ABSTRACT
This study aimed to evaluate the applicability of remifentanil-based anesthesia in comparison to sevoflurane-based anesthesia in 60 children assigned to undergo lower abdominal extra-intestinal surgical procedures, Patients were randomly allocated into two equal groups: Propofol/Remifentanil [PR group] or Propofol/Sevoflurane [PS group]. All patients were premedicated using oral midazolam with a maximum dose of 15mg, ondansteron [100 microg/kg] and dexamethasone [0.25-0.5 mg/kg]. In PR Group, anesthesia was induced with propofol 3 mg/kg followed by remifentanil 1 microg/kg; during surgica procedure further injections of remifentanil 0.5 microg/kg were given depending on whether the patient moved or showed signs of awakening in response to skin incision or during the procedure. In PS group; anesthesia was induced with a sleep dose of propofol [3-5 mg/kg] and was continued with 2%-8% sevoflurane and 66% nitrous oxide in oxygen. The minimum sevoflurane concentration used was 2% and was increased up to 8% if the patient moved during skin incision or the procedure. During anesthesia, patients were non-invasively monitored and the times of the start of anesthesia, of the start of the procedure and the time of the end of the procedure and the occurrence of movement during the procedure were noted. During recovery, children were left undisturbed, being called every minute until they first opened their eyes. Anesthetic recovery and distress behavior were assessed using recovery and distress scoring systems. The times at which children first opened their eyes, interacted spontaneously, drank, ate and were ready for discharge from the recovery ward and the hospital were recorded. Incidence of adverse events; hypotension, bradycardia and postoperative nausea and vomiting were monitored throughout the study period. Time till the start of anesthesia was significantly shorter, while time till start of the surgical procedure was non-significantly shorter in PR group compared to that recorded in PS group. Eleven patients; 7 in PS and 4 in PR groups showed minor movement during procedure with a non-significant difference between both groups. All patients were hemodynamically sable throughout the duration of surgery till skin closure and in PACU with a non-significant difference between both groups. Patients included in PR group showed superior emergence off anesttiesia compared to PS group in the form of significantly shorter time to respire spontaneously, to eye opening and to verbalization. Moreover, patients received remifentanil showed significantly shorter time till drinking and eating with significantly shorter PACU and hospital stay in comparison to PS group. Number of patients required rescue analgesia despite increased in both groups, did not show a significant difference. Moreover, mean DS was non-significantly higher in PR group compared to PS group. The incidence of adverse events did not reach the significance level. It can conclude that remifentanil is appropriate for opioid-based anesthesia for children for its provided shorter anesthesia times, hemodynamic stability and rapid recovery characteristics however, attention must be paid for prophylactic antiemesis and proper postoperative analgesia
Subject(s)
Humans , Male , Female , Abdomen/surgery , Child , Propofol , Piperidines , Methyl Ethers , Hemodynamics , Postoperative Period , AnalgesiaABSTRACT
This study aimed to compare the effect of anesthesia using isoflurane [ISO] or sevoflurane [SEVO] in conjunction with nitrous oxide on postoperative liver function tests in 30 cirrhotic patients [Child-Pugh Grade A] assigned to undergo laparoscopic cholecystectomy [LC]. Anesthesia was maintained with either sevoflurane [SEVO group] or isoflurane [ISO group] with nitrous oxide 3 L/min in oxygen 3 L/min. Non-invasive intraoperative monitoring included heart rate [HR], systolic and diastolic blood pressure [SBP and DBF] estimated before induction of anesthesia [T[1]], 5 min. after insufflation [T[2]], 5-min after tilting in reverse Trendlenburg position [T[3]] and after exsufflation of CO2 [T[4]]. Venous blood samples were taken for estimation of serum levels of aspartate [AST] and alanine [ALT] aminotransferases, total bilirubin [TB] and alkaline phosphatase [AP] before and I, 3, and 7 days after surgery. Another venous blood samples were taken at time of induction of anesthesia, at, 2-hrs and 24-hrs after the end of surgery for estimation of serum levels of a-glutathione S-transferase [GST]. The formation of the lidocaine metabolite monoethylglycinexylidide [MEGX Test] was estimated preoperatively and immediately postoperative. All patients developed significantly higher HR, SBP and DBF at T[2] and T[3] compared to at T[1] with a significantly higher measures at T[3] compared to at T[2], but measures recorded at T[4] were significantly lower compared to that recorded at T[2] and T[3] in both groups with a significantly lower blood pressure in ISO group and non-significantly lower blood pressure measures in SEVO group compared to measures recorded at T[1]. Postoperative serum AST and ALT levels were significantly higher compared to preoperative levels in both groups reaching a peak at 3-days PO and declined on the 7[th] PO day with significantly higher levels in ISO group compared to SEVO group at 3-day and 7-day PO. Serum GST levels estimated at and 2-hrs after end of surgery were significantly higher in both groups compared to levels estimated at time of induction of anesthesia with significantly higher levels at 2-hrs compared to levels estimated at end of surgery in both groups, but was significantly higher in ISO group compared to SEVO group. Postoperative serum MEGX levels were significantly lower in both groups compared to levels estimated at time of induction of anesthesia with a nonsignificant difference between both ISO and SEVO group. It could be concluded that LC in cirrhotic patients performed under sevoflurane anesthesia supplemented by NO[2] is a feasible safe procedure with less postoperative impairment of liver function tests in comparison to isoflurane anesthesia and serum GST and MEGX are useful early biomarkerfor liver dysfunction that precede enzymes alteration in cirrhotic patients undergoing LC