ABSTRACT
Background and objective: Laparoscopic techniques have rapidly increased in popularity because of associated benefits. Although the most commonly performed surgery still remains laparoscopic cholecystectomy, many other surgical procedures have been included in the list. Our aim of this study was to compare the hemodynamic changes and emergence characteristics during maintenance of anesthesia either with sevoflurane or propofol infusion in laparoscopic surgeries
Methodology: Fifty patients of ASA physical status I or II, aged between 18-60 years, of either sex, scheduled for various elective laparoscopic surgeries of around 2 hours duration under general anesthesia were selected for this study. All the patients were given premedications; inj glycopyrrolate 0.004 mg/kg, inj ondansetron 0.08 mg/kg and inj fentanyl 1.0 g/kg IV. Induction was done with inj thiopentone sodium 5 mg/kg and inj succinylcholine 2 mg/kg, followed by intubation. Muscle relaxation was achieved with inj vecuronium 0.1 mg/kg loading dose followed by 0.02 mg/kg IV 20-45min post initial PRN. Patients were then randomly divided into 2 groups: Group S [Sevoflurane group] was maintained on sevoflurane 1-1.5% + O[2]:N[2]O [50:50]. Group P received inj propofol 1 mg/kg bolus followed by 100-300 micro g/kg/min infusion + O[2]:N[2]O [50:50]. Mean arterial 2 2 pressure, mean heart rate, and emergence characteristics were recorded. All the quantitative data were analyzed using unpaired T test
Results: Mean heart rate after pneumoperitonium was 93.32 +/- 6.29 vs. 91.00 +/- 4.46 per min for Group S and Group P respectively. Mean blood pressure after pneumoperitonium for Group S was 101.72 +/- 6.32 and for Group P was 98.00 +/- 7.69 mmHg. There was no significant difference in EtCO[2], and SpO[2] was maintained at 99-100% throughout the surgery in both groups. Time for spontaneous respiration, time to spontaneous eye opening, following verbal command and telling own name by the patient were significantly lower in Group S than Group P
Conclusion: We conclude that maintenance of general anesthesia with sevoflurane is associated with faster emergence from anesthesia when compared with propofol, while propofol is associated with lower incidence of PONV in laparoscopic surgical procedures
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Infusions, Intravenous , Methyl Ethers , Laparoscopy , Hemodynamics , Anesthesia , Anesthesia, GeneralABSTRACT
Background: Abdominal field blocks with local anesthetic solutions have been suggested in postoperative analgesia in patients undergoing abdominal wall incisions. In the present study we assessed the analgesic efficacy of ultrasound guided rectus sheath and transversus abdominis plane blocks over first 24 postoperative hours after cesarean deliveries performed through pfannensteil or midline incisions
Methodology: Sixty women undergoing elective or emergency cesarean delivery were enrolled in this randomized, controlled, double-blind trial, and then randomized either to undergo ultrasound guided rectus sheath and transversus abdominis plane blocks with bupivacaine [n=30] or no block [n=30]. Inj diclofenac and inj. paracetamol 1 G, were given to all patients, and inj tramadol was given on request as a rescue analgesic. All patients received a spinal anesthesia with 0.5% heavy bupivacaine, and at the end of surgery [after the skin sutures] bilateral rectus sheath and transversus abdominis plane blocks were performed using 15 to 20 ml of 0.25% bupivacaine in each block on either side [to maximal dose of 3 mg/kg] and no block in the control patients. Each patient was evaluated postoperatively by a blinded investigator at 2, 4, 6, 12 and 24 h postoperatively
Results: Ultrasound guided abdominal field blocks with 0.25% bupivacaine reduced the total tramadol requirement in the first 24 postoperative hours [157 +/- 50.709 vs 386.67 +/- 29.16 mg] and also the visual analogue pain scores at 2 [2 vs 8], 4 [2 vs 8],6 [2 vs 8],12 [4 vs 7] and 24 [4 vs 7] hours postoperatively. No significant difference was found between groups in the incidence of nausea. Sedation was reduced in the patients who received the blocks. There were no complications attributed to the blocks
Conclusion: Ultrasound guided abdominal field blocks, as a part of a multimodal analgesic regimen, provided greater analgesia up to 24 h postoperatively after elective or emergency cesarean delivery