ABSTRACT
BACKGROUND AND AIMS: Carotid endarterectomy (CEA) reduces the risk of stroke in patients with significant carotid stenosis and may be performed under general anaesthesia (GA) or regional anaesthesia (RA). This study aimed to compare RA and GA with regard the jugular venous bulb blood lactate and pyruvate levels. METHODS: This randomised-controlled trial was done between October-2013 and September-2015. Thirty-six patients were randomised into either GA or RA groups, with six excluded after randomisation. In the RA group, combined deep and superficial cervical plexus blocks were performed. In the GA group, anaesthesia was induced with propofol and fentanyl. In both groups, monitoring of neurological function was done. Sampling of the contralateral jugular bulb blood was done. The main outcome measures were lactate and pyruvate in the jugular venous blood. For comparing categorical data, Chi-square test was used, and for the numerical variables, t-test was used. RESULTS: Demographics were comparable in the two Groups. Serum lactate and pyruvate levels were higher in the GA group than RA group. At 120 min under anaesthesia, lactate and pyruvate levels under RA vs. GA, respectively were 0.76±0.03 mEq/L vs. 1.14±0.06, p-0.001 mEq/L, and 0.08± 0.00 mEq/L vs. 0.10±0.01 mEq/L, p=0.006. Lactate/ pyruvate ratios were normal in both groups. The mean blood pressure was significantly lower in the GA group during anaesthesia. CONCLUSION: In patients undergoing Carotid endarterectomy, serum levels of both lactate and pyruvate were higher under general versus regional anaesthesia.
ABSTRACT
BACKGROUND: Shoulder surgeries are known to cause moderate to severe pain. Many techniques have been used successfully to minimize that stress response including interscalene block. Ultrasound guided techniques are becoming widely spread and commonly used for regional anesthesia. The objective of the present randomized controlled study is to compare the ultrasound guidance with nerve stimulation for interscalene brachial plexus block (IBPB) regarding the effect on stress response. PATIENTS AND METHODS: 50 patients, American Society of Anesthesiologists physical status I, II, and III, undergoing shoulder surgery were enrolled in the current study. Group U patients (n = 25) received ultrasound guided IBPB and Group N patients (n = 25) received IBPB using nerve locator. IBPB was done under ultrasound guidance using the linear 13-6 MHz transducer of the SonoSite M-Turbo ultrasonic device. In both groups, venous blood samples to measure cortisol level and assess stress response as a primary outcome were collected. RESULTS: The current study demonstrated that the stress response, as indicated by the cortisol level in blood, showed no significant difference in the preoperative blood level between Group U and Group N, as well as blood level after block and before skin incision. However, it differed significantly between the two groups postoperatively. CONCLUSION: The current study concluded that the use of ultrasound guidance for IBPB in shoulder surgeries offered a significant suppression of the stress response intraoperatively and postoperatively as indicated by the low cortisol level with less complications and easier technique compared to nerve location.
