Effect of bispectral index [BIS] monitoring on postoperative recovery and sevoflurane consumption among morbidly obese patients undergoing laparoscopic gastric banding

Early and uneventful postoperative recovery of morbidly obese patients remains a challenge for anesthesiologists. It could be valuable to titrate the administration of inhaled anesthetic, such as sevoflurane, in morbid obese patients, in order to shorten emergence using bispectral index [BIS] monitoring. It would be a great advantage if BIS permitted a more rapid recovery and less consumption in morbidly obese patients with a high cost inhaled agent. The aim of the study is to show whether the titration of sevoflurane based on the BIS monitoring would allow shortening of recovery time in morbidly obese patients and to evaluate whether BIS monitoring would contribute to reduce the amount of sevofLurane administered while providing an adequate anesthesia. Thirty morbidly obese ASA I and II patients undergoing laparoscopic gastric banding [LAGB] procedures were studied. In the first group [15 patients], patients were anesthetized without the use of BIS [non BIS or control group], and sevoflurane being administered according to standard clinical practice [control group]. In the second group [15 patients], sevoflurane was titrated to maintain a BIS value between 40 and 60 during surgery, and then 60-70 during 15 min prior to the end of surgery [BIS group]. Recovery times were recorded. Time to extubation was also noted, as well as the time to achieve a modified Aldrete score of 9 were evaluated subsequently at 10-min intervals until 3 h after surgery by nurses who had no knowledge of the study. Sevoflurane consumption was calculated using the vaporizer weighing method. Awakening and extubation times were significantly shorter in the BIS group [P <0.05]. In the BIS [vs. non BIS] group, there were no significant differences observed in the time to obtain an Aldrete score of 9. The sevoflurane consumption and cost in the BIS group were lower than in the non BIS group [P <0.05]. Bispectral index monitoring during anesthesia for morbidly obese patients provides statistically significant reduction in recovery times. It also has the added advantage in decreasing sevoflurane consumption

Anesthesia for third ventriculostomy-a report of 128 cases

Endoscopic third ventriculostomy [ETV] has become the standard surgical procedure for treatment of non-communicating hydrocephalus. The aim of this study is to report our results over the past ten years with reference to perioperative complications of ETV with a review of some specific anesthetic issues. The computerized database [in the Department of Neurosurgery] and the medical records of 128 patients who underwent ETV between February 1998 and February 2007 at our Hospital, were reviewed. Data collected were, age, sex, weight, height, preoperative biochemical analysis, duration of the procedure, anesthetic drugs used, amount of irrigation fluid used, blood loss, postoperative biochemical analysis and perioperative complications. Preoperative biochemical analysis for all patients was within normal ranges. Normal saline 0.9% was used as irrigation fluid for all patients. The volume during the procedure used ranged from 2 to 6 L [mean 3 L]. When correlating postoperative serum sodium mean values to the volume of irrigation fluid used, it showed non significant correlation [r = 0.07]. Serum potassium level has shown significant decrease postoperatively compared to preoperative levels [P <0.05]. The other biochemical analysis parameters showed non-significant changes postoperatively compared to preoperative data [P > 0.05]. Anesthesiologists should be aware of the intra and postoperative complications secondary to ETV. Intraoperative bradycardia is the commonest arrhythmia occuring during the procedure. Precautions, like alerting the surgeon and pulling out the scope, are enough to revert bradycardia if it occurs. Though postoperative electrolyte imbalance occurs we believe it has no clinical significance. We believe that either normal saline or lactated Ringer solutions could be safely used for intraoperative irrigation with minimal postoperative impact. Though the procedure is a minimally invasive procedure, close observation of vital signs, serum electrolytes as well as volume and temperature of the irrigation fluid and close communication between anesthesiologist and surgeon, are prerequisites for better outcome