Evaluation of cerebral blood flow during laparoscopic cholecystectomy using transcranial doppler ultrasonography

Laparoscopic procedures are common nowadays. They have many advantages, however, they carry special risks in certain cases due to the associated cardiac and pulmonary dysfunction as well as CO2 retention. The aim of this work is to evaluate the effect of one of these procedures; namely laparoscopic cholecystectomy; on cerebral blood flow [CBP] using transcranial Doppler [TCD] ultrasonography to determine the right middle cerebral artery velocity [MCAV] which is proved to correlate well with CBF. Sixteen patients classified as American Society of Anaesthesiologists [ASA] physical status I, and II were included in the study. Their heart rate [HR], mean arterial pressure [MAP], end-tidal carbon dioxide concentration [PETCO2], arterial carbon dioxide tension [PaCO2], and MCAV were recorded before CO2 insufflation, then 10, 20, 30 and 40 minutes after insufflation, and again 10 minutes after peritoneal deflation. Significant increase [P<0.01] in MCAV in all the recorded values was found. This increase was attributed mainly to the accompanying rise in PaCO2. The present study concluded that CBF was increased significantly in laparoscopic procedures utilizing C02 as the insufflation gas. ft is recommended to avoid pneumoperitonium or to use it with extreme caution in patients with suspected or documented intracranial injuries due to the potential for significant increase in intracranial pressure [ICP] and alterations in cerebral perfusion pressure [CPP]

Comparison between percutaneous retrogasserian glycerol rhizolysis and percutaneous radiofrequency trigeminal gangliolysis for management of trigeminal neuralgia

Approximately 70% of trigeminal neuralgia [TN] patients are well controlled by medical management. Although they are well controlled initially, many of them will become non-responders and the majority of patients will eventually fail medical management. The aim of this work is to study the difference between 2 of the minor surgical procedures used for treatment of trigeminal neuralgia, namely, percutaneous retrogasserian glycerol rhizolysis [PRGR] and percutaneous radiofrequency trigeminal gangliolysis [PRTG]. Thirty two patients with intractable trigeminal neuralgia, had failed medical treatment were included in the study. The patients were divided into 2 equal groups according to the procedure used, PRGR group and PRTG group under fluoroscopic guidance. It was found that PRTG had faster onset of action, higher success and lesser failure rates than PRGR. Recurrence rates after 6 months and one year were 6.25% and 18.75% for PRTG and 12.5% and 25% for PRGR. The incidence of keratitis was higher with PRTG than PRGR while no case of anaesthesia dolorosa was reported in both techniques. In conclusion, both techniques are effective with relative advantages and disadvantages to each. PRTG disadvantages include requirements for a cooperative patient and access to radiofrequency equipment. Its great merits include high initial success rates and modest rate of recurrence. PRGR has a lesser initial success rate and a higher rate of recurrence than with the thermal therapy. It requires less patient cooperation and minimal equipment and appears to be associated with lower incidences of corneal anaesthsia and keratitis

comparison of bupivacaine 0.25% with ropivacaine 0.2% and 0.375% for caudal anaesthesia in children

Thirty- nine boys aged 3-7 yrs. ASA I. undergoing inguinal hernia repair were randomly allocated in this double-blind study. After induction of general anaesthesia, patients were given caudal injection [1 ml/kg] of bupivacaine 0.25% [B 0.25 group], ropivacaine 0.2% [R 0.2 group], or ropivacaine 0.375% [R 0.375 group]. The clinical effectiveness, the degree of motor block and any adverse effects were determined. Data were available for 36 children. The groups were comparable for demographic data and duration of surgery. The onset time of block was similar for B 0.25 and R 0.2 groups, but it was shorter for R 0.375 group [7.2 +/- 1.2 min, P<0.05]. A significantly longer [P <0.05] duration of analgesia was observed in the R 0.375 group [366 +/- 72 min], whereas the B 0.25 group [246 +/- 64 min] and the R 0.2 group [[268 +/- 81 min] were comparable. There was no difference [p >0.05] in the number of patients who did not require postoperalive analgesia in all groups. The degree of motor block was significantly lower [P <0.05] in the R 0.2 group than in the two other groups at 1.2 and 3 hours postoperatively. The mean time to first voiding was longer [P<0.05] in R 0.375 group compared to the two other groups. The mean time to first ambulation was significantly shorter [P< 0.05; in R 0.2 group compared to the two other groups. No significant difference was detected in the incidence of vomiting between the three groups. These findings suggest that caudal administration of 1 ml/kg of 0.2% ropivacaine provide equivalent analgesia to 1 ml/kg of 0.25% bupivacaine with less degree and duration of motor block. On the other hand ropivacaine 0.375% provides longer duration and better quality of analgesia but more intense motor block