Intraoperative Hemodynamic Parameters Research Articles

The Effect of Single-Dose Preemptive Intravenous Ibuprofen on the Intraoperative Hemodynamic Parameters, Recovery Characteristics, and Acute Pain after Laparoscopic Cholecystectomy: A Randomized Double-Blind, Placebo-Controlled Clinical Trial

The aim of this study was to investigate the effects of the preemptive administration of a single dose of intravenous (IV) ibuprofen on the intraoperative hemodynamic parameters, recovery characteristics, and postoperative pain management in patients undergoing laparoscopic cholecystectomy. The time to first analgesic requirement during postoperative period was the main goal of this study.

Effect of Off-pump Coronary Artery Bypass Grafting on the Intraoperative Hemodynamics

Abstract: Background: The hemodynamic instability during off-pump coronary bypass grafting (CABG) may impair the complete coronary revascularization. We evaluated the effect of off-pump CABG on intraoperative hemodynamic parameters. Methods: We included 40 patients who underwent off-pump CABG from 2017 to 2019. The mean age was 55.75± 6.73 years, and 28 patients were males (70%). The mean ejection fraction was 60.08 ± 3.81%. Study endpoints were the intraoperative hemodynamic parameters and postoperative complications. Results: Heart rate was significantly higher during the grafting of the posterior descending artery (PDA) (79.3± 2.8 beats/min) and right coronary artery (79.5 ± 1.8 beats/min) compared to all other grafts (p < 0.001). The highest central venous pressure (12.6± 1.2 mmHg) and mean pulmonary artery pressure (33.2± 1.4 mmHg) and the lowest mean arterial and pressure (68.1± 3.3 mmHg) were recorded during PDA grafting (p < 0.001, for all parameters). There was no significant difference in adrenaline dose infused during the anastomosis of all grafts (p= 0.2). Ejection fraction significantly decreased predischarge (52.18 ± 2.58 %) and at 6 months (52.83 ± 3.57%) compared to the preoperative value (p < 0.001). Conclusion: Off-pump CABG was associated with significant hemodynamic instability, which was more evident during the posterior descending artery grafting. Proper anesthetic management and fluid infusion are required, especially during the anastomosis of the right and posterior coronary systems.

Perioperative factors associated with postoperative morbidity after emergency laparotomy: a retrospective analysis in a university teaching hospital

Emergency Laparotomy (EL) is associated with significant morbidity and mortality. Variation in practice and patient outcomes for patients undergoing emergency laparotomy has been identified through the UK National Emergency Laparotomy Audit (NELA), with 30-day mortality ranging from 11 to 15%. A correlation between preoperative haemodynamic parameters and increased postoperative mortality has been demonstrated by both NELA and other observational studies. The association between intraoperative haemodynamic parameters and overall postoperative morbidity has not been evaluated in EL patients. The aims of our study were to investigate the association between perioperative haemodynamic and logistic parameters and postoperative morbidity in a tertiary referral university hospital; and to compare our outcomes to that of the NELA data. A retrospective analysis correlating a range of perioperative parameters with Comprehensive Complication Index (CCI) among 86 patients who underwent EL during 2018 was conducted. Mean age was 64 years (SD 16). Median CCI was 27 [9–45], and 30-day mortality was 11.7%. Several intraoperative parameters correlated with CCI on univariate analysis. On multivariate analysis, ASA status (P = 0.005) and unplanned escalation to postoperative intensive care (P = 0.03) were independently associated with CCI. Our study shows a correlation between ASA status and unplanned escalation to ITU with increased postoperative morbidity in patients undergoing emergency laparotomy. We did not demonstrate an independent correlation between intraoperative parameters and postoperative morbidity. These findings warrant confirmation in a larger scale observational study. Outcomes in our institution are comparable to those seen in the NELA.

Application of Intravenous Lidocaine in Obese Patients Undergoing Painless Colonoscopy: A Prospective, Randomized, Double-Blind, Controlled Study.

ObjectivePropofol for procedural sedation and analgesia (PSA) for colonoscopy can result in a high prevalence of severe respiratory depression. Studies have shown that intravenous (IV) infusion of lidocaine can reduce propofol requirements significantly and increase the ventilatory response to carbon dioxide in humans. We tested the hypothesis that IV lidocaine could improve propofol-induced respiratory depression in obese patients during colonoscopy.MethodsNinety obese patients scheduled for painless colonoscopy were randomized to receive lidocaine (1.5 mg/kg, then 2 mg/kg/h, IV) or the same volume of 0.9% saline. Intraoperative sedation was provided by propofol. The primary outcome was the number of oxygen-desaturation episodes. Secondary outcomes were: the number of apnea episodes; total propofol consumption; time to the first hypoxia episode; time to consciousness loss; intraoperative hemodynamic parameters; awakening time; adverse events; duration of post-anesthesia care unit (PACU) stay; satisfaction of endoscopists and patients.ResultsDemographic characteristics between the two groups were comparable. The number of oxygen-desaturation episodes in group L (1.49±1.12) decreased by 0.622 (P=0.018) compared with that in group N (2.11±1.32), and the number of apnea episodes in group L decreased by 0.533 (P<0.001). Kaplan–Meier curves showed that the median time to the first hypoxia episode was longer in group L (86.78 s) than that in group N (63.83 s) (Log rank P=0.0008). The total propofol consumption, awakening time, and duration of PACU stay were reduced in group L. There was no significant difference in the prevalence of adverse events (P>0.05 for all). Satisfaction scores for endoscopists and patients in group L were higher than that in group N (P<0.001).ConclusionIntravenous infusion of lidocaine could significantly reduce the number of oxygen-desaturation and apnea episodes in obese patients during painless colonoscopy. This method is worthy of clinical promotion.Clinical Trials RegistrationChiCTR2000028937.

Dexmedetomidine as an adjuvant to infraorbital block in children undergoing cleft lip surgery – A clinical comparative study

Regional nerve blocks provide excellent analgesia in children without adverse effects. However the duration of analgesia may be limited therefore addition of adjuvants can effectively prolong the duration of analgesia. Since alpha 2 agonist effectively prolong the duration of analgesia, we conducted a randomised double blind study to evaluate the effectiveness of dexmedetomidine as an adjuvant in infraorbital nerve block.: Eighty children of ASA grade 1 and 2, of either sex scheduled for cleft lip repair under general anaesthesia were allocated randomly into one of two equal groups (Group B and Group D, n=40). In both group sinfraorbital nerve block was performed with 1ml of solution on each side. The B group received bupivacaine 0.25% and the D group received b upivacaine 0.25% with 0.5µg/kg dexmedetomidine. The mean duration of analgesia and number of patients receiving rescue analgesia was recorded in both groups. The intraoperative hemodynamic parameters and postoperative sedation scores were recorded. For pain and sedation scores, Mann–Whitney U-test was used. Fisher’s exact test was used for comparison of categorical data. P ≤ 0.05 was considered as the level of statistical significance.Both groups were comparable in demographic profile. The mean duration of analgesia in Group D (733±49.15 minutes) was significantly longer compared to Group B (496±28.26) (p=0.001). There was a statistically significant difference in the number of patients receiving rescue analgesics in Group B (36) and Group D(8). The number of times of rescue analgesics in Group B and Group D was 3and 1 respectively, which was statistically significant. The intraoperative and postoperative hemodynamic HR was comparable in both groups (). The sedation score in the postoperative period did not differ between the two groups.

Perioperative outcome of severe rigid idiopathic scoliosis: Single-staged posterior spinal fusion utilizing a dual attending surgeon strategy. A report of 41 patients.

Various surgical strategies including combined approach and spinal osteotomies in severe rigid scoliosis had been reported with significant perioperative complication rates. The use of single-staged posterior spinal fusion (PSF) utilizing a dual attending surgeon strategy for severe rigid scoliosis has not been widely reported. This was a retrospective study aimed to evaluate the perioperative outcome of single-staged PSF in severe rigid idiopathic scoliosis patients (Cobb angle ≥90° and ≤30% flexibility). Forty-one patients with severe rigid idiopathic scoliosis who underwent single-staged PSF were included. The perioperative outcome parameters were operation duration, intraoperative blood loss, intraoperative hemodynamic parameters, preoperative and postoperative hemoglobin, transfusion rate, patient-controlled anesthesia morphine usage, length of postoperative hospital stay, and perioperative complications. Radiological parameters included preoperative and postoperative Cobb angle, correction rate, side-bending flexibility, and side-bending correction index. The mean age was 16.9 ± 5.6 years. The mean preoperative Cobb angle was 110.8 ± 12.1° with mean flexibility of 23.1 ± 6.3%. The mean operation duration was 215.5 ± 45.2 min with mean blood loss of 1752.6 ± 830.5 mL. The allogeneic blood transfusion rate was 24.4%. The mean postoperative hospital stay was 76.9 ± 26.7 h. The mean postoperative Cobb angle and correction rate were 54.4 ± 12.8° and 50.9 ± 10.1%, respectively. The readmission rate in this cohort was 2.4%. Four perioperative complications were documented (9.8%), one somatosensory evoke potential signal loss, one superficial infection, one lung collapse, and one superior mesenteric artery syndrome. Severe rigid idiopathic scoliosis treated with single-staged PSF utilizing a dual attending surgeon strategy demonstrated an average correction rate of 50.9%, operation duration of 215.5 min, and postoperative hospital stay of 76.9 h with a 9.8% perioperative complication rate.

Comparison of The Effects of Remifentanil and Fentanyl Combined with Desflurane on Intraoperative Hemodynamic Parameters and Postoperative Recovery Period in Anesthesia for Day Case Surgery

Objective: We aimed to compare the effects of two different opioids, fentanyl and remifentanil with short-acting inhalation agent, desflurane on intraoperative hemodynamics and recovery quality in the postoperative period in anesthesia for day case surgery.Methods: A prospective randomized case control study was carried out at Anesthesia and Reanimation Clinics of The Istanbul Education and Research Hospital with the approval of the local ethics committee between 2001-2002. The study population (n=100) who has arthroscopic knee surgery was composed of patients between the ages of 18-65 classified as ASAI-II. The cases were randomized and divided into two groups. After giving fentanyl to patients in the first group and remifentanil infusion to patients in the second group, induction has administered by propofol and mivacurium was given as a muscle relaxant in both groups. After endotracheal intubation, systemic blood pressure, heart rate and peripheral oxygen saturation (SpO2) values were recorded every five minutes. When the surgery was completed, eye opening, following commands, saying her name, saying her birthday, sitting without help and getting the correct answer to the DSS test was recorded for both groups. Visual Pain Scale (VAS) and Modified Aldrete Score were evaluated and recorded at 0, 15, 30, and 60 minutes. Patients were observed and recorded in terms of side effects such as increased secretion, bradycardia, nausea, vomiting, dizziness, headache, and tremors in both groups.Results : In terms of demographic features there was no statistically significant difference between the two groups. Generally; systemic blood pressures were significantly higher in the fentanyl group. Heart rate was significantly higher in fentanyl group during intubation and intraoperative periods . There was no statistically significant difference between groups in terms of Sp02 . Time until spontaneous breathing, extubation, eye opening, following commands, saying the name, DSST and unassisted sitting were significantly longer in the fentanyl group . The mean values of VAS scores at the 15th and 30th minutes were significantly higher in the remifentanil group . Similarly, the mean Aldrete recovery scale score scores at 15th and 30th minutes were significantly higher in the remifentanil group . When postoperative pathological findings were evaluated, the frequency of bradycardia was significantly higher in the remifentanil group, there was no difference in terms of other side effects. Conclusion: According to the our study results; we concluded that it is a better alternative to use remifentanil together with desflurane which is preferred short-acting inhalation agent in ambulatory anesthesia; in terms of hemodynamic stability during the intubation, peroperative and extubation periods and rapid postoperative recovery.

Listening to music during arteriovenous fistula surgery alleviates anxiety: A randomized single-blind clinical trial.

Both end-stage renal disease and being wait-listed for a kidney transplant are anxiety-causing situations. Wait-listed patients usually require arteriovenous fistula surgery for dialysis access. This procedure is performed under local anesthesia. We investigated the effects of music on the anxiety, perceived pain and satisfaction levels of patients who underwent fistula surgery. To investigate the effect of music therapy on anxiety levels and perceived pain of patients undergoing fistula surgery. Patients who were on a waiting list for kidney transplants and scheduled for fistula surgery were randomized to control and music groups. The music group patients listened to music throughout the fistula surgery. The State-Trait Anxiety Inventory was performed to assess anxiety, additionally visual analog scale was used to evaluate perceived pain, willingness to repeat the procedure and patient satisfaction. Demographic features, comorbidities, surgical history, basic surgical data (location of fistula creation, duration of surgery, incision length) and intra-operative hemodynamic parameters were recorded by an investigator blinded to the study group. An additional trait anxiety assessment was performed following the surgery. There was a total of 55 patients included in the study. However, 14 patients did not fulfill the criteria due to requirement of sedation during surgery or uncompleted questionnaires. The remaining 41 patients were included in the analysis. There were 26 males and 15 females. The control and music groups consisted of 20 and 21 patients, respectively. With regard to basic surgical and demographic data, there was no difference between the groups. Overall patient satisfaction was significantly higher and intra-operative heart rate and blood pressure were significantly lower in the music group (P < 0.05). Postoperative state anxiety levels were significantly lower in the music group. Music therapy can be a complimentary treatment for patients undergoing fistula surgery. It can reduce anxiety and perceived pain, improve intraoperative hemodynamic parameters and enhance treatment satisfaction, thus may contribute to better compliance of the patients.

Predictors of Immediate Tracheal Extubation in the Operating Room After Pediatric Liver Transplantation.

Pediatric orthotopic liver transplant recipients frequently need mechanical ventilation during the immediate posttransplant period. However, intensive care unit beds are costly and scarce; therefore, anticipating which patients will require postoperative mechanical ventilation support is important. In addition, immediate postoperative extubation may reduce the incidence of postoperative respiratory complications and improve patient outcomes after orthotopic liver transplant. Here, we aimed to determine the predictors of need for mechanical ventilation after orthotopic liver transplant in pediatric patients. We retrospectively analyzed the records of 57 pediatric patients who underwent orthotopic liver transplant (performed by the same team at Baskent University Hospital from April 1996 to August 2009). Patients were divided into 2 groups according to whether they required postoperative mechanical ventilation or not. Collected data included demographic features; comorbidities; cause of liver failure; perioperative laboratory values; intraoperative hemodynamic parameters; use and volume of crystalloids, colloids, and blood products; albumin levels; portal vein clamping time, requirement of inotropes/vasopressors; and anesthesia duration. Mean age and body weight of patients were 25.0 ± 23.1 months and 10.8 ± 5.3 kg, respectively. Of 57 patients, 26 (46%) needed postoperative mechanical ventilation. Compared with those who did not require postoperative mechanical ventilation, patients who required mechanical ventilation had growth failure (P = .03), higher mean intraoperative lactate level (P = .03), and higher mean intraoperative fresh frozen plasma/erythrocyte suspension (P = .049) and intraoperative vasopressor (P = .022) requirements. Multivariate logistic regression analysis revealed that growth failure (odds ratio = 37; P = .03) and higher intraoperative lactate level (odds ratio = 1.5; P = .03) were predictors of the need for mechanical ventilation. About 46% of our pediatric orthotopic liver transplant recipients required mechanical ventilation postoperatively. Growth failure and higher intraoperative lactate levels were associated with need for postoperative mechanical ventilation.

Combined Xenon and Epidural Anesthesia During Surgical Correction of Joint Deformities in the Lower Extremities of Children with Cerebral Palsy

Objectives. The objective of this study is to compare different methods of combination general and regional anesthesia based on xenon.Materials and methods. Xenon anesthesia combined with epidural block was performed in 50 children with cerebral palsy aged 3–17 years. In 30 patients xenon was used to maintain anesthesia, in 20 children xenon was combined with sevoflurane. We compared the process of anesthesia, the intraoperative hemodynamic parameters and cognitive status before surgery and after it.Results. The use of xenon in all studied anesthesia methods increased the cardiac performance and was associated with a stable hemodynamic profile at all stages of anesthesia despite the depressive effect of epidural blockade on hemodynamics. Psychological testing revealed that xenon anesthesia has no negative effect on cognitive functions in children with cerebral palsy.Conclusion. Xenon anesthesia is a promising trend in anesthesia care for children with cerebral palsy. Xenon can compensate the hemodynamic depression caused by epidural anesthesia due to its cardiac stimulant property, with no neurotoxicity being a significant benefit for children with initial damage of CNS. However, anesthesia with xenon turned out to have some disadvantages. In our study, xenon showed insufficient analgesic properties, had emetic properties and was associated with spirometric abnormalities. It was more difficult to maintain normal ventilation parameters in young children when using xenon. Several adverse events were noted in the recovery period. These disadvantages can be partially reduced by using a combination of xenon and sevoflurane.

Inadvertent Perioperative Hypothermia and Important Risk Factors during Major Abdominal Surgeries.

A relation between inadvertent perioperative hypothermia and possible important risk factors during major abdominal surgeries was investigated. Cross-sectional descriptive study. Trakya University Hospital, Edirne, Turkey during 2016-2018. Five hundred and twenty-nine patients undergoing major abdominal surgey were divided into two groups depending on postoperative body core temperature (CTM) by the use of tympanic membrane measurement. Patients with a temperature of less than 36oC indicated hypothermia group; whereas, patients with a temperature between 36 and 37.5oC indicated normothermia group. The parameters that were considered as risk factors for hypothermia include; baseline characteristics, American Society of Anesthesiologists (ASA) status, comorbidities, operative type, duration of surgery, patient and operative room temperatures, intraoperative hemodynamic parameters, transfusion of fluids and packed red blood cells (PRBCs), labaratory data, and adverse events. Correlation between these parameters and inadvertent hypothermia was sought. A p-value of less than 0.05 was considered statistically significant. The risk factors that showed a correlation with hypothermia include: male gender, advanced age, high ASA scores, smoking, prolonged duration of operation, transfusion of fluids and PRBCs (p<0.05). In hypothermia group, duration of operation time was longer, need for transfusion was greater, hematocrit and hemoglobin values were lower than Normothermia Group of patients (p<0.05). Hypothermia was detected in 335 (63.3%) of patients. In this study, important risk factors for inadvertent hypothermia were found as; male gender, advanced age, high ASA scores, smoking, prolonged duration of operation, transfusion of fluids and/or PRBCs.

Hemodynamic stability during adrenalectomy for pheochromocytoma: A case control study of posterior retroperitoneal vs lateral transperitoneal approaches.

Hemodynamic stability is one of the most critical aspects of adrenal surgery for pheochromocytoma. Few articles have evaluated the hemodynamic status of patients undergoing posterior retroperitoneal adrenalectomy (PRA) for pheochromocytoma. The aim of this study is to compare the intraoperative hemodynamic parameters between lateral transperitoneal adrenalectomy (TPA) and PRA in this groups of patients.This report describes a retrospective study of 53 pheochromocytoma patients who underwent endoscopic adrenalectomy via transperitoneal (22 patients) or posterior retroperitoneal (31 patients) approaches from January 2008 to March 2015. Data from these patients were compared to investigate the differences in hemodynamic parameters between the 2 approaches.Clinical parameters at presentation were similar between the 2 groups, except for tumor size, which was larger in the TPA group. The PRA group is associated with reduced operative time, blood loss, and length of hospital stay compared to TPA even after adjusting for the tumor size. There was greater BP fluctuations and higher maximum systolic and diastolic blood pressure (BP) within the TPA group compared to PRA during univariate analysis. This was however not significant after adjusting for tumor size. There was no difference in the intraoperative inotropic support requirement between the 2 groups.PRA is associated with stable intraoperative hemodynamic status, as well as favorable perioperative outcomes compared to TPA in patients with small pheochromocytomas.

Pharmacological preconditioning with intralipid in patients undergoing off-pump coronary artery bypass surgery

Aims and Objectives:The objective of the study was to determine the preconditioning myocardial protective effects of intralipid (IL) in off-pump coronary artery bypass (OPCAB) surgery by measuring highly sensitive troponin T (hsTnT) and cardiac-specific creatine kinase (CK-MB) as markers of myocardial injury.Materials and Methods:Thirty patients, scheduled to undergo elective OPCAB surgery, were randomly assigned to the IL group (n = 15) or control (C) group (n = 15); the IL group received an infusion of 20% IL 2 ml/kg, 30 min prior to revascularization and the control group received an equivalent volume of normal saline. Serum levels of hsTnT and CK-MB were measured before surgery and at 6 h, 24 h, 48 h, and 72 h postoperatively. Also, intraoperative hemodynamic parameters, inotrope use, ventilatory hours, ICU stay, postoperative left ventricular ejection fraction, postoperative lipid profile, renal and hepatic function tests were measured.Results:The hsTnT values at the 24 h, 48 h, and 72 h in IL group were significantly lower as compared with the control group. The decline in plasma levels of CK-MB mirrored the hsTnT levels post revascularization at 24 h and 48 h in the IL group compared with the control group; however, at 72 h, level was comparable in both the groups. None of the treated patients had abnormal lipid metabolism, deranged renal, and hepatic function.Conclusion:The study revealed Intralipid as a safe pharmacological preconditioning agent for OPCAB surgeries which can reduce the postischemic myocardial injury indicated by the reduction in postischemic cardiac enzymes hsTnT and CK-MB.

Transtorasik Ekokardiyografinin Spinal Anestezi Sonrası Hipotansiyonu Öngörmede Değeri

INTRODUCTION: Spinal Anesthesia (SA) can lead to hypotension due to sympathic denervation, which causes a reduction in venous return to the heart as a result of peripheral vasodilation and redistribution of intravascular blood. Transthoracic Echocardiography (TTE) is a noninvasive and easy-to-use method to visualize cardiac reserve and functions. We aimed to evaluate whether parameters attained via transthoracic echocardiography are predictive of development of post-SA hypotension. METHODS: Forty-two patients between the ages of 18 and 80, who would undergo inguinal hernia operation under SA, with ASA physical status I-II and had no clinically recognized cardiovascular disease, were included in the study. TTE was performed for each patient 30 minutes before the operation, and measurements were recorded along with the intraoperative hemodynamic parameters. RESULTS: There was a statistically significant difference between the medians of left ventricle end-diastolic diameter (LVEDD) (cm) according to the status of post-SA hypotension (p=0.003).Accordingly, median LVEDD of patients who did not develop hypotension was significantly larger compared with that of those who had hypotension. Similarly, a statistically significant difference emerged between the medians of right ventricular (RV) tricuspid annular plane systolic excursion (TAPSE) (cm) showing RV global function according to the status of post-SA hypotension (p=0.001). Accordingly, patients who did not have hypotension had a larger RV-TAPSE median compared with that of those who had hypotension. The difference between the medians of RV isovolumetric relaxation time (RV-IVRT), which is one of the indicators of RV diastolic functions was again statistically significant according to the status of post-SA hypotension (p=0.025). DISCUSSION AND CONCLUSION: TAPSE, RV-IVRT and LVEDD measured via preoperative TTE, can be significant parameters to predict the development of post-SA hypotension.

Investigation of the effects of melatonin premedication on intraoperative and postoperative hemodynamic parameters, peripheral oxygen saturation, postoperative anxiety and cognitive functions in patients undergoing epidural anesthesia; Letter to editor

Investigation of the effects of melatonin premedication on intraoperative and postoperative hemodynamic parameters, peripheral oxygen saturation, postoperative anxiety and cognitive functions in patients undergoing epidural anesthesia; Letter to editor

Anesthetic efficacy and safety of 2% lidocaine hydrochloride with 1:100,000 adrenaline and 4% articaine hydrochloride with 1:100,000 adrenaline as a single buccal injection in the extraction of maxillary premolars for orthodontic purposes.

BackgroundPalatal injection of local anesthetics is the most painful injection. To obviate the need for palatal injections, local anesthetic agents with diffusibility are being investigated. Hence the present study was designed to analyze the anesthetic efficacy of 2% lidocaine hydrochloride (HCl) with 1:100,000 adrenaline and 4% articaine hydrochloride (HCl) with 1:100,000 adrenaline using single buccal infiltration for the extraction of maxillary premolars.MethodsA prospective, double-blind, crossover, randomized clinical study was performed on 60 consecutive systemically healthy patients with an age range of 15-30 years, requiring extraction of asymptomatic bilateral maxillary premolars for orthodontic purposes. They received 1ml buccal infiltration of 4% articaine HCl with 1:100,000 adrenaline on one side and 2% lidocaine HCl with 1:100,000 adrenaline on the other side. The extraction procedure on either side was scheduled 14 days apart. Parameters assessed were the time of onset of anesthesia, intraoperative discomfort, hemodynamic parameters, and the duration of analgesia. Analysis of the data was done using the Mann-Whitney test, the Wilcoxon test, the Kruskal-Wallis ANOVA test, and the chi-square test. Statistical significance was established at P < 0.05.ResultsArticaine showed a faster time of onset and longer duration of analgesia than lidocaine. However, the difference in the intraoperative discomfort and hemodynamic parameters was statistically insignificant.ConclusionWithin the limitations of the study, it can be concluded that the extraction of maxillary premolars can be performed with a single buccal infiltration of 2% lidocaine HCl with 1:100,000 adrenaline, which is one of the most commonly used local anesthetic agent.

Unilateral versus bilateral spinal anaesthesia in geriatric patients undergoing hemiarthroplasty: a comparative study.

Conventional bilateral spinal anaesthesia can produce haemodynamic alterations that can be detrimental to geriatric patients. Unilateral spinal anaesthesia produces predominant blockade on the operated side, thereby reducing the incidence of hypotension. There is a scarcity of comparative studies evaluating the effects of unilateral spinal anaesthesia in the elderly population. Therefore, we conducted this study to compare the effects of unilateral and bilateral spinal anaesthesia in geriatric patients. Aprospective, parallel group, randomized, controlled study was conducted on 72 patients of age 60-85 years, ASA physical status Iand II undergoing hemiarthroplasty under spinal anaesthesia. Patients were randomly allocated to two groups: patients in group U(n = 36) received unilateral spinal anaesthesia, those in group B (n = 36) received bilateral spinal anaesthesia. All patients received 1.5 mL of hyperbaric bupivacaine (0.5%) and 0.5 mL of fentanyl intrathecally in the lateral decubitus position. Patients in group B were turned to the supine position and those in group Umaintained the lateral decubitus position for 15 minutes. Intraoperative and postoperative haemodynamic parameters, Bromage score and sensory block height were compared. Hypotension in group B patient was more pronounced compared to group U. There was no significant difference in the Bromage score and the number of patients reaching T10 sensory block height on the operated side between the two groups. The Bromage score and the number of patients reaching T10 sensory block height on the non-operated side were higher in group B. In geriatric patients unilateral spinal anaesthesia produces predominant motor and sensory block on the operated side with less hypotension.

Combined lumbar plexus-sciatic nerve block in the emergency surgery for pertrochanteric fracture: an alternative technique in patients at high risk of anaesthetic complications

Introductionl’anesthésie pour la chirurgie urgente de la fracture pertrochantérienne (FPT) chez les patients à haut risque anesthésique représente souvent un véritable challenge pour les praticiens en vue du risque periopératoire majeur. Nous rapportons notre expérience avec le bibloc ou bloc combiné lombaire et sciatique plexique (BCLS) comme technique anesthésique alternative face à ce type de situation.Méthodesune étude transversale, descriptive, monocentrique, a été menée sur une période de 3 ans, incluant les patients à haut risque anesthésique présentant une FPT récente. Les deux blocs nerveux étaient réalisés au niveau plexique selon la technique classique de neurostimulation. Un mélange de 20ml de lidocaine 2% et de bupivacaine 0,5% (50/50) a été injecté au niveau de chaque bloc. Le critère d’évaluation principal était l’efficacité du BCLS apprécié par l’incidence d’échecs de la technique anesthésique, définie par la nécessité de convertir en anesthésie générale (AG). Les critères d’évaluation secondaires étaient: 1) les données techniques de la procédure anesthésique, 2) les retentissements hémodynamiques, respiratoires et neurologiques periopératoires, et 3) les résultats et les complications éventuelles en postopératoire.Résultatstrente patients ont été colligés. L’âge moyen était de 74 ± 10 ans. Le délai moyen d’admission aux urgences-intervention était de 12(5-36) heures. La durée moyenne pour la réalisation de la procédure était de 15,20 ± 3,45 minutes. Aucune conversion en AG n’a été nécessaire. Il n’y avait pas de différences statistiquement significatives entre les différentes valeurs enregistrées des paramètres hémodynamiques et respiratoires periopératoires (PAM, FC, SpO2) (p > 0,05). La durée de l’intervention était de 46 ± 5 minutes. La satisfaction des chirurgiens était de 9,7 ± 0,1. La première demande en antalgiques postopératoires était après 8(1-24) heures. Tous les patients avaient une récupération sensitivomotrice complète.Conclusionle BCLS est une alternative anesthésique pour les interventions urgentes de FPT chez les patients à haut risque anesthésique: délais opératoires réduits, efficacité anesthésique, stabilité hémodynamique et respiratoire periopératoire, absence de complications inhérentes aux autres techniques anesthésiques, passage rapide en salle de surveillance post-interventionnelle (SSPI), et analgésie postopératoire de qualité.

A Comparative Study of Atracurium and Cisatracurium in paediatric cleft Lip and Cleft palate surgeries

General anaesthesia with intubation with RAE tube is preferred in children undergoing cleft lip and palate surgeries. Neuromuscular blocking drugs (NMBDs), are given to infants and children to attain ideal intubating conditions by providing adequate muscle relaxation. In contrast to routinely used atracurium, cisatracurium is comparatively a newer drug with lesser histamine release. The study was designed with the aim to compare the efficacy of atracurium (2×ED95) and cisatracurium (4×ED95).90 patients, 6 months-5 years, ASA class I &II were randomly allocated to cisatracurium and atracurium group. After administration of induction agent, dose of neuromuscular blocking drug atracurium 0.5mg/kg or cisatracurium 0.2mg/kg was given to the patients. The intubating conditions were graded using ‘Cooper et al’ scoring system. Neuromuscular blockade was assesed using train of four ratio. Alongwith intubating conditions, onset and duration of action, hemodynamic effects, and signs of histamine release were measured in both the groups. In the atracurium group the mean score according to ‘Cooper et al'scale was 6.86±0.54, whereas in the cisatracurium group it was 8.12±0.64, the difference between the groups was statistically significant. Time of onset was found to be 2.7±0.12 minutes in the cisatracurium group and 3.28±0.64 minutes in the atracurium group. Duration of action was 64.6±6.18minutes in the cisatracurium group as compared to 35.4±4.64minutes in the atracurium group. Cisatracurium(0.2mg/kg) is more efficacious as compared to atracurium(0.5mg/kg)with respect to intubating conditions, it has a faster onset of action, good intraoperative hemodynamic parameters, longer duration of action with no side effects.

Video-assisted thoracoscopic total thymectomy: two-lung ventilation with artificial pneumothorax

Objectives: Double-lumen endotracheal tube (DLET) and one-lung ventilation (OLV) have been generally accepted as the classic anesthetic method in video-assisted thoracoscopic total thymectomy (VATT). However, there are still some disadvantages of DLET. Two-lung ventilation (TLV) with single-lumen endotracheal tube (SLET) is considered to be an alternative in VATT to avoid these disadvantages. This study evaluated the safety and feasibility of TLV in VATT by comparing it with OLV cases.Material and methods: We retrospectively screened 198 patients who received TLV unilateral thoracic incision VATT and 117 patients who received OLV unilateral thoracic incision VATT. Perioperative data were analyzed, including surgical variables, intraoperative hemodynamic parameters, and postoperative complications and hospital stay.Results: No significant differences with regard to operative time (p = .146), postoperative hospital stay (p = .553), complications (p = .254), hemodynamic parameters and pulse oxygen saturation (SpO2) were found between TLV group and OLV group. However, end-tidal CO2 (EtCO2) was higher in TLV group at 15 min (39.95 ± 5.03 vs 38.70 ± 4.57, p = .021) and 30 min (41.91 ± 5.50 vs 38.91 ± 4.51, p < .001) after initiation of the operation.Conclusions: It is safe and feasible to adopt TLV using SLET with CO2 insufflation artificial pneumothorax in unilateral thoracic incision VATT.