[Word recognition test after general anesthesia: the influence of previous anesthesia]. / Test prepoznavanja rijeci nakon opce anestezije: utjecaj prijasnje anestezije.

Among other higher brain functions such as consciousness and learning, general anesthesia also affects memory. A number of information retrieval tests are performed to determine the effects of drugs on explicit memory. In this study, we investigated the recognition of words before and after general anesthesia in subjects having and not having received anesthesia on one or more occasions before the present one. The study included 51 patients, ASA physical status I or II, median age 50, at least high-school graduates, without head trauma, known psychiatric or memory disorder, and taking no psychoactive medication. A standardized anesthesia technique, a single surgical procedure and a defined study-test interval were used. We designed our own test as a combination of story recall test and brief word learning test, both widely used in psychological and psychiatric examination. There was no significant difference in word recognition before and after general anesthesia in either patient group. Many studies indicate that anesthesia and surgery are associated with cognitive impairment lasting for 33 months in 10%-14% of elderly patients. We hypothesized that general anesthetics can cause prolonged cognitive alterations. Study results showed that previous anesthesia in addition to the current one had no significant influence on the word recognition test.

Spinal anesthesia at the L2-3 and L3-4 levels: comparison of analgesia and hemodynamic response.

Aim of this study was to evaluate level of analgesia and hemodynamic response to spinal anesthesia obtained by administering 15 mg 0.5% isobaric bupivacaine at L2-3 vs. L3-4 interspace for inguinal herniorrhaphy, since studies comparing analgesia and hemodynamic response at the L2-3 vs. L3-4 interspaces are lacking. In a prospective, randomized clinical study that encountered 72 patients undergoing elective inguinal herniorrhaphy randomly allocated in to two equal groups L2-3 (N = 36) and L3-4 (N = 36) according to lumbar interspace where intrathecal injection of bupivacaine was administered. Analgesia was evaluated by intraoperative "rescue" fentanyl requirements, the absence of pain and the maximal visual analogue scale (VAS) scores reached per patient during the operation. The severity of intraoperative pain was quantified by a 10 cm VAS scale (VAS 0: no pain to 10: worst pain imaginable) every 5 minutes after skin incision until the end of the operation. VAS > 3 was treated with intravenous fentanyl 25 microg. Hemodynamic response was monitored and evaluated, heart rate was continuously monitored as well as, baseline systolic, diastolic and mean arterial pressure prior to induction and every 5 minute after applying spinal anesthesia until surgical completion. Intraoperative fentanyl requirements were significantly higher in group L3-4 (L2-3 0%, 97.5% confidence interval [CI] 0.0-0.11 vs. L3-4 17%, 95% CI 0.07-0.32, p = 0.025). Absence of pain was significantly higher in L2-3 group at the beginning of the operation (L2-3 89%, 95% CI 0.74-0.96 vs. L3-4 67%, 95% CI 0.50-0.79, p = 0.047). The maximal VAS scores reached per patient during the operation in L2-3 group were lower then in L3-4 group (L2-3 median [M] 0, range [R] 0-3, L3-4 M 0, R 0-8, p = 0.014). There were no significant differences (p > 0.05) in the incidence of hypotension (L2-3 19%, 95% CI 0.09-0.35 vs. L3-4 17%, 95% CI 0.07-0.32) and bradycardia (L2-3 19%, 95% CI 0.09-0.35 vs. L3-4 8%, 95% CI 0.02-0.23). Spinal anesthesia with isobaric bupivacaine administered in L2-3 interspace for inguinal herniorrhaphy provides superior analgesia and equal hemodynamic stability as compared to neuroaxial anesthesia administered in the L3-4 interspace.

Effects of high intraoperative inspired oxygen on postoperative nausea and vomiting in gynecologic laparoscopic surgery.

STUDY OBJECTIVE: To assess the efficacy of intraoperative inspired oxygen fractions (FIO(2)) of 0.8 and 0.5 when compared with standard FIO(2) of 0.3 in the prevention of postoperative nausea and vomiting (PONV). DESIGN: Prospective, randomized, double-blinded, controlled study. SETTING: General hospital, postanesthesia care unit (PACU), and gynecology floor room. PATIENTS: 120 ASA physical status I and II women, aged 21 to 76 years, undergoing elective gynecologic laparoscopic surgery. INTERVENTIONS: Patients were randomized to receive a gas mixture of 30% oxygen in air (FIO(2) = 0.3, Group G30), 50% oxygen in air (FIO(2) = 0.5, Group G50), or 80% oxygen in air (FIO(2) = 0.8, Group G80); there were 36 patients in each group. A standardized sevoflurane general anesthesia, postoperative pain management, and antiemetic regimen were used. MEASUREMENTS: Frequency of nausea, vomiting, and both was assessed for early (0 to two hrs) and late PONV (two to 24 hrs), along with use of rescue antiemetic, degree of nausea, and severity of pain. MAIN RESULTS: There was no overall difference in the frequency of PONV at the early and late assessment periods among the three groups. G80 patients had significantly less vomiting than Group G30 at two hours, 3% (1/36) vs. 22% (8/36), respectively, P = 0.028. Nausea scores, rescue antiemetic use, pain scores, and opioid consumption did not differ among the groups. CONCLUSION: High intraoperative FIO(2) of 0.8 and FIO(2) of 0.5 do not prevent PONV in patients without antiemetic prophylaxis. An intraoperative FIO(2) of 0.8 has a beneficial effect on early vomiting only.

The effect of propofol and fentanyl as compared with sevoflurane on postoperative vomiting in children after adenotonsillectomy.

Postoperative vomiting (PV) after adenotonsillectomy in children is a common problem with an incidence as high as 40-80%. Only few studies in the recent literature compared the effect of different anesthetic techniques concerning PV in children. The aim of this study was to compare the incidence of PV in two groups of children who underwent two different general anesthesia techniques in order to determine what type of anesthetic technique is more related to less PV. The clinical trial included 50 children (physical status ASA I, 3-12 years old) divided into 2 groups and monitored for PV 24 hours following the surgery. Group one (G1) consisted of 25 children who underwent general anesthesia with gas mixture 60% nitrous oxide and 40% oxygen and anesthetic propofol, opioid fentanyl and muscle relaxant vecuronium intravenously and group two (G2) included 25 children to whom volatile anesthesia with sevoflurane in the same gas mixture was given. Demographic characteristics (gender, age, weight, history of motion sickness and earlier PV) as well as surgical data (length of surgery and anesthesia, intraoperative blood loss) were recorded. There were no significant differences considering demographic characteristics and surgical data between the investigated groups. The incidence of PV was relatively low 3 children (12%) in G1 group and 5 children (20%) in G2 group. Statistically there was no significant difference between the groups regarding the incidence of PV and both anesthetic techniques can be used equally safe regarded to PV.