Inguinal hernia repair: comparative study between local spinal and general anesthesia

To compare three different anesthetic techniques for inguinal hernia repair [regional, spinal and general] anesthesia. Prospective study included 75 adult male patients scheduled for elective unilateral reducible primary inguinal hernia repair. Patients were between 18-80 years, ASA physical status I and II. Patients were divided into 3 groups: group I: 25 patients received general anesthesia. Group II: 25 patients received local anesthesia. Group III: 25 patients, received spinal anesthesia. The period from the beginning to the end of the operation was recorded as the duration of the operation. Mean B.P and heart rate, were also recorded. Satisfaction would be recorded as satisfactory or unsatisfactory. Complication: postoperative nausea, vomiting, retention of urine, headache and sore throat were recorded for each patient. There was no statistical significant difference as regard to age, body mass index [BMI], HR and BP [P value > 0.05]. The duration of the procedure was significantly longer in local anesthesia group in comparison to general anesthesia and spinal anesthesia group [P value < 0.01]. Hospital stay was less in group II than the other two groups. Patients were more satisfied in local anesthesia group than the other groups. The cost of the operation was significantly lower in local anesthesia group in comparison to the other two groups. Postoperative pain as measured by Visual analogue scale [VAS] was lower in local anesthesia group than the other groups. Also complications were lower in local anesthesia group in comparison with other groups. We concluded that a proper inguinal field block for inguinal hernia repair provides satisfactory intraoperative analgesia and great benefits for patients as regard faster recovery, less pain, faster mobilization and higher satisfaction

Effect of gynecological laparoscopy on intraocular pressure in patients anesthetized with propofol total intravenous anesthesia versus isoflurane inhaled anesthesia

To evaluate the effect of gynecological laparoscopy on intraocular pressure changes in patients anesthetized with propofol total intravenous anesthesia in comparison to isoflurane inhaled anesthesia. This is a prospective randomized clinical study was done in the departments of Obstetrics and Gynaecology, Sohag University Hospital. Thirty patients underwent an elective gynecological laparoscopy were recruited in this study after fulfilling the inclusion criteria. Patients were divided randomly into two groups; propofol group [n=15] and isoflurane group [n=15]. MAP, HR, peak and plateau airway pressures [Paw], ETco2 and IOP were recorded at the following time points. Tl: before the induction of anesthesia, T2: before pneumoperitoneum, T3: after pneumoperitoneum, T4: at 15°-20° head-down tilt, T5: After return to the horizontal position, T6: after the pneumoperitoneum had been evacuated and lastly T7: in the recovery room, 20 minute after tracheal extubation. Both groups were comparable as regard to their age, body mass index [BMI], duration of the procedure and the preoperative IOP. There were no significant differences in MAP or HR between both groups. After induction of anesthesia, IOP decreased significantly in propofol group [P<0.01] than isoflurane group [P<0.05]. In the isoflurane group, there was a significant increase in IOP after pneumoperitoneum [T3 versus T2, P< 0.05]. Also there was a significant increase in the IOP after head-down position [T4 versus T2, P< 0.01], which exceeded the preoperative IOP value [T4 versus Tl]. In the propofol group, IOP insignificantly increased after pneumoperitoneum and with head-down position. IOP in propofol group was at all times less than isoflurane group. In the recovery room, IOP returned to baseline in the Isoflurane group, but remained insignificantly lower in the propofol group. There was no significant correlation between MAP, HR, IOP values and plateau airway pressures in both groups. Laparoscopic gynecologic surgery with head down position increases IOP within the normal diurnal range. propofol TIVA has an IOP controlling effect during laparoscopy and may be preferred if control of IOP is a must before laparoscopy