The effect of sevoflurane vs. TIVA on cerebral oxygen saturation during cardiopulmonary bypass--randomized trial.

BACKGROUND: Neuropsychological and neurological deficits are still major causes of mortality and morbidity after cardiac surgery. These complications are thought to be caused by embolisms and cerebral hypoxia. Thus, continuous neuromonitoring is essential during cardiac surgery due to cerebral oxygen desaturation during different periods. Near-infrared spectrophotometry (NIRS), a non-invasive method, appears to offer many advantages for monitoring cerebral oxygenation and hemodynamics. Desaturation of cerebral oxygen may occur at the beginning of cardiopulmonary bypass (CPB) or during the low perfusion and rewarming stages if not corrected. OBJECTIVES: This study was designed to assess the effects of sevoflurane on cerebral protection during CPB. MATERIAL AND METHODS: Eighty patients were divided into two groups. Anesthesia was maintained either with fentanyl and midazolam (total intravenous anesthesia, TIVA) or with one minimum alveolar concentration of sevoflurane and fentanyl. Cerebral desaturation was defined as an absolute decrease in saturation of 20% from baseline cerebral saturation. When desaturation occurred, PaCO2, hematocrit and PaO2 levels were checked and corrected. If desaturation continued, anesthetic depth was increased to reserve saturation with 50-100 mg of propofol. NIRS values and hemodynamics were recorded at predetermined time intervals. RESULTS: Cerebral oxygen saturation values on the right side were higher in the sevoflurane group than in the TIVA group. The values on the left side were higher in the sevoflurane group than in the TIVA group, and meaningful differences were seen at the lowest temperature and at 36°C. CONCLUSIONS: Oxygen saturation was higher in the sevoflurane group than in the TIVA group. Thus, the effect of sevoflurane was useful for maintaining cerebral oxygen saturation during CBP.

[Postoperative pain therapy after laparoscopic cholecystectomy: paracetamol versus diclofenac]. / Laparoskopik kolesistektomilerde cerrahi sonrasi agri tedavisi: Parasetamol ile diklofenak karsilastirmasi

OBJECTIVES: Laparoscopic cholecystectomy is the first treatment choice for symptomatic gallstone disease. We compared the efficacy of intravenous (i.v.) paracetamol and intramuscular (i.m.) diclofenac Na(+) after laparoscopic cholecystectomy. METHODS: Following approval from the Local Ethics Committee and receipt of written informed consent, 40 ASA physical status I-II patients who underwent laparoscopic cholecystectomy were enrolled into the study. General anesthesia was standardized. The patients received 1 g i.v. Paracetamol (Group I, n: 20) or 75 mg diclofenac Na+ i.m. (Group II, n: 20) 15 minutes (min) before the end of the operation. Pain was assessed by numeric rating scale (NRS) after arrival in the postanesthesia care unit (PACU) (NRS 1) and at the 30th minute (NRS 2) and 1st hour (NRS 3) of the PACU stay. 10 mg i.v. Pethidine HCL was administered to the patient with NRS >5. The following measures were recorded: intensity of pain by NRS at arrival and after 30 and 60 min, total consumption of pethidine HCL, and nausea and vomiting. RESULTS: All assessments were performed by an anesthesiologist blinded to the study protocol. NRS 3 scores were significantly higher in Group I than Group II (p<0.05). Opioid consumption was not different between the groups. Two patients in each group had postoperative nausea and vomiting; no other adverse effects were noted. CONCLUSION: We recommend the use of i.v. Paracetamol as an opioid adjuvant. Regarding its use as a unique drug for postoperative pain therapy, further comparative studies with higher doses of paracetamol are needed.