Bispectral index and cerebral oximetry in low-flow and high-flow rate anaesthesia during laparoscopic cholecystectomy - a randomized controlled trial.

INTRODUCTION: The need to reduce pollution emissions in the operating room and to reduce treatment costs motivates more frequent use of general anaesthesia with a small or minimal fresh gas flow rate. Nevertheless, the reduction of the delivery of fresh gases should not influence the quality and safety of the anaesthesia. MATERIAL AND METHODS: A total of 105 elective laparoscopic cholecystectomy patients were included in the study. There were 72 female (68.6%) and 33 male (31.4%) patients. Patients were randomized by a 'closed envelope' method into two groups. Group I included patients with low-flow anaesthesia and group II included patients with high-flow anaesthesia. In all patients the cerebral oximetry was measured separately for each cerebral hemisphere; the bispectral index (BIS), heart rate, blood pressure, end-tidal carbon dioxide concentration and haemoglobin oxygen saturation were monitored. RESULTS: Heart rate, blood pressure, end-tidal carbon dioxide concentration and saturation were similar in both groups and the differences between them were statistically insignificant. The BIS values were similar in both groups and indicated that patients who underwent low-flow anaesthesia were not exposed to a higher risk of awakening during the procedure than the high-flow anaesthesia patients. The changes in brain oximetry values were similar in both low-flow and high-flow anaesthesia. CONCLUSIONS: Use of both low-flow and high-flow rate general anaesthesia provided patients undergoing laparoscopic cholecystectomy proper oxygenation of the central nervous system, adequate sleep depth and haemodynamic stability.

[Comparison of two methods of pre-emptive infiltration anaesthesia for inguinal hernia repair]. / Ocena porównawcza dwòch metod znieczulenia nasiekowego z wyprzedzeniem u chorych operowanych z powodu przepukliny pachwinowej.

BACKGROUND: Intraarticular injection of neostigmine has been reported to create long-lasting analgesia due to the blockade of muscarinic receptors and neuronociceptive transmitters. The aim of the study was to determine if similar effects could be achieved after adding neostigmine to bupivacaine during infiltration of the surgical area before inguinal hernia surgery. METHODS: Ninety patients (82 males and 8 females), aged 20-88 (mean 54.8) years, scheduled for Lichtenstein hernia surgery under spinal anaesthesia, were randomly allocated to three groups. The surgical area was infiltrated with 10 mL of 0.5% bupivacaine in group 1, or 10 mL of 0.5% bupivacaine with 0.5 mg neostigmine in group 2. Patients in the control group did not receive local infiltration. Postoperative pain was assessed using a numerical rating scale (NRS), and adjective rating scale (ARS) and the need for rescue analgesia (ketoprofen or pethidine) was recorded. RESULTS: The patients of group 1 required rescue analgesia significantly later, compared to the other two groups. Intense pain occurred less frequently in group 1 and the most frequently in group 3. The need for rescue analgesia was also least in group 1 and greatest in group 3. CONCLUSIONS: Neostigmine added to bupivacaine had no effect on analgesia after pre-emptive local wound infiltration.

[Intralipid for treatment of local anaesthetic-induced toxicity]. / Intralipid w leczeniu objawów przedawkowania srodków znieczulenia miejscowego.

Regional anaesthesia can be associated with severe complications, which may be due to overdose or accidental intravascular injection of local anaesthetics. The clinical picture varies and depends on the pharmacodynamics of specific drugs, the total dose used, and the route of injection. Among the most common side effects are: excitation, seizures, loss of consciousness, cardiac dysrhythmias, severe shock and cardiac arrest. Cardiovascular resuscitation in such cases may be prolonged and very difficult, mostly because local anaesthetics are lipid soluble and require a long time for redistribution. The majority of cases with lidocaine-induced cardiovascular complications can be successfully resuscitated due to the relatively short duration of action of the drug. Bupivacaine-induced cardiac arrest is probably the most dangerous, with resuscitations in such cases being usually very long and frequently unsuccessful. Recently, intravenous fat emulsion (Intralipid) has been used during resuscitation. This review focuses on the role of intravenous fat emulsions in the treatment of toxicity due to local anaesthetics. The possible antidotal mechanisms are discussed.