Comparison of postoperative complication between Laryngeal Mask Airway and endotracheal tube during low-flow anesthesia with controlled ventilation

Objective: To compare the postoperative complications between Laryngeal Mask Airway [LMA] and endotracheal tube [ETT] during low-flow anesthesia with controlled ventilation

Methodology: Eighty adult Patients with ASA class I or II were randomly allocated into two forty-patient groups [ETT or LMA]. Cuff pressure was monitored during anesthesia. After high uptake period, fresh gas flow [FGF] was decreased to 1 lit/min and isoflurane set to 1%. Monitoring during anesthesia included non-invasive blood pressure, ECG, ETCO2 and pulse oximetry. System leakage [>100 ml/min], rebreathing and any attempt to increase FGF to overcome the leak were monitored during anesthesia. Later, patients were extubated and transferred to Post Anesthesia Care Unit [PACU]. In PACU, the incidence of sore throat, cough, difficulty in swallowing and shivering was monitored for all patients

Results: Leakage was observed in two and three cases in ETT and LMA groups respectively [P>0.05]. Postoperative cough, sore throat and difficulty in swallowing were significantly less in LMA than ETT group. No significant difference was observed regarding ETCo2 values between 2 groups

Conclusion: If careful measures regarding insertion techniques, correct LMA position and routine monitoring of LMA cuff pressure are taken, LMA can be used as a safe alternative with lower incidence of post operation complication compared with ETT during low-flow controlled anesthesia with modern anesthetic machines

[Effect of thoracic epidural anesthesia on oxygen saturation during one-lung ventilation in pulmonary resection surgery]

The perfusion in the nonventilated, operative lung during one-lung ventilation [OLV] in patients undergoing thoracic surgery increases intrapulmonary shunt and decreases systemic arterial oxygenation. The anesthesia with OLV may affect oxygenation. The aim of this study was comparing the effect of total intravenous anesthesia [TIVA] and thoracic epidural anesthesia [TEA] combined with TIVA on saturation of oxygen during OLV in patients undergoing pulmonary resection. In a randomized double-blind clinical trial, 60 patients undergoing elective pulmonary resection were Divided in to two groups. The intervention group received TEA [bupivacaine 0.25%] plus TIVA [propofol+remifentanil] while the control group received TEA [saline] plus TIVA.The hemodynamic parameters, Aldrete score and possible complications were compared between the two groups, within the study period. The change of hemodynamic parameters, as well as SaO2, PaO2 and ETCO2 within the study period was not significantly different between the two groups. The mean Aldrete score was comparable between the two groups upon entering recovery and after getting discharged from there. During the recovery stay, frequency of patients with pain and shivering was significantly higher in the group with sole TIVA. There was no significant difference in nausea and hypotension between the two groups. TEA plus TIVA does not have a significant effect on O2 saturation in OLV in patients comparing with sole TIVA. However, this combination significantly decreases the post-operative pain and shivering and so may be recommended

Cost-effectiveness of intraoperative transesophageal echocardiography in cardiac valve surgery

Being a unique diagnostic technique, transesophageai echocardiography [TEE] has influenced many different aspects of cardiac surgery including valve repair surgery. The cost-effectiveness of this method however is questioned considering the conditions of every region and country. In this study we aimed at answering the question if utilizing TEE throughout valve repair surgery could be cost-effective. Twenty four patients were studied within two groups of case "valve repair operation plus intra-operative TEE [10-TEE]" and control [valve replacement operation]. Variables including age, gender, left ventricle ejection fraction [LVEF], re-operation, intensive care unit [ICU] stay, hospital stay and cost were studied and compared. There was no significant difference regarding age, gender and LVEF between two groups [p=0.559, p=0.413, and p=0.408, respectively] ICU stay in repair group was less than replacement group [p=0.009]. Hospital stay difference however was not statistically significant [p=0.928]. The cost of valve repair under 10-TEE monitoring was significantly less than valve replacement [p=0.00l]. 10-TEE not only would assist surgeons by increasing their interest toward valve repair operation instead of replacing impaired cardiac valves but also consequently decrease hospital costs. It is also advised for the cardiac anesthesiologists to use 10-TEE routinely in the valve repair operations provided that there are no contraindications

Preincisional ipsilateral stellate ganglion block for acute post operative pain control in unilateral mastectomy

To evaluate the effect of preincisional ipsilateral stellate ganglion block for acute post operative pain control in unilateral mastectomy. In a randomized clinical trial, 62 patients selected for unilateral mastectomy were recruited in Tabriz Imam Reza educational Hospital during 18-month period. They were randomly divided into two equal groups; receiving either preincisional ipsilateral stellate ganglion block using bupivacaine [study group] or without these blocks [control group]. Postoperative pain was evaluated based on visual analogue scale [VAS]. The total dose of analgesics were also compared between the two groups. Thirty one female patients with a mean age of 48.7 +/- 7.4 [36-60] years and 31 other female patients with a mean age of 50.7 +/- 6.9 [36-60] years were enrolled in the study and control groups, respectively [p=0.292]. The number of patients with decrease in postoperative pain was significantly higher in the case study group comparing with that of the control group [p < 0.001]. Decrease in total dose of postoperative analgesics was also significantly lower in the case study group compared with control group [P < 0.001]. Forty eight hours after operation, there were 15 pain-free patients in the study group with no pain-free patients in the control group. This difference was statistically significant [P < 0.001]. Based on our findings, the preincisional ipsilateral stellate ganglion block is an effective method in controlling the postoperative pain after unilateral mastectomy. This approach had also got a considerable analgesic-sparing effect

Comparison of cardiac stress index with rate pressure product in trans - abdominal prostatectomy

The current study is to evaluate cardiovascular effects of anesthetic medications and volatile anesthetics on cardiac stress using cardiac stress index [CSI] and rate pressure product [RPP] and to determine which of them in useful in evaluating cardiac stress after comparing results obtained from each method. Forty patients, 60-80 years old, who were all performed Trans abdominal prostatectomy, were studied. Patients were divided into tm groups; half of patients were placed in group A and the other half in group B. The study was carried out as a blinded study. CCSI was measured and evaluated in group A and RPP changes were studied in group B. The mean CSI were 60.25 +/- 5.57, 63.05 +/- .54, 55.75 +/- 4.78 and 67.65 +/- 4.88 before anesthesia induction, after induction, before surgical incision and in recovery respectively. There was no meaningful difference among these four stages measurements. RPP mean in four above mentioned stages was 10.15 +/- 0.44, 9.9 +/- 0.69, 6.8 +/- 0.36 and 9.2 +/- 0.61 respectively. There was a significant difference between RPP in stages before anesthesia induction and before surgical incision [P< 0.0001]. Considering the obtained results from this study, it can be seen that even in non-cardiac surgery, the stress level is high in patients in preoperative period. This condition was not clear in RPP index case and was not in accordance with CSI, which means CSI has been able to illustrate existing stress level better and efficiently