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

Total intravenous anesthesia versus inhalational anesthesia in patients undergoing laparoscopic cholecystectomy. A comparative study of postoperative subclinical hepatic dysfunction

Inhalational anesthetics are reported to cause mild liver dysfunction in some cases. This dysfunction reflected as asymptomatic transient elevation in liver enzyme. On the other hand no reports have indicated that total intravenous anesthetics [TIVA] cause liver or other organ dysfunction. In addition the use of TIVA become popular due to the availability of new drugs which have short acting effects and TIVA technique produce less air pollution. 40 patients undergoing laparoscopic cholecystectomy were randomized into two equal groups. The first group received inhalational anesthesia. Anesthesia induced with fentanyl 2 microg/kg, atracurium 0.5 mg/kg, propofol 2.5mg/kg and was maintained using sevoflurane 2-3%, nitrous oxide 66% in oxygen with atracurium infusion at rate of 0.5 mg/kg/hr. The second group received TIVA. Anesthesia was induced with fentanyl 2 microg /kg and atracurium 0.5 mg/kg and propofol 2.5 mg/kg. and anesthesia was maintained using propofol infusion using a syringe pump at a rate of 10 mg/kg/hr for 10 mm then 8 mg/kg for the next 10 mm and finally maintained at 6mg/kg/hr with nitrous oxide 66% in oxygen and muscle relaxation was maintained with infusion of atracurium in rate of 0.5 mg/kg/h. Liver enzymes were measured preoperative, at the end of operation, 3h, 6h, and 24 hours postoperative and compared to the preoperative values. There were transient significant increase in the values of AD, GST, and AST in inhalational group and ALT significantly increased in both groups. There were insignificant changes in hemodynamic parameters. TIVA technique is superior to inhalational technique during laparoscopic cholecystectomy as regards its effect on the liver enzymes

Comparative study to evaluate positioning of double-lumen endobroncheal tubes and the correlation between clinical and the role of fiber optic brochoscopy in thoracic anesthesia

Fiber optic bronchoscopy has been recommended to verify and the position of double lumen tubes [DLT], but this remains controversial. We studied the role of brochoscopy for placing and monitoring DLTs, after blind intubation and after positioning of the patient. 25 other patients undergoing thoracotomy were studied. Clinical criteria suggested good positioning in all cases, however, subsequent bronchoscopy revealed mal-position in 4 cases. A DLT was considered mal-positioned when it had to be moved> 0.5 cm to correct its position. Critical mal-position were those that might have affected patients safety or influenced the surgical procedure if left uncorrected. Bronchoscopic finding included bronchial cuff herniation and obstruction of left upper lobe brunchus. So, after blind intubation and the patient positioning, about one fifth of DLTs required repositioning. Routine fiber optic bronchoscopy is therefore recommended after intubation and after patients positioning