Propofol vs isoflurane anesthesia-incidence of PONV in patients at maxillofacial surgery.

PURPOSE: Prophylaxis of PONV (postoperative nausea and vomiting) is important for maxillofacial surgery. Vomiting is particularly unpleasant for the patient and undesirable as it may be detrimental to the operative area. The aim of this study is to compare the incidence of PONV after propofol with that after isoflurane anesthesia. MATERIALS AND METHODS: 84 patients age 15-50, ASA I-II, undergoing maxillofacial surgery were randomly allocated in two groups. Group P n=42 -using TIVA (Total Intravenous Anesthesia) with propofol and Group I n=42- using isoflurane anesthesia. The incidence and severity of PONV was evaluated for 24 hours postoperatively based on scoring system: 0=no emetic symptoms, 1=nausea, 2=vomiting. Whereas the severity of nausea was assessed using a four-point Likert scale, with 0=none, 1=mild, 2=moderate, 3=severe. RESULTS: There were no significant differences between the groups with respect to demographic data and duration of anesthesia. The incidence of nausea (2-3 Likert scale) in the propofol group was 11.9% compared to the isoflurane group 38.1% during early post-operative period (0-6 hrs) (p=0.011), whereas during late post-operative period 7.1% in group P compared with 11.9% in group I (p=0.712).Incidence of vomiting in early post-operative period in-group P was 4.8%, whereas in-group I 11.9% (p=0.432). In late postoperative period in-group P no patient suffered from vomiting or retching, whereas in-group I 4.8% (p=0.494). CONCLUSIONS: TIVA with propofol reduces the postoperative incidence of nausea and vomiting after maxillofacial surgery, compared with isoflurane anesthesia, and also reduces requirements of antiemetic medications.

[Results of different surgical methods in management of hepatic hydatidosis]. / Rezultati razlicitih hirurskih procedura u lijecenju hidatidnih cista jetre.

INTRODUCTION: Hepatic hydatidosis has been a common pathology for decades in our department. In the past were used different surgical methods to manage liver hydatidosis, but, a method of choice still is not found, especially for treatment of large liver hydatid cysts. OBJECTIVE: To analyze the outcome of different surgial methods used for treatment of large hepatic hydatid cysts in our department over a period of 12 years. MATERIAL AND MEDTHODS: A retrospective random chart review of patients with liver hydatid cysts treated surgically during 1981-1990 and 2000-2001. RESULTS: A total of 183 patients were studied: 110 (60.1% = female, 73 (39.9%) male; the medican age was 37 years (range 17 to 81); the mean preoperative ultrasonographic diameter of cysts was 13.05 cm (median 11.3 cm and maximal 22.3 cm). 72.7% of cysts were localized in the right hepatic lobe and 27.3% in the left hepatic lobe in 21 (11.5%) patients two different cysts in both hepatic lobes were found. Following surgical methods were performed; in 50 (27.3%) patients endocystectomy and capitonnage, in 10 (5.4%) patients external drainage, in 115 (62.8%) endocystectomy and partial pericystectomy with omentoplication according Papadimitris and in 8 (4.4%) opatients complete pericystectomy or atypical liver resection. In 31 (16.9%) choledochal T-tube was placed. Mean postoperative hospital stay was 15.7 days (minimum 5, maximum 71). Overall complication rate was 18.8%, there was no mortality. CONCLUSIONS: Enucleatin of endocysts and partial pericystectomy witzh omentoplication accroding Papadimitris was most often used last years. Endocystectomy with capitonnage as well as external drainage that were used in the past for treatment of large hydatid hepatic cysts, had a more postoperative complications and longer hospital stay compared to the method of Papadimitris.