ABSTRACT
ABSTRACT Purpose To compare the effect of general anesthesia (GA) and regional anesthesia (RA) on f-URS outcomes and surgeon comfort. Material and Methods The study was conducted between June 2017 to January 2018 and data collection was applied in a prospective, randomized fashion. 120 patients participated in the study and were divided into RA group (n=56) and GA group (n=64). Demographic, operative and post-operative parameters of patients were analysed. The end point of this study was the effect of two anesthesia regimens on the comfort of the surgeon, and the comparability of feasibility and safety against perioperative complications. Results The study including 120 randomized patients, 14 patients were excluded from the study and completed with 106 patients (45 in RA group and 61 in GA group). No difference was detected between the two groups in terms of preoperative data. During the monitorization of operative vital signs, 3 patients in RA group experienced bradycardia, and this finding was significant when compared with GA group (p=0.041). Additionally, 2 patients in RA group experienced mucosal tears and 1 patient experienced hemorrhage during the operation, but no complications were observed in the GA group (p=0.041). Postoperative surgeon comfort evaluation revealed statistically significant results in favor of GA group (p=0.001). Conclusions Both GA and RA are equally effective and safe anesthesia methods for f-URS procedures. However, RA group showed significantly increased likelihood of bradycardia and mucosal injury during surgery, and significantly decreased surgeon comfort during surgery.
Subject(s)
Humans , Male , Female , Adult , Lithotripsy, Laser/adverse effects , Anesthesia, Conduction , Prospective Studies , Retrospective Studies , Treatment Outcome , Anesthesia, General , Middle AgedABSTRACT
Abstract Objective: General anesthesia causes reduction of functional residual capacity. And this decrease can lead to atelectasis and intrapulmonary shunting in the lung. In this study we want to evaluate the effects of 5 and 10 cmH2O PEEP levels on gas exchange, hemodynamic, respiratory mechanics and systemic stress response in laparoscopic cholecystectomy. Methods: American Society of Anesthesiologist I-II physical status 43 patients scheduled for laparoscopic cholecystectomy were randomly selected to receive external PEEP of 5 cmH2O (PEEP 5 group) or 10 cmH2O PEEP (PEEP 10 group) during pneumoperitoneum. Basal hemodynamic parameters were recorded, and arterial blood gases (ABG) and blood sampling were done for cortisol, insulin and glucose level estimations to assess the systemic stress response before induction of anesthesia. Thirty minutes after the pneumoperitoneum, the respiratory and hemodynamic parameters were recorded again and ABG and sampling for cortisol, insulin, and glucose levels were repeated. Lastly hemodynamic parameters were recorded; ABG analysis and sampling for stress response levels were taken after 60 minutes from extubation. Results: There were no statistical differences between the two groups about hemodynamic and respiratory parameters except mean airway pressure (P mean). P mean, compliance and PaO2; pH values were higher in 'PEEP 10 group'. Also, PaCO2 values were lower in 'PEEP 10 group'. No differences were observed between insulin and lactic acid levels in the two groups. But postoperative cortisol level was significantly lower in 'PEEP 10 group'. Conclusion: Ventilation with 10 cmH2O PEEP increases compliance and oxygenation, does not cause hemodynamic and respiratory complications and reduces the postoperative stress response.
Resumo Objetivo: A anestesia geral causa a redução da capacidade residual funcional e essa diminuição pode levar à atelectasia pulmonar e ao shunt intrapulmonar. Neste estudo pretendemos avaliar os efeitos de níveis de 5 e 10 cmH2O de pressão expiratória final positiva (PEEP) sobre as trocas gasosas, a hemodinâmica, a mecânica respiratória e a resposta ao estresse sistêmico em colecistectomia laparoscópica. Método: Foram selecionados aleatoriamente 43 pacientes, estado físico ASA I-II, agendados para colecistectomia laparoscópica, para receber PEEP a 5 cmH2O (grupo PEEP-5) ou PEEP de 10 cmH2O (grupo PEEP-10) durante o pneumoperitônio. Os parâmetros hemodinâmicos foram registrados, gasometria arterial e coleta de sangue foram feitas para estimativa dos níveis de cortisol, insulina e glicose para avaliar a resposta ao estresse sistêmico antes da indução anestésica. Trinta minutos após o pneumoperitônio, os parâmetros hemodinâmicos e respiratórios foram registrados novamente e gasometria e amostragem para os níveis de cortisol, insulina e glicose foram repetidos. E os últimos parâmetros hemodinâmicos foram registrados, análise e amostragem de gasometria para os níveis de resposta ao estresse foram feitas após 60 minutos da extubação. Resultados: Não houve diferença estatística entre dois grupos quanto aos parâmetros hemodinâmicos e respiratórios, exceto pressão média das vias aéreas (Pmédia). Os valores de Pmédia, complacência, PaO2 e do pH foram maiores no grupo PEEP-10. Também os valores de PaCO2 foram menores no grupo PEEP-10. Não foram observadas quaisquer diferenças entre os níveis de insulina e de ácido láctico nos dois grupos. Porém, o nível de cortisol no pós-operatório foi significativamente menor no grupo PEEP-10. Conclusão: Ventilação com PEEP de 10 cmH2O aumenta a complacência e a oxigenação, não causa hemodinâmica e complicações respiratórias e reduz a resposta ao estresse no pós-operatório.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Stress, Physiological/physiology , Respiratory Mechanics/physiology , Cholecystectomy, Laparoscopic , Hemodynamics/physiology , Blood Pressure/physiology , Prospective Studies , Positive-Pressure Respiration , Electrocardiography , Heart Rate/physiology , Middle AgedABSTRACT
ABSTRACT OBJECTIVE: The local anesthetics may cause neurotoxicity. We aimed to compare the neurotoxic potential of different local anesthetics, local anesthetic induced nerve damage and pathological changes of a peripheral nerve. METHODS: Sixty Wistar rats weighing 200-350 g were studied. Rats were assigned into 3 groups and 26-gauge needle was inserted under magnification into the left sciatic nerve and 0.2 mL of 0.5% bupivacaine, 5% levobupivacaine, and 2% lidocaine were injected intraneurally. An individual who was blind to the specifics of the injection monitored the neurologic function on postoperative 1st day, and daily thereafter. Neurologic examination included assessment for the presence and severity of nociception and grasping reflexes. At the 7th day sciatic nerve specimen was taken for evaluation of histopathologic changes. RESULTS: There was no statistical difference detected among groups regarding grasping reflex and histopathologic evaluation. Two cases in bupivacaine group, 1 case in levobupivacaine group and 2 cases in lidocaine group had slight grasping, while 1 case in lidocaine group had no grasping reflex on the seventh day. Severe axonal degeneration was observed in all groups, respectively in bupivacaine group 4 (20%), levobupivacaine group 3 (15%), and lidocaine group 6 (30%). CONCLUSION: In all groups, histopathological damage frequency and severity were more than the motor deficiency.
RESUMO OBJETIVO: Os anestésicos locais podem causar neurotoxicidade. Nosso objetivo foi comparar o potencial neurotóxico de diferentes anestésicos locais, os danos induzidos aos nervos e as alterações patológicas de um nervo periférico. MÉTODOS: Foram estudados 60 ratos Whistler com 200-350 g. Os ratos foram divididos em três grupos, uma agulha de calibre 26 foi inserida no nervo ciático esquerdo, com o uso de ampliação, e 0,2 mL de bupivacaína a 0,5%, levobupivacaína a 5% e lidocaína a 2% foram injetados por via intraneural. Um colaborador, cego para os conteúdos das injeções, monitorou a função neurológica no primeiro dia de pós-operatório e depois diariamente. O exame neurológico incluiu a avaliação da presença e da gravidade da nocicepção e dos reflexos de agarrar. No sétimo dia, uma amostra do nervo ciático foi colhida para avaliar as alterações histopatológicas. RESULTADOS: Não houve diferença estatística entre os grupos em relação ao reflexo de agarrar e à avaliação histopatológica. Dois casos no grupo bupivacaína, um no grupo levobupivacaína e dois no grupo lidocaína apresentaram um leve reflexo de agarrar; também no grupo lidocaína, um caso não apresentou reflexo de agarrar no sétimo dia. Degeneração axonal grave foi observada em todos os grupos: quatro casos no grupo bupivacaína (20%), três no grupo levobupivacaína 3 (15%) e seis no grupo lidocaína (30%). CONCLUSÃO: Em todos os grupos, a frequência de dano histopatológico e de gravidade foi maior do que a deficiência motora.