Comparative histological and clinical study of two inhalar anaesthetics

Sevoflurane [Fluromethyl 1,1,1,3,3,3, Hexafluoro isopropyl ether] is one of the newly introduced inhalational Anaesthesia. It is considered as a rapid acting and potent inhalation anaesthetic agent. It is metabolized in the body into non-toxic substances. It also has a rapid uptake and elimination rate due to its low blood gas partition coefficient, which approaches that of nitrous oxide. Interest in sevoflurane has increased with the recent emphasis for out patient surgery because it has a mild ethereal odor and low solubility in blood; lipid; and tissues. So, it is suggested as being anaesthetic of the future. This study is designed to illustrate the histological and the clinical effects of sevoflurane in comparison with isoflurane as a common inhalational anaesthetic agent, regarding the haemodynamic, hepatic and renal effects. The clinical study included 80 adult persons of both sexes, during surgical operations. The patients were divided into 2 groups, 40 persons each. Group I: received sevoflurane and group II: received isoflurane. Routine examinations; investigations; Liver and renal function tests were done just before induction and after 2 hours; 4 hours; 24 hours and 7 days of recovery. The experimental study was done on 90 rats of both sexes. They were divided into 3 groups: 30 rats each. Group [A]: control group, group [B]: Anaesthetized with sevoflurane and group [C]: Anaesthetized with isoflurane. Each group was subdivided into 2 subgroups, 15 rats. The 1st subgroup was sacrificed after 24 hours of exposure. The 2nd subgroup was sacrificed after 7 days from the start of exposure. The rats were sacrificed and their blood was investigated. Liver and kidney structure were evaluated histologically and histochemically. Our results revealed that, sevoflurane and isoflurane had non-significant post-operative clinical manifestations and non-significant changes on the liver or kidney function tests. Histological examination of liver revealed normal hepatocytes and mild congestion in blood sinusoids and central veins in sevoflurane group. While, liver sections in isoflurane group showed more congestion, dilatation and cellular infiltration. . Histological examination of the kidney revealed no changes in the sevoflurane group. In contrast, isoflurane group had congestion and cellular infiltration of renal parenchyma. All changes almost completely disappeared after seven days of recovery. Histochemical results revealed significant decrease in PAS positive material and succinic dehydrogenase enzyme activity in hepatocytes and renal tubules, mainly in isoflurane than sevoflurane groups. While, acid and alkaline phosphatase enzymes activity showed non-significant decrease in both drugs. All changes were non-significant after seven days of recovery. This study proved that the sevoflurane had no harmful effect and can be considered as a safe inhalational drug

Neuromuscular blocking effects of rocuronium with different inhalation anaesthetics

This study was designed to examine the interactions of 1.0 MAC of two different inhalation anesthetic agents, isoflurane and sevoflurane, [and 66% nitrous oxide in oxygen, 20-min steady state] or total intravenous anesthesia [TIVA] using propofol/fentanyl with rocuronium. Neuromuscular function was monitored using relaxograph date, NMT100. Neuromuscular block was monitored by measuring the force of contraction of the abductor pollicis muscle after single-twitch stimulation of the ulnar nerve at 0.1 Hz. The ED50 and ED95 [dose required to produce 50% and 95% depression of twitch tension, respectively] of rocuronium were recorded

Prolonged total parenteral nutrition to tunnel or not?

The effects of subcutaneous catheter tunneling on the incidence of catheter sepsis and catheter life-span was studied in 30 patients who received prolonged total parenteral nutrition [TPN] and long-term chemotherapy. The effects of catheter tunneling were compared with conventional venous catheters inserted in 120 surgical patients. The total number of catheters inserted was 235. Catheter life span range was 30-180 days in tunneling group and 8-15 days in the non-tunneling one. Catheter sepsis occurred in 39 cases in the non-tunneling group, while it was suspected in only one case in the tunneling one. It was concluded that tunneling should be considered in chronic venous access because it increases catheter life span and diminishes the incidence of catheter-related sepsis, especially in critical surgical patients where nursing care is suboptimal

Anaesthetic and surgical considerations of hepatotoxic effects of organophosphorous pesticides pollution on human and rabbit's liver

This work included clinical and experimental study to clarify the toxic effects of organophosphorous compounds [OPC]. The clinical work was done on 20 adult male patients known to be in contact with OPC passively or actively and scheduled for elective cholecystectomy under general anesthesia. Preoperative, operative and postoperative serum hepatic transaminase, alkaline phosphates, bilirubin and liver biopsy were studied. The experimental work included 24 rabbits allowed to inhale airline, rosepher and their mixture for five hours daily for seven successive days. Serum liver transaminase, alkaline phosphatase, bilirubin and liver biopsy were studied to clarify the histopathologic effects of OPC. This study proved that serum hepatic transaminase and alkaline phosphatase showed higher level than base level after anesthesia and postoperatively in clinical work. Liver biopsy revealed mild to moderate histopathologic changes in the form of fatty infiltration associated with focal steatosis. However, the experimental study showed marked and significant higher levels of serum hepatic transaminase and reduction of alkaline phosphatase level. Liver biopsy showed marked ballooning degenerative massive venous congestion and marked lymphatic infiltration

Laparoscopic vagotomy in treatment of chronic duodenal ulcer [Posterior truncal vagotomy associated with anterior highly selective vagotomy]

To evaluate the safety of laparoscopic vagotomy this study included 20 patients with chronic duodenal ulcer, admitted in Al-Zahraa university hospital in the period between 1994-1997. Preoperatively, full history, clinical examination upper gastrointestinal endoscopy, abdominal ultrasonography and barium meal were done to all patients. Laparoscopic posterior truncal vagotomy associated with anterior highly selective vagotomy was done to all patients and any operative or postoperative complications were recorded. Postoperatively clinical evaluation and endoscopy were repeated to compare with the preoperative data and to assess ulcer healing. 90 to 180 minutes [mean 135 mm.]. Intraoperatively there was minimal bleeding in 2 cases and was controlled by diathermy and clips, two cases of arrthymia and one case of hypercapnoea improved spontaneously after temporal desufflation of co2. Postoperatively scapular pain, diffuse abdominal pain and mild fever were noticed in 6,2 and 2 patients respectively. Postoperative stay in the hospital was ranged from one to 5 days [mean 3 days]. Two patients were still complaining of dyspepsia and were improved by medical treatment. Six months follow up by endoscopy revealed that 19 cases were completely free and one case still had an ulcer which also was improved by medical treatment. One patient developed a very small hernia at the site of laparoscopic port above the umbilicus. However laparoscopic vagotomy is a new promising, minimally invasive technique. Its simplicity, safety, efficacy, minimal scarring and early mobilization support its wider use, but it will be necessary to validate this initial experience with a large number of patients and adequate long term follow up. So we concluded that laparoscopic vagotomy should not be developed so as to avoid or be contrary to the established principles of open surgery, but rather it should be designed as a continuation of classical surgery with new and different techniques