Pulmonary function and pain relief after laparoscopic gastric banding performed under combined general epidural anesthesia in morbidly obese patients

Recovery from general anesthesia might be compromised in morbidly obese patients due to increased the risk of postoperative hypoxaemia and pulmonary complications, particularly after abdominal surgery. This study was carried out to compare the effect of general anesthesia and combined general epidural anesthesia in laparoscopic gastric banding to control postoperative pain, their effect on pulmonary functions and recovery time. Thirty adult patients aged 20-33years, ASA status I-II, undergoing elective laparoscopic gastric banding for treatment of morbid obesity. They were divided randomly into 2 equal groups according to anesthesia received. Group I [n=15] received combined general cervical epidural anesthesia and group II [n=15] received general anesthesia alone. Subjective pain relief was assessed by visual analogue scale. Pulmonary functions were assessed by forced vital capacity, forced expiratory volume in 1st second and peak expiratory flow rate [FVC, FEV1 and PEFR]. Pulmonary function tests were better in group I than group II at first and six hours postoperatively. FVC, FEV1 and PEFR were reduced significantly in group II than in group I [forced vital capacity was reduced by 42% compared with 30%, forced expiratory volume in 1st second was reduced by 43% compared with 31% and peak expiratory flow rate by 12% compared with 8% respectively]. Pain severity during mobilization and on coughing was significantly less in group I than in group II as evidenced by less VAS scores. Also, the narcotic consumption was less in group I. Postoperative recovery time was shorter in group I than in group II. [Times to extubation were 6 +/- 1min, 13 +/- 8 min respectively]. It was concluded that: Combined general epidural anesthesia, in morbidly obese patients had less postoperative pain and more preservation of pulmonary functions after laparoscopic gastric banding

comparative study evaluating the efficacy of cuffed oropharyngeal airway and the laryngeal mask airway in spontaneously breathing anesthetized patients

The cuffed oro-pharyngeal airway [COPA], a modified Guedel airway, was compared with laryngeal mask airway [LMA] during spontaneous breathing anesthesia. Parameters of comparison were ease of use, physiological tolerance, hemodynamics and the frequency of clinical problems. We studied 50 adult patients, ASA grade I and II undergoing short surgical procedures. The patients were randomly allocated into two groups of 25 each, group I [COPA] and group II [LMA] were pre-medicated with intravenous glycopyrrolate, intravenous midazolam and pentazocine for sedation. Intravenous propofol was the inducing agent, and the patients was maintained using oxygen, nitrous oxide and sevoflurane. The insertion time, number of attempts, ease of insertion, airway manipulations, hands free anesthesia, hemodynamic parameters, complications and overall efficacy with the use of either device were compared. In group I, in 92% of cases insertion was easy and successful in the first attempt, in group II, it was 80%. Less time required in group I versus group II but more airway manipulations were needed in group I in order to achieve unobstructed airway, hence not very good for hand free anesthesia. Hemodynamic parameters were comparable in the two groups Complication rate was less and the overall assessment for COPA was graded as good. Thus, the cuffed oropharyngeal airway is comparable to laryngeal mask airway but it is not better as far as hand free anesthesia is concerned

Comparative study evaluating the efficacy of various ventilatory modes used for weaning from mechanical ventilation in adult respiratory distress syndrome [ARDS]

Sixty-four patients with ARDS requiring mechanical ventilation were studied retrospectively to evaluate the efficacy of various ventilatory modes of weaning. Weaning was attempted in 50 patients. IMV and PEEP was used as a primary mode in 86% of the patients. There was a 28% failure rate to wean by these methods and those who were weaned successfully did so in a mean period of 2.2 days CPAP alone, as a primary mode of weaning was used in 10% of patients awl in those who failed with IMV and PEEP modes, with excellent results. However, the number of patients in this group is too small for further conclusions. The improvements in ventilator settings and introduction of pressure support and pressure control ventilation make comparison with practices described here problematic. The availability of Mandatory Minute Volume [MMV] for weaning with Dragher Evita Ventilators, that have recently been introduced, promise to offer an alternative mode for weaning