ABSTRACT
Background: In a time of increased concern over the environmental impact of chlorofluorocarbons, there is an impetus to minimize inhalational anesthetic consumption. It is possible with multimodal analgesia (MMA) and the use of end-tidal controlled anesthesia (EtCA) which is a low-flow anesthesia technique with adequacy of anesthesia (AoA) monitoring. In MMA, all four elements of pain processing namely transduction, transmission, modulation, and perception are targeted with drugs having a different mechanism of action. In EtCA, anesthetic gases are automatically adjusted for the set minimal alveolar concentration by newer anesthesia work station (GE Healthcare Aisys CS2). AoA is a derived parameter of entropy and surgical pleth index which measures the depth of anesthesia and analgesia, respectively. Aim: The aim is to assess the difference in isoflurane consumption between MMA and conventional groups for a given period of time with EtCA and AoA monitoring. Setting and Design: This was a prospective randomized controlled trial involving 60 patients undergoing laparoscopic cholecystectomy. They were divided into MMA group and conventional group. Materials and Methods: Both the groups received preemptive intravenous diclofenac sodium 75 g and 2% xyloadrenaline infiltration at entry ports. MMA group in addition received paracetamol 1 g and clonidine 0.75 µg.kg- 1. Intraoperatively, patients were on EtCA with AoA monitoring. Statistical Analysis: Mean differences in isoflurane consumption between the two groups were compared using an independent t-test. Postextubation adverse effects of analgesic drugs and awareness under general anesthesia were compared using the Chi-square test and presented as numbers and percentages. P < 0.05 was considered a statistically significant. Results: Mean isoflurane consumption in the conventional group was 12.7 ± 5.3 mL which was significantly higher than the MMA group which was 8.9 ± 4.1 mL (P = 0.002). The duration of anesthesia between the groups was not significant clinically (P = 0.931). Conclusion: EtCA with MMA significantly reduces isoflurane consumption compared to the conventional group of anesthesia.
ABSTRACT
Objectives: del Nido cardioplegia which was traditionally used for myocardial protection in pediatric congenital heart surgery is now being extensively utilized in adult cardiac surgery. The aim of this study was to compare the safety and efficacy of del Nido cardioplegia (DNC) with blood cardioplegia (BC). Materials and Methods: This is a historical cohort study using secondary data. Two hundred and eighty six patients who underwent coronary artery bypass graft (CABG) or valve surgery were included. They were divided into 2 matched cohorts of which 143 patients received BC and 143 patients received DNC. Results: There was no difference in cardiopulmonary bypass time (P = 0.516) and clamp time (P = 0.650) between the groups. The redosing of cardioplegia was significantly less for DNC (1.13 vs. 2.35, P = <0.001). The post bypass hemoglobin was higher for DNC (9.1 vs. 8.7, P = 0.011). The intraoperative and postoperative blood transfusion was comparable (P = 0.344) (P = 0.40). The incidence of clamp release ventricular fibrillation (P = 0.207) was similar. The creatine kinase-MB isotype levels for the CABG patients were comparable on all 3 days (P = 0.104), (P = 0.106), and (P = 0.158). The postoperative left ventricle ejection fraction was lesser but within normal range in the DNC group (53.4 vs. 56.0, P = <0.001). The duration of ventilation (P = 0.186), ICU days (P = 0.931), and postoperative complications (P = 0.354) were comparable. There was no 30-day mortality or postoperative myocardial infarction in both the groups. Conclusion: DNC provides equivalent myocardial protection, efficacy, and surgical workflow and had comparable clinical outcomes to that of BC. This study shows that DNC is a safe alternate to BC in CABG and valve surgeries.
