Perioperative effects of various anesthetic adjuvants with TIVA guided by bispectral index / 대한마취과학회지

BACKGROUND: This prospective, randomized, double blinded, controlled study was designed to compare effects of intravenous co-administration of clonidine, magnesium, or ketamine on anesthetic consumption, intraoperative hemodynamics, postoperative analgesia and recovery indices during Bispectral Index (BIS) guided total intravenous anesthesia (TIVA). METHODS: After ethical committee approval and written informed consent, 120 adult patients ASA I and II scheduled for open cholecystectomy were randomly assigned to one of 4 equal groups. Group CL received clonidine 3 microg/kg and maintained by 2 microg/kg/h. Group MG received magnesium sulphate 50 mg/kg and maintained by 8 mg/kg/h. Group KET received racemic ketamine 0.4 mg/kg and maintained by 0.2 mg/kg/h. Control group (CT) received the same volume of isotonic saline. Anesthesia was induced and maintained by fentanyl, propofol and rocuronium. Propofol infusion was adjusted to keep the BIS value between 45-55. Intraoperative hemodynamics, induction time, anesthetic consumption, recovery indices, and PACU discharge were recorded. RESULTS: Induction time, propofol requirements for induction and maintenance of anesthesia, intraoperative fentanyl and hemodynamic values were significantly lower with Groups CL and MG compared to Groups KET and CT (P < 0.05). Patients in Group MG showed significantly lower muscle relaxant consumption, delayed recovery and PACU discharge than other groups (P < 0.05). First, analgesic requirement was significantly longer and total postoperative analgesic consumption was significantly lower in the adjuvant groups versus Group CT (P < 0.05). CONCLUSIONS: Clonidine, magnesium, and ketamine can be useful adjuvant agents to BIS-guided TIVA. Pharmacokinetic studies of such drug combinations were recommended to investigate their interaction.

Controlled mechanical ventilation with lmasureme[TM] Versus I-Gel[TM] in anesthetized adult patients

The efficacy, safety and ease of insertion of LMA[TM] Supreme and the i-gel™ in adult cases undergoing elective surgical procedures requiring general anesthesia with controlled mechanical ventilation. This study included 60 ASA physical status I-II adult patients of both sexes scheduled for elective surgical procedures under general anesthesia. Patients were randomly allocated into one of two groups; LMA-S[TM] GI [n=30] and i-gel[TM] Gil [n=30]. A size 4 LMA Supreme[TM] and a size 4 i-gel[TM] were used with standard monitoring. Number of insertion attempts, ease of insertion, presence of gastric insufflation, laryn-geal leak, leak pressure, ease of gastric tube insertion, ventilatory parameters, complications as well as hemodynamic variables was recorded. The results showed no clinically significant changes of heart rate, MAP, Sp0[2] or P[ET] CO[2] in GI and GIL The i-gel[TM] showed higher frequency of ease of insertion[p=0.048] and gastric tube [p< 0.001]. First attempt of insertion was successful in 60% of LMA-S[TM] GI and 73.3% of the i-gel[TM]Gil [p=0.460] without failures in both groups. Leak pressure was significantly higher in the i-gel[TM] [25.5 +/- 4.8 cm H[2]O] compared to the LMA-S[TM] [21.1 +/- 7.6 cm H[2]O] [p=0.010] while both peak and plateau pressures were significantly lower in i-gel[TM] GI [19.35 +/- 2.25 cm H[2]O and 17.75 +/- 2.07 cm H[2]O] compared to LMA-S[TM] Gil [30.05 +/- 3.82 cm H[2]O and 28.80 +/- 3.99cm H[2]O][p<0.001] respectively. There was no significant difference between both groups in the frequency of complications encountered during insertion or recovery

Sub-antibiotic doses of erythromycin as a prokinetic in abdominal surgeries: reviving the old

All patients undergoing major abdominal procedures have some degree of gastric atony in the immediate postoperative period, presenting mainly with vomiting. Many prokinetic agents have been used in the past, but none is a universal remedy. Studies showed that subantibiotic doses of erythromycin, a macrolide. antibiotic and motilin agonist, accelerates gastric emptying. This study investigated whether preoperative subantibiotic dose oral erythromycin [250 mg], altered residual gastric volume and postoperative adverse effects in patients scheduled for abdominal surgeries. Erythromycin was compared with the commonly used prokinetic metoclopramide and antiemetic ondansetron, in terms of prokinetic efficacy, cost and adverse effects. In a double-blind study, eighty patients [20 each] were allocated randomly to receive orally, either erythromycin 250 mg [E250] or erythromycin 500 mg [E500], or 10 mg metoclopramide [M], or 4mg ondansetron [Z], an hour pre-induction of anesthesia. Preoperative oral erythromycin in subantibiotic dose 250mg elicited a significantly lower residual gastric volume [P<0.001] and a lower VAS for vomiting, compared with ondansetron. As for metoclopramide and erythromycin 500, residual gastric volume was comparable, but E 250 had a lower VAS for vomiting than both groups. Rescue remedy for vomiting was required for groups E500, M and Z [100, 10 and 10 %] compared to 0% in group E250. Ultimately, subantibiotic oral dose of erythromycin [250 mg], given1 hr preoperatively, is an inexpensive prokinetic alternative with a promising post-operative profile which may be superior to the inexpensive prokinetic metoclopramide with known adverse effects, and the expensive antiemetic ondansetron