Encuesta sobre la práctica de los anestesiólogos en la cirugía de hernia inguinal en Galicia / Survey on the practice of anaesthesiologists in inguinal hernia surgery in Galicia

Objetivos: Evaluar la preferencia en la técnica anestésica de los anestesiólogos para el manejo de la cirugía de hernia inguinal en Galicia. Material y métodos: A partir del Catálogo Nacional de Hospitales del Ministerio de Sanidad y Consumo, en Galicia, se remitió a los jefes de servicio de Anestesiología y coordinadores de las unidades de Cirugía Mayor Ambulatoria (CMA) una encuesta con 11 preguntas sobre la técnica anestésica elegida por los anestesiólogos en el manejo de los pacientes para cirugía de hernia inguinal, así como sus motivos. Resultados: La encuesta se envió a 11 hospitales: 8 con unidades de CMA y 3 comarcales. Contestaron 94 profesionales, un 56% con más de 10años de experiencia, que realizaban entre 8-10 procedimientos/mes (58%) en régimen ambulatorio (61,54%). La técnica anestésica más empleada fue la intradural en un 52,8%, frente a un 41,8% de la anestesia general. Los encuestados con más de 10años de experiencia prefirieron la anestesia raquídea en un 38,6% de los casos frente a los de menor experiencia (6,8%) (p=0,037). Uno de cada 4 que eligieron la anestesia general empleó bloqueos interfasciales guiados por ultrasonidos (27,5%). El anestésico local más empleado en la anestesia intradural fue la bupivacaína hiperbara (70,8%) a dosis superiores a 7mg. Conclusión: La anestesia intradural con bupivacaína hiperbara representó la técnica más elegida por los anestesiólogos para el manejo de la cirugía de hernia inguinal. Las técnicas anestésicas escogidas entre los diferentes hospitales no siguieron una distribución homogénea. En la encuesta presentada se mostró una tendencia a la elección de la técnica asociada a la experiencia del anestesiólogo

Objectives: To evaluate the preference in the anaesthetic technique by anaesthesiologists for the management of inguinal hernia surgery in Galicia. Material and methods: Using the National Catalogue of Hospitals of the Ministry of Health and Consumer Affairs in Galicia, a questionnair was sent to the Heads of Anaesthesiology Service and Coordinators of the Postanaesthesia Care Unit (PACU) with 11 questions on the anaesthetic technique chosen by anaesthesiologists in the management of patients for inguinal hernia surgery, as well as their reasons. Results: The questionnaire was sent to 11 hospitals: 8 with PACU and 3 District. A total of 94 professionals responded, 56% with more than 10 years of experience, who performed between 8-10 procedures/month (58%) on an outpatient basis (61.54%). The most used anaesthetic technique was intradural in 52.8%, compared to 41.8% of general anaesthesia. Respondents with more than 10 years of experience preferred spinal anaesthesia in 38.6% of cases, compared to those with less experience (6.8%) (P=.037). One in 4 of those who chose general anaesthesia used ultrasound-guided interfascial blocks (27.5%). The local anaesthetic most used in intradural anaesthesia was hyperbaric bupivacaine (70.8%) at doses higher than 7mg. Conclusion: Intradural anaesthesia with hyperbaric bupivacaine was the technique most chosen by anaesthesiologists for the management of inguinal hernia surgery. The anaesthetic techniques chosen among the different hospitals did not follow a homogenous distribution. In this survey, there was a tendency to choose the technique associated with the experience of the anaesthesiologist

Survey on the practice of anaesthesiologists in inguinal hernia surgery in Galicia. / Encuesta sobre la práctica de los anestesiólogos en la cirugía de hernia inguinal en Galicia.

OBJECTIVES: To evaluate the preference in the anaesthetic technique by anaesthesiologists for the management of inguinal hernia surgery in Galicia. MATERIAL AND METHODS: Using the National Catalogue of Hospitals of the Ministry of Health and Consumer Affairs in Galicia, a questionnair was sent to the Heads of Anaesthesiology Service and Coordinators of the Postanaesthesia Care Unit (PACU) with 11 questions on the anaesthetic technique chosen by anaesthesiologists in the management of patients for inguinal hernia surgery, as well as their reasons. RESULTS: The questionnaire was sent to 11 hospitals: 8 with PACU and 3 District. A total of 94 professionals responded, 56% with more than 10 years of experience, who performed between 8-10 procedures/month (58%) on an outpatient basis (61.54%). The most used anaesthetic technique was intradural in 52.8%, compared to 41.8% of general anaesthesia. Respondents with more than 10 years of experience preferred spinal anaesthesia in 38.6% of cases, compared to those with less experience (6.8%) (P=.037). One in 4 of those who chose general anaesthesia used ultrasound-guided interfascial blocks (27.5%). The local anaesthetic most used in intradural anaesthesia was hyperbaric bupivacaine (70.8%) at doses higher than 7mg. CONCLUSION: Intradural anaesthesia with hyperbaric bupivacaine was the technique most chosen by anaesthesiologists for the management of inguinal hernia surgery. The anaesthetic techniques chosen among the different hospitals did not follow a homogenous distribution. In this survey, there was a tendency to choose the technique associated with the experience of the anaesthesiologist.

Lesión de nervio peroneo: no siempre la anestesia es la culpable / Peroneal nerve injury: anesthesia is not always to blame

Presentamos el caso de una paciente sometida a una cirugía correctora de pie bajo anestesia locorregional con bloqueo nervioso periférico ciático poplíteo ecoguiado. Como complicación postoperatoria se objetivó una lesión de nervio peroneo. Indicamos el diagnóstico diferencial y la estrategia terapéutica que se debe plantear ante una lesión de nervio periférico. En nuestro caso se trata de una axonotmesis de alto grado secundaria a compresión extrínseca e isquemia producida por el manguito de isquemia colocado en el tobillo utilizado durante la cirugía, que no guarda relación con la técnica anestésica (AU)

We introduce a case report of a woman that was operated of foot surgery under locoregional anesthesia with an echo-guided peripheral sciatic-popliteal nerve block. As post operatory complication a peroneal nerve injury was noticed. We revised differential diagnosis of peripheral nerve block and therapeutic strategy we should take. In our case the finding was a high degree axonotmesis secondary to extrinsic compressure due to pneumatic tourniquet placed in the ankle used during surgery. There was no relationship with the anesthetic technique (AU)

[Peroneal nerve injury: anesthesia is not always to blame]. / Lesión de nervio peroneo: no siempre la anestesia es la culpable.

We introduce a case report of a woman that was operated of foot surgery under locoregional anesthesia with an echo-guided peripheral sciatic-popliteal nerve block. As post operatory complication a peroneal nerve injury was noticed. We revised differential diagnosis of peripheral nerve block and therapeutic strategy we should take. In our case the finding was a high degree axonotmesis secondary to extrinsic compressure due to pneumatic tourniquet placed in the ankle used during surgery. There was no relationship with the anesthetic technique.

[Ultrasound-assisted approach to blocking the intercostal nerves in the mid-axillary line for non-reconstructive breast and axilla surgery]. / Abordaje guiado por ultrasonidos de los nervios intercostales en la línea media axilar para cirugía de mama no reconstructiva y de la axila.

INTRODUCTION: Several nerve blocks have recently been used for pain treatment in breast surgery. The main objective of our study was to determine the efficacy and safety of ultrasound-assisted blocking of the anterior and lateral cutaneous branches of the intercostal nerves in the mid-axillary line for non-reconstructive breast and axilla surgery. MATERIAL AND METHODS: A prospective observational study was conducted on 30 patients scheduled for non-reconstructive breast and axilla surgery. An intercostal branches block was performed in the mid-axillary line with 0,5% levobupivacaine (3ml in each intercostal space). Clinical efficacy was assessed by standard intraoperative hemodynamic response to surgical stimulus and the need for opioids, and in the postoperative period, by assessing pain intensity as a verbal numerical scale and the need for rescue treatment. We also evaluated the quality of sleep the first night after surgery, any adverse events that occurred, and the satisfaction of patients and surgeons with the anesthetic technique. RESULTS: The intercostal branches block in the mid-axillary line was effective in most cases, with only 2 patients requiring intraoperative opioids, and in one case analgesic rescue was necessary in the postoperative period. The duration of postoperative analgesia was 19±4h. There were no notable adverse events or complications. The satisfaction with the chosen technique was assessed as "very good" in all patients, and by 97% of the surgeons. CONCLUSIONS: Intercostal branches block in the mid-axillary line provides adequate intraoperative and postoperative analgesia for non-reconstructive breast and axilla surgery. It is a simple, reproducible technique in most patients of this study, with an easy to understand ultrasound anatomy, in which adequate analgesia could be provided through a single puncture, and may be an alternative to neuroaxial blocks.

Abordaje ecoguiado a nivel antecubital para cirugía del síndrome del túnel del carpo / Ultrasound-guided block at the antecubital fossa for carpal tunnel syndrome surgery

Introducción. Existen diferentes técnicas anestésicas para la cirugía ambulatoria del síndrome del túnel del carpo. Los bloqueos nerviosos ecoguiados brindan ventajas frente a otras técnicas. El objetivo del estudio fue determinar la eficacia del bloqueo ecoguiado a nivel de la fosa antecubital, así como la evaluación de las complicaciones, la satisfacción del paciente y del cirujano. Material y métodos. Estudio observacional prospectivo en 32 pacientes programados para cirugía del síndrome del túnel del carpo, en régimen ambulatorio. Se realizó un bloqueo nervioso ecoguiado a nivel de la fosa antecubital, de los nervios mediano, cubital y cutáneos medial y lateral del antebrazo con mepivacaína 1%. Se registraron las mediciones de los diámetros anteroposterior y laterolateral de los nervios mediano y cubital, antes y después de la inyección. Se evaluó el inicio del bloqueo sensitivo y motor en los territorios de los nervios mediano y cubital cada 5 min, hasta 30 min después de la administración del anestésico local, con respecto a la mano contralateral. Se registró la presencia de dolor durante la incisión quirúrgica, en el postoperatorio, las complicaciones y la satisfacción del paciente y del cirujano con la técnica anestésica realizada. Resultados. El bloqueo nervioso ecoguiado a nivel de la fosa antecubital fue eficaz en un 93,7% de los pacientes. Ningún paciente requirió rescate analgésico, no se produjeron efectos adversos reseñables ni complicaciones. La satisfacción con respecto a la técnica anestésica elegida fue valorada como «muy buena» por el 93,7% de los pacientes y por el 97% de los cirujanos. Conclusiones. El bloqueo nervioso ecoguiado de los nervios mediano, cubital y cutáneos medial y lateral del antebrazo a nivel de la fosa antecubital es una técnica anestésica eficaz y satisfactoria para la cirugía ambulatoria del síndrome del túnel del carpo, permite la movilización del brazo por parte del paciente, minimiza los riesgos y disminuye la dosis de anestésico local empleada(AU)

Introduction. There are various anaesthetic techniques for ambulatory surgery of carpal tunnel release. The ultrasound-guided nerve blocks offer advantages compared to other techniques. The purpose of this study was to evaluate the efficacy using ultrasound-guided block at the antecubital fossa, as well as to evaluate complications, patient satisfaction and surgeon satisfaction with the block. Materials and methods. Prospective observational study with 32 elective patients for carpal tunnel release in a one-day case unit. An ultrasound-guided block with mepivacaine 1% was performed at the antecubital fossa, aiming for the median, ulnar and the lateral and medial cutaneous nerves of the forearm. The measurements of the anteroposterior and laterolateral diameters of the median and ulnar nerves were recorded, before and after injection. Motor and sensory levels were evaluated for the median and ulnar nerves at 5 and 30min post injection, and compared with the contralateral hand. Pain from the surgical incision time and recovery were recorded, together with complications, and patient and surgeon satisfaction with the block. Results. The antecubital fossa ultrasound-guided block was successful in 93.7% of the patients. No patients needed rescue analgesia in recovery and no complications were recorded. Patient satisfaction was 93.7% and surgeon satisfaction was 97%. Conclusions. A selective block of the medial, ulnar and medial and lateral cutaneous nerves of the forearm are effective and satisfactory anaesthetic techniques for carpal tunnel release in a one-day case unit. It allows early mobilization, minimises risks and amount of local anaesthetic used(AU)

Edema agudo de pulmón postobstructivo en colecistectomía laparoscópica / Acute pulmonary edema in laparoscopic colecystectomy

El edema pulmonar agudo por presión negativa es una causa importante de edema pulmonar que se desarrolla inmediatamente después de la extubación. Se expone el caso de una paciente con antecedentes importantes de alergia a múltiples medicamentos, programada para colecistectomía laparoscópica que, de manera inmediata, después de la extubación, desarrolló un laringoespasmo que evolucionó a edema agudo de pulmón con insuficiencia respiratoria aguda que requirió ventilación mecánica. El cuadro evolucionó favorablemente y se resolvió en las 72 horas posteriores a la cirugía (AU)

Negative presure pulmonary edema is an important cause of pulmonary edema that takes place inmediately after the extubation. We describe the case of a patient with history of multiple medications allergies. She was admitted outpatient laparoscopic colecystectomy and immediately after extubation she developed a laryngospasm wich envolved acute pulmonary edema with severe acute respiratory failure and she required mechanic ventilation. The patient was discharge after 72 hours (AU)

[Ultrasound-guided block at the antecubital fossa for carpal tunnel syndrome surgery]. / Abordaje ecoguiado a nivel antecubital para cirugía del síndrome del túnel del carpo.

INTRODUCTION: There are various anaesthetic techniques for ambulatory surgery of carpal tunnel release. The ultrasound-guided nerve blocks offer advantages compared to other techniques. The purpose of this study was to evaluate the efficacy using ultrasound-guided block at the antecubital fossa, as well as to evaluate complications, patient satisfaction and surgeon satisfaction with the block. MATERIALS AND METHODS: Prospective observational study with 32 elective patients for carpal tunnel release in a one-day case unit. An ultrasound-guided block with mepivacaine 1% was performed at the antecubital fossa, aiming for the median, ulnar and the lateral and medial cutaneous nerves of the forearm. The measurements of the anteroposterior and laterolateral diameters of the median and ulnar nerves were recorded, before and after injection. Motor and sensory levels were evaluated for the median and ulnar nerves at 5 and 30 min post injection, and compared with the contralateral hand. Pain from the surgical incision time and recovery were recorded, together with complications, and patient and surgeon satisfaction with the block. RESULTS: The antecubital fossa ultrasound-guided block was successful in 93.7% of the patients. No patients needed rescue analgesia in recovery and no complications were recorded. Patient satisfaction was 93.7% and surgeon satisfaction was 97%. CONCLUSIONS: A selective block of the medial, ulnar and medial and lateral cutaneous nerves of the forearm are effective and satisfactory anaesthetic techniques for carpal tunnel release in a one-day case unit. It allows early mobilization, minimises risks and amount of local anaesthetic used.

Eficacia analgésica del bloqueo de los nervios pectorales en cirugía de mama / No disponible

Introducción: Los procedimientos de reconstrucción mamaria tienen una rápida recuperación postoperatoria producen un dolor de moderado a intenso requiriendo un abordaje multimodal para garantizar un buen control postoperatorio del mismo. Material y métodos: Estudio observacional prospectivo realizado en 20 mujeres con cáncer de mama programadas para cirugía con reconstrucción mamaria. Previo a la anestesia general, como parte del abordaje multimodal del dolor, se realizó un bloqueo de los nervios pectorales utilizando una sonda lineal de ultrasonidos. Se localizó el espacio entre los músculos pectorales mayor y menor para luego depositar un bolo de 0,4 ml/kg de levobupivacaína al 0,25%. Treinta minutos antes de finalizar la cirugía se administraron 50 mg de dexketoprofeno y 1 g de paracetamol intravenoso, pautado posteriormente cada 8 horas respectivamente. La analgesia de rescate fue 2 mg de cloruro mórfico. La evaluación postoperatoria del dolor fue realizada a los 30 minutos, 1, 2, 4, 8, 12, 24 y 48 horas, mediante la escala verbal numérica (de 0 = no dolor a 10= máximo dolor imaginable). A las 48 horas se realizó una encuesta del grado de satisfacción y de la técnica analgésica mediante un cuestionario directo. Las náuseas y vómitos se evalúan al ingreso en la unidad de recuperación postanestésica, a las 24 y 48 horas mediante escala numérica de 0 a 3.Resultados: De los 20 pacientes a los 30 minutos postcirugía,11 presentaron dolor leve o nulo (< 3), 6 dolor moderado (4-5) y solo 3 dolor severo (> 6). En las evaluaciones posteriores de dolor ningún paciente presentó dolor severo. La valoración de la técnica (..) (AU)

Introduction: Breast reconstructive surgery has a fast recovery, and the pain can be classified between moderate to severe during the postoperative period. This is why a multimodal approach is required. Material and methods: Prospective observational study in 20 women booked for reconstructive breast surgery. Prior to the operation we performed an ultrasound guided “pecs block” with a linear probe. This was part of the multimodal approach for pain control. The plane between the pectoralis major and minor was located and 0.4 ml/kg of 0.25% levobupivacaine was injected. Thirty minutes before the end of surgery dexketoprofeno (50 mg i.v.) and paracetamol(1 g i.v.) were administered. Rescue analgesia was prescribed as morphine 2 mg. Postoperative pain evaluation was recorded at 30 minutes, 1, 2, 4, 8, 12, 24 and 48 hours by visual analog scale (0 = no pain, 10 = worst imaginable pain). At 48 hours we performed a grade of satisfaction evaluation. Nausea and vomitus were evaluated at admission, 24 and 48 hours with a numeric scale from 0 to 3.Results: Out of the 20 patients 11 presented with pain less than 3, 6 with moderate pain (3 to 6) and only 3 with severe pain(more than 6). At a later stage no patient presented with severe pain. Grade of satisfaction was recorded as very good or excellent in 16 cases, good in 3 cases and only one regular. No patient said it was bad. In relation with nausea and vomitus 17 presented with none, 2 were moderate and 1 was severe. Conclusion: Ultrasound guided “Pecs block” can be useful inreconstructive breast surgery as part of the multimodal strategy for postoperative pain control. It can be consider as an alternative to paravertebral or thoracic epidurals (AU)

Complicaciones tras esofagoscopia rígida y posterior colocación de sonda nasogástrica / No disponible

No disponible

Obstrucción total del tubo endotraqueal tras intubación nasotraqueal no complicada / No disponible

No disponible

[Early extubation with caudal morphine after pediatric heart surgery]. / Extubación precoz con morfina caudal tras cirugía cardíaca pediátrica.

OBJECTIVES: To analyze the viability of immediate extubation of children after corrective surgery for congenital heart defects with extracorporeal membrane oxygenation using an anesthetic technique involving caudal morphine, and to study the effect on length of stay in the pediatric intensive care unit (PICU) or elsewhere in the hospital. MATERIAL AND METHODS: Twenty-nine ASA I-II patients without coagulation alterations undergoing surgery to correct simple heart defects were selected for extubation after surgery. Anesthesia was provided with with sevoflurane, midazolam, rocuronium, fentanil (maximum dose 10 micrograms/Kg) and a bolus of caudal morphine (50-60 micrograms/Kg) after anesthetic induction. Patient characteristics, type of surgery, times of extracorporeal circulation and of ischemia, arterial blood gases upon arrival in the PICU, postoperative complications and quality of analgesia were the variables analyzed. We also compared length of stay in the PICU and hospital for the study group and for a historical control group of 23 patients who had no received caudal morphine or been selected for early extubation. RESULTS: All patients were extubated satisfactorily in the operating room. None required reintubation or reoperation. Postoperative pain was controlled with metamizol alone for 79.3%. No episodes of respiratory depression or neurological complications were observed. PICU and hospital stays were significantly shorter in the study group than in the control group. CONCLUSIONS: Of patients undergoing simple corrective heart surgery with extracorporeal membrane oxygenation immediate extubation did not increase postoperative morbimortality and shortened the hospital stay. A single dose of caudal morphine provided optimum conditions for extubation and good control of postoperative pain. Strict measures must be taken, however, to avoid postpuncture bleeding.

Extubación precoz con morfina caudal tras cirugía cardíacapediátrica / Early exttubation with caudal morphine after pediatric heart surgery

OBJETIVO: Analizar la viabilidad y la influencia en la estancia en la Unidad de Cuidados Intensivos Pediátricos (UCIP) y en el hospital de la extubación inmediata de niños sometidos a corrección de cardiopatías congénitas bajo circulación extracorpórea (CEC) utilizando una técnica anestésica basada en la administración de morfina caudal. MATERIAL Y MÉTODOS: 29 pacientes ASA I-II, sin alteraciones de la coagulación y sometidos a corrección de una cardiopatía simple, fueron seleccionados para ser extubados tras la intervención. La anestesia se realizó con sevoflurano, midazolam, rocuronio, fentanilo (dosis máxima de 10 µg/Kg) y bolo de morfina caudal (50-60 µg/Kg) tras la inducción anestésica. Se analizaron las variables demográficas, tipo de cirugía, tiempo de CEC y de isquemia, gasometría arterial a su llegada a UCIP, complicaciones postoperatorias y grado de analgesia. Asimismo se compararon las estancias en la UCIP y en el hospital con las de un grupo control histórico de 23 pacientes a los que no se administró morfina caudal ni hubo intencionalidad de conseguir su extubación precoz. RESULTADOS: Todos los pacientes fueron extubados satisfactoriamente en quirófano. Ninguno requirió reintubación o reintervención. En el 79,3 por ciento de los casos el dolor se controló sólo con metamizol durante el postoperatorio. No se registraron episodios de depresión respiratoria ni complicaciones neurológicas. La estancia en UCIP y hospitalaria fueron significativamente más bajas que en el grupo control. CONCLUSIONES: La extubación inmediata de pacientes intervenidos por cardiopatía simple bajo CEC no aumentó la morbimortalidad postoperatoria y acortó la estancia hospitalaria. La morfina caudal en dosis única proporcionó unas condiciones óptimas para la extubación y un buen control del dolor postoperatorio, aunque deben extremarse las precauciones para prevenir un sangrado postpunción (AU)

Recuperación anestésica inmediata y función psicomotriz de los pacientes tras anestesia prolongada con desflurano, sevoflurano o isoflurano / Recovery and psychomotor function of patients after prolonged anesthesia with desflurane, sevoflurane or isoflurane

OBJETIVOS. Comparar el mantenimiento, la recuperación y la función psicomotriz en el postoperatorio inmediato de los pacientes tras anestesia con desflurano, sevoflurano o isoflurano en cirugía urológica abierta de duración prolongada. PACIENTES Y MÉTODOS. Se seleccionaron 75 pacientes para recibir de forma aleatoria desflurano, sevoflurano o isoflurano con N2O al 60 por ciento durante el mantenimiento de la anestesia. La concentración de estos agentes se ajustó para mantener la presión arterial y la frecuencia cardíaca en ñ 20 por ciento de los valores basales. Al final de la intervención se suprimieron los agentes anestésicos y se registró el tiempo hasta la apertura de ojos de los enfermos, ventilación espontánea, extubación y orientación.En la unidad de recuperación postanestésica (URPA) se evaluaron el test de Newman-Trieger, el test de Aldrete, las náuseas y vómitos, y las necesidades de analgesia de los enfermos en las primeras 24 h. RESULTADOS. No hubo diferencias significativas entre los grupos con respecto a datos demográficos, mantenimiento anestésico, duración de la anestesia o dosis relativas de agentes anestésicos utilizados. Los tiempos de recuperación de los enfermos en quirófano fueron significativamente menores (p < 0,05) tras anestesia con desflurano o sevoflurano que con isoflurano, sin diferencias entre los dos primeros grupos (duración de la anestesia: 198 ñ 90, 171 ñ 67 y 191 ñ 79; apertura de ojos: 7,6 ñ 3,7, 7,8 ñ 3,0 y 11,9 ñ 4,5; tiempo hasta extubación: 7,8 ñ 3,0, 8,3 ñ 3,0 y 11,0 ñ 3,5; desflurano, sevoflurano e isoflurano, respectivamente; todos los datos expresados en min).La recuperación en la URPA no objetivó diferencias significativas entre los tres grupos. CONCLUSIONES. Los tres agentes fueron comparables durante el mantenimiento anestésico. El desflurano y el sevoflurano evidenciaron ventajas sobre el isoflurano durante la recuperación de la anestesia en quirófano. No se encontraron diferencias entre los grupos en la recuperación psicomotriz, náuseas y/o vómitos o requerimientos de analgesia postoperatoria (AU)

[Immediate anesthesia recovery and psychomotor function of patient after prolonged anesthesia with desflurane, sevoflurane or isoflurane]. / Recuperación anestésica inmediata y función psicomotriz de los pacientes tras anestesia prolongada con desflurano, sevoflurano o isoflurano.

OBJECTIVE: To compare the anesthetic maintenance and early postoperative recovery and psychomotor function in patients who have been anesthestized with desflurane, sevoflurane or isoflurane during prolonged open urological surgery. PATIENTS AND METHODS: Seventy-five patients were randomly assigned to receive desflurane, sevoflurane or isoflurane with N2O 60% for anesthetic maintenance. The concentration of each drug was adjusted to maintain arterial pressure and heart rate +/- 20% of baseline. After the operation the anesthetics were discontinued and times until eye opening, spontaneous breathing, extubation and orientation were recorded. In the post-anesthesia recovery ward we applied the Newman-Trieger and Aldrete tests and recorded instances of nausea and vomiting and need for analgesia during the first 24 hours after surgery. RESULTS: The groups were similar with regard to demographic features, anesthetic maintenance, duration of anesthesia and relative doses of the anesthetics used. Recovery times in the operating room were significantly shorter (p < 0.05) after anesthesia with desflurane and sevoflurane than with isoflurane, with no significant differences between the desflurane and sevoflurane groups (duration of anesthesia 198 +/- 90, 171 +/- 67 and 191 +/- 79; eye opening 7.6 +/- 3.7, 7.8 +/- 3.0 and 11.9 +/- 4.5; time until extubation 7.8 +/- 3.0, 8.3 +/- 3.0 and 11.0 +/- 3.5 for desflurane, sevoflurane and isoflurane, respectively; all data in minutes). Recovery in the post-anesthetic recovery ward was similar for all three groups. CONCLUSIONS: Anesthetic maintenance was comparable with all three drugs. Desflurane and sevoflurane demonstrated advantages over isoflurane during recovery from anesthesia in the operating theater. No significant differences were found in psychomotor recovery, nausea and/or vomiting or requirements for postoperative analgesia.