Prolonged pneumoperitoneum in exaggerated trendlenburg position; anesthetic implications

Laparoscopic radical cystectomy is a relatively new surgical procedure. Being a procedure of long duration, performed with pneumoperitonium in exaggerated Trendlenberg position; it is expected to pose unfavorable effects. We report pulmonary and haemodynamic changes in addition to postoperative outcome following laparoscopic radical cystectomy in the exaggerated head-down position. A prospective study was conducted on 31 patients anaesthetized with a combination of epidural and total intravenous anaesthesia [using midazolam, fentanyl, ketamine and vecuronium]. Surgery was done while the patient in head down position [40o]. Lungs were ventilated using air-oxygen [FiO2 = 0.35] with a tidal volume of 8 ml kg[-1] at a rate of 12-14 min[-1]. Lung mechanics, gasometric and haemodynamic variables were recorded at different strategic points. Recovery and postoperative outcome were also evaluated. Two patients discontinued because of conversion to open surgery and 29 completed the procedure. Fourteen of 29 patients [48.2%] had preoperative medical diseases and 11 patients [38%] received blood. There were significant decrease in lung compliance and significant increase in peak pressures after pneumoperitoneum and Trendelenburg. Concomitantly, heart rate, arterial pressure and carbon dioxide tension increased significantly. Three patients suffered postextubation airway obstruction and were reintubated. On the first postoperative day, one patient desaturated and one patient suffered severe nausea and vomiting. Laparoscopic radical cystectomy in exaggerated head down position is associated with brisk consequences and potential risks

Good correlation between mixed and central venous oxygen variables in both hyperdynamic and normodynamic states

This study was undertaken to assess whether or not central venous oxygen variables [CvO2] measurement can replace mixed venous oxygen variables [MvO2] measurement in two clinical settings, hyperdynamic kidney recipient [KR] and normodynamic patients subjected to radical cystectomy [RC]. MV and CV oxygen tension [PvO2], saturation [SvO2] and arteriovenous O2 content difference [a-vDO2] during the perioperative period of kidney transplantation [10 patients, 69 samples] and radical cystectomy [10 patients, 83 samples] under different FiO2 [0.21-0.35] were compared. The findings of this study demonstrate strong correlation between MvO2 and CvO2 variables in both hyperdynamic and normodynamic clinical settings

General anaesthesia for endoscopic sinus surgery; hypotensive anaesthesia versus isoflurane - local epinephrine

This study included 30 patients, they were randomly classified into two groups. In hypotensive anesthesia [HA] group, anesthesia was maintained by N2O: O2, halothane 0.4-1% and atracurium. Deliberated hypotension was achieved using nitroglycerine infusion [2-5 mug/kg/min.]. In isoflurane-epinephrine [IE] group, halothane was replaced by isoflurane and epinephrine [1: 100,000] injected into the nasal mucosa. HR, MAP, SPO2 and ETpCO2 were recorded in the perioperative period. A surgical field was assessed and an average blood loss was calculated