[Comparative study between propofol and isoflurane as a maintenance anesthetic in ambulatory surgery]. / Estudio comparativo entre propofol e isoflurano como mantenimiento anestésico en cirugía ambulatoria.

OBJECTIVES: To evaluate postanesthetic recovery and complications in outpatient surgery for which anesthetic maintenance was achieved with either isoflurane or propofol. PATIENTS AND METHODS: Eighty patients were randomly divided into two groups for prospective study according to anesthetic used: isoflurane (group A) or propofol (group B). The patients were undergoing short surgery and in both groups induction was with 2-2.5 mg/kg propofol, 0.4-0.5 mg/kg atracurium, 20 microgram/kg alfentanil and 20 microgram/kg droperidol. In 40 patients maintenance was with 0.5-1% isoflurane (group A) and in the remaining 40 0.1-1.15 mg/kg/min propofol (group B) was used; in both groups 50% N2O-O2 was used. RESULTS: We found no statistically significant differences in time until eye opening after a verbal command (3.8 +/- 2 in group A and 4.1 +/- 2.8 min in group B), in time until the patient was able to answer five questions (6.5 +/- 3 in group A and 6 +/- 2.9 min in group B) or in Aldrete test scores upon awakening (9 +/- 1 in group A and 8.7 +/- 0.9 in group B). Nor were there differences in frequency of nausea reported (2 in each group) or in level of pain after surgery. CONCLUSIONS: Recovery and incidence of complications after out-patient anesthesia were similar when anesthetic maintenance was achieved with propofol or isoflurane.

[Sympathetic-adrenergic and hypophysial response to different anesthesia-analgesia technics]. / Réponse sympathico-adrénergique et hypophysaire à différentes techniques d'anesthésie-analgésique

The authors used techniques of pure anesthesia analgesia with Fentathienyl-Pavulon, or anesthesia and analgesia potentialised with Fentathienyl-Flunitrazepam, or Pentothal-Fentathienyl-Pavulon on various series of patients. The study was oriented on changes in the sympathetico-adrenalin pituitary response, and the use of glucose under the effect of these techniques. There was noted a fall in plasma cortisol levels, a fall in urinary excretion of catecholamines, an increase in growth hormone and better peripheral use of glucose. A comparative study was carried out with similar techniques using morphine, pentazocine or fentanyl.

[Analgesics and neuroendocrine response in heart surgery: III. Metabolic aspects]. / Analgésicos y respuesta neuroendocrina en cirugía cardíaca: III. Aspectos metabólicos

A study done in 121 patients undergoing extracorporeal perfusion heart surgery for the correction of valvular cardiopathies. In a first stage, we evaluated, in 77 patients, the influence of different analgesics on renal function, acid-base balance, glucemia and lactic acid. Afterwards we completed our observation with analysis of insulin in 44 patients. We observed no important difference in glomerular filtration rate, urinary output per minute, acid-base equilibrium, or oxigenation, according to administration of the different analgesics. After the glucose overload which the extracorporeal perfusion imposes, we observed a better insulinic response and consequently a faster recuperation of normal levels of glucemia in patients who received Fentathienyl. The lowest response was obtained in patients anesthesized with Pentazocina. In view of these results we can affirm that analysis if the inter-relation between glucose and insulin is a good exponet for evaluation of the grade of analgesic protection, offered by a drug, against nociceptive stimuli triggered by surgery.

[Analgesics and neuroendocrinic response in cardiac surgery. I. Adrenal cortex response]. / Analgésicos y respuesta neuroendocrina en cirugía cardiaca. I.--Respuesta cortico-suprarrenal

In 91 patients who had undergone surgery under C.E.C. the influence of the analgesia on adrenal cortex system was studied. With the exception of the analgesic used, the anaesthesia was performed following the same guidelines in all of the operations. Concentrations of cortisol in plasma were maximum with Pentazocina, the weakest analgesic used by us, and minimum with Fentanest. In view of these results, we can affirm that, in the absence of alterations haemodynamic, metabolic and neurological, concentrations of cortisol in plasma are a true reflexion of the amount of analgesic protection that different drugs offer against noxins stimuli triggered by the surgical act. These findings guarantee the intimate relationship that exists between the nervous system and the endocrine system and they are further confirmed by results obtained with a recently acquired analgesic Fentathienil, which is more potent than Fentanyl.