Total intravenous versus inhalational anesthesia for one lung ventilation during thoracic surgery

This study was designed to compare the effect of intra-venous [iv] anesthetic technique using propofol and inhalation anesthetic technique using enflurane on oxygenation and haemodynamics before, during and after one lung ventilation [OLV] in patients undergoing lung surgery. Forty patients undergoing elective thoracotomy for lung surgery with periods of OLV were included in this study. The study investigated the cardiovascular effects and oxygenation status before, during [at selected intervals] and after OLV in 2 groups of patients anaesthetized with either propofol, used for induction and maintenance of anesthesia, or enflurane used for maintenance of anaesthesia. Propofol O[2] anesthesia induced a decrease in HR and MAP and a rise in PCWP and CVP. Enflurane in O[2] for maintenance of anesthesia induced mostly a moderate rise in HR, less decrease in MAP and a rise in PCWP and CVP. The decrease in MAP found in both groups was associated with greater decrease in SVRI in propofol group than enflurane group. The PVRI was increased in both groups of patients, especially in late stages of OLV in propofol group. The CI was decreased in both groups. SVI was found to be increased in most periods of OLV in both anesthesized groups. Both groups had elevated shunt fractions at baseline, no changes during two lung ventilation [TLV], while dynamics and respiratory variables were similar for the two groups. We concluded that total intravenous anesthesia technique [TIVA] with propofol and fentanyl is suitable for major thoracic surgery. It provides smooth and easily controllable anesthetic with stable blood pressure and pulse rate even during the period of one lung ventilation. In spite that the shunt fraction was increased in both groups, the present results suggest that oxygenation may be maintained to a greater degree with propofol anesthesia as shunt fraction was less, which means that propofol anesthesia has a relatively less influence on HPV. The majority of the patients awake quickly and were able to cough and sigh on command

S100-beta and cytokines as early markers to predict outcome after moderate head injury

The aim of this study was to evaluate the potential role of S-100[beta] protein, 1L-1[beta], IL-6 and TNF-alpha as early predictive markers of the severity and outcome after moderate head injury. Twenty-four patients with moderate head injury with Glasgow Coma Scale score "GCS score" [9-12], who, required admission to the intensive care Unit[ICU] were included in this study. Routine ICU monitoring was applied e. g. heart rate, mean blood pressure, continuous ECG, capnography, SaO[2], and CVP. Parameters assessed included GCS at admission, 30 minutes, 60 minutes, 4 hours and then every 12 hours till the end of the study. Ten ml of blood was taken from the internal jugular cannula and another ten mil from the radial artery cannula at admission then at 24, 48, 72 hours for analysis of S-100[beta] protein and interleukin-1 beta;, interteukin-6 and tumour necrosis factor-alpha. A single venous blood sample was taken from 24 healthy volunteers to be considered as a control for the laboratory work. The serum concentrations of S-100[beta] protein, IL-1[beta] IL-6 and TNF-alpha were found to be significantly increased in the arterial and the venous samples at admission, then gradually declines over the next three days with management suggesting that there is a significant brain release of S-100[beta], IL-1[beta], IL-6 and TNF alpha with head injury. The jugular venous concentrations were significantly higher than the arterial concentration all over the time of the study. There were significant inverse correlations between GCS score and both arterial and venous concentrations of S-100[beta] and IL-6 throughout the study period. Also, there were significant inverse correlations between aterial venous concentrations of interleukin-1 beta, TNf -alpha and GCS score at admission and at 24 hours and this correlations became insignificant thereafter. The present study has demonstratred that S-100[beta], interleukin-1 [beta], and tumor- necrosis factor-alpha were increased after head injury. However, S-100 [beta] and interleukin-6 appeared to be the most sensitive predictors and their significant correlations with GCS score make them helpful as prognostic tools in assessing the severity and predicting the outcome after moderate head trauma