Comparison between general anesthesia and spinal anesthesia in attenuation of stress response in laparoscopic cholecystectomy: a randomized prospective trial

Laparoscopy though minimally invasive produces significant hemodynamic surge and neuroendocrine stress response. Though general anesthesia [GA] is the conventional technique, now-a-days, regional anesthesia has been accepted for laparoscopic diagnostic procedures, and its use is also being extended to laparoscopic surgeries. The aim was to compare the hemodynamic surge and neuroendocrine stress response during laparoscopic cholecystectomy [LC] under GA and spinal anesthesia [SA] in American Society of Anesthesiologists [ASA] PS 1 patients. Thirty ASA physical status I patients, aged 18-65 years were randomly allocated into two equal groups of 15 each. Group A received GA with controlled ventilation. Patients were preoxygenated for 5 min with 100/5 oxygen, premedicated with midazolam 0.03 mg/kg intravenous [i.v], fentanyl 2 mcg/kg i.v; induction was done with thiopentone 3-5 mg/kg i.v; intubation was achieved after muscle relaxation with 0.5 mg/kg atracurium besylate i.v. Anesthesia was maintained with 1-2% sevoflurane and N[2]O:O2 [60:40] and intermittent i.v injection of atracurium besylate. Group B SA with 0.5% hyperbaric bupivacaine and 25 microg fentanyl along with local anesthetic instillation in the subdiaphragmatic space. Mean arterial pressure, heart rate [HR], oxygen saturation, end tidal carbon-dioxide were recorded. Venous blood was collected for cortisol assay before induction and 30 min after pneumoperitoneum. All data were collected in Microsoft excel sheet and statistically analyzed using SPSS software version 16 [SPSS Inc., Chicago, IL, USA]. All numerical data were analyzed using Student's t-test and paired t-test. Any value <0.05 was taken as significant. Mean arterial pressure and mean HR and postpneumoperitoneum cortisol level were lower in group B than group A though the difference was not statistically significant in hemodynamic parameters but significant in case of cortisol. Spinal anesthesia administered for LC maintained comparable hemodynamics compared to GA and did not produce any ventilatory depression. It also produced less neuroendocrine stress response as seen by reduction in the level of serum cortisol in ASA PS 1 patients put for LC

Extensive papulonodular lesion in a child - granuloma annulare presenting as a diagnostic dilemma

Granuloma annulare is an idiopathic, palisaded, granulomatous disorder. There are four main clinical varieties of GA of which the subcutaneous type is less commonly encountered. Here, we report a case of generalized subcutaneous granuloma annulare in a 10-year-old boy. This variety is common in children but its generalized form is a rare presentation.