Procedimiento anestésico-quirúrgico en un adulto con esplenomegalia por linfoma primario de bazo / Anesthetic-surgical procedure in an adult with splenomegaly due to primary spleenic lymphoma: en

Se describe el caso clínico de un adulto joven de 30 años de edad, con antecedente de buena salud, quien fue asistido en el Servicio de Cirugía del Hospital Universitario Manuel Ascunce Domenech en Camagüey por presentar aumento de volumen en la región abdominal de dos meses de evolución, concomitante con astenia, anorexia, vómitos y pérdida de peso. En el examen físico resultaron notables el abdomen globuloso (bazo palpable) sin dolor, un hematoma periumbilical y múltiples adenopatías supraclaviculares; en tanto, en los estudios imagenológicos se evidenció la presencia de esplenomegalia. Se realizó esplenectomía con administración de anestesia general endotraqueal y en el estudio histopatológico de la muestra resecada se confirmó el diagnóstico de linfoma primario del bazo.

The case report of a 30-year-old young adult with a history of good health is described, who was assisted at the Surgery Service of Manuel Ascunce Domenech University Hospital in Camagüey due to volume increase in the abdominal region with a course of two months, concomitant with asthenia, anorexia, vomits and weight loss. Physical examination revealed a globular abdomen (palpable spleen) with no pain, a periumbilical hematoma, and multiple supraclavicular adenopathies; meanwhile, in the imaging studies splenomegaly was evidenced. Splenectomy was performed with administration of general endotracheal anesthesia and the histopathological study of the resected sample confirmed the diagnosis of primary spleenic lymphoma.

Comparison of post-operative nausea and vomiting with intravenous versus inhalational anesthesia in laparotomic abdominal surgery: a randomized clinical trial / Comparação entre anestesia intravenosa e inalatória na náusea e vômito pós-operatórios em laparotomia: estudo clínico randomizado

Abstract Background: Postoperative Nausea and Vomiting (PONV) is a multifactorial surgical complication with an unclear underlying cause. Anesthetic methods, patients' characteristics and the type of surgery are considered as factors affecting PONV. This study was designed to compare the effect of inhalational and intravenous anesthesia in abdominal surgery on the incidence and severity of PONV. Methods: A single-blinded prospective randomized clinical trial on 105 patients aged 18 − 65 years was carried out. Patients were divided into two groups of Total Intravenous Anesthesia (TIVA) and inhalational anesthesia. The incidence and the severity of PONV were examined at 0, 2, 6, 12 and 24 hours after the surgery. The use of a rescue antiemetic was also evaluated. Results: 50.9% of the patients in the inhalation group and 17.3% of the patients in the intravenous group developed PONV (p < 0.001). The incidence of vomiting was reported in 11.3% of the inhalational group and 3.8% of the TIVA group (p = 0.15). 24.5% of patients in the inhalation group and 9.6% of patients in the intravenous group needed an antiemetic medication (p = 0.043). Conclusion: The incidence of postoperative nausea and vomiting and the need for administration of an antiemetic rescue drug and the severity of nausea in patients were significantly lower in the TIVA group.

Resumo Justificativa: Náusea e Vômito no Pós-Operatório (NVPO) é uma complicação multifatorial com etiologia não esclarecida. A técnica anestésica, as características dos pacientes e o tipo de cirurgia são considerados fatores que afetam a NVPO. O presente estudo foi desenhado para comparar o efeito da anestesia inalatória com anestesia intravenosa na incidência e gravidade de NVPO na cirurgia abdominal. Método: Foi realizado estudo clínico mono-cego prospectivo randomizado com 105 pacientes com idades de 18 − 65 anos. Os pacientes foram divididos em dois grupos, Anestesia Total Intravenosa (TIVA) e anestesia inalatória. A incidência e gravidade de NVPO foram avaliadas em cinco momentos: 0, 2, 6, 12 e 24 horas pós-cirurgia. O uso de antiemético de resgate também foi avaliado. Resultados: NVPO ocorreu em 50,9% dos pacientes no grupo inalatória e 17,3% dos pacientes no grupo TIVA (p< 0,001). A incidência de vômitos relatados foi 11,3% no grupo Inalatória e 3,8% no grupo TIVA (p = 0,15). Necessitaram de medicação antiemética 24,5% dos pacientes no grupo Inalatória e 9,6% dos pacientes no grupo TIVA (p = 0.043). Conclusão: A incidência de náusea e vômito no pós-operatório, a necessidade de administração de droga antiemética de resgate e a gravidade da náusea foram significantemente mais baixas no grupo TIVA.

Anesthetic Consideration for Peroral Endoscopic Myotomy

A recent achalasia guideline suggests that peroral endoscopic myotomy (POEM) is a safe option for achalasia that is as effective as Heller myotomy. It is recommended that POEM should be performed under general anesthesia. The incidence of adverse events such as bleeding, perforation, and carbon dioxide insufflation-related complications was lower in POEM under endotracheal general anesthesia than in POEM under sedation. Subcutaneous emphysema, pneumothorax, pneumomediastinum, pneumoperitoneum, and accompanying hemodynamic instability can be caused by carbon dioxide insufflation. Treatment of possible physiological changes and adverse events during the POEM procedure from the point of view of anesthesiologists may give endoscopists a new perspective on improving patient safety. The territory of therapeutic endoscopy can be expanded through cooperation with other departments, including anesthesia services. Efforts to understand different perspectives will certainly help not only secure patient safety but also expand the area of treatment.

The effect-site concentration of remifentanil for blunting hemodynamic responses: comparative study in single-lumen endotracheal and double-lumen endobronchial intubation

BACKGROUND: This study undertook to compare the effect-site concentration of remifentanil for prevention of hemodynamic responses to endotracheal intubation, employing the single-lumen tracheal tube and the double-lumen bronchial tube during total intravenous anesthesia. METHODS: Based on the nature of the surgery, 38 patients undergoing general anesthesia were assigned either to the single-lumen tube group or the double-lumen tube group. Anesthesia was induced by a target controlled infusion of propofol, with an effect-site concentration of 4 µg/ml. Remifentanil was then administered to the first patient in each group, with an effect-site concentration of 3.5 ng/ml. Subsequent concentration of remifentanil was determined by hemodynamic responses of the previous patient to intubation, based on the up-and-down method. RESULTS: The effect-site concentrations of remifentanil for prevention of hemodynamic responses to endotracheal intubation in 50% of patients (EC₅₀) were 2.8 ng/ml (95% CI, 2.0–3.7 ng/ml) in the single-lumen tube group, and 2.9 ng/ml (95% CI, 2.5–3.2 ng/ml) in the double-lumen tube group. No significant difference was observed between the two groups. CONCLUSIONS: The effect-site concentration of remifentanil for prevention of hemodynamic responses to endotracheal intubation did not differ during total intravenous anesthesia, using either the single-lumen tracheal tube or the double-lumen bronchial tube.

The Effect of Discontinuation of N2O on the Middle Ear Pressure during General Endotracheal Anesthesia / 대한마취과학회지

N2O can diffuse in and/or out the middle ear cavities and it may alter the middle ear pres-sure. This study was performed to investigate the effect of N2O discontinuation on the changes in middle ear pressure during general endotracheal anesthesia. We measured middle ear pres-sures and end-tidal NO concentrations at preanesthesia, immediately after N2O discontinuation and then at every five minutes for 60 minutes under either halothane or enflurane an- esthesia in two groups(group 1=50% administration of N2O in O2; group 2=60% administration of N2O in O2). The middle ear pressures after N2O discontinuation decreased slowly but they did not returned to the preanesthetic value in both groups. The end-tidal N2O concentrations decreased rapidly until five minutes and then they decresed slowly to the zero leve1 until 30 minutes after N2O discontinuation in both groups. The expected time of the middle ear pres-sure of preanesthesia value was 89.4 minutes in group 1 and 80.9 minutes in group 2 respectively. The middle ear pressure do not return to the level of preanesthesia at 60 minutes after N2O discontinuation while the end-tidal N2O concentration decrease to the zero level via 30 minutes after its discontinuation. Thus it is recommended that N2O administration should be discontinued at least 30 minutes before an application of tympanic membrane patch on the ear drum and N2O is carefully administered in patients with middle ear and/or upper airway disesses.

The Effect of Discontinuation of N2O on the Middle Ear Pressure during General Endotracheal Anesthesia / 대한마취과학회지

N2O can diffuse in and/or out the middle ear cavities and it may alter the middle ear pres-sure. This study was performed to investigate the effect of N2O discontinuation on the changes in middle ear pressure during general endotracheal anesthesia. We measured middle ear pres-sures and end-tidal NO concentrations at preanesthesia, immediately after N2O discontinuation and then at every five minutes for 60 minutes under either halothane or enflurane an- esthesia in two groups(group 1=50% administration of N2O in O2; group 2=60% administration of N2O in O2). The middle ear pressures after N2O discontinuation decreased slowly but they did not returned to the preanesthetic value in both groups. The end-tidal N2O concentrations decreased rapidly until five minutes and then they decresed slowly to the zero leve1 until 30 minutes after N2O discontinuation in both groups. The expected time of the middle ear pres-sure of preanesthesia value was 89.4 minutes in group 1 and 80.9 minutes in group 2 respectively. The middle ear pressure do not return to the level of preanesthesia at 60 minutes after N2O discontinuation while the end-tidal N2O concentration decrease to the zero level via 30 minutes after its discontinuation. Thus it is recommended that N2O administration should be discontinued at least 30 minutes before an application of tympanic membrane patch on the ear drum and N2O is carefully administered in patients with middle ear and/or upper airway disesses.