[Carotid endarterectomy: evaluation of a "combined" technique of general anesthesia]. / Endoarterectomia carotidea: valutazione di una tecnica di anestesia generale "combinata".

INTRODUCTION: The literature suggests several techniques to ensure the optimal anesthetic procedure for carotid surgery. The aim of our study is to combine, in the carotid endarterectomy, a model of general anesthesia with the loco-regional anesthesia in order to test the safety of the method, the eventual brain damage and hemodynamic stability. We also wanted to test whether the immediate postoperative analgesia was adequate. MATERIAL AND METHODS: Seventy eight (78) patients were enrolled in the study (from 60 to 75 years), ASA II-III, candidates for unilateral carotid endarterectomy in a period from June 2008 to January 2009. During the procedure data about perioperative neurologic and hemodynamic complications were collected. At the end of the surgical treatment the pain at the awakening moment through verbal numerical scale VNS was estimated. Data are presented as mean values +/- sd and validated using the chi2 test, when required. Significance was accepted at a value of P < or = 0.05. RESULTS: 85% of patients reported a VNS between 1 and 2 and 10% equal to 3-5. In the study 95% of patients (P<0.05) appreciated the technique and only 3 patients reported their dissatisfaction. There was no mortality and in 5 patients a postoperative morbidity was registered. DISCUSSION: The study demonstrated the advantages in combining loco-regional anesthesia (valid monitoring of neurological and hemodynamic stability) with general anesthesia (complete airways control and patient comfort) during carotid surgery.

[Two strategies of morphine administration on the control of post-surgical pain after anesthesia with remifentanil]. / Due strategie di somministrazione della morfina per il controllo del dolore post-chirurgico dopo anestesia con remifentanil.

AIM: The post-operative pain (POP) is accompanied by autonomic, psychological and behavioural responses which can result in a significant increase in morbidity and mortality. The purpose of this study was to compare the efficacy and safety of intravenous bolus administration of morphine versus subcutaneous administration. MATERIAL OF STUDY: Fifty subjects scheduled for elective abdominal surgery were randomized into a group S (n = 26) and group E (n = 24). The first group was administered morphine (0.35 mg/kg) subcutaneously immediately after induction of anesthesia, while the second group the same drug at a dose of 0.25 mg/kg was administered intravenously 45' before the end of the intervention. All patients received intraoperative remifentanil (0.25-0.50 microg/kg/min), and at the end of surgery paracetameolo 1 g and ondansetron 4 mg. Upon awakening, the DPO has been reviewed by the NRS (numerical scale of pain) at time zero (TO), after 30' (t1), 1h (T2) and 24h (T3). Furthermore, it was annotated request for rescue doses of morphine and the collateral effects. RESULTS: The two study groups did not show significant differences related to the anthropometric characteristics, duration of surgery, type of surgery, ASA class. No difference between the two groups was highlighted during the evaluation of POP through NRS scale and quantity of "rescue" doses requested. In group E there was a single case of respiratory depression. CONCLUSIONS: Our study suggests that whether intravenous or subcutaneous administration of morphine, both simple and economical analgesic techniques, they are able to guarantee the same quality control of POP in patients undergoing abdominal surgery.