Combined epidural-general anesthesia [CEGA] in patients undergoing pancreatic surgery: comparison between bupivacaine 0.125% and 0.25%

Major abdominal surgery results in homodynamic instability mainly due to endogenous prostacyclin release, bleeding, major intercompartemental fluid shift and the hormonal surgical response. This study compared the effects of low thoracic epidural anesthesia with 0.125% and 0.25% bupivacaine on haemodynamic variables, sevoflurane requirements, and stress hormone responses during pancreatic surgery under combined epidural-general anaesthesia [CEGA]. Forty patients undergoing different pancreatic surgery were randomly allocated into two equal groups to receive 10 ml of either isobaric bupivacaine 0.125% [group I] or 0.25% [group II] by low thoracic epidural with sevoflurane general anaesthesia. Sevoflurane was adjusted to achieve a target bispectral index [BIS] of 40-60. Measurements included the inspired [F'SEVO] and the end-tidal sevoflurane concentrations [E'SEVO], blood pressure [BP] and heart rate [HR] before surgery and every 5 min during surgery for 2 h, and stress hormones. Plasma samples for stress response evaluation were taken before and 1 and 2 h after the start of surgery for measurements of epinephrine, and cortisol. During surgery, both groups were similar for HR, BPand BIS, but [EISEVO] and [E'SEVO] were significantly higher and more fluctuated with bupivacaine 0.125% than with 0.25%. Moreover, the total amount of propofol used for induction of general anesthesia and the total fentanyl used during anesthesia were significantly low in 0.25% bupivacaine group. Intraoperative requirements of ephedrine were higher in 0.25% bupivacaine group, Intraoperative blood loss and fluid requirements were significantly increase in 0.125% group. Plasma concentrations of epinephrine and cortisol were found to be higher with bupivacaine 0.125% as compared with 0.25%. Combined thoracic epidural-general anesthesia [CEGA] for pancreatic surgery, with 0.25% bupivacaine significantly reduces sevoflurane requirements, blood loss and fluid requirements. In addition, bupivacaine 0.25% suppressed the stress hormone responses better than 0.125% did. However this was on the expenses of more ephedrine requirements

Induced preconditioning of cardiac performance in coronary bypass surgery

Twenty ASA III and IV adult patients scheduled for elective coronary artery surgery were included in the study. Anesthesia was induced and maintained with either sevoflurane [sevoflurane group; n = 10] or propofol [propofol group; n = 10]. All preoperative cardiac medications were continued until the morning of surgery. There were significant decreases in mean arterial blood pressure, cardiac index and ejection fraction after CPB in propofol group compared with sevoflurane. Further, the plasma creatine kinase myocardial isoenzyrne concentrations were significantly higher in propofol group but did not approach the critical values needed for diagnosis of myocardial infarction. It is concluded that, sevoflurane appears to be associated with better hemodynamic stability before and after CPB than propofol. This could be attributed to cardioprotective effect of sevoflurane during ischemia and reperfusion

Airway protection by the laryngeal mask airway in children

The pediatric laryngeal mask airway [LMA] is a scale-down version of the adult form, and no direct postmortem specimen work has been performed so far. There are several anatomical differences between pediatric and adult airways, and hence, the scale- down version of the adult LMA is not necessarily water-tight in pediatric patients. We performed a prospective study to assess airway protection by the LMA in pediatric patients, using methylence blue [injected in the pharynx outside the LMA] and the fbreoptic bronchoscope to view the inside of the mask, to detect any leakage of the dye. Fifty Patients [40 boys and 10 girls] aged 1-10 years [mean 4.5 yr] were studied. All patients underwent surgery below the level of the umbilicus, under light general anesthesia combined with caudal epidural block. All patients were allowed to breath spontaneously over an Ayre's T-Piece. Dye staining of the inside of the mask was detected in 5 patients [10%]. The esophageal opening was visualized within the mask in 3 patients [6%]. No serious complications occurred in any of our patients

Efficacy of local anesthetic [EMLA] in producing painless venipuncture in children

Children between the ages of 4-16 years constitute a considerable proportion of patients presenting for eye surgery at King Khaled Eye Specialist Hospital. We conducted a clinical double-masked prospective to compare the efficacy of EMLA cream [eutectic mixture of lidocaine 25 mg and prilocaine 25 mg/Gm] versus placebo in alleviating pain from venipuncture in 96 children, 4-16 years old [age and sex matched], presenting for genetic blood testing or routine pre-hospitalization examination. Both patient and observer assessed pain using a 1-3 visual analogue score and 1-4 verbal analogue score. EMLA cream produced significantly better analgesia than placebo. EMLA cream 5% seems to be effective in producing dermal analgesia in children for routine blood extraction and intravenous injection