Comparison of general anesthesia and combined spinal-epidural anesthesia for retrograde intrarenal surgery.

BACKGROUND: To investigate the applicability of the combined spinal-epidural anesthesia (CSEA) method in RIRS for the treatment of kidney stone disease and also to compare with general anesthesia (GA) in terms of their effects on early postoperative pain levels and their cost. METHODS: A hundred consecutive patients who were scheduled for RIRS were enrolled in this study and were prospectively evaluated according to the anesthesia methods. Patients were divided into 2 groups randomly: the GA (N.=50) and CSEA (N.=50) groups. Five patients were excluded due to patient incompatibility or inadequate anesthesia. The pain levels of patients in the Group 2 were recorded during the operation using the Visual Analog Scale (VAS) at minutes 1, 5, 10, 15, 30 and 60. Peak pain levels within the first 24 hours following the operation were recorded for both groups. RESULTS: Ninety five patients in the two groups were determined to be similar in terms of demographic characteristics. The mean VAS score at the postoperative 1st day was found as 1.20±0.9 for Group 1 and 0.82±1.3 for Group 2. No statistically significant differences were identified between the VAS-nram and VAS-ram groups (P=0.450). The total cost of anesthesia medications was similar between the both groups. CONCLUSIONS: Combined spinal-epidural anesthesia, which produces favorable outcomes in the intraoperative and postoperative periods, will become an alternative to general anesthesia. Also, the costs associated with these two anesthesia methods were calculated, it was found that the total cost of anesthesia medications and materials per operation was similar both methods.

The effect of acute normovolaemic haemodilution on blood gas parameters: a case report.

INTRODUCTION: Increased awareness of the risks related to homologous blood transfusions such as immunological reactions, transmission of infections, and immunosuppression, has necessitated exploration of alternative techniques to deal with the needs of intra-operative blood transfusion. Strategies that reduce or remove the risks associated with allogeneic transfusion include pre-operative autologous donation, peri-operative cell-salvage techniques, deliberate hypotension, and pharmacological interventions. Acute normovolaemic haemodilution is another such technique. METHODS: The effect of acute normovolaemic haemodilution on haemodynamics and blood gas parameters was studied in a male patient (58 y, 94 kg, American Society of Anesthesiologists physical status I) undergoing an orthopaedic surgical procedure for joint arthroplasty. After induction of general anaesthesia, 1600 ml of blood was collected and replaced with an equal volume of 6% hexaethyl starch. RESULTS: Haemoglobin and haematocrit concentrations were significantly lower following haemodilution (14.9 and 9.2 g/dl for haemoglobin versus 45.0% and 31.7% for haematocrit). There was no significant change in the heart rate, blood pressure or end-tidal carbon dioxide tension throughout the operation period. Central venous pressure increased marginally from 5 to 90 min, but was within normal limits. There was no significant change in blood gas parameters following haemodilution. Platelet count decreased following haemodilution but the values were within normal limits. CONCLUSION: Acute normovolaemic haemodilution with 6% hexaethyl starch is a safe procedure for blood conservation in selected operations. It did not cause any haemodynamic or blood gas parameters to change. It did not have any adverse effect on haemostatic mechanisms that could enhance the risk of bleeding at surgery.

Glutamate/aspartate supplementation during cardiopulmonary bypass: effect on postoperative neurocognitive function.

In this randomized trial, we investigated the effect of glutamate/aspartate-containing cardioplegia on neurocognitive function in 70 patients undergoing first-time elective coronary artery bypass graft surgery. Half of the patients received glutamate/aspartate, and the other 35 patients served as controls and received crystalloid cardioplegia. Neurocognitive function after surgery was assessed with the Mini-Mental State Examination performed before surgery and again on postoperative day 3. Although patients in both groups scored slightly lower postoperatively (17 versus 18 of a total of 30 points), no significant group differences were found. Our results indicate that glutamate/aspartate supplementation had no impact on neurocognitive function after coronary artery bypass graft surgery.

Efficacy of thoracic epidural analgesia for laparoscopic cholecystectomy.

INTRODUCTION: Postoperative pain is a commonly observed phenomenon after laparoscopic procedures. The use of new low-solubility inhalation anaesthetics leads to faster induction and recovery, but the effect of analgesics on pain when used with them is not sufficiently known. Optimally, analgesic therapy should be started in sufficient time as to be effective at the point of emergence from anaesthesia. We compared the effectiveness of intravenous and epidural analgesia in patients undergoing general anaesthesia with sevoflurane for laparoscopic cholecystectomy in the early postoperative period. METHODS: Thirty adult patients with American Society of Anesthesiologists (ASA) physical status I-II, scheduled for laparoscopic cholecystectomy, were enrolled in this study. The patients in the intravenous group (n = 15) received general anaesthesia with sevoflurane and intravenous infusion of 1.5 microg/ml/kg/h fentanyl analgesia followed by postoperative intravenous infusion of 1.0 microg/ml/kg/h fentanyl, supplied by a programmed continuous analgesia pump. The patients in the epidural group (n = 15) had combined epidural analgesia with 0.125% bupivacaine plus 50 microg fentanyl and general anaesthesia with sevoflurane, followed by continuous epidural infusion of 4 ml/h bupivacaine 0.125% plus 50 microg fentanyl. Visual analogue scores and the patients' needs for analgesics and were recorded. RESULTS: Epidural analgesia with a bupivacaine/febtanyl combination provided a statistically and clinically significant improvement in postoperative pain control compared with intravenous analgesia during the first 24 h following laparoscopic cholecystectomy. CONCLUSION: The epidural technique provided a significant effect on postoperative pain in patients undergoing laparoscopic cholecystectomy.

Is general anesthesia a risk for myocardium? Effect of anesthesia on myocardial function as assessed by cardiac troponin-i in two different groups (isofluran+N2O inhalation and propofol+fentanyl iv anesthesia).

BACKGROUND AND OBJECTIVES: Peroperative myocardial infarction (MI) is the most common cause of morbidity and mortality. What is the role of general anesthesia in this process? Is general anesthesia a risk for myocardial infarction? The present study was designed to determine whether the measurement of serum levels of cardiac troponin I (cTnI), a highly sensitive and specific marker for cardiac injury, would help establish the diagnosis of myocardial infarction in two different types of anesthesia. METHOD: Elective abdominal hysterectomy was planned with the permission of the ethic committee in 40 patients who were 20-45 years range, in ASA-I group, and have a Goldman Cardiac Risk Index-0. The patients were divided into two groups. Isoflurane + N2O was administrated to first group, and Propofol + Fentanyl to second group. cTnI levels were determined before anesthesia, after induction before surgery and 9 hours after the second period respectively. RESULTS: There was no significant difference between the groups by the means of demographic properties, hemodynamic parameters and cTnI levels, and the cTnI levels were determined under the basal levels in all samples. CONCLUSION: General anesthesia is not a risk for myocardial infarction to state eliminating risk factors and protection hemodynamia cardiac.

Perioperative management of a patient with Henoch-Schonlein purpura for appendectomy.

Henoch-Schonlein purpura HSP is a multisystem disease and immunoglobulin A-mediated vasculitis with a self-limited course affecting the skin, joints, gastrointestinal tract, and kidneys. It is the most common form of acute small-vessel vasculitis primarily affecting children. Severe renal and central nervous system disease may lead to life-threatening conditions, and immunosuppressive agents and plasmapheresis may be needed. The cause of HSP is unknown; immunizations, certain food allergies, insect bites, infection, and some medications may play a role in the development of the disease. Perioperative management for liver and kidney functions is very important for anesthetized patients with HSP. We report the perioperative management of a patient with HSP for appendectomy.

Examination of changes caused by tubal sterilization in ovarian hormone secretion and uterine and ovarian artery blood flow rates.

OBJECTIVES: To examine the changes caused by tubal sterilization (TS) in ovarian hormone secretion and uterine and ovarian circulation. DESIGN: Tubal sterilization was performed by minilaparotomy and laparoscopy methods in 36 women. Blood samples were taken for hormonal tests on Preoperative Day 3 (D3) of the menstrual cycle, on Postoperative Days 13-15 (periovulatory period) of the same cycle and on D3 in the 1st and 6th months post-TS. Uterine and ovarian artery blood flow rates of the women were measured on the same days as hormonal tests by transvaginal color Doppler ultrasonography (TVCDUSG). The control group was composed of 15 volunteers in the same age group who preferred the barrier method and who had the same TVCDUSG and hormonal analyses in the same periods. RESULTS: There was a decrease in the uterine and ovarian artery pulsatility index (PI) measurements and an increase in serum luteinizing hormone (LH) and estradiol (E2) values during the periovulatory period as compared with preoperative and postoperative menstrual measurements in all groups. There was no difference between baseline uterine and ovarian artery PI and serum follicle-stimulating hormone, LH and E2 values and those measured on D3 of the menstrual cycle in the 1st and 6th months post-TS. CONCLUSIONS: The 6-month postoperative follow-up of groups that had undergone different TS methods showed no difference in uterine or ovarian artery blood flow rates or ovarian hormone secretion in comparison with baseline values.