (P = 0.002). The average VAS score was 1.8 vs. 3.7 60 minutes after surgery (P &lt;0.001). For the first time 12 hours after surgery, PONV was not observed in the RBB group, and in the control group it was observed in 45% of patients. Conclusions. The study revealed that intraoperative retrobulbar blockade with 0.5% ropivacaine solution in children with RB is effective and safe. Provides stable intraoperative hemodynamics and reduces the need for opioids. Promotes the prevention of OCD and PONV, as well as the improvement of postoperative analgesia during the operation of enucleation of the eyeball in pediatric. Key words: ropivacaine, retrobulbar block, oculocardial reflex, pain, retinoblastoma, enucleation, pediatric patients.

Comparision of dexmedetomidine and fentanyl as adjuvants to 0.5% hyperbaric bupivacaine in spinal anesthesia in elective lower abdominal surgeries

Spinal anesthesia has become most commonly used and choice of anaesthesia for surgeries on lower half of body after first planned spinal anaesthesia for surgery in man was administered by August Bier (1861–1949) on 16 August 1898, in Kiel(1), Germany. Coadministration of adjuvant drugs improve the quality and duration of anesthesia and analgesia and patient safety. To compare effects of Dexmedetomidine and Fentanyl as adjuvants to 3ml of 0.5% heavy bupivacaine injected intrathecally, in lower abdominal surgeries. Prospective randomized comparative study. The study was approved by ethics committee and was conducted in 100 randomly selected patients posted for elective lower abdominal surgeries in the age group 18-60yrs belonging to both sex. Patients were divided into two groups- Group D (n=50) - received 5μg Dexmedetomidine+3ml 0.5% heavy bupivacaine, Group F(n=50)-received 25μg Fentanyl +3ml 0.5% heavy bupivacaine, intrathecally respectively.In groupD patients onset of sensory block was significantly faster 2.62±0.56 mins (p&amp;#60;0.001) with better haemodynamic stability, intraoperative sedation, less incidence of side effects and analgesic sparing effect in post operative period when compared to group F.αadrenergic agonist dexmedetomidine is a valuable adjunct to spinal anaesthesia it augments quality of spinal anaesthesia provides intraoperative sedation and hemodynamic stability.

The combinatorial use of propofol-fentanyl-ketamine for sedoanalgesia in patients undergoing urological procedures.

Objectives:To compare sedoanalgesia achieved using propofol-fentanyl-ketamine (PFK) combination with general anesthesia (GA) in terms of safety, hemodynamic stability, and perioperative complications.Methods:Patients in the GA group were anesthetized using fentanyl (2 μg kg-1) and propofol (2 mg kg-1). The PFK group was anesthetized using a mixture of which each one ml contains 0.005 mg of fentanyl, 5 mg of propofol, 5 mg of ketamine, and 2 mg of lidocaine. Patients received an initial dose of 0.05 ml kg-1, followed by 0.05 mg kg-1 60 seconds later. Maintenance boluses of 0.025 ml kg-1 were administered every 3-5 minutes. Respiration occurred spontaneously through a simple face mask with 3 L min-1 O2.Results:The GA group had 37 (37%) patients develop hypotensive episodes, compared to one (1%) episode in the PFK group (p<0.001). Five (5%) patients in the PFK group had an episode of transient O2 desaturation, compared to one (1%) patient in the GA group (p=0.212). The duration of induction and termination of anesthesia were significantly shorter in the PFK group (p<0.001).Conclusion:The PFK combination herein described is safe, effective, and provides intraoperative hemodynamic stability in patients with multiple comorbidities undergoing urological procedures.