ABSTRACT
Objectives: This study was designed to evaluate the applicability of anesthetic myocardial protection [pre-conditioning and minimization of reperfusion injury] using two anesthetic regimens on plasma levels of cardiac troponin T [cTnT], as a marker of myocardial ischemia, in pediatric patients assigned for surgical correction of congenital heart diseases using cardiopulmonary bypass [CPB]
Patients and Methods: The study included 60 patients [36 males and 24 females]. Patients were randomly allocated in 2 equal groups: Midazolam group received a continuous infusion of midazolam [0.2 mg/kg/hour] and Isoflurane group maintained by an end-tidal concentration of isoflurane of 1-1.5% throughout the operation. Six blood samples were taken for estimation of plasma cTnT levels immediately after induction of anesthesia [S1], 8- hours [S2], 16-hours [S3], 24-hours [S4], 36-hours [S5] and 48-hours [S6] after aortic cross-clamping
Results: Plasma cTnT levels estimated after aortic cross-clamping [S2-S6] showed a significant [P1<0.001] elevation in both groups compared to levels estimated in S1 sample. Moreover, plasma cTnT levels showed a progressive increase in all patients irrespective of anesthetic regimen used reaching a peak levels in S4 sample and started to decline thereafter but still significantly higher compared to levels estimated in S1 sample. Plasma cTnT levels estimated in S2 sample showed a non-significant increase in midazolam group compared to levels estimated in isoflurane group. On contrary, plasma cTnT levels estimated in midazolam group at 16, 24, 36 and 48 hours after aortic cross-clamping were significantly higher [P[6]=0.034, 0.01, <0.001 and =0.031, respectively] compared to levels estimated in isoflurane group. In midazolam group, there was a positive significant correlation between mechanical ventilation time and plasma cTnT levels estimated at 24-hours [r=0.413, p=0.023], respectively. However, such correlations were non-significant despite being positive in isoflurane group, [r=0.265, p>0.05]
Conclusion: It could be concluded that the hypothesis of anesthetic myocardial protection [preconditioning and minimization of reperfusion injury] is applicable for pediatric patients with congenital heart disease who are assigned for cardiac surgery. Isoflurane-based anesthesia minimized myocardial ischemic and reperfusion injury and provided efficient cardioprotection irrespective of the type of cardiac lesion
ABSTRACT
We compared general anesthesia [GA] with spinal anesthesia [SA] foroutpatient knee arthroscopy. Fifty patients were randomized to receive either sevoflurane in a mixture of nitrous oxide [60%] in oxygen with laryngeal mask, or 30 mg of lidocaine 1% spinal anesthesia. All patients received premedication with intravenous [iv] lornoxicam 8 mg and at theend of the operation; patient's knee joint was injected with 1 ug/kg cloni-dine diluted in 20 ml of 0.25% bupivacaine. Postoperatively, iv fentanyl was given if visual pain scale [VAS] at rest exceed 4 and on discharge from the hospital, patients were instructed to take lornoxicam 8 mg tablet every 12 hour [h] as needed for pain. Perioperative vital signs, intraoperative time intervals, duration in the recovery and discharge times were re-corded. Postoperatively, we also evaluated pain and sedation scores, to-tal analgesic requirements, patient satisfaction, and incidence of complications [nausea, vomiting, pruritus, positional headache, backache,difficulty voiding, and dizziness]. We found that in the recovery, no patients in either group asked for analgesia. VAS pain scores were very low in both groups [2.6 +/-0.8 in GA group versus 2.4 +/-1.0 in SA group after60 min postoperatively]. There were no significant differences between both groups as regards total analgesic consumption during 72h postoperatively, and sedation scores. Patients in SA group had longer time of operating room [OR] entry until starting skin preparation [13 +/-4.5 versus 5.2+/-3.1 min] and also, from OR entry until skin incision [16 +/-5.2 versus 10.9 +/-4.7 min] in comparison with patients in GA group. However, the total duration inside OR was not different between both groups. Patients received SA had met the criteria for home readiness earlier than those received GA [68.3 +/-44 versus 95.2 +/-33 min respectively]. Patients in GA group suffered more nausea than in SA [24% vs 8% respectively]. The incidences of other side effects were comparable in both groups and there were no differences in patients' satisfaction scores between groups. We concluded that the two techniques with the multimodal analgesia given had provided comparable patient satisfaction and efficiencies both intra-operatively and postoperatively with low incidence of complications
ABSTRACT
We have evaluated the hypnotic effect of perioperative sublingual melatonin administration in 50 adult patients undergoing major surgery in a prospective, randomized, double blind, placebo-controlled study. 25 patients were given sublingual melatonin and 25 patients were given saline, approximately 100 minutes before a standard anaesthetic and again at 23:00 hours on the day of the operation and on the following day. Sedation and anxiety were quantified before, and 10, 30, 60, and 90 min after premedication, and 15, 30, 60, and 90 min after admission to the recovery room. Blood samples were taken for evaluation of melatonin and stress hormones 'cortisol and epinephrine" concentrations. On the 3rd day postoperatively, patients were asked about satisfaction with the premedication, sleep disruption and any of the suspected side effects of melatonin. Patients who received melatonin had a significant decrease in anxiety levels and increase in levels of sedation before operation compared with controls. Melatonin was effective in decreasing perioperative levels of cortisol and epinephrine compared to placebo. Patients in the placebo group had a decreased nocturnal secretion of melatonin during the first 48 hours postoperatively while patients received melatonin had a better circadian rhythm. Patients received melatonin were more satisfied with premedication without significant differences in the side effects as compared to placebo. It can be concluded that melatonin can be used safely and effectively for premedication and postoperatively as a hypnotic in patients undergoing major surgery