[Postoperative Analgesia for Video-assisted Thoracoscopic Surgery--Continuous Intravenous Infusion of Fentanyl Combined with Intercostal Nerve Block v.s. Continuous Epidural Analgesia].

BACKGROUND: Epidural analgesia or paravertebral block is widely used in postoperative analgesia for video-assisted thoracic surgery (VATS). We investigated the efficacy of the continuous intravenous infuion of fentanyl combined with intercostal nerve block, in comparison with the continuous epidural analgesia. METHODS: Forty-one patients received a bolus of 0.375% ropivacaine 6-10 ml through the epidural catheter placed at the T5-9 at the end of surgery. Then, continuous epidural infusion of 0.2% ropivacaine at a rate of 4 or 6 ml x hr(-1) was started (Group E). 44 patients received intercostal nerve block at three insertion points of thoracoscopy (using 0.75% ropivacaine 3-4 ml, respectively) at the end of surgery. Then, continuous intravenous infusion of fentanyl at a rate of 0.5 µg x kg(-1) x hr(-1) was started (Group F). The efficacy of post-operative analgesia was evaluated by additional analgesic requirements. RESULTS : There was no significant difference in the additional analgesic requirements between the two groups. However, the additional analgesics were required significantly earlier in Group E than Group F (P < 0.05). CONCLUSIONS: Continuous intravenous infusion of fentanyl combined with intercostal nerve block is effective in the postoperative analgesia for VATS, as well as continuous epidural analgesia.

[Effects of Sevoflurane or Desflurane Anesthesia on Perioperative Delirium in Elderly Patients Undergoing Surgical Repair of Hip Fracture].

BACKGROUND: Perioperative delirium increases the morbidity and mortality in elderly patients. The present retrospective study was carried out to evaluate whether desflurane or sevoflurane has influence on the incidence of perioperative delirium. METHODS: In 30 patients above 75 years of age undergoing surgical procedure, anesthesia was maintained with sevoflurane (group S), and with desflurane (group D). The incidence of perioperative delirium was obtained retrospectively from their medical chart The delirium was diagnosed with the Richmond agitation-sedation scale. RESULTS: The incidence of perioperative delirium on postoperative day (POD) 1-3 was not significantly different between group D and group S. The patients in group D were discharged earlier about 10 days compared with those group S. CONCLUSIONS: Desflurane anesthesia is same as sevoflurane regarding perioperative delirium in elderly patients. Shorter hospitalization in group D was achieved for 10 days compared with those in group S, due to the lower incidence of delirium on POD 3 and 5 in group D.

Greater incidence of emergence agitation in children after sevoflurane anesthesia as compared with halothane: a meta-analysis of randomized controlled trials.

BACKGROUND: Sevoflurane is a popular inhalational anesthetic for general anesthesia in children. The higher incidence of emergence agitation has been suspected after sevoflurane anesthesia as compared with halothane, whereas some controlled studies showed conflicting results. In this report, the authors performed a meta-analysis of randomized controlled trials to compare the incidence of emergence agitation in children after sevoflurane or halothane anesthesia. METHODS: A comprehensive literature search was conducted to identify clinical trials that compared the incidence of emergence agitation in children anesthetized with sevoflurane versus halothane. Two reviewers independently assessed each report to meet the authors inclusion criteria and extracted data. The data from each trial were combined using the Mantel-Haenszel fixed-effect model to calculate the pooled odds ratio and 95% confidence interval. Funnel plots were used to assess publication bias. Subgroup analysis was used to clarify the effects of age, surgical procedure, pain treatment, and premedication on the incidence of emergence agitation. RESULTS: The authors identified 23 studies that met their inclusion criteria. Overall, 1,252 patients received sevoflurane and 1,111 had halothane. Heterogeneity of data was statistically refuted. The pooled odds ratio for all studies was 2.21, with a 95% confidence interval of 1.77-2.77 (P < 0.0001). Publication bias was not apparent in a funnel plot. All subgroup analyses showed a higher incidence of agitation after sevoflurane anesthesia. CONCLUSIONS: This meta-analysis revealed that emergence agitation occurred more frequently with sevoflurane than with halothane anesthesia in children.