Effect of local infiltration with oxytocin on hemodynamic response to surgical incision and postoperative pain in patients having open laparoscopic surgery under general anesthesia.

BACKGROUND: Preemptive analgesia encompasses different perioperative interventions that have the final aim of decreasing postoperative pain and improving recovery. Recently, peripheral analgesic effects of oxytocinergic modulation have been suggested. In this regard, we tested the potential analgesic effects of subcutaneous oxytocin (OT) infiltration in patients submitted to laparoscopic cholecystectomy. METHODS: Thirty patients with similar general characteristics and medical physical conditions were evaluated. The patients were assigned by simple random selection to one of three groups: (a) OT group (n = 10), which received preincisional subcutaneous OT (4 µg/4 ml saline) in the surgical sites for trocar placements; (b) Lidocaine group (n = 10), which received subcutaneous lidocaine 1% (4 ml) in the surgical sites; and (c) Control group (n = 10), which did not receive any treatment. Then we measured the effect of those treatments on the hemodynamic variations produced as responses to the surgical incisions and trocar insertions (open port placements using the Hasson technique). Moreover, we assessed the intensity of postoperative pain with the visual analogue scale during recovery and 24 hr after surgery. RESULTS: Hemodynamic parameters were stable in both intervention groups (subcutaneous OT and lidocaine) during the surgical incisions and trocar placements, whereas a most likely sympathetic activation due to trocar insertions (open port placements) was not blunted in the placebo group. Furthermore, postoperative pain was diminished in both OT and lidocaine groups when compared to the control group. CONCLUSIONS: Preincisional subcutaneous OT administration reduced the hemodynamic response produced by the latter. Furthermore, OT also diminished postoperative pain.

Manejo anestésico de emergencia hipertensiva perioperatoria secundaria a tumores neuroendocrinos A propósito de un caso / Anesthetic management of hypertensive emergency perioperative secondary neuroendocrine tumors. Report of a case

Resumen Introducción: Los tumores neuroendocrinos son neoplasias secretoras de hormonas, principalmente catecolaminas, que pueden presentarse en cualquier parte del cuerpo. La incidencia del feocromocitoma es de 2 a 8 por millón de personas por año, y el 10% de ellos son tumores extra adrenales. El manejo anestésico se considera un reto para el anestesiólogo, ya que deben tomar en cuenta varios puntos para el control hemodinámico del paciente, así como el manejo multidisciplinario en el periodo pre, trans y posquirúrgico. Caso clínico: Presentamos el caso de un paciente masculino portador de para-ganglioma vesical sometido a resección quirúrgica bajo anestesia general e infusión de isosorbide para control de la emergencia hipertensiva. Conclusiones: Se consideró, en este caso en particular, que el uso de vasodilatadores periféricos fue benéfico para el tratamiento de la emergencia hipertensiva durante el transanestésico. Discusión: El tratamiento de la emergencia hipertensiva reportado en la bibliografía muestra que el uso de fármacos intravenosos como nitroprusiato de sodio, nitroglicerina, labetalol, esmolol, entre otros, son los más indicados. El uso de nitritos es una alternativa viable con descontrol hipertensivo severo.

Abstract Introduction: Neuroendocrine tumors, can be found anywhere on the body. The incidence of pheochromocytoma is 2-8 per million people per year and 10% of these are extra-adrenal tumors. Anesthetic management is considered a challenge for the anesthesiologist, since they are primarily catecholamine secreting tumors, and they must take into account several points for a hemodynamic monitoring of the patient and the multidisciplinary management in the pre, trans and postsurgical period. Case report: We report the case of a male patient carrier of a bladder para-ganglioma who underwent a surgical resection under general anesthesia and an infusion of isosorbide to control a hypertensive emergency. Conclusions: We considered, in this particular case, that the use of peripheral vasodilators was beneficial for the treatment of hypertensive emergency during trans- anesthetic. Discussion: The treatment of hypertensive emergencies reported in the literature shows that the use of intravenous drugs such as sodium nitroprusside, nitroglycerin, labetalol, esmolol, among others, are the most recommended. The use of nitrite is a viable alternative with severe uncontrolled hypertension.