Thoracic Epidural Anesthesia Research Articles

Feasibility of segmental thoracic epidural anesthesia in cancer patients undergoing feeding jejunostomy: A randomized controlled trial

Feasibility of segmental thoracic epidural anesthesia in cancer patients undergoing feeding jejunostomy: A randomized controlled trial

The Effect of Ultrasound-Guided Erector Spinae Plane Block versus Thoracic Epidural Block on Postoperative Analgesia After Nuss Surgery in Paediatric Patients: Study Protocol of a Randomized Non-Inferiority Design Trial

PurposeThe Nuss procedure is a recognized treatment for adolescent pectus excavatum that results in severe postoperative pain. Erector spinae plane block (ESPB) is a novel technique that provides postoperative analgesia and reduces opioid consumption. Our aim is to explore whether ESPB produces analgesia similar to thoracic epidural anaesthesia (TEA) in paediatric patients undergoing Nuss procedure.Study Design and MethodsThis randomized, controlled, non-inferiority trial will enrol 300 paediatric patients undergoing Nuss surgery. Participants will be randomly assigned 1:1 to receive ESPB or TEA preoperatively. The primary, joint endpoint is the average numeric rating scale (NRS) score and cumulative sufentanil consumption. The secondary endpoints are pain scores and sufentanil consumption at different time points after surgery, analgesia-related side effects, and other postoperative complications. Data will be analysed by the intention-to-treat principle.DiscussionThis study investigates the effect of ESPB on postoperative opioid consumption and pain scores and intend to provide a new strategy of analgesia management for Nuss procedure in paediatric patients.

Effects of Thoracic Epidural Anesthesia on Systemic and Local Inflammatory Responses in Patients Undergoing Lung Cancer Surgery: A Randomized Controlled Trial

Inflammatory responses play major roles in the development of acute lung injury following lung cancer surgery. The authors tested the hypothesis that thoracic epidural anesthesia (TEA) during surgery could attenuate both systemic and local inflammatory cytokine productions in patients undergoing lung cancer surgery. A prospective randomized controlled trial. At Keio University Hospital, Tokyo, Japan. Patients scheduled for lung cancer surgery. Sixty patients were randomly allocated into two groups (n = 30 each group): the epidural group (group E), in which anesthesia was maintained with propofol, fentanyl, rocuronium, and epidural anesthesia with 0.25% levobupivacaine; or the remifentanil group (group R), in which a remifentanil infusion was used as a potent analgesia instead of epidural anesthesia. The lung epithelial lining fluid (ELF) and blood sampling were collected prior to one-lung ventilation (OLV) initiation (T1) and at 30 minutes after the end of OLV (T2). The concentrations of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-10 in the ELF at T2 were increased significantly compared with those at T1 in both groups. The ELF concentration of IL-6 in group E was significantly lower than that in group R at T2 (median [interquartile range]: 39.7 [13.8-80.2] versus 76.1 [44.9-138.2], p = 0.008). Plasma IL-6 concentrations at T2, which increased in comparison to that at T1, were not significantly different between the two groups. The plasma concentrations of TNF-α did not change in both groups. This randomized clinical trial suggested that TEA could attenuate local inflammatory responses in the lungs during lung cancer surgery.

Perioperative use of thoracic epidural anaesthesia, dexmedetomidine and magnesium sulphate infusion in a dog undergoing neuroendocrine tumour resection

AbstractAn 11‐year‐old, 22 kg, male neutered English Staffordshire Bull Terrier, in which a pheochromocytoma was removed from the left retroperitoneal space, was referred to investigate the regrowth of a mass in the same region. A neuroendocrine tumour, compatible with pheochromocytoma, was cytologically diagnosed after ultrasound‐guided fine‐needle aspirates, and the dog underwent explorative celiotomy. A combination of thoracic epidural anaesthesia, dexmedetomidine and magnesium sulphate infusion was used intraoperatively to control nociception and potential haemodynamic changes caused by sudden catecholamines release. Postoperative analgesia was provided by administering 0.12% levobupivacaine through the thoracic epidural catheter and oral paracetamol and gabapentin. Postoperative methadone was administered twice during the first 24 postoperative hours only. Two days after the surgery, the dog was anaemic and packed red blood cells were administered. No other complications occurred, and the dog was discharged from the hospital 5 days following surgery.

New method of epidural anesthesia in closed blunt chest injury

The thoracic epidural anesthesia is the most suitable method for the treatment of the closed blunt chest injury but there is probability of the spinal cord injuiry. The original method combining the efficiency of classic thoracic epidural anesthesia with safety and simplicity of lumbar epidural anesthesia is suggested. This method is based on the postulates of the molecular hydrokinetic theory. Two catheters ends are disposed in lumbar epidural space in distance about two inches between them. Through one catheters end the anesthetic solution and through others end the 0,9% saline are injected synchronously in equal volumes. Hydroplunger phenomenon provides the upward anesthetic solution spreading

Incorporation of an intercostal catheter into a multimodal analgesic strategy for uniportal video-assisted thoracoscopic surgery: a feasibility study

BackgroundWell-controlled postoperative pain is essential for early recovery after uniportal video-assisted thoracoscopic surgery (UVATS). Conventional analgesia like opioids and thoracic epidural anaesthesia have been associated with hypotension and urinary retention. Intercostal catheters are a regional analgesic alternative that can be inserted during UVATS to avoid these adverse effects. This feasibility study aims to evaluate the postoperative pain scores and analgesic requirements with incorporation of an intercostal catheter into a multimodal analgesic strategy for UVATS.MethodsIn this observational study, 26 consecutive patients who underwent UVATS were administered a multilevel intercostal block and oral paracetamol. All of these patients received 0.2% ropivacaine continuously at 4 ml/h via an intercostal catheter at the level of the incision. Rescue analgesia including etoricoxib, gabapentin and opioids were prescribed using a pain ladder approach. Postoperative pain scores and analgesic usage were assessed. The secondary outcomes were postoperative complications, days to ambulation and length of stay.ResultsNo technical difficulties were encountered during placement of the intercostal catheter. There was only one case of peri-catheter leakage. Mean pain score was 0.31 (range 0–2) on post-operative day 1 and was 0.00 by post-operative day 5. 16 patients (61.6%) required only oral rescue analgesia. The number of patients who required rescue non-opioids only increased from 1 in the first 7 months to 8 in the next 7 months. There were no cases of hypotension or urinary retention. Median time to ambulation was 1 day (range 1–2). Mean post-operative length of stay was 4.17 ± 2.50 days.ConclusionsIncorporation of an intercostal catheter into a multimodal analgesia strategy for UVATS is feasible and may provide adequate pain control with decreased opioid usage.

A comparison of high thoracic epidural anaesthesia versus conventional intravenous opioids in pediatric patients undergoing corrective open heart surgery for ventricular septal defect

Background: We compared high thoracic epidural anaesthesia with a combination of morphine and bupivacaine versus IV fentanyl as an alternative for perioperative pain management.Methods: Group-E: Injection Morphine 75-100 mcg/kg and Injection 0.25 % Bupivacaine 0.5 ml/kg was given via epidural catheter at insertion, Injection 0.25% Bupivacaine 0.5 ml/kg just before skin incision, and continuous infusion of Injection 0.125% Bupivacaine at 0.2 ml/kg/hr intra-operatively. Post-operative 0.1 ml/kg/hr infusion. Group F- intravenous fentanyl 2-3 mcg/Kg IV bolus given just before skin incision, followed by 1-2 mcg/Kg/hr IV fentanyl started after weaning from cardiopulmonary bypass.Results: The mean ScvO2 was comparable between the two groups during induction period but became higher in group E during bypass and post bypass period intraoperatively, and the difference in rise in ScvO2 is statistically significant with a p<0.05. The mean rSo2- C was comparable between the two groups in the first postoperative hour but group F shows higher rSo2-C postoperatively which was statistically significant. The postoperative pain was significantly lower in group E in the postoperative period (except for 4,5,6 and 40 and 48th hour).Conclusions: HTEA to paediatric patients prior to sternotomy for cardiac surgeries resulted in a much better control of haemodynamic parameters. Produces better central venous and regional tissue oxygenation during bypass and post bypass intraoperatively as compared to the patients that received only intravenous fentanyl. There was lower amount of postoperative bleeding in the HTEA group with significant reduction in requirement of post-operative ventilation and time to extubation after surgery, better post-operative pain control and overall outcome.

The Anesthetic Management of Patients Undergoing Nonintubated Video-Assisted Thoracic Surgery.

Purpose of ReviewThis review focuses on describing the procedural and anesthetic management of patients undergoing nonintubated video-assisted thoracoscopy surgery.Recent FindingsMost thoracic surgery is performed under general endotracheal anesthesia with either a double lumen endotracheal tube or a bronchial blocker. In an attempt to lessen the incidence and severity of postoperative complications, the nonintubated video-assisted thoracoscopic technique was developed, where the surgical procedure is performed under regional anesthesia with sedation. Currently, this technique is recommended for the elderly and in patients with severe cardiopulmonary disease who are at increased risk of complications after general anesthesia. It is the role of the anesthesia team to assist in the decisions whether the patient is a candidate and which block should be performed and to carefully monitor these patients in the operating room.SummaryNonintubated video-assisted thoracic surgery is an emerging technique with the goal of reducing postoperative complications. The anesthetic technique is highly variable and ranges from general anesthesia with a laryngeal mask airway with a truncal block to thoracic epidural anesthesia with minimal to no block. It is important to have excellent communication with the surgical team and the patient to ensure a safe, successful procedure.

Thoracic Epidural Anesthesia for Modified Radical Mastectomy in a High-Risk Patient: A Case Report With Literature Review

Surgery is one of the mainstays of treatment in breast cancers. Typically, modified radical mastectomy (MRM) is done under general anesthesia (GA). However, GA is not a reasonable choice in patients with multiple comorbidities and difficult airways. Thoracic epidural anesthesia (TEA) is a reasonable and safe alternative to GA as it involves blunting of stress response and avoidance of airway handling apart from hemodynamic stability, lower analgesic consumption, superior postoperative analgesia, reduced postoperative nausea and vomiting, earlier resumption of feeding, and shorter duration of hospitalization. We report a case of advanced breast cancer in a 57-year-old female with a co-existing difficult airway, bronchial asthma, and hypertension in whom MRM was conducted successfully under TEA. We also present a comprehensive review of literature on the use of TEA for MRM.

The efficacy of thoracic epidural anesthesia for breast surgeries

Thoracic epidural anesthesia provides selective blockade for the surgical site, with diminished requirements of opioids and local anaesthetics. If the efficacy of the same is better or equivalent to general anesthesia, the adverse effects with the later can be avoided. Hence this study was conducted to know the effectiveness of thoracic epiduralanesthesia in breast surgeries using 1.5% lignocaine with adrenaline.This prospective cross-sectional study was conducted in the department of Anaesthesiology in association with the Department of Surgery at Raja Muthaiah Medical College and Hospital, Chidambaram from January 2013 to June 2014. Adult female patients aged between 18-60 years belonging to ASA class I, class II and class III undergoing breast surgeries were included in the study. Patients with bleeding diathesis and local infections were excluded from the study. A total of thirty cases were included in the study and efficacy of epidural anaesthesia was determined by monitoring vitals in the peri-operative period. Results were analysed using Statistical package for Social Sciences (SPSS) version 17.Heart rate, blood pressure (both systolic and diastolic) and mean arterial pressure were significantly different with respect to time. Mean duration of rescue analgesia was found to be 127.33±27.62 minutes. Also 10%, 23.3%, 13.3% and 6.7% of cases reported bradycardia, shivering, hypotension and nausea during the intra operative period whereas 10% of cases reported backache and nausea, each during the post-operative period.Thoracic epidural anesthesia for breast surgeries provides good analgesia with minimal amount of drugs without significant complications.

Comparison of transversus abdominis plane catheters with thoracic epidurals for cost and length of stay in open colorectal surgeries: a cohort study

BackgroundThoracic epidural analgesia has long been a common method of postoperative analgesia for major open abdominal surgeries and is frequently used within enhanced recovery after surgery programs. An alternative postoperative analgesia method is the single shot transversus abdominis plane block, which has shown promising outcomes with respect to total length of stay, cost, pain scores, and decreased opioid usage. However, far less is known regarding continuous transversus abdominis plane analgesia using catheters. We evaluated the total cost-effectiveness of transversus abdominis plane catheter analgesia compared to thoracic epidural analgesia for patients undergoing open colorectal surgeries within the enhanced recovery after surgery program at our institution.MethodsThis cohort study included patients booked under the colorectal surgery enhanced recovery after surgery program from November 2016 through March 2018 who received either bilateral transversus abdominis plane catheters (n = 52) or thoracic epidural analgesia (n = 24).ResultsThere was no difference in total direct cost (p = 0.660) and indirect cost (p = 0.220), and median length of stay (p = 0.664) in the transversus abdominis plane catheter group compared to the thoracic epidural group. Additionally, the transversus abdominis plane catheter group received significantly less morphine equivalents compared to the thoracic epidural group (p = 0.008) and had a lower mean body mass index (p = 0.019). There was no significant difference between the two groups for age (p = 0.820), or sex (p = 0.330).ConclusionsTransversus abdominis plane catheter analgesia is not associated with increased cost or longer hospital stays when compared to thoracic epidural analgesia in patients undergoing open colorectal surgery within an enhanced recovery after surgery program. Furthermore, transversus abdominis plane catheter analgesia led to decreased opioid consumption while maintaining similar pain scores, suggesting similar pain control between the two modalities.

Quasilobar minimalist lung volume reduction surgery.

Our goal was to assess the results and the costs of the quasilobar minimalist (QLM) thoracoscopic lung volume reduction (LVR) surgical method developed to minimize the trauma from the operation and the anaesthesia and to maximize the effect of the lobar volume reduction. Forty patients with severe emphysema underwent QLM-LVR that entailed adoption of sole intercostal block analgesia and lobar plication through a single thoracoscopic incision. Results were compared after propensity matching with 2 control groups undergoing non-awake resectional LVR with double-lumen tracheal intubation or awake non-resectional LVR by plication with thoracic epidural anaesthesia. As a result, we had 3 matched groups of 30 patients each. Baseline forced expiratory volume in 1 s, residual volume, the 6-min walking test and the modified Medical Research Council dyspnoea index were 0.77 ± 0.18, 4.97 ± 0.6, 328 ± 65 and 3.3 ± 0.7, respectively, with no intergroup difference after propensity score matching. The visual pain score was better (P < 0.007), the hospital stay was shorter (P < 0.04) and overall costs were lower (P < 0.04) in the QLM-LVR group than in the control groups. The morbidity rate was lower with QLM-LVR than with non-awake resectional-LVR (P = 0.006). Significant improvements (P < 0.001) occurred in all study groups during the follow-up period. At 24 months, improvements in residual volume and dyspnoea index were significantly better with QLM-LVR (P < 0.04). QLM-LVR proved safe and showed better perioperative outcomes and lower procedure-related costs than the control groups. Similar clinical benefit occurred at 12 months, but absolute improvements in residual volume and dyspnoea index were better in the QLM-LVR group at 24 months.

Cholecystectomy with Thoracic Epidural Anesthesia in Geriatric Patients.

To determine the outcome of thoracic epidural anaesthesia in open cholecystectomy procedures of comorbid advanced elderly patients. Observational study. Faculty of Medicine, Karadeniz Technical University Hospital, Trabzon, Turkey during 2014-2019. This study included 103 geriatric patients of over 65 years, who underwent open cholecystectomy under thoracic epidural anaesthesia during the study period. Patient files, anaesthesia registration forms, early postoperative follow-up, and discharge process were retrospective. The mean age of the patients included in the study was 79.42 ± 9.03 years, while the mean operation time was 68.02 ± 17.44 minutes. While only 7 (6.8%) patients had a chronic disease, the number of patients with two or three comorbid diseases was 67 (65%). The number of patients with 4 or more comorbidities was 29 (28.2%). The most common intraoperative complications were hypotension (n = 22, 21.4%) and bradycardia (n = 19, 18.4%). Intraoperative desaturation was observed in 7 (6.8%) patients; and oxygen and bronchodilator therapy was effective. The median discharge time was 6.5 (5.0-8.25) days; whereas, 5 (4.9%) patients died postoperatively. In open cholecystectomy operations on comorbid advanced elderly patients, thoracic epidural anaesthesia can be preferred to general anaesthesia. Key Words: Geriatrics, Cholecystectomy, Anesthesia, Thoracic epidural, Comorbidity.

Hypotension Associated with MTS is Aggravated by Early Activation of TEA During Open Esophagectomy.

ObjectiveA mesenteric traction syndrome (MTS) is elicited by prostacyclin (PGI2)-induced vasodilation and identified by facial flushing, tachycardia, and hypotension during abdominal surgery. We evaluated whether thoracic epidural anesthesia (TEA) influences the incidence of MTS.DesignRandomized, blinded controlled trial.SettingSingle-center university hospital.ParticipantsFifty patients undergoing open esophagectomy.InterventionsPatients were randomized to either early (EA, after induction of general anesthesia) or late activation of TEA (LA, after re-established gastric continuity). Plasma 6-keto-PGF1α, a stable metabolite of PGI2 and interleukine-6 (IL6) were measured in plasma during surgery along with hemodynamic variables and MTS graded according to facial flushing together with plasma C-reactive protein on the third post-operative day.ResultsForty-five patients met the inclusion criteria. Development of MTS tended to be more prevalent with EA (n=13/25 [52%]) than with LA TEA (n=5/20 [25%], p=0.08). For patients who developed MTS, there was a transient increase in plasma 6-keto-PGF1α by 15 min of surgery and plasma IL6 (p<0.001) as C-reactive protein (P<0.009) increased. EA TEA influenced the amount of phenylephrine needed to maintain mean arterial pressure >60 mmHg in patients who developed MTS (0.16 [0.016–0.019] mg/min vs MTS and LA TEA 0.000 [0.000–0.005] mg/min, p<0.001).ConclusionThe incidence of MTS is not prevented by TEA in patients undergoing open esophagectomy. On the contrary, the risk of hypotension is increased in patients exposed to TEA during surgery, and the results suggest that it is advantageous to delay activation of TEA. Also, MTS seems to be associated with a systemic inflammatory response, maybe explaining the aggravated post-operative outcome.

The Analgesic Effects of Thoracic Paravertebral Block versus Thoracic Epidural Anesthesia After Thoracoscopic Surgery: A Meta-Analysis.

BackgroundTo date, there is no definitive evidence for the analgesic effects and side effects of thoracic epidural anesthesia (TEA) versus thoracic paravertebral block (TPVB) after thoracoscopic surgery. In this study, we conducted a meta-analysis of published randomized clinical trials (RCTs) to analyze the analgesic effects of TEA versus TPVB after thoracoscopic surgery.MethodsWe systematically searched RCTs published by October 26, 2020, in PubMed, EMBASE, and Cochrane library and conducted a meta-analysis to analyze the analgesic effects of TEA versus TPVB after thoracoscopic surgery. The primary measure was postoperative pain score, and the secondary measures were postoperative 24-hour usage of opioids, hypotension, postoperative nausea, and vomiting.ResultsA total of 458 patients from five RCTs were included in this study. After thoracoscopic surgery, the numerical rating scale (NRS) score for resting pain was higher in the TPVB group than in the TEA group at 1–2 hours and 4–6 hours after surgery (MD = 0.44, 95% CI = 0.24 to 0.64, P < 0.0001, I2 = 0%; MD = 0.47, 95% CI = 0.23 to 0.70, P < 0.0001, I2 = 0%). The postoperative 24-hour usage of morphine was higher in the TPVB group than in the TEA group (SMD = 0.67; 95% CI = 0.03 to 1.31; P = 0.04; I2 = 84%). The incidence of hypotension was significantly lower in the TPVB group than in the TEA group (OR = 4.52; 95% CI = 2.03 to 10.10; P = 0.0002; I2 = 0%). No significant between-group difference was observed in postoperative nausea and vomiting (PONV).ConclusionCompared with TPVB, TEA provides statistically significant but clinically unimportant short-term benefits following thoracoscopic surgery.

THORACIC COMBINED SPINAL EPIDURAL ANESTHESIA FOR LAPAROSCOPIC CHOLECYSTECTOMY

Background and Aims: The use of regional anesthesia for laparoscopic cholecystectomy has been reserved for patients who are at high-risk under general anesthesia (GA). The aim of this study was to assess whether thoracic combined spinal epidural (CSE) anesthesia is a feasible option for American Society of Anesthesiologists (ASA) physical status I and II patients undergoing elective laparoscopic cholecystectomy. Material and Methods: Thirty ASA physical status I and II patients undergoing elective laparoscopic cholecystectomy received thoracic CSE anesthesia at T9-T10 or T10-T11 interspinous space using the midline approach. Two ml of isobaric levobupivacaine 0.5% with 25 μg of fentanyl was given intrathecally. Surgery was conducted successfully in all except Results: one patient. Thoracic CSE was performed at T9-T10 interspace in 25 patients and T10-T11 interspace in ve patients. Paresthesia occurred in two patients (6.6%) transiently on Whitacre needle insertion that disappeared spontaneously. Dural puncture on epidural needle insertion occurred in one patient, and intrathecal placement of epidural catheter occurred in one. Ten patients (33%) complained of shoulder pain. Conversion to GA was done in one patient due to severe shoulder pain and anxiety. Hypotension occurred in 11 patients (36%) and all responded to single dose of mephenteramine 6 mg and uid bolus. Bradycardia occurred in six patients (20%) which was managed in all with a single dose of atropine. Thoracic CSE anesthesia can be used Conclusion: effectively for ASA I and II patients undergoing laparoscopic cholecystectomy with signicant postoperative benets

Does thoracic epidural anaesthesia constitute over-instrumentation in video- and robotic-assisted thoracoscopic lung parenchyma resections?

Effective and sustained perioperative analgesia in thoracic surgery and pulmonary resection is beneficial to patients by reducing both postoperative pulmonary complications and the incidence of chronic pain. In this review, the indication of thoracic epidural anaesthesia in video- (VATS) and robotic-assisted (RATS) thoracoscopy shall be critically objectified and presented in a differentiated way. Pain following VATS and RATS has a negative influence on lung function by inhibiting deep respiration, suppressing coughing and secretion and favours the development of atelectasis, pneumonia and other postoperative pulmonary complications.In addition, inadequate pain therapy after these procedures may lead to chronic pain. Since clear evidence-based recommendations for optimal postoperative analgesia are still lacking in VATS and RATS, there can be no universal recommendation that fits all centres and patients. In this context, thoracic epidural analgesia is the most effective analgesia procedure for perioperative pain control in VATS and RATS-assisted surgery for patients with pulmonary risk factors.

Biventricular function in exercise during autonomic (thoracic epidural) block

BackgroundBlockade of cardiac sympathetic fibers by thoracic epidural anesthesia (TEA) was previously shown to reduce right and left ventricular systolic function and effective pulmonary arterial elastance. At conditions of constant paced heart rate, cardiac output and systemic hemodynamics were unchanged. In this study, we further investigated the effect of cardiac sympathicolysis during physical stress and increased oxygen demand.MethodsIn a cross-over design, 12 patients scheduled to undergo thoracic surgery performed dynamic ergometric exercise tests with and without TEA. Hemodynamics were monitored and biventricular function was measured by transthoracic two-dimensional and M-mode echocardiography, pulsed wave Doppler and tissue Doppler imaging.ResultsTEA attenuated systolic RV function (TV Sʹ: − 21%, P < 0.001) and LV function (MV Sʹ: − 14%, P = 0.025), but biventricular diastolic function was not affected. HR (− 11%, P < 0.001), SVI (− 15%, P = 0.006), CI (− 21%, P < 0.001) and MAP (− 12%, P < 0.001) were decreased during TEA, but SVR was not affected. Exercise resulted in significant augmentation of systolic and diastolic biventricular function. During exercise HR, SVI, CI and MAP increased (respectively, + 86%, + 19%, + 124% and + 17%, all P < 0.001), whereas SVR decreased (− 49%, P < 0.001). No significant interactions between exercise and TEA were found, except for RPP (P = 0.024) and MV E DT (P = 0.035).ConclusionCardiac sympathetic blockade by TEA reduced LV and RV systolic function but did not significantly blunt exercise-induced increases in LV and RV function. These data indicate that additional mechanisms besides those controlled by the cardiac sympathetic nervous system are involved in the regulation of cardiac function during dynamic exercise.Trial registration Clinical trial registration: Nederlands Trial Register, NTR 4880 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4880.

Epidural versus general anesthesia for open pyloromyotomy in infants: A retrospective observational study.

BackgroundThoracic epidural anesthesia for open infantile hypertrophic pyloric stenosis surgery is a controversial issue in the presence of little comparative data.AimsTo compare this approach to general anesthesia for desaturation events (≤90% oxygen saturation) and absolute values of minimal oxygen saturation, minimal heart frequency, operating‐room occupancy time, and durations of surgery in a retrospective study design.MethodsData were retrieved for patients with infantile hypertrophic pyloric stenosis managed by thoracic epidurals under sedation or general anesthesia with rapid sequence induction between 01/2007 and 12/2017. Oxygen saturation and heart rate were analyzed over eight 5‐minutes intervals relative to the start of anesthesia / sedation (four‐time intervals) and before discharge of the patient from the operating room (four‐time intervals). Fisher's exact tests and mixed model two‐way analysis of variance for repeated measures were employed for intergroup comparisons.ResultsThe epidural and general anesthesia groups included 69 and 32 evaluable infants, respectively. Patients managed under epidural anesthesia had cumulatively higher minimimal mean (SD) oxygen saturation values (98.2 [2.6] % versus 96.6 [5.2] %, p < 0.001) and lower minimal mean (SD) heart rate values (127.9 [15.0] beats per minute versus 140.7 [17.2] beats per minute, p < 0.001) over time. Similarly, the frequency of desaturation events (defined as ≤90% oxygen saturation) was significantly lower for these patients during the period of 5 minutes after induction of sedation or general anesthesia (odds ratio 7.4 [2.1–25.9]; p = 0.001) and during the subsequent period of five minutes (odds ratio 6.2 [1.1–33.9]; p = 0.031). One case of prolonged respiratory weaning was observed in the general anesthesia group. The mean (SD) operating‐room occupancy was 61.9 (16.6) minutes for the epidural anesthesia group versus 73.3 (22.2) minutes for the general anesthesia group (p = 0.005) as a result of shorter emergence from sedation.ConclusionsIn our series, maintaining spontaneous breathing with minimal airway manipulation in patients undergoing open repair of hypertrophic pyloric stenosis under single‐shot epidural anesthesia resulted in fewer desaturation events ≤90% than general anesthesia. In addition, this approach seems to result in shorter turnover times in the operating room.

A prospective study on the comparison of general anesthesia and tea (thoracic epidural anesthesia) for perioperative outcomes in patients undergoing modified radical mastectomy

The 2nd most common tumor among women is breast cancer. Surgery is usually done by general anesthesia (GA). TEA is one of the anesthetic procedures that can be performed using local anesthetic epidural administration. TEA may boost pain relief without the potential for respiratory muscle weakness and sedation. An epidural catheter was inserted in T4 to T5 for the T-group, with a 10-15 ml injection of 0.75% ropivacaine. Intermittent supplements of 5-10 ml 0.75% ropivacaine maintained anesthesia. General anesthesia was caused by fentanyl of 1-2 μg/kg, accompanied by propofol (1.5-2 mg/kg), with sevoflurane. We evaluated intraoperative hemodynamics, post-operative patient parameters like nausea and vomiting, shivering, respiratory depression. Overall patient satisfaction is compared between two groups. The demographic data was similar in both groups. Intraoperative hypotension observed in 33.3% of group T patients and 16.6% of group G patients. 20% of the group T patients showed intraoperative bradycardia, whereas 6.66% of group G patients showed intraoperative bradycardia. Incidence of vomiting &amp; nausea is 26.6% in group G, whereas in group T it is 6.66%. The incidence of post-operative shivering is equal in both groups. Post-operative respiratory depression is not observed in both groups. 86.6% of the group T patients are satisfied overall, whereas it is 60% in group G.