Presentación de un caso y revisión de literatura: anestesia total intravenosa en cirugía de estesioneuroblastoma / Presentation of a case and literature review: total intravenous anesthesia in estesioneuroblastoma surgery

Resumen: El estesioneuroblastoma es una neoplasia de las células del neuroepitelio olfatorio. Tiene una baja incidencia de 0.4 por cada millón de habitantes. Se caracteriza por síntomas como sinusitis, epistaxis, cefalea, discapacidad visual, obstrucción nasal, hiposmia y rinorrea. En este reporte se presenta el caso de un paciente masculino de 29 años con estesioneuroblastoma estadio Kadish C, quien fue programado para resección quirúrgica bajo anestesia total intravenosa con resultados satisfactorios durante el procedimiento quirúrgico.

Abstract: Esthesioneuroblastoma is a neoplasm of the olfactory neuroepithelium cells, it has a low incidence of 0.4 per million inhabitants. It is characterized by symptoms such as sinusitis, epistaxis, headache, visual impairment, nasal obstruction, hyposmia, and rhinorrhea. We present the case of a 29-year-old male patient with Kadish C stage esthesioneuroblastoma, who was scheduled for surgical resection under total intravenous anesthesia with satisfactory results during the surgical procedure.

A difficult airway approach in a merosin-deficient congenital muscular dystrophy patient: a case report

Abstract Merosin-deficient muscular dystrophy is caused by an autosomal recessive mutation on laminin-α2 gene characterized by severe progressive muscle weakness associated with neuromuscular scoliosis and restrictive lung disease. In this case report, we describe an alternative airway approach performed in a child with anticipated difficult airway and merosin-deficient muscular dystrophy. Significant anesthetic implications may increase the perioperative risk, requiring accurate knowledge to anticipate an adequate management and provide patient-safety strategies.

Dos concentraciones de ketofol en anestesia total intravenosa para cirugía mínimamente invasiva / Tow concentrations of ketofol in total intravenous anesthesia for minimally invasive surgery

Introducción: En los últimos años se ha iniciado un interés especial por la combinación de ketamina/propofol para pacientes intervenidos por procedimientos mínimamente invasivos. Objetivo: Evaluar la efectividad y seguridad de la anestesia intravenosa total con ketofol en concentración 1:4 contra la concentración 1:2 en pacientes intervenidos por cirugía mínimamente invasiva. Métodos: Estudio analítico, cuasiexperimental, prospectivo y longitudinal, en el Hospital Universitario General Calixto García entre diciembre de 2019 a diciembre de 2020, en 30 pacientes divididos en dos grupos de 15 pacientes: grupo estudio (GE): Ketofol 1:4 y grupo control (GC): Ketofol 1:2. Se analizaron: tensión arterial media y frecuencia cardiaca intra operatoria, grado de hipnosis, grado de nocicepción, necesidad de rescate para hipnosis y analgesia, tiempo de recuperación anestésica, analgesia posoperatoria y efectos adversos. Resultados: Entre los grupos fueron similares la edad, el sexo, el peso, estado físico y tipo de intervención quirúrgica. La frecuencia cardiaca no mostró diferencias entre los grupos. En relación a la tensión arterial mediapos-incisión, fue mayor en el grupo control con diferencias significativas (p=0,03). La necesidad de rescate intraoperatorio para la hipnosis y analgesia fue significativamente mayor en el grupo control. Con respecto a la recuperación anestésica, analgesia posoperatoria y efectos adversos no hubo diferencias significativas. Conclusiones: La combinación ketofol resultó segura y efectiva para proveer una adecuada anestesia en procedimientos quirúrgicos mínimamente invasivos con tiempos quirúrgicos menores a 30 min. La concentración de 1:4 brindó mejor estabilidad hemodinámica, adecuada hipnosis y analgesia intraoperatoria, con menor incidencia de efectos adversos(AU)

Introduction: In recent years, a special interest has appeared in the ketamine/propofol combination for patients intervened by minimally invasive procedures. Objective: To evaluate the effectiveness and safety of total intravenous anesthesia with ketofol at 1:4 concentration versus 1:2 concentration in patients undergoing minimally invasive surgery. Methods: An analytical, quasiexperimental, prospective and longitudinal study was carried out at General Calixto García University Hospital, between December 2019 and December 2020, with thirty patients divided into two groups of fifteen patients each: study group (SG; ketofol 1:4) and control group (CG; ketofol 1:2). The following aspects were analyzed: mean blood pressure and intraoperative cardiac frequency, degree of hypnosis, degree of nociception, necessity of rescue for hypnosis and analgesia, anesthetic recovery time, postoperative analgesia and adverse effects. Results: Age, sex, weight, physical condition and type of surgery were similar between groups. Heart rate showed no differences between groups. Mean blood pressure after incision was higher in the control group, with significant differences (P=0.03). The necessity of intraoperative rescue for hypnosis and analgesia was significantly higher in the control group. Regarding anesthetic recovery, postoperative analgesia and adverse effects, there were no significant differences. Conclusion: The ketofol combination was safe and effective for providing adequate anesthesia in minimally invasive surgical procedures with surgical times of less than thirty minutes. The 1:4 concentration provided better hemodynamic stability, adequate hypnosis and intraoperative analgesia, with lower incidence of adverse effects(AU)

Resultados de la anestesia total intra venosa (TIVA) con perfusión controlada por objetivo (TCI) en pacientes sometidos a trasplante renal / Outcomes of Total Intravenous Anesthesia (TIVA) with Goal Controlled Perfusion (TCI) in Kidney Transplant Patients

Introducción: La anestesia total intravenosa (TIVA) con perfusión controlada por objetivo (TCI) es una técnica de anestesia general que usa una combinación de fármacos administrados exclusivamente por vía intravenosa sin usar fármacos por vía inhalatoria. Objetivos: Determinar los resultados del uso de TIVA TCI en los pacientes sometidos a trasplante renal, donantes y receptores, entre noviembre de 2014 y julio de 2018, en el Hospital de Clínicas. Pacientes y métodos: Estudio observacional, analítico transversal, con muestreo no probabilístico a criterio. La serie se agrupó en donantes y receptores. Los datos se expresan en medias y proporciones, se analizó el Odds Rattio y el R2. Se consideró una p< 0,05 como significativa. Resultados: se incluyeron a 198 intervenciones anestésicas, 131 (66,2%) fueron receptores. El rango de edad fue de entre 5 y 66 años (35,8±13 años) y 114 (57%) fueron masculinos. En el post operatorio inmediato, el tiempo en despertar, la PAS, PAD, PAM, frecuencia cardiaca y saturación de oxígeno no tuvieron diferencias significativas, en la comparación de los grupos (donante y receptor). Se observó cefalea en 3 (1,5%) del grupo de donantes y ninguna en los receptores. La diuresis fue tardía en 18 (9,1%) pacientes (p= 0,084 R2=29). Conclusión: La TIVA TCI demostró ser una técnica muy efectiva en el trasplante renal, con pronta recuperación y despertar inmediato tras la extubación, con lucidez absoluta en todos los pacientes.

Introduction: Total intravenous anesthesia (TIVA) with goal-controlled perfusion (TCI) is a general anesthesia technique that uses a combination of drugs administered exclusively intravenously without using inhalational drugs. Objectives: To determine the results of the use of TIVA TCI in kidney transplant patients, donors and recipients, between November 2014 and July 2018, at the Hospital de Clínicas. Patients and methods: Observational, cross-sectional analytical study, with non-probabilistic sampling at the discretion. The series was grouped into donors and recipients. The data is expressed in means and proportions, the Odds Rattio and the R2 were analyzed. A p<0.05 was considered significant. Results: 198 anesthetic interventions were included, 131 (66.2%) were recipients. The age range was between 5 and 66 years (35.8±13 years) and 114 (57%) were male. In the immediate postoperative period, time to awakening, SBP, DBP, MAP, heart rate and oxygen saturation did not show significant differences when comparing the groups (donor and recipient). Headache was observed in 3 (1.5%) of the donor group and none in the recipients. Diuresis was late in 18 (9.1%) patients (p= 0.084 R2=29). Conclusion: TIVA TCI proved to be a very effective technique in kidney transplantation, with prompt recovery and immediate awakening after extubation, with absolute clarity in all patients.

Anestesia total intravenosa libre de opioides guiada por qCON y qNOX en paciente obesa / Total Intravenous anesthesia in patients with intestinal occlusive syndrome

Introducción: En los últimos años la anestesia libre de opioides ha constituido una alternativa más a las técnicas tradicionales de anestesia general. Con la exclusión de este grupo de fármacos se evitan los múltiples efectos adversos y complicaciones asociados al mismo. A pesar de que la anestesia libre de opioides tiene sus indicaciones y que ha demostrado sus beneficios en cierto grupo de pacientes, existen aún controversias en relación con su utilidad en el paciente obeso. Características como la obesidad hacen que los modelos multimodales empleados para programar la anestesia libre de opioides sean cada vez más complejos. Objetivos: Describir un caso clínico realizado con la técnica de anestesia libre de opioides que constituye la primera experiencia en Ecuador. Presentación del caso: Se presenta el caso de una paciente obesa intervenida de colecistectomía laparoscópica mediante infusión de propofol, ketamina, lidocaína, sulfato de magnesio, y dexmedetomidina. La titulación de estos fármacos se realizó mediante cálculo de concentraciones plasmáticas a través de modelos farmacocinéticos y guiada por monitorización de profundidad anestésica y analgésica, con lo cual se logró optimizar el consumo de fármacos, disminuir las complicaciones y una evolución clínica favorable. Hasta donde se conoce a nivel local y de país (Ecuador) es la primera experiencia que se reporta con esta técnica. Conclusiones: La anestesia libre de opioides puede resultar una elección en el paciente obeso ya que asegura una adecuada recuperación sin efectos adversos asociados(AU)

Introduction: In recent years, opioid-free anesthesia has become another alternative in front of traditional general anesthesia techniques. The exclusion of this group of drugs avoids the numerous adverse effects and complications associated with its usage. Although opioid-free anesthesia has its indications and has showed its benefits in a certain group of patients, there is still controversy regarding its usefulness in the obese patient. Characteristics such as obesity make the multimodal models used to program opioid-free anesthesia increasingly complex. Objectives: To describe a clinical case involving the opioid-free anesthesia technique, which is the first experience in Ecuador. Case presentation: The case is presented of a female obese patient who underwent laparoscopic cholecystectomy by infusion of propofol, ketamine, lidocaine, magnesium sulfate and dexmedetomidine. Titration of these drugs was carried out by calculating plasma concentrations through pharmacokinetic models and guided by monitoring of anesthetic and analgesic depth, thus optimizing drug consumption, reducing complications and achieving a favorable clinical evolution. As far as known locally and in the country (Ecuador), this is the first reported experience with this technique. Conclusions: Opioid-free anesthesia may be a choice in the obese patient, since it ensures adequate recovery without associated adverse effects(AU)

Anestesia total intravenosa en pacientes con síndrome oclusivo intestinal / Total Intravenous anesthesia in patients with intestinal occlusive syndrome

Introducción: La anestesia total intravenosa es una técnica de anestesia general en la que se administran los fármacos exclusivamente por vía endovenosa, en ausencia de agentes inhalatorios. Objetivo: Describir los resultados que se observaron en el empleo de la anestesia total intravenosa en los pacientes con diagnóstico de síndrome oclusivo para tratamiento quirúrgico. Métodos: Se desarrolló una investigación observacional descriptiva, longitudinal en el Hospital General Docente "Abel Santamaría Cuadrado", de enero de 2014 a enero de 2017. De un universo de 417 pacientes, se seleccionó una muestra de 205 casos que cumplieron con los criterios de inclusión y exclusión. Las variables fueron presión arterial media, frecuencia cardíaca, saturación de oxígeno, complicaciones, tiempo de recuperación, nivel de sedación y respuesta analgésica. Resultados: El 95,61 por ciento de los casos se mantuvieron normotensos y el 96,10 por ciento con frecuencia cardíaca normal. Se constataron signos clínicos de superficialidad anestésica en el 1,46 por ciento de los individuos. La mayoría de los casos se recuperaron entre 10 y 20 min para un 92,19 por ciento. Se observó un nivel de sedación insuficiente en 189 pacientes (92,19 por ciento). No se evidenciaron complicaciones posoperatorias en el 96,58 por ciento. La respuesta analgésica fue adecuada en el 95,12 por ciento de los casos. Conclusiones: La aplicación de la anestesia total intravenosa para cirugía por oclusión intestinal demostró resultados satisfactorios como método anestésico(AU)

Introduction: Total intravenous anesthesia is a general anesthesia technique in which drugs are administered exclusively intravenously, in the absence of inhalation agents. Objective: To describe the outcomes observed in the use of total intravenous anesthesia in patients diagnosed with occlusive syndrome for surgical treatment. Methods: A descriptive, longitudinal and observational research was carried out in Abel Santamaría Cuadrado General Teaching Hospital of Pinar del Río, Cuba, from January 2014 to January 2017. From a universe of 417 patients, a sample of 205 cases that met the inclusion and exclusion criteria was selected. The variables were mean arterial pressure, heart rate, oxygen saturation, complications, recovery time, level of sedation, and analgesic response. Results: 95.61 percent of the cases remained normotensive and 96.10 percent kept a normal heart rate. Clinical signs of sedation were found in 1.46 percent of the individuals. Most of the cases recovered between 10 and 20 minutes, accounting for 92.19 percent. Insufficient sedation was observed in 189 patients (92.19 percent). No postoperative complications were observed in 96.58 %. Analgesic response was adequate in 95.12 percent of cases. Conclusions: The application of total intravenous anesthesia for intestinal occlusion surgery showed satisfactory outcomes as an anesthetic method(AU)

Anestesia total intravenosa en la cirugía oncológica de mama / Total intravenous anesthesia in oncologist breast surgery

Introducción: El cáncer es la principal causa de muerte. Cada año se diagnostican millones de mujeres con cáncer de mama que necesitan tratamiento quirúrgico, para lo cual la anestesia total intravenosa parece ser una excelente opción. Objetivo: Describir los resultados de la aplicación de la anestesia total intravenosa en las pacientes a las que se les efectuó cirugía oncológica de mama. Métodos: Se realizó un estudio observacional, descriptivo, longitudinal, prospectivo, en el Servicio de Anestesiología del Hospital General Docente "Abel Santamaría Cuadrado" en el período comprendido entre enero de 2013 y enero de 2015. Se estudió una población accesible de 111 pacientes seleccionados mediante criterios de inclusión y exclusión. Para el análisis estadístico se utilizaron distribuciones de frecuencias, cálculo de medidas de tendencia central y de dispersión. Algunas de las variables fueron tensión arterial, frecuencia cardíaca, saturación de oxígeno, complicaciones, tiempo de recuperación, nivel de sedación, respuesta analgésica. Resultados: Se logró gran estabilidad hemodinámica en más del 95 por ciento de las pacientes. Se detectó superficialidad anestésica en 1,80 por ciento de los casos. El 92,80 por ciento de los casos se recuperaron entre 10 y 20 min. Se presentó sedación adecuada en 106 pacientes. Las principales complicaciones fueron las náuseas y los vómitos en 9,01 por ciento. Existió una adecuada respuesta analgésica en 93,69 por ciento de los casos. Conclusiones: La aplicación de la anestesia total intravenosa para cirugía oncológica de mama arrojó resultados muy satisfactorios como método anestésico(AU)

Introduction: Cancer is the leading cause of death worldwide. Every year millions of women are diagnosed with breast cancer and they need surgical treatment, for which total intravenous anesthesia seems to be an excellent option. Objective: Describe the results of the application of total intravenous anesthesia in patients undergoing oncological breast surgery. Methods: An observational, descriptive, longitudinal, prospective study was conducted in the Anesthesiology Service of "Abel Santamaría Cuadrado" Hospital in the period between January 2013 and January 2015. An accessible population of 111 patients selected using inclusion and exclusion criteria was studied. For the statistical analysis, frequency distributions, calculation of measures of central tendency and dispersion were used. Some of the variables were blood pressure, heart rate, oxygen saturation, complications, recovery time, level of sedation, analgesic response. Results: High hemodynamic stability was achieved in more than 95 percent of the patients. Anesthetic superficiality was detected in 1.80 percent of cases. 92.80 percent of the cases recovered after 10 to 20 minutes. Adequate sedation was present in 106 patients. The main complications were nausea and vomiting in 9.01 percent There was an adequate analgesic response in 93.69 percent of the cases. Conclusions: The application of total intravenous anesthesia for oncological breast surgery yielded very satisfactory results as an anesthetic method(AU)

Effects of intravenous combined epidural anesthesia on perioperative hemodynamic indexes, cardiac function and immune function during laparoscopic surgery in elderly gastric cancer patients complicated with coronary heart disease / 肿瘤研究与临床

Objective:To explore the effects of intravenous combined epidural anesthesia on perioperative hemodynamic indexes, cardiac function and immune function during laparoscopic surgery in elderly gastric cancer patients complicated with coronary heart disease.Methods:A total of 94 elderly gastric cancer patients with coronary heart disease who were admitted to Shanxi Province Cancer Hospital from January 2017 to June 2021 were selected. They were divided into the total intravenous anesthesia group (control group) and intravenous combined epidural anesthesia group (observation group) by random envelope lottery, with 47 cases in each group. Hemodynamic indexes, cardiac function, immune function, pain and sedation scores were compared between the two groups.Results:When pneumoperitoneum was established (T 1) and the left gastric artery was immediately free during operation (T 2), systolic blood pressure in the observation group was (136.6±9.9) mmHg (1 mmHg = 0.133 kPa) and (133.9±9.4) mmHg, and diastolic blood pressure was (74.6±4.6) mmHg and (80.7±6.0) mmHg; heart rate was (79.8±4.0) times/min and (80.9±2.7) times/min, respectively. The systolic blood pressure of the control group was (159.3±7.6) mmHg and (162.5±8.5) mmHg, and the diastolic blood pressure was (91.2±5.2) mmHg and (88.3±4.7) mmHg, respectively. The heart rate was (106.2±3.3) times/min and (101.9±4.0) times/min, respectively; compared with the control group at the same time point, the observation group had lower blood pressure and slower heart rate ( t values were 4.25, 2.53, 6.40, 6.81, 1.85, and 1.35, all P < 0.05). The blood concentrations of cardiac troponin and creatine kinase isoenzyme in the control group were (0.143±0.052) ng/ml and (5.65±0.77) mg/L at 12 h (T 4) after surgery, which were higher than those in the observation group [(0.098±0.015) ng/ml and (3.08±1.06) mg/L] ( t values were 4.32 and 10.19, both P < 0.05). The intraoperative utilization rate of vasoactive drugs and the incidence of electrocardiogram abnormalities in the observation group were 19.1% (9/47) and 25.5% (12/47), which were lower than those in the control group [48.9% (23/47) and 55.3% (26/47)] ( χ2 values were 8.49 and 8.66, both P < 0.05). Compared with 1 day before operation (T 5), the proportion of CD4 + T cells increased and the proportion of CD8 + T cells decreased in control group at 3 days after operation (T 6) (both P < 0.05). The pain score and sedation score of the observation group at 12 h (T 4) and 1 day after surgery (T 7) were better than those of the control group (all P < 0.05). Conclusions:Laparoscopic radical gastrectomy with intravenous combined epidural anesthesia in elderly gastric cancer patients with coronary heart disease can achieve better anesthesia effect, and can provide better protection for the patient's cardiac function and immune function.

Oxigenación apnéica para extracción de cuerpo extraño en vía aérea / Apneic oxygenation for extracting a foreign body in the airway

La oxigenación apnéica consiste en la administración de flujos altos de oxígeno a través de algún dispositivo supraglótico mientras el paciente se mantiene en apnea. Se explica por qué el alveolo desnitrogenizado con una composición en su mayor parte de oxígeno, permite la difusión alveolo capilar y genera una presión subatmosférica capaz de arrastrar el flujo de oxigeno existente en el árbol traqueobronquial hasta el mismo alveolo, siempre y cuando no hubiera obstrucción mecánica de la vía aérea. El tiempo aumenta considerablemente hasta que la saturación de oxígeno disminuya, lo que se conoce como tiempo de apnea segura. Se presenta la experiencia de emplear esta técnica en un escolar de 5 años sin antecedentes patológicos, que ingirió un cuerpo extraño (semilla de girasol), la cual se localizaba en vía aérea bronquio principal derecho. Este se extrajo por fibrobroncoscopía bajo anestesia total intravenosa, priorizando la ventilación espontánea hasta localizarlo, y luego, debido a la dificultad que presentó su extracción, se empleó relajación muscular y apnea para optimizar las condiciones de la extracción. Durante este periodo, se empleó la técnica de oxigenación apnéica, la cual se mantuvo durante 12 min. La saturación pulsátil de oxigeno fue mayor al 92 por ciento, tiempo suficiente para culminar la extracción con éxito y sin complicaciones(AU)

Apneic oxygenation consists in the administration of high flows of oxygen through a supraglottic device while the patient remains in apnea. It is explained because the alveolus with low nitrogen concertation/accumulation, with a composition mostly of oxygen, allows capillary alveolus to diffuse, as well as it generates a subatmospheric pressure capable of dragging the oxygen flow existing in the tracheobronchial tree to the alveolus itself, as long as there is no mechanical airway obstruction. The time increases considerably until oxygen saturation decreases, which is known as the safe apnea time. The experience of using this technique is presented is it was used with a five-year-old boy with no pathological history and who swallowed a foreign body (sunflower seed), which was located in the airway, specifically the right main bronchus. The foreign body was extracted by fiberoptic bronchoscopy under total intravenous anesthesia, prioritizing spontaneous ventilation until it was located; and then, due to the difficulty for its extraction, muscle relaxation and apnea were used to optimize the extraction conditions. During this period, the apneic oxygenation technique was used and maintained for twelve minutes. Pulsatile oxygen saturation was greater than 92 percent, enough time to complete the extraction successfully and without complications(AU)

Infusiones controladas por objetivo y sistemas de circuito cerrado. Límites en expansión / Target-controlled infusions and closed-loop systems: expansion limits

Introducción: La administración manual en bolo ha evolucionado desde la infusión volumétrica basada en regímenes farmacológicos estandarizados, hasta los sistemas de infusión controlada por objetivo y los más sofisticados sistemas de circuito cerrado. Objetivo: Describir los principios tecnológicos y aplicaciones clínicas extendidas de la infusión controlada por objetivo y los sistemas de circuito cerrado. Métodos: Se realizó una revisión no sistemática de la literatura, en bases de datos científicas como Cochrane Database of Systematic Reviews, Pubmed/Medline, EMBASE, Scopus, Web of Science, EBSCOhost, Science Direct, OVID y el buscador académico Google Scholar, en el mes de septiembre del año 2020. Desarrollo: La disponibilidad y portabilidad de dispositivos electrónicos con capacidad de procesamiento avanzado a precios relativamente accesibles, el perfeccionamiento del aprendizaje automático e inteligencia artificial aplicado a las decisiones médicas, y las iteraciones tecnológicas complejas incorporadas en los sistemas de circuito abierto y cerrado, desarrollados originalmente en el campo de la Anestesiología, han posibilitado su expansión a otras especialidades y entornos clínicos tan disímiles como el tratamiento de la diabetes mellitus, administración de fármacos antineoplásicos, ventilación mecánica, control de las variables hemodinámicas y la terapia antimicrobiana en pacientes críticos. Conclusiones: La infusión controlada por objetivo y los sistemas de circuito cerrado se han convertido en tecnologías maduras, seguras y viables, aplicadas clínicamente en múltiples naciones y escenarios, con un desempeño superior a los sistemas manuales tradicionales(AU)

Introduction: Manual bolus administration has evolved from volumetric infusion based on standardized pharmacological regimens to target-controlled infusion systems and the most sophisticated closed-loop systems. Objective: To describe the technological principles and extended clinical applications of target-controlled infusion and closed-loop systems. Methods: A nonsystematic review of the literature was carried out, during September 2020, in scientific databases such as Cochrane Database of Systematic Reviews, Pubmed/Medline, EMBASE, Scopus, Web of Science, EBSCOhost, Science Direct, OVID and the academic search engine Google Scholar. Development: The availability and portability of electronic devices with advanced processing capacity at relatively affordable prices, the refinement of machine learning and artificial intelligence applied to medical decisions, as well as the complex technological iterations incorporated into open and closed-loop systems, originally developed in the field of anesthesiology, have enabled their expansion to other specialties and clinical settings so diverse as treatment of diabetes mellitus, administration of antineoplastic drugs, mechanical ventilation, control of hemodynamic variables and antimicrobial therapy in critical patients. Conclusions: Target-controlled infusion and closed-loop systems have become mature, safe and viable technologies, applied clinically in multiple nations and settings, with superior performance compared to traditional manual systems(AU)

Impacto de la anestesia intravenosa en cirugía robótica para paciente de alto riesgo sometido a cirugía oncológica de larga duración en el Centro Médico Naval / Impact of intravenous anesthesia in robotic surgery for high-risk patient undergoing long-term oncologic surgery at the Naval Medical Center

Resumen: La práctica de cirugía robótica es un proceso complejo que implica desarrollo y tecnología no sólo en el campo de la cirugía, sino también en el campo de la anestesiología. Implica un proceso multifactorial, ya que ha generado un cambio drástico multidisciplinario basado en tecnología de punta que pretende ofrecer mejores condiciones durante el manejo perioperatorio en cirugía robótica. La anestesia total intravenosa cumple objetivos específicos en relación a la posición del paciente, relajación cerebral, neuroprotección, hemodinamia, pérdida y recuperación de la conciencia, parálisis neuromuscular, parámetros ventilatorios, etc. Ofrece seguridad y calidad al paciente durante el procedimiento con una mínima interferencia con el monitoreo electrofisiológico y permite modular la profundidad anestésica desde una neurosedación hasta una anestesia general, de acuerdo a las diferentes etapas de la cirugía. Un factor atribuible a la anestesia moderna para el éxito de la cirugía robótica es usar diferentes agentes anestésicos que promuevan inducción, mantenimiento y emersión anestésica más rápida y suave, a fin de reducir el tiempo de recuperación del estado de conciencia, funciones básicas y psicomotoras como la anestesia general multimodal.

Abstract: The practice of robotic surgery is a complex process, involving development and technology; not only in the surgery field but also in the anesthesiology field. It implies a multifactorial process since it has generated a drastic multidisciplinary change based on state-of-the-art technology; which aims to offer better conditions during perioperative management in robotic surgery. Intravenous Total Anesthesia accomplishes specific objectives in relation to patient position, brain relaxation, neuroprotection, hemodynamics, loss and recovery of consciousness, neuromuscular paralysis, ventilatory parameters, providing safety and quality during the procedure; with minimal intervention during electrophysiological monitoring and enabling anesthetic depth to be modulated from neurosedation to general anesthesia, according to the different stages of the surgery. A factor attributable to modern anesthesia for robotic surgery success is to employ different anesthetic agents promoting induction, maintenance of general anesthesia, smother and faster anesthetic emersion, for the purpose of reducing recovery time of the state of consciousness), basic and psychomotor functions; as is the general multimodal anesthesia.

Challenges in the performance of awake craniotomies in the Philippine General Hospital: A case series

@#Awake craniotomy is a neurosurgical technique that involves an awake neurological testing during the resection of an intracranial lesion in eloquent cerebral cortical areas representing motor, language, and speech. This technique is highlighted by an intra-operative cortical mapping that requires active participation by the patient and poses unique challenges to the anesthesiologist. The surgical and anesthetic techniques have evolved significantly over time, as the neurosurgeon and the anesthesiologist learn new steps in making this technique safe to achieve reasonable patient satisfaction. A thorough understanding of this surgical technique's rationale will guide the anesthesiologist in planning the anesthetic management depending on the surgery and neurologic testing. Constant communication between the neurosurgeon, anesthesiologist, and the patient will define this surgical technique's success. It is already a well-established procedure; however, factors that contribute to failures in awake craniotomy procedures have not been well characterized in the literature. Failure is defined as the inability to conduct awake neurologic testing during the awake craniotomy procedure because of various factors which will be described. This paper aims to review the challenges in the performance of three (3) cases of awake craniotomies performed in the Philippine General Hospital. The challenges described in these three (3) cases reveal that this can be experienced by the neurosurgeon, neuroanesthesiologist, and most especially the patient in an acute critical condition. Identification of the procedures' failure and the steps taken to manage such situations with the patient's safety in mind are discussed.

Maximum dose of continuous infusion of mivacurium for thyroid surgery under total intravenous anesthesia: a sequential trial of monitoring neurological function in 30 patients / 南方医科大学学报

OBJECTIVE@#To investigate the maximum dose of continuous mivacurium infusion for intraoperative neuromonitoring (IONM) and observe the adverse reactions during thyroid surgery under total intravenous anesthesia (TIVA).@*METHODS@#Thirty patients undergoing IONM during thyroid surgery received continuous infusion of mivacurium at the initial rate of 14.97 μg · kg@*RESULTS@#The EC@*CONCLUSIONS@#In patients undergoing thyroid surgery under TIVA, the EC

Sedación endovenosa versus lidocaína intraarticular en pacientes con luxación glenohumeral aguda / Endovenous sedation versus intra-articular lidocaine in patients with acute glenohumeral dislocation

INTRODUCCIÓN. La sedación endovenosa y la aplicación de lidocaína intraarticular se han convertido en las técnicas anestésicas preferidas en el área de emergencia para la reducción de la luxación glenohumeral, sin embargo, no están exentas de complicaciones. OBJETIVO. Determinar las diferencias y complicaciones entre el uso de sedación endovenosa y lidocaína intraauricular en la reducción de luxación glenohumeral. MATERIALES Y MÉTODOS. Estudio de evaluación, descriptivo, correlacional, retrospectivo, no experimental. Población de 125 Historias Clínicas, se tomó una muestra 82, que fueron atendidos en el Servicio de Emergencia del Hospital General Riobamba, periodo enero 2015 a diciembre 2019. Criterios inclusión: mayores de 15 años de edad con diagnóstico de luxación glenohumeral aguda, que firmaron el Consentimiento Informado. Se dividieron en dos grupos: grupo I: reducciones con lidocaína intraarticular, grupo II: sedación endovenosa. Los datos se obtuvieron del sistema informático MIS-AS400. El análisis de datos se realizó en el programa estadístico IBM SPSS versión 23. RESULTADOS. Se logró la reducción del 96,7% (29; 30) con el grupo I y un 94,2% (49; 52) con el grupo II. Las complicaciones con el grupo II fueron: depresión respiratoria 5,8% (3; 52), mareo 5,8% (3; 52), cefalea 1,9% (1; 52). No se encontraron complicaciones en el grupo I. DISCUSIÓN. Fue indispensable conseguir el alivio del dolor mediante el uso de técnicas anestésicas/analgésicas como: sedación en combinación con opioides y lidocaína intraarticular. CONCLUSIÓN. Se determinó menor número de complicaciones con la aplicación de lidocaína intraarticular y menor tiempo de estancia en emergencia.

INTRODUCTION. Endovenous sedation and the application of intra-articular lidocaine have become the preferred anesthetic techniques in the emergency area for the reduction of glenohumeral dislocation, however, they are not free of complications. OBJECTIVE. To determine the differences and complications between the use of intravenous sedation and intra-atrial lidocaine in the reduction of glenohumeral dislocation. MATERIALS AND METHODS. Evaluation, descriptive, correlational, retrospective, non-experimental study. Population of 125 Clinical Histories, a sample of 82 was taken, who were treated in the Emergency Service of the Riobamba General Hospital, period from January 2015 to December 2019. Inclusion criteria: over 15 years of age with a diagnosis of acute glenohumeral dislocation, who signed Informed Consent. They were divided into two groups: group I: reductions with intra-articular lidocaine, group II: intravenous sedation. The data was obtained from the MIS-AS400 computer system. Data analysis was performed using the IBM SPSS version 23 statistical program. RESULTS. A reduction of 96,7% (29; 30) was achieved with group I and 94,2% (49; 52) with group II. Complications with group II were: respiratory depression 5,8% (3; 52), dizziness 5,8% (3; 52), headache 1,9% (1; 52). No complications were found in group I. DISCUSSION. It was essential to achieve pain relief through the use of anesthetic / analgesic techniques such as: sedation in combination with opioids and intra-articular lidocaine. CONCLUSION. A lower number of complications was determined with the application of intra-articular lidocaine and a shorter stay in the emergency room.

Comparison of post-operative nausea and vomiting with intravenous versus inhalational anesthesia in laparotomic abdominal surgery: a randomized clinical trial / Comparação entre anestesia intravenosa e inalatória na náusea e vômito pós-operatórios em laparotomia: estudo clínico randomizado

Abstract Background: Postoperative Nausea and Vomiting (PONV) is a multifactorial surgical complication with an unclear underlying cause. Anesthetic methods, patients' characteristics and the type of surgery are considered as factors affecting PONV. This study was designed to compare the effect of inhalational and intravenous anesthesia in abdominal surgery on the incidence and severity of PONV. Methods: A single-blinded prospective randomized clinical trial on 105 patients aged 18 − 65 years was carried out. Patients were divided into two groups of Total Intravenous Anesthesia (TIVA) and inhalational anesthesia. The incidence and the severity of PONV were examined at 0, 2, 6, 12 and 24 hours after the surgery. The use of a rescue antiemetic was also evaluated. Results: 50.9% of the patients in the inhalation group and 17.3% of the patients in the intravenous group developed PONV (p < 0.001). The incidence of vomiting was reported in 11.3% of the inhalational group and 3.8% of the TIVA group (p = 0.15). 24.5% of patients in the inhalation group and 9.6% of patients in the intravenous group needed an antiemetic medication (p = 0.043). Conclusion: The incidence of postoperative nausea and vomiting and the need for administration of an antiemetic rescue drug and the severity of nausea in patients were significantly lower in the TIVA group.

Resumo Justificativa: Náusea e Vômito no Pós-Operatório (NVPO) é uma complicação multifatorial com etiologia não esclarecida. A técnica anestésica, as características dos pacientes e o tipo de cirurgia são considerados fatores que afetam a NVPO. O presente estudo foi desenhado para comparar o efeito da anestesia inalatória com anestesia intravenosa na incidência e gravidade de NVPO na cirurgia abdominal. Método: Foi realizado estudo clínico mono-cego prospectivo randomizado com 105 pacientes com idades de 18 − 65 anos. Os pacientes foram divididos em dois grupos, Anestesia Total Intravenosa (TIVA) e anestesia inalatória. A incidência e gravidade de NVPO foram avaliadas em cinco momentos: 0, 2, 6, 12 e 24 horas pós-cirurgia. O uso de antiemético de resgate também foi avaliado. Resultados: NVPO ocorreu em 50,9% dos pacientes no grupo inalatória e 17,3% dos pacientes no grupo TIVA (p< 0,001). A incidência de vômitos relatados foi 11,3% no grupo Inalatória e 3,8% no grupo TIVA (p = 0,15). Necessitaram de medicação antiemética 24,5% dos pacientes no grupo Inalatória e 9,6% dos pacientes no grupo TIVA (p = 0.043). Conclusão: A incidência de náusea e vômito no pós-operatório, a necessidade de administração de droga antiemética de resgate e a gravidade da náusea foram significantemente mais baixas no grupo TIVA.

Anestesia total intravenosa libre de opioides en un paciente con síndrome de Joubert: caso clínico / Opioid free total intravenous anesthesia in Joubert syndrome: Case report

Joubert syndrome (JS) is a rare autosomal recessive disorder characterized by abnormal eye movements, respiratory pattern abnormalities, anatomical airway alterations, mental retardation and hypoplasia/aplasia of the cerebellar vermis confirmed by magnetic resonance imaging. This case report describes the successful management of a patient with JS operated of cholesteatoma under 100% opioid-free total intravenous general anaesthesia. We also provide a brief review of JS, its anaesthetic implications and opioid-free anaesthesia (OFA) technique.

El síndrome de Joubert (SJ) es una enfermedad autosómica recesiva poco frecuente caracterizada por trastornos oculares, respiratorios, alteraciones anatómicas de la vía aérea, retraso mental e hipoplasia/aplasia del vermis cerebeloso constatada mediante resonancia magnética. Presentamos un caso exitoso de paciente con SJ operado de colesteatoma bajo anestesia general endovenosa total 100% libre de opioides. Asimismo, realizamos una breve revisión del SJ, sus implicaciones anestésicas y de la técnica de anestesia libre de opioides.

Incidencia del déficit cognitivo postoperatorio en anestesia regional y general en una institución de cuarto nivel en Bucaramanga (Santander, Colombia) en el año 2017 / Postoperative cognitive dysfunction incidence for regional and general anesthesia in a level four institution in Bucaramanga (Santander, Colombia) during 2017 / Incidência do déficit cognitivo pós-operatório em anestesia regional e geral em uma instituição de quarto nível em Bucaramanga (Santander, Colômbia) em 2017

Introducción. En el proceso de envejecimiento, la mayoría de los sistemas orgánicos mantienen su funcionamiento basal, pero existe una reducción de la reserva funcional y de la capacidad para compensar el estrés fisiológico, lo que hace que los pacientes de mayor edad sean más propensos a complicaciones postoperatorias. Se realizó un estudio en instituciones de Bucaramanga para determinar la incidencia de déficit cognitivo postoperatorio y los factores de riesgo asociados. Metodología. Estudio observacional analítico de cohorte prospectivo realizado en instituciones de salud de Bucaramanga durante 2017 con pacientes mayores de 55 años intervenidos bajo anestesia regional, general balanceada o anestesia total intravenosa. Resultados. Se estudiaron 173 pacientes, 112 mujeres (64.74%) y 61 hombres (35.26%) operados. Las técnicas anestésicas más empleadas fueron: Regional (46.24%) y General balanceada (44.51%). La incidencia de Déficit Cognitivo Postoperatorio a corto plazo fue 6.36% en pacientes previamente sanos, con valor P significativo (0.001) ajustado. Se detectó deterioro cognitivo del 51.41% con alteraciones en los dominios de lenguaje, atención y memoria; con aumento en la evaluación a largo plazo. Durante el seguimiento de pacientes a largo plazo resultó en un 11.55%, determinando la incidencia de Déficit Cognitivo Postoperatorio tardío en un 17.91%. La técnica anestésica con mayor proporción de déficit a largo plazo fue la anestesia mixta, comparada con anestesia regional. Discusión. En la actualidad no existe una definición estandarizada de Déficit Cognitivo Postoperatorio, se ha observado mayor frecuencia y mayor prolongación en pacientes de edad avanzada. El estudio demostró una incidencia temprana significativamente menor, comparándolo con artículos internacionales, pero una incidencia mayor en déficit postoperatorio tardío, resultado de mayores complicaciones intraoperatorias, comparado con otros estudios. Conclusiones. El Déficit Cognitivo Postoperatorio involucra múltiples factores de riesgo; en el estudio se encontró mayor asociación con la edad, la escolaridad, la hipotensión y la anestesia general. No hubo asociación entre comorbilidades y el Déficit Cognitivo Postoperatorio. Se determinó la presencia de hipotensión para desarrollo de este déficit. Cómo citar: Contreras-Forero FJ, Ochoa ME, Perez M, Pinillos M, Celis L, Valencia-Guampe JS, et al. Incidencia del déficit cognitivo postoperatorio en anestesia regional y general en una institución de cuarto nivel en bucaramanga (santander, colombia) en el año 2017. MedUNAB. 2020;23(3): 450-463. Doi: https://doi.org/10.29375/01237047.3711

Introduction. Within the aging process, most organic systems maintain their basal functions. However, there is a reduction in functional reserve and the capacity to compensate physiological stress, which makes older patients more prone to postoperative complications. A study was performed in institutions in Bucaramanga to determine the incidence of postoperative cognitive dysfunction and the associated risk factors. Methodology. This was a analytical observational prospective cohort study performed in healthcare institutions in Bucaramanga in 2017 with patients older than 55 years of age under regional, balanced general or total intravenous anesthesia. Results. One hundred and seventy-three operated patients were studied, among which 112 (64.74%) were women and 61 (35.26%) were men. The most commonly used anesthetic techniques were: regional (46.24%) and balanced general (44.51%). Short-term Postoperative Cognitive Dysfunction incidence was 6.36% in previously healthy patients, with an adjusted significant P value (0.001). Cognitive deterioration was detected in 51.41% of patients, with alterations in their mastery of language, attention and memory. This increased for the long-term evaluation. During long-term patient follow-up, it resulted in 11.55%, determining the incidence of delayed Postoperative Cognitive Dysfunction at 17.91%. The anesthetic technique with the highest proportion of long- term dysfunction was mixed anesthesia, compared to regional anesthesia. Discussion. There is currently no standardized definition for Postoperative Cognitive Dysfunction. It has been observed more frequently and for longer extensions in older patients. The study demonstrated a significantly lower early incidence when compared to international articles, but a greater incidence of delayed postoperative dysfunction as a result of more intraoperative complications compared to other studies. Conclusions. Postoperative Cognitive Dysfunction involves multiple risk factors. The study observed a greater association with age, level of education, hypotension and general anesthesia. There was no association between comorbidities and Postoperative Cognitive Dysfunction. The presence of hypotension was determined for developing this dysfunction. Cómo citar: Contreras-Forero FJ, Ochoa ME, Perez M, Pinillos M, Celis L, Valencia-Guampe JS, et al. Incidencia del déficit cognitivo postoperatorio en anestesia regional y general en una institución de cuarto nivel en bucaramanga (santander, colombia) en el año 2017. MedUNAB. 2020;23(3): 450-463. Doi: https://doi.org/10.29375/01237047.3711

Introdução. No processo de envelhecimento, a maioria dos sistemas orgânicos mantém seu funcionamento basal, mas há uma diminuição da reserva funcional e da capacidade de compensar o estresse fisiológico que torna os pacientes idosos mais sujeitos a complicações pós-operatórias. Foi realizado um estudo em instituições da cidade de Bucaramanga para determinar a incidência de déficit cognitivo pós-operatório e os fatores de risco associados. Métodos. Estudo observacional analítico de coorte prospectivo realizado em instituições de saúde em Bucaramanga durante o ano de 2017 em pacientes com idade superior a 65 anos operados sob anestesia regional, geral balanceada ou anestesia geral intravenosa. Resultados. Foram estudados 173 pacientes, 112 mulheres (64.74%) e 61 homens (35.26%) operados. As técnicas anestésicas mais utilizadas foram: regional (46.24%) e geral balanceada (44.51%). A incidência de déficit cognitivo pós-operatório de curto prazo foi de 6.36% em pacientes previamente saudáveis, com um valor P significativo (0.001) ajustado. Detectou- se deterioração cognitiva de 51.41% com alterações nos domínios da linguagem, atenção e memória; com aumento na avaliação de longo prazo. No seguimento a longo prazo dos pacientes resultou em 11.55%, determinando a incidência de déficit cognitivo pós-operatório tardio em 17.91%. A técnica anestésica com maior proporção de déficit no longo prazo foi a anestesia mista, em comparação com a anestesia regional. Discussão. Atualmente não existe uma definição padronizada de Déficit Cognitivo Pós-operatório, a qual observa-se com maior frequência e por mais tempo em pacientes idosos. O estudo demonstrou incidência precoce significativamente menor, em comparação com resultados de artigos internacionais, mas maior incidência de déficit pós-operatório tardio, resultado de maiores complicações intraoperatórias, em comparação com outros estudos. Conclusões. O Déficit Cognitivo Pós-operatório envolve múltiplos fatores de risco; o estudo encontrou maior associação com idade, escolaridade, hipotensão e anestesia geral. Não houve associação entre comorbidades e Déficit Cognitivo Pós-operatório. Determinou-se a presença de hipotensão para o desenvolvimento desse déficit. Cómo citar: Contreras-Forero FJ, Ochoa ME, Perez M, Pinillos M, Celis L, Valencia-Guampe JS, et al. Incidencia del déficit cognitivo postoperatorio en anestesia regional y general en una institución de cuarto nivel en bucaramanga (santander, colombia) en el año 2017. MedUNAB. 2020;23(3): 450-463. Doi: https://doi.org/10.29375/01237047.3711

Anestesia total intravenosa en cirugía oncológica de mama / Total intravenous anesthesia in breast oncology surgery

Introducción: La anestesia total intravenosa se caracteriza por estabilidad hemodinámica, profundidad anestésica, recuperación rápida y predecible, menor cantidad de medicamentos y menor toxicidad. Objetivo: Describir los resultados de la anestesia total intravenosa en cirugía oncológica de mama. Método: Se realizó un estudio descriptivo, longitudinal en el Hospital Clínico Quirúrgico Hermanos Ameijeiras, entre enero de 2016 a diciembre 2016, en 100 pacientes a las que se les administró anestesia total intravenosa con midazolam y fentanilo para proceder quirúrgico oncológico de mama. En ellas se determinó la repercusión hemodinámica, el nivel de sedación, analgesia, la recuperación y complicaciones. Resultados: La media de la edad de las pacientes fue 58,99 ± 12,5 años. De las pacientes en estudio 92 por ciento no presentó signos clínicos de superficialidad. Solo 21 pacientes presentaron complicaciones. Las variaciones de la tensión arterial fueron las más frecuentes (16 por ciento), seguidas de la bradicardia o taquicardia en solo cuatro casos. De forma inmediata se recuperó 74 por ciento de los casos y 26 por ciento restante lo hizo de manera mediata. El nivel de sedación fue adecuado en 50 por ciento y excesivo en 4 por ciento. Del total de los casos, 99 por ciento experimentaron respuesta analgésica sin dolor. Conclusiones: Los resultados del uso de anestesia total intravenosa fueron buenos, con adecuada respuesta analgésica y escasas complicaciones(AU)

Introduction: Total intravenous anesthesia is characterized by hemodynamic stability, anesthetic depth, rapid and predictable recovery, less medication and less toxicity. Objective: To describe the outcomes of total intravenous anesthesia in breast cancer surgery. Method: A descriptive, longitudinal study was carried out in Hermanos Ameijeiras Clinical-Surgical Hospital, from January 2016 to December 2016, in 100 patients who were administered total intravenous anesthesia with midazolam and fentanyl for breast oncology surgery. The patients were determined hemodynamic repercussion, the level of sedation, analgesia, recovery and complications. Results: The mean age of the patients was 58.99±12.5 years. Among the patients under study, 92 percent did not present clinical signs of superficiality. Only 21 patients presented complications. Variations in blood pressure were the most frequent (16 percent), followed by bradycardia or tachycardia in only four cases. Immediately, 74 percent of the cases were recovered and the remaining 26 percent did so timely. The level of sedation was adequate in 50 percent and excessive in 4 percent. Among the total number of cases, 99 percent experienced analgesic response without pain. Conclusions: The outcomes of total intravenous anesthesia usage were good, with adequate analgesic response and few complications(AU)

Sufentanil during anesthetic induction of remifentanil-based total intravenous anesthesia: a randomized controlled trial / Sufentanil durante a indução da anestesia intravenosa total à base de remifentanil: ensaio clínico randômico

Abstract Background Postoperative pain represents an important concern when remifentanil is used for total intravenous anesthesia because of its ultrashort half-life. Longer acting opioids, such as sufentanil, have been used during induction of remifentanil-based total intravenous anesthesia as a means to overcome this shortcoming. However, the effectiveness and safety of such strategy still lacks evidence from randomized clinical trials. Hence, we aimed to assess the postoperative analgesic efficacy and safety of a single dose of sufentanil administered during the induction of remifentanil-based total intravenous anesthesia. Methods Forty patients, scheduled for elective open abdominal surgery, were randomized to receive remifentanil-based total intravenous anesthesia with or without a single dose of sufentanil upon induction. We assessed the postoperative morphine consumption administered through a patient-controlled analgesia pump. Self-reported pain scores and the occurrence of nausea, vomiting, pruritus, agitation, somnolence and respiratory depression were also assessed up to 2 days after surgery. Results The mean difference between the sufentanil and control groups regarding morphine consumption in the post-anesthetic care unit and at 12, 24 and 48 h after surgery were -7.2 mg (95%CI: -12.5 to -2.1, p < 0.001), -3.9 mg (95%CI: -11.9 to 4.7, p = 0.26), -0.6 mg (95%CI: (-12.7 to 12.7, p = 0.80), and -1.8 mg (95%CI: (-11.6 to 15.6, p = 0.94), respectively. Neither self-reported pain nor the incidence of adverse events were significantly different between groups at any time point. Conclusion Our findings suggest that the administration of sufentanil during induction of remifentanil-based total intravenous anesthesia is associated with decreased early postoperative opioid consumption.

Resumo Justificativa A dor pós-operatória é uma grande preocupação quando o remifentanil é usado para anestesia intravenosa total devido à sua meia-vida ultracurta. Os opioides de ação mais longa, como o sufentanil, têm sido usados durante a indução de anestesia intravenosa total à base de remifentanil como um meio de superar essa deficiência. Porém, a eficácia e segurança de tal estratégia ainda precisam de evidências advindas de ensaios clínicos randômicos. Portanto, objetivamos avaliar a eficácia analgésica e a segurança pós-operatória de uma dose única de sufentanil administrada durante a indução de anestesia intravenosa total à base de remifentanil. Métodos Quarenta pacientes eletivamente agendados para cirurgia abdominal aberta foram randomizados para receber anestesia intravenosa total à base de remifentanil, com ou sem uma dose única de sufentanil, após a indução da anestesia. Avaliamos o consumo de morfina no pós-operatório, administrado através de uma bomba de analgesia controlada pelo paciente. Os escores de dor autorrelatados e a ocorrência de náusea, vômito, prurido, agitação, sonolência e depressão respiratória também foram avaliados até dois dias após a cirurgia. Resultados A diferença média entre os grupos sufentanil e controle em relação ao consumo de morfina em sala de recuperação pós-anestesia e após 12, 24 e 48 horas da cirurgia foi de -7,2 mg (IC 95%: -12,5 a -2,1, p < 0,001), -3,9 mg (IC 95%: -11,9 a 4,7, p = 0,26), -0,6 mg (IC 95%: (-12,7 a 12,7, p = 0,80) e -1,8 mg (IC 95%: -11,6 para 15,6, p = 0,94), respectivamente. Não houve diferença significativa tanto nos escores de dor autorrelatados, quanto na incidência de eventos adversos entre os grupos. Conclusão Nossos achados sugerem que a administração de sufentanil durante a indução de anestesia intravenosa total à base de remifentanil está associada à redução do consumo de opioides no pós-operatório imediato.

Assessment of Total Intravenous Anaesthesia in Laparoscopic Surgery: A Hospital Based Prospective Study

Background: Total Intravenous Anaesthesia (TIVA) iscommonly applied during gynecological laparoscopic surgery.Hence; the present study was undertaken for assessingefficacy of Total Intravenous Anaesthesia in LaparoscopicSurgery.Materials & Methods: A total of 30 patients scheduled toundergo laparoscopic cholecystectomy (LC) were enrolled inthe present study. Pre-anaesthetic checkup were done.Solutions of propofol containing different concentrations ofsufentanil were prepared. All the hemodynamic parameterswere recorded intra-operatively. Separate recording of the timeduration required for rescue analgesia was done. Prevalenceof postoperative complications was done. All the results wererecorded and analyzed by SPSS software.Results: Mean age of the patients of the present study was41.7 years. There were 22 females and 8 males in the presentstudy. Mean time to rescue analgesia was 159.15 minutes.Only two patients exhibited nausea and Vomiting.Conclusion: In patients undergoing LC, Total IntravenousAnaesthesia (TIVA) through sufentanil mixed in propofoldelivers adequate anesthesia.