The effect of peribulbar block with ropivacaine on bi-hemispheric cerebral oxygen saturation in aged patients.

We evaluated the effects of peribulbar block for eye surgery on bi-hemispheric regional cerebral oxygenation (rSO2)) of aged patients. In 66 adult patients, peribulbar block was performed using ropivacaine 10 mg.ml(-1) with hyaluronidase 100 IU.ml(-1). Cerebral oxygenation was monitored using continuous non-invasive, near-infrared spectroscopy. The rSO2 data on the side where the eye block was performed were evaluated as eye block side values, whereas the data recorded on the other side were taken as control values. Mean rSO2 values on the side where regional block was performed were not significantly different from control values (p > 0.05). Nevertheless, in several patients, a slight desaturation in the cerebral hemisphere on the block side was detected. Therefore, in aged patients, peribulbar block with ropivacaine does not significantly modify bi-hemispheric rSO2, but rSO2 monitoring during peribulbar block should be a field of future research in aged patients with brain injury or disease.

Effect of tramadol on Bispectral Index during intravenous anaesthesia with propofol and remifentanil.

The aim of this study was to investigate the effects of tramadol on the Bispectral Index (BIS) during total intravenous propofol-remifentanil anaesthesia. Forty-four adult ASA Physical status I-II patients, scheduled for elective general surgical procedures were included in a prospective observational randomized study. Doses for anaesthetics and opioids were adjusted to keep the BIS value at 50 +/- 5. After 20 minutes of stable anaesthesia, the subjects were randomly allocated to receive intravenous saline (control group) or tramadol 1.5 mg/kg (tramadol group). BIS values, mean arterial pressure, and heart rate were recorded every five minutes for 20 minutes. Mean BIS values after tramadol administration were not significantly different from those following saline, throughout the observation period (P > 0.05). There were no patients in whom BIS values were more than 60 or who presented explicit recall of events under anaesthesia. There were no significant changes in mean arterial pressure, SpO2, or heart rate (P > 0.05). The results indicate that the administration of tramadol during stable total intravenous anaesthesia with propofol-remifentanil does not affect BIS values. The clinical relevance is that tramadol can be safely administered pre- and intraoperatively as pre-emptive or preventive analgesia without modification of the depth of anaesthesia.

Tramadol does not modify the Bispectral Index during anaesthesia with sevoflurane and remifentanil.

BACKGROUND: The aim of this study was to investigate the effects of tramadol administered with ketorolac on the Bispectral Index (BIS) during anaesthesia with sevoflurane and remifentanil. METHODS: Forty-six adult patients, ASA I-III, scheduled for elective minor surgical procedures were studied. Patients were premedicated with remifentanil infusion 0.4 microg kg(-1) min(-1) and anaesthesia was induced 4-5 min later with propofol 1.5 mg kg(-1) and maintained with air-oxygen (FI(O(2)) 0.4), remifentanil 0.1-0.15 microg kg(-1) min(-1) and sevoflurane, adjusted to keep the BIS between 40 and 50. After 20 min of stable anaesthesia, the subjects were allocated randomly to receive i.v. tramadol 1.5 mg kg(-1) and i.v. ketorolac 0.3 mg kg(-1) (tramadol group) or saline (control group). BIS values, mean arterial pressure, heart rate and end-tidal carbon dioxide were recorded every 5 min for 20 min. RESULTS: Mean BIS values after tramadol administration were not significantly different from those recorded in patients receiving saline throughout the period of observation. There were no patients who presented explicit recall of events under anaesthesia. No significant changes in mean arterial pressure, heart rate and end-tidal carbon dioxide were noted after tramadol injection. CONCLUSION: Tramadol, given with ketorolac to prevent postoperative pain, during anaesthesia maintained with sevoflurane and remifentanil at BIS between 40 and 50, does not modify the BIS value.

Comparison between local and general anaesthesia for carotid endarterectomy. A retrospective analysis.

AIM: The aim of this study was to compare by a retrospective analysis local anesthesia (LA) versus general anesthesia (GA) for carotid endarterectomy (CEA). METHODS: Two-hundred and 59 patients who underwent CEA, at the Ospedali Riuniti of Reggio Calabria in the period 2000-2001, were enrolled in this study. For analysis purposes, patients were divided into 4 groups, according to their neurological status and to the type of anesthesia. LA was induced either by deep and superficial cervical plexus block (side approach according to Moore). GA was induced with propofol and maintained with sevoflurane. Monitoring of the neurological status was achieved by simple clinical evaluation of the state of consciousness under LA, and by continuous EEG under GA. RESULTS: With LA, a reduction in the duration of intervention and hospital stay, in the number of neurological complications and consequent intraoperative shunts was observed, and admission to the intensive care unit (ICU) was never required. With GA better blood pressure control was achieved, but more intraoperative shunts and admissions to ICU were required, thus increasing overall costs. CONCLUSION: In our experience, LA seems to be the approach of choice for CEA because 1) by preserving the state of consciousness, it allows a simple clinical monitoring of cerebral perfusion maintenance; 2) it reduces the number of intraoperative shunts and the risk of admission to the ICU; 3) it is cost-effective.