Comparison of postoperative quality in sevoflurane versus propofol- ketamine anesthesia for outpatient laparoscopy

Outpatient laproscopic surgery, put the anesetheologist in challenge for either total intravenous anesthesia [TIVA] or inhalational anesthesia with sevoflurane, which gives rise to rapid recovery. This study shows a comparison in postoperative quality between propofol in combination with ketamine-group [1] and sevoflurane group [2] for forty patients undergoing laproscopic procedures[n=20]. The differences between both groups as regard: nausea visual analogue scoee [VAS], nausea VAS >75, postoperative nausea and vomiting [PONV], and N/V treatment were significantly higher in group [1] with also higher incidence of dreaming state but the pain VAS and analgesic requirements were significantly higher in group[2] Postoperative haemodynamic or respiratory changes were statistically insignificant. It is concluded that sevoflurane anesthesia is better than propofol-ketamine combination in the anesthetic management of outpatient laproscopic surgery as it provides rapid recovery, no PONV, but less postoperative analgesia which can be overcomed by giving patients a long acting non-steroidal analgesic near the end of surgery

Laparoscopic cholecystectomy during pregnancy; is it safe?

Laparoscopic management of Biliopancreatic gallstone disease [BPD] during pregnancy remains controversial. Although perioperative problems and fetal loss have been reported, recent publications have advocated an early surgical approach. Twenty-eight patients, who required surgical treatment for BPD during pregnancy because of persistent symptoms, were randomly allocated into either laparoscopic or open surgery. Their mean age was 28 years, range 19-40 years. Thirteen patients underwent a laparoscopic cholecystectomy [LC], and 15 open cholecystectomy [OC], including one conversion from laparoscopic. There was no maternal mortality or morbidity. A single case of fetal loss occurred for a patient with acute cholecystitis who underwent OC during her 17[th] week of gestation. There was no statistically significant difference in preterm delivery rate between the LC and OC groups. Neither birth weights nor Apgar scores were significantly different across the groups. Early involvement of the obstetric team, with preoperative and postoperative fetal monitoring, and adequate management of anesthetic and tocolytic agents make laparoscopic cholecystectomy a safe procedure