Comparison of Propofol and Ketofol on Transcranial Motor Evoked Potentials in Patients Undergoing Thoracolumbar Spine Surgery

Methods@#Amplitude and latency of TcMEPs were recorded bilaterally from the abductor pollicis brevis (APB) and abductor hallucis (AH) muscles in 38 adult American Society of Anesthesiologists I and II patients undergoing thoracolumbar spine surgery. Baseline recordings of TcMEPs in both groups were recorded under propofol infusion. Group X patients then received propofol and fentanyl (1 mcg/kg/hr), and group Y patients received ketofol and fentanyl (1 mcg/kg/hr). Bispectral index was maintained at 40–60 in both groups. Amplitude and latency were recorded at 30 minutes intervals for 2 hours. @*Results@#Propofol caused no significant changes in amplitude and latency in any muscle. In contrast, amplitude increased significantly at all time points in the bilateral APB muscles and 60, 90, and 120 minutes in the left AH muscle without changes in latency in response to ketofol. When the two groups were compared, ketofol induced significantly higher amplitudes at 60, 90, and 120 minutes in the (left) APB, at all time points in the (right) APB, and at 120 minutes in both AH muscles, compared with propofol. Blood pressures were lower and fluid and vasopressor requirements were higher in group X. Muscle power was similar between the two groups. @*Conclusions@#Ketofol facilitates TcMEP amplitudes without affecting latency. Use of ketofol resulted in a better and more stable hemodynamic profile than did use of propofol.

Comparison of intraoperative brain condition, hemodynamics and postoperative recovery between desflurane and sevoflurane in patients undergoing supratentorial craniotomy

Post operative recovery has been reported to be faster with desflurane than sevoflurane anesthesia in previous studies. The use of desflurane is often criticized in neurosurgery due to the concerns of cerebral vasodilation and increase in ICP and studies comparing desflurane and sevoflurane in neurosurgey are scarce. So we compared the intraoperative brain condition, hemodynamics and postoperative recovery in patients undergoing elective supratentorial craniotomy receiving either desflurane or sevoflurane. Fifty three patients between 18-60yr undergoing elective supratentorial craniotomy receiving N[2] O and oxygen [60%:40%] and 0.8-1.2 MAC of either desflurane or sevoflurane were randomized to group S [Sevoflurane] or group D [Desflurane]. Subdural intra cranial pressure [ICP] was measured and brain condition was assessed. Emergence time, tracheal extubation time and recovery time were recorded. Cognitive behavior was evaluated with Short Orientation Memory Concentration Test [SOMCT] and neurological outcome [at the time of discharge] was assessed using Glasgow Outcome Score [GOS] between the two groups. The emergence time [Group D 7.4 +/- 2.7 minutes vs. Group S 7.8 +/- 3.7 minutes; P = 0.65], extubation time [Group D 11.8 +/- 2.8 minutes vs. Group S 12.9 +/- 4.9 minutes; P = 0.28] and recovery time [Group D 16.4 +/- 2.6 minutes vs. Group S 17.1 +/- 4.8 minutes; P = 0.50] were comparable between the two groups. There was no difference in ICP [Group D; 9.1 +/- 4.3 mmHg vs. Group S; 10.9 +/- 4.2 mmHg; P = 0.14] and brain condition between the two groups. Both groups had similar post-operative complications, hospital and ICU stay and GOS. In patients undergoing elective supratentorial craniotomy both sevoflurane and desflurane had similar intra-operative brain condition, hemodynamics and post operative recovery profile

Anesthetic management in children with Hurler's syndrome undergoing emergency ventriculoperitoneal shunt surgery

Mucopolysaccharidoses [MPSs] are a group of lysosomal storage disorder characterized by progressive multiorgan accumulation of glycosaminoglycans. Patients with MPS I [Hurler's syndrome] present as one of the most difficult airway problems to be managed by anesthesiologists. Hydrocephalus with increased intracranial pressure is a frequent complication seen in these patients. The rarity of the syndrome accounts for the small number of case reports and anecdotal information on the intracranial manifestations of this syndrome. We describe the successful anesthetic management of 2 children with Hurler's syndrome who underwent ventriculoperitoneal shunt surgery for acute hydrocephalus

Application of indigenous continuous positive airway pressure during one lung ventilation for thoracic surgery

During one lung ventilation [OLV] hypoxemia may occur due to ventilation-perfusion mismatch. It can be prevented with application of ventilation strategy that prevents atelectasis while minimally impairing perfusion of the dependant lung. Here, two cases are reported who required OLV and in whom hypoxemia could be prevented with the application of continuous positive airway pressure to the deflated or non-dependant lung, using an indigenous technique. We suggest use of this technique which is easy to be employed during the intraoperative period