RESUMO
BACKGROUND AND AIMS: Low-volume high-concentration bupivacaine irrigation of the peritoneal cavity has been reported to be ineffective for short-term analgesia after laparoscopic cholecystectomy (LC). This study was conducted to evaluate the effectiveness of intraperitoneal instillation of high-volume low-concentration bupivacaine for post-operative analgesia in LC. METHODS: Sixty patients undergoing LC were included in this prospective, double-blind, randomised study. Patients were divided into two (n = 30) groups. In Group S, intraperitoneal irrigation was done with 500 ml of normal saline. In Group B, 20 ml of 0.5% (100 mg) bupivacaine was added to 480 ml of normal saline for intraperitoneal irrigation during and after surgery. Post-operative pain was assessed by numeric pain rating scale (NRS) at fixed time intervals. Duration of analgesia (DOA), total rescue analgesic requirement (intravenous tramadol), presence of shoulder pain, nausea and vomiting were recorded for the initial 24 h post-operatively. RESULTS: Mean DOA in Group S was 0.06 ± 0.172 h (3.6 ± 10.32 min) and that in Group B was 19.35 ± 8.64 h (P = 0.000). Cumulative requirement of rescue analgesic in 24 h in Group S was 123.33 ± 43.01 mg and that in Group B was 23.33 ± 43.01 mg (P = 0.000). There was no significant difference in incidence of shoulder pain, nausea and vomiting between the groups. CONCLUSION: High-volume low-concentration of intraperitoneal bupivacaine significantly increases post-operative DOA and reduces opioid requirement after LC.
RESUMO
OBJECTIVE: To review the anesthetic management for percutaneous transcatheter closure of perimembranous ventricular septal defect (VSD) with an Amplatzer asymmetric occluder device and to highlight the hemodynamic effects and potential complications associated with its delivery. DESIGN: Retrospective review of prospectively collected data. SETTING: University-affiliated teaching hospital. PARTICIPANTS: Nine consecutive children undergoing elective percutaneous transcatheter closure of perimembranous VSD. INTERVENTIONS: General anesthesia with sevoflurane for cardiac catheterization and percutaneous transcatheter device placement. MEASUREMENTS AND MAIN RESULTS: Ten anesthetics were delivered in 9 children ages 23 to 65 months with perimembranous VSD for attempted placement of an Amplatzer asymmetric device. The device was successfully placed in 7 patients. In 1 patient the device embolized to the right femoral artery, and was retrieved with a bioptome. Fluoroscopy time (59.8 +/- 17.24 min) was prolonged compared to that in other studies of placement of this device. All patients had episodes of arrhythmia and hemodynamic disturbance. Arrhythmias ranged from atrial or ventricular ectopic events to various degrees of atrioventricular block. Complete heart block occurred during the procedure in 1 patient and after the procedure in another patient. Hypotensive episodes occurred in 7 patients, and were attributed to arrhythmias in 5 patients and hypovolemia in 2 patients. Two patients were given blood transfusions after the procedure because they had signs of hypovolemia and a greater than 10% decrease in hemoglobin levels. CONCLUSIONS: Anesthesia for perimembranous VSD occluder placement is associated with hemodynamic instability, arrhythmias, prolonged procedure times, and inevitable and sometimes substantial blood loss.