Hepatocellular integrity during sevoflurane anesthesia with induced hypotension

The effect of sevoflurane anesthesia with or without induced hypotension on hepatocellular integrity was studied. Forty adult consented patients scheduled for various urological procedures were allocated randomly to either NTG group [nitroglycerin-induced hypotension] or a control group of twenty patients each. Anesthesia was induced and maintained by fentanyl, sevoflurane and vecuronium in both groups. In NTG group, nitro-glycerin infusion was adjusted to maintain mean arterial pressure [MAP] of 50-65 mm Hg. Specific and sensitive hepatic biomarkers; alpha [alpha] and pi [pi] glutathione S-transferases [GST] and hyaluronic acid [HA], also traditional liver enzymes; aspartate [AST] and alanine [ALT] aminotransferases were measured at: TO [pre-induction], T1, T2, T3 [15, 30 and 60 minutes after MAP stabilization respectively] and T4 [24 hours after anesthesia end]. Plasma alpha-GST significantly increased at T3 in control group [p < 0.05] and in NTG group [p < 0.01] compared to T0 in same group. In NTG group, hyaluronic acid con-centrations was significantly increased at T1, T2 [p < 0.05] and T3 [p < 0.01] from T0. Compared to control group, alpha- GST and HA concentrations showed significant increases in NTG group at T3 with p < 0.05 then returned back to normal range at T4. But, pi-GST, AST and ALT showed no significant changes throughout the study in both groups

non opioid fast track anesthetic regimen for colonic resection

Fast-tracking implies a preoperative patient care paradigm that reduces time to recovery and discharge. The current study adopted fast-track anesthetic techniques, comparing outcome of a multimodal non-opioid and another opioid regimen, on recovery profiles after colonic surgery, with standard anesthetic practice. Seventy five ASA II colectomy patients were randomly assigned to one of three groups. Control group for conventional general anesthetic technique and two fast-track anesthesia groups using combined light general anesthesia and epidural techniques. Epidural maintenance was by infusion cocktail of bupivacaine-fentanyl in opioid-based group, while in non-opioid group by bupivacaine-ketamine which were both continued postoperatively for pain in lower doses and concentrations. Postoperative analgesia in control group was achieved by morphine. Supplemental ketorolac and acetaminophen were added only to non-opioid group. Early and intermediate recovery profiles were compared among the three groups together with recorded side effects. All patients in fast-track groups had significant shorter times to: awakening, extubation, orientation, both PACU arrival and discharge, hospital stay with a significant lower mean VAS for pain at rest, and rescue analgesia, compared to control group. Control group had a significant higher rate of postoperative nausea and vomiting, drowsiness and pruritis. Non-opioid fast-track regimen had a significant shorter PACU and hospital stay with lower side-effects rate than opioid one. Fast-track anesthesia enhanced recovery profile. Non-opioid regimen was superior to opioid-based, having a better recovery profile and a lower rate of side-effects