effect of intraoperative use of esmolol and nicardipine on splanchnic perfusion in functional endoscopic sinus surgery

There are many techniques for reduction of mean arterial blood pressure [MAP] and heart rate [HR] during anesthesia. We designed this prospective, randomized, double-blinded study to test the effect of this technique for maintaining hemodynamic stability during general anesthesia and their influences on splanchnic perfusion. Sixty healthy consenting patients undergoing functional endoscopic sinus surgery [FESS] were randomly assigned to 1 of 3 treatment groups: Group I [control n = 20] received normal saline 5 mL and 1 mL, followed by a saline infusion at a rate of 0.005 mL kg[-1] min[1]; Group 2 [n = 20] received esmolol 50 mg and saline 1.mL, followed by an esmolol infusion 5 micro g kg[-1] min[-1]; and Group 3 [n = 20] received esmolol 50 mg and nicardipine 1 mg, followed by an esmolol infusion 5 micro g kg[-1] min[-1]. The study drugs were administered after the induction of anesthesia with fentanyl 1.5 micro g/kg, and propofol 2 mg/kg IV. Tracheal intubation was facilitated with vecuronium 0.12 mg/kg IV. Anesthesia was initially maintained with sevoflurane 2% end-tidal and N[2]O 50% In oxygen in all 3 groups. After induction of anesthesia a gastric tonometer [TRIP] NGS Catheter and a radial catheter were inserted. Baseline values of gastric intramucosal pH [pHi] were determined before induction of hypotension. The [pHi] values were calculated every 30 min until hypotension was discontinued .The CO2 -gap [i.e., the difference between arterial and gastric Pco2] was registered. Arterial blood lactate levels also were measured. During surgery, the mean arterial blood pressure [MAP] was maintained within +/- 15% of the baseline value by varying the study drug infusion rate and the inspired concentration of sevoflurane. In addition to MAP and heart-rate values, were recorded throughout the perioperative period. Recovery times and postoperative side effects were assessed. None of the [pHi] values calculated was less than 7.35 in the three studied groups. Arterial blood lactate levels did not increase in any of the patients. Compared with the control group, adjunctive use of esmolol and nicardipine attenuated the increase in heart rate [in Group 2] and MAP [in Group 3]. after tracheal intubation. Furthermore, the use of an esmolol infusion as an adjunct to sevoflurane to control the acute autonomic responses during the maintenance period significantly decreased emergence times [4 +/- 2 versus 7 +/- 4 min], decreased the need for postoperative opioid analgesics [35% versus 60%], and reduced the time before discharge [209 +/- 89 versus 269 +/- 100 min]. We conclude that the adjunctive use of esmolol alone or in combination with nicardipine during the induction of anesthesia reduced the hemodynamic response to tracheal intubation. It did not compromise splanchnic tissue oxygen balance in healthy patients nor increased blood lactate. Furthermore, use of an esmolol infusion as an adjuvant to sevoflurane- N[2] O anesthesia for controlling the acute hemodynamic responses during the maintenance period improved the recovery profile after functional endoscopic sinus surgery

Elevation of liver enzymes after laparoscopic cholecystectomy versus open cholecystectomy

Laparoscopic cholecystectomy [LC] has been accepted as an alternative to laparotomy, and has become the standard treatment of benign gall bladder diseases. However, it has been noticed that following LC, the serum level of certain liver enzymes rises markedly, in patients who had preoperatively normal liver enzyme value. We measured serum values of hepatic alcohol dehydrogenase [AD] and glutathione S-transferase [GST] alanine aminotransferase [ALT] and aspertase aminotransferase [AST], in 80 patients who underwent open cholecystectomy or laparoscopic cholecystectomy, they were divided randomly into two groups. Group 1[40 patients] underwent laparoscopic cholecystectomy [LC]. Group 11[40 patients] underwent open cholecystectomy [OC]. To assess the liver function, serum liver enzymes of AD, GST, ALT, and AST were measured before operations and at 1, 3, 7, and 10 days postoperative. Pre operative AD, GST, ALT, and AST were insignificantly different between the two groups. Twenty four hours after the procedure. AD, GST, ALT and AST increased significantly in the LC group [AD 8.1 +/- 2.2 U/L, GST 82.2 +/- 19.1 U/L, ALT 87.1 +/- 24.2 U/L, and AST 95.1 +/- 7.7 U/L but in [OC] group these enzymes were [AD 4.8 +/- 1.9 U/L, GST 35.3 +/- 3.9 U/L, ALT 27.8 +/- 11.9 U/L, and AST 5.3 +/- 0.9 U/L]. A further increase in serum AD, GST, ALT and AST value in LC group at the 3 [rd] day after the operation [AD 9.3 +/- 1.5 U/L, GST 103.5 +/- 21.6 U/L, ALT 99.3 +/- 19.4 U/L, and AST 120.9 +/- 10.4 U/L] but in [OC] group these enzymes were [AD 5.6 +/- 3.4 U/L, GST 47.9 +/- 1.4 U/L, ALT 38.6 +/- 3.4 U/L, and AST 17.9 +/- 1.4 U/L]. Slow return to normality occurred 7-10 days after the procedure in the LC group. Alterations in hepatic function occur after LC and appear to be clinically insignificant. These alterations in hepatic function return to normal levels within ten days. CO2 pneumoperitoneum seems to be the main reason for these changes but other factors may also contribute

Effect of dexamethasone on postoperative nausea and vomiting in children after tonsillectomy surgery

After approval by the local ethics committee sixty ASA 1 and 11 children, undergoing tonsillectomy surgery by dissection technique were included into the study. The parents of all children had been informed to the nature of the study and a written informed consent was obtained. The children who fulfilled our inclusion criteria were classified into three equal groups according to the timing of dexamethasone administration: Group I: Received dexamethasone 8mg IV one hour before induction of anesthesia. Group II. Received dexamethasone 8mg IV at the end of anesthesia. Group III: Received placebo [2 ml saline]. Anesthesia was managed in a standardized manner in the three groups. Postoperative pain was assessed by questioning the children on a visual analogue toy at one, two and, six hours postoperatively. Nausea and vomiting were assessed by 3 point ordinal scale: 0 = none. 1 = Nausea. 2 = Vomiting. Vomiting was assessed immediately after operation and was defined as forceful expulsion of gastric contents. Leach vomiting episode was counted in the operating room after the tracheal tube was removed. No distinction was made between vomiting and retching, [defined as active efforts without expulsion of gastric contents], and retching was graded as a vomiting event. The severity of vomiting episodes was recorded as: None [no emetic episode], Mild [1-3 episodes], Moderate [4-6 episodes], or Severe [> 7 episodes]. Vomiting was classified according to its time of occurrence after recovery as: none, early [within the first 180 minutes after the end of anesthesia], or delayed [after 180 minutes]. No vomiting and no rescue antiemetic medication during the 24 hour postoperative period were defined as successful protection. Surgery time, anesthesia time, need for rescue antiemetics, quality of oral intake in the PACU were recorded for each patient. Paracetamol suppositories 10 mg/kg 4-hourly were described for postoperative analgesia and on request of the patient, the total dose of paracetamol consumption was recorded. Our results showed that, at 0-2 hour postoperatively: Patients in group I reported a significantly less frequent incidence of PONV than those in group II and III with frequencies of 20%, 60% and 70% in group 1, II and III respectively. At 2-6 h postoperatively, no patient [0%]. Two patients]10%] and three patients [15%] suffered form vomiting in group I, II and III respectively. At 0-2h postoperatively, four patients [20%] in group I, and 12 patients [60%] in group II, and 14 patients [70%] in group III suffered vomiting early within 180 minutes after the end of anesthesia. At 2-6 hours postoperatively, no patient in group I suffered from vomiting, one patient [5%] in group II suffered vomiting early within 180 minutes after the end of anesthesia, and one patient [5%] in group II and 3 patients [15%] in group III had delayed vomiting after 180 minutes from the end of anesthesia. There were no children in group I who required antieienietic rescue while 4 patients [20%] in group II and 5 patients [25%] in group III required treatment with metoclopramide. Children in group I achieved early oral intake than the other two groups. We concluded that 8 mg IV dexamethasone, when administered 1 hour before the induction of anesthesia provided an effective antiemetic therapy throughout the first six hours of the postoperative period. On the other hand, dexamethasone when administred at the end of anesthesia, failed to provide an effective antiemetic therapy during the immediate postoperative period in children after tonsillectomy surgery