Résumé
Background: The aim of this study was to compare the effects of hyperbaric ropivacaine versus hyperbaric bupivacaine in geriatric hypertensive patients subjected to orthopedic surgery
Methods: This study was carried out on 60 patients aged above 60 years undergoing orthopedic lower limb surgery. The studied patients were randomely classified into 2 groups. Bupivacaine group [BG] [n-30]: 3 ml of hyperbaric bupivacaine 0.5% [15 mg] was injected. Ropivacaine group [ RG] [n=30]: 2 ml of isobaric ropivacaine 0.75% [15 mg] added to 1 ml glucose 5% [to give 3 ml solution containing 5 mg ropivacaine + 17 my glucose/ml]. The patients in both groups were observed for: Sensory block duration, level and recovery], degree of motor block [according to Bromage score], the hemodynamic parameters [including MAP, HR, CVP and SpO2], analgesia [assessed by VAS] and side effects
Results: we found that there was a significant decrease in MAP in BG at 5, 15 and 30 minutes compared with the basal value but in RG there was insignificant differences in MAP compared with the basal value. There was insignificant difference as regards time of onset of sensory block or peak sensory level reached in both BG and RG. There was no difference in potency of motor block or adequacy of sensory block between both groups. There was a significant difference in the duration of sensory and motor block as there was faster recovery from motor and sensory block in RG. Also, there was a significant difference in duration of analgesia between RG and BG. The duration of analgesia in BG was longer than in RG
Conclusion: Intrathecal administration of either 15 mg hyperbaric ropivacaine or 15 mg hyperbaric bupivacaine was well tolerated and provided similar effective anaesthesia for lower limb orthopedic surgery. Ropivacaine showed more hemodynamic stability than bupivacaine especially during the first 30 minutes after intrathecal injection. Both ropivacaine and bupivacaine produced the same potency of motor and sensory block with more rapid recovery with ropivacaine. So for these results ropivacaine may prove useful when surgical anaesthesia is desired especially in geriatric hypertensive patients whom are more liable for hemodynamic instability
Résumé
Background: the major determinant of postoperative morbidity and mortality after pulmonary resection is the functional status of the cardiac and pulmonary systems. Right ventricular [RV] thermodilution ejection fraction/oximeteric catheter has been recently proposed as a new technique to evaluate the pulmonary hemodynamics and gas exchange variables in lung resection
Aim of the work: the aim of this study was to evaluate the effect of lobectomy on pulmonary hemodynamics and gas exchange variables using the RV thermodilution ejection fraction/oximeteric catheter and its possible effects on early morbidity and mortality
Patients and methods: we evaluated the acute postoperative effects of lung resection on hemodynamic and gas exchange parameters in thirty patients using the RV thermodilution ejection fraction/oximeteric catheter. Anesthesia was induced with thiopentone sodium and maintained with midazolam, fentanyl and pipecuronium. Intubation was performed with double-lumen, left-sided endobronchial tube for one lung ventilation. The hemodynamic and gas exchange parameters were recorded before and after induction of anesthesia, and two hours after lung resection
Results: lobectomy was associated with significant hemodynamic changes and good maintenance of gas exchange variables. SVI, LVSWI and RVEF were significantly decreased in the early postoperative period after lung resection. MPAP, COP, CI, SVRI, PVRI, RVSWI, and RVEDVI showed no significant changes during perioperative period. Svo2 showed a significant increase after lung resection when compared with preinduction values, while Vo2 significantly decreased. Sao2, a-A Po2., QS- QT, Do2, and Og ER showed no significant changes during perioperative period. No operative mortality is encountered in this study. Post-operative supraventricular arrhythmias were recorded in five patients [16.7%] which were hemodynamically well tolerated and did not correlate with the perioperative changes in the hemodynamics or gas exchange variables
Conclusion: we can conclude that the acute post resection period [up to 2 hours postoperatively] revealed right and left ventricular dysfunction with good maintenance of gas exchange. Despite these changes, lobectomy is well tolerated with minimal morbidity and mortality