Utility of the gastro-laryngeal tube during transesophageal echocardiography: A prospective randomized clinical trial.

BACKGROUND: To validate the utility and performance of the gastro-laryngeal tube (GLT) in terms of cardiologist and patient satisfaction levels, incidence of and attempts at successful transesophageal echocardiography (TEE) probe placement, perioperative and postoperative hemodynamics, and adverse events related to the TEE procedure. METHODS: In this randomized prospective clinical study, forty-four patients undergoing TEE and aged 20 to 80 years old scheduled for TEE were randomly allocated to two study groups: Group SA (sedation and analgesia) and Group GLT. Cardiologist and patient satisfaction levels, TEE probe placement performance, hemodynamics, adverse events related to the TEE procedure, demographic characteristics, and TEE procedure data were recorded. RESULTS: The cardiologist satisfaction level was significantly higher in Group GLT (P = .011). The TEE probe was successfully placed at the first attempt in all the patients in Group GLT and at the first attempt in 11 patients, at the second attempt in 8 patients, and at the third attempt in 3 patients in Group SA. The TEE probe placement success was significantly higher in Group GLT (P < .001), and TEE probe placement was significantly easier in Group GLT (P < .001). There were no significant differences in patient satisfaction, heart rate, mean arterial pressure, oxygen saturation, adverse events related to the TEE procedure between the groups. CONCLUSION: The present study revealed that GLT use elicited a higher cardiologist satisfaction level and resulted in more successful and easier TEE probe placement. We thus conclude that the use of the recently developed GLT may ensure airway management safety and a comfortable TEE experience.

Comparison of Cytokine Hemadsorption as an Immunomodulator Therapy in COVID-19 Patients with and without Bacterial Sepsis.

BACKGROUND: In this retrospective study, we aimed to compare the laboratory and clinical results of cytokine hem-adsorption as an immunomodulation therapy in COVID-19 ICU patients with or without sepsis. METHODS: The levels of PCT, CRP, and ferritin were determined as indicators of infection/sepsis; the levels of in-terleukins (IL-6, IL-8 and IL-10, and TNF-α) were determined as indicators of cytokine storm were compared. APACHE score, SOFA score, and mortality rates were compared for the progression of the disease in 23 COVID-19 patients. RESULTS: The therapy was generally successful in reducing the levels of IL-6, IL-8, IL-10, and TNF-α but the levels measured after the procedure did not differ among the patients with or without sepsis, suggesting that the presence of sepsis did not affect the efficacy and function of the cytokine hemadsorption procedure in COVID-19 patients. All parameters were reduced after the procedure except the levels of PCT and ferritin and mortality rates of patients diagnosed with sepsis. The level of PCT was significantly higher in these patients compared with the patients without sepsis while the ferritin and mortality did not show any significant difference between the two groups, suggesting that the cytokine hemadsorption may be safe in the treatment of critical COVID-19 patients. CONCLUSIONS: As a result, the progression of sepsis in COVID-19 may be avoided with cytokine hemadsorption applied as an immunomodulator therapy. However, this therapy should be further explored and validated prior to its introduction to everyday clinical practice when the epidemic conditions end.

Literature Review of Hemadsorption Therapy in Severe COVID-19 Cases: a Narrative Review.

BACKGROUND: A novel therapy for reducing the cytokines in the circulatory system used for severe COVID-19 cases was hemoperfusion or hemadsorption method. Although the hemoperfusion methods have been shown to be beneficial in the cytokine storm during influenza infection, it is not known to what extent it is successful for COVID-19 patients. Therefore, the purpose of this study is to review the studies on severe COVID-19 treated with the hemoperfusion methods. METHODS: A literature search was conducted using the databases PubMed, Science Direct, and Springer databases. Since the included articles consisted of case reports, case series, and one controlled trial, only the mean of the analyzed data could be calculated. RESULTS: Sixteen studies were included in the narrative review, including 86 patients with severe COVID-19. All the patients had hemoperfusion therapy with following cartridges: CytoSorb®, oXiris®, Biosky filter, SeaStar® CLR filter, HA280, HA330 Jafron©, and resin directed hemadsorption cartridges. Mortality rate, the mean of intubation time, duration in intensive care unit and hospital were 29%, 14.93 days, 17.21 days, and 31.7 days, respectively. The mean values of C-reactive protein and interleukin-6 decreased after hemoperfusion sessions (131.7 to 66.0, 527.5 to 334.7, respectively). CONCLUSIONS: In this narrative review, it is demonstrated that hemadsorption therapy is an alternative salvage treatment method in critically ill COVID-19 patients, but the data must be supported by strong evidence.

Prospective evaluation of remifentanil-propofol mixture for total intravenous anesthesia: A randomized controlled study.

Application of total intravenous anesthesia (TIVA) may be considered as unpractical when compared with inhalational anesthesia. Although it is mostly not recommended, mixing intravenous agents is popular in clinical practice. The aim of the present study was to investigate the suitability of using remifentanil-propofol mixture (MIXTIVA) for TIVA. Adult patients with an American Society of Anesthesiologists grade of I-II scheduled for elective thyroidectomy were randomly allocated to 3 groups (n=32 for each) to receive TIVA with remifentanil and propofol infusions separately (control group, Group I) or with MIXTIVA infusion that contained remifentanil/propofol at a proportion of 2/1,000 or 3/1,000 (remifentanil concentration, 20 or 30 µg/ml in 1% propofol in Group II or Group III, respectively). The extubation time (the primary outcome of the study), the orientation time and number of patients in whom intraoperative hypotension, hypertension or bradycardia episodes were encountered during anesthesia were comparable among the groups. The mean remifentanil infusion rate in Group III was significantly higher than that in the other groups. The mean propofol infusion rates and mean bispectral index (BIS) scores during anesthesia were comparable among groups. Hypotension accompanied with a high BIS was encountered in one patient in Group III. In conclusion, compared to the standard TIVA technique using separate drug infusions, MIXTIVA infusion used for thyroidectomies did not result in any statistically significant difference in recovery and clinical outcomes. This technique may be considered as a practical implementation for busy ambulatory centers performing general anesthesia. The present study was retrospectively registered at clinicaltrials.gov (trial registration no. NCT04394897).

The Effect of Intraoperative Body Temperature on Postoperative Nausea and Vomiting in Pediatric Patients.

PURPOSE: Pediatric patients are at greater risk for both perioperative hypothermia and postoperative nausea and vomiting (PONV). The primary aim of this study was to investigate whether there is a relationship between intraoperative body temperature and PONV in children undergoing anesthesia. The secondary aim was to investigate the relationship between PONV and intraoperative fentanyl use, age and duration of operation. DESIGN: A prospective cohort study METHODS: The study included 80 children who were undergoing lower abdominal surgery. Body temperature was monitored after routine preoperative preparation and standard induction. Analgesic and antiemetic requirements and the presence of nausea and vomiting were assessed postoperatively on the 30th minute and the 6th, 12th and 24th hour. FINDINGS: The children with or without PONV were compared. At the postoperative 6th hour, the incidence of nausea was statistically significant in the children with a mean body temperature below 36°C (P = 0.044; P < 0.05). The mean duration of the surgery was statistically significant longer in the children with PONV (P = 0.001; P = 0.004; P <0.05). Mean body temperature was not statistically significant when comparing children with and without vomiting(P > 0.05). CONCLUSION: While a body temperature below 36°C increases the incidence of postoperative nausea, it does not cause an increase in the incidence of vomiting. A long operation time in pediatric patients causes an increase in the incidence of PONV. Although not statistically significant, PONV is encountered more than twice as much in patients receiving intraoperative fentanyl administration.

Usefulness of oxidative stress marker evaluation at admission to the intensive care unit in patients with COVID-19.

OBJECTIVE: Two critical processes in the coronavirus disease 2019 (COVID-19) pandemic involve assessing patients' intensive care needs and predicting disease progression during patients' intensive care unit (ICU) stay. We aimed to evaluate oxidative stress marker status at ICU admission and ICU discharge status in patients with COVID-19. METHODS: We included patients in a tertiary referral center ICU during June-December 2020. Scores of Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and clinical severity, radiologic scores, and healthy discharge status were noted. We collected peripheral blood samples at ICU admission to evaluate total antioxidants, total oxidants, catalase, and myeloperoxidase levels. RESULTS: Thirty-one (24 male, 7 female) patients were included. At ICU admission, patients' mean APACHE II score at ICU admission was 17.61 ± 8.9; the mean SOFA score was 6.29 ± 3.16. There was no significant relationship between clinical severity and oxidative stress (OS) markers nor between radiological imaging and COVID-19 data classification and OS levels. Differences in OS levels between patients with healthy and exitus discharge status were not significant. CONCLUSIONS: We found no significant relationship between oxidative stress marker status in patients with COVID-19 at ICU admission and patients' ICU discharge status.

Comparison of LMA® Gastro™ airway and gastrolaryngeal tube in endoscopic retrograde cholangiopancreatography: a prospective randomized observational trial.

BACKGROUND: New generation airway devices with different designs have been developed as an alternative to endotracheal intubation in order to avoid adverse events associated with sedation in endoscopic procedures and to provide patent airway. We aimed to compare two supraglottic airway devices (SGADs), the LMA® Gastro™ airway and gastrolaryngeal tube (GLT), in terms of airway efficiency, performance during procedure and adverse events in endoscopic retrograde cholangiopancreatography (ERCP). METHODS: A hundred-three ERCP patients without high risk of aspiration were included. Patients were randomly allocated to the LMA Gastro and GLT groups. The primary study outcomes were the comparison of the two SGADs in terms of oropharyngeal leak pressure (OLP). Secondary study outcome was SGADs-related adverse events. RESULTS: Procedures were completed with SGADs in fifty patients in each group. The rate of successful insertion at first attempt was 72% in GLT and 96% in LMA Gastro (P=0.004). The mean OLP of LMA Gastro Group (31.8 cmH2O) was significantly higher than that of the GLT Group (26.5 cmH2O), (P=0.0001). However, endoscopists' satisfaction was higher in GLT (P=0.0001). Mucosal damage and sore throat were lower in LMA Gastro Group. CONCLUSIONS: LMA® Gastro™ had a higher OLP than GLT. However, GLT was better for endoscopist satisfaction, as it provides more satisfying maneuverability. As to secondary outcome advers events were lower in LMA® Gastro™. The lower complication rates associated with the device and providing a more patent airway also highlighted the apparent clinical efficacy of LMA® Gastro™ than GLT, in ERCP.

Determining host factors contributing to disease severity in a family cluster of 29 hospitalized SARS-CoV-2 patients: Could genetic factors be relevant in the clinical course of COVID-19?

In this study, we report a large family cluster consisting of 29 genetically related patients hospitalized with coronavirus disease-2019 (COVID-19). We sought to determine the clinical characteristics relevant to the clinical course of COVID-19 by comparing the family cluster to unrelated patients with SARS-CoV-2 infection so that the presence of potential determinants of disease severity, other than traditional risk factors previously reported, could be investigated. Twenty-nine patient files were investigated in group 1 and group 2 was created with 52 consecutive patients with COVID-19 having age and gender compatibility. The virus was detected for diagnosis. The clinical, laboratory and imaging features of all patients were retrospectively screened. Disease course was assessed using records regarding outcome from patient files retrospectively. Groups were compared with respect to baseline characteristics, disease severity on presentation, and disease course. There was no difference between the two groups in terms of comorbidity and smoking history. In terms of inhospital treatment, use differed not significantly between two groups. We found that all 29 patients in the group 1 had severe pneumonia, 18 patients had severe pneumonia. Hospitalization rates, length of hospital stay, and transferred to intensive care unit were found to be statistically significantly higher in the group 1. In the present study, COVID-19 cases in the large family cluster were shown to have more severe disease and worse clinical course compared with consecutive patients with COVID-19 presenting to the same time. We believe further studies into potential genetic mechanisms of host susceptibility to COVID-19 should include such family clusters.

Tocilizumab challenge: A series of cytokine storm therapy experiences in hospitalized COVID-19 pneumonia patients.

To recognize the period of exaggerated cytokine response in patients with coronavirus disease 2019 (COVID-19) pneumonia, and to describe the clinical outcomes of using tocilizumab as a treatment option. The data of 12 adult COVID-19 pneumonia patients who were followed in the inpatient clinics of Biruni University Medical Faculty Hospital (Istanbul, Turkey) were retrospectively analyzed. Diagnostic tests, laboratory examinations, clinical findings, and computed tomography of the thorax imaging results were evaluated. A dramatic laboratory and clinical improvement was observed in 83% (10 out of 12) of patients after tocilizumab. In 17% (2 out of 12) of our patients, short-term ventilator support was required in the intensive care unit. The longest hospital stay was 18 days. However, in the end, all of our patients were discharged home with good health. Although arterial oxygen saturations (87.58 ± 3.12%) dropped in room air in the pre-tocilizumab period, post-tocilizumab they normalized in all patients (94.42 ± 1%). None of them had fever after tocilizumab treatment and the levels of C-reactive protein (13.08 ± 12.89) were almost within normal limits. Eosinophil values were quite low at the time of diagnosis (10 ± 17.06), but increased significantly post-tocilizumab (155.33 ± 192.69). There is currently no proven treatment for COVID-19 induced by novel coronavirus SARS-CoV-2. Based on our experience with twelve adult COVID-19 pneumonia patients, we can say that tocilizumab, an IL-6 inhibitor, is more beneficial in preventing the damage caused by excessive cytokine response in the body if administered at the right time and provides clinical and radiological recovery.

The Effect of Sphenopalatine Ganglion Block on the Postoperative Pain in Patients Undergoing Septorhinoplasty.

OBJECTIVES: This study aimed to evaluate the effect of preoperative sphenopalatine ganglion block (SPBG) on the postoperative pain (POP) in patients undergoing septorhinoplasty (SRP). METHODS: A retrospective cohort study was performed. A total of 42 patients that had received septorhinoplasty included in the study. The patients that had received SPBG before the surgery included in the Block group (n:20) and the patients that had not received SPBG before the surgery included in the Control group (n:22). POP was questioned with a numeric rating scale (NRS) at the 30th minute (t1), 1st hour (t2), 4th hour (t3), 12th hour (t4), and 24th hour (t5) and noted. The intraoperative details and the dose of the postoperative rescue analgesics were also noted. RESULTS: The average dose of Paracetamol that was used in the postoperative first 24 hours was 500 mg in the Block group and 1363 mg in the Control group, and the difference was statistically significant (P = .001). The average dose of Tramadol was 0 mg in the Block group and 45 mg in the Control group, and the difference was statistically significant (P = .001). There was a statistically significant difference among the groups with respect to NRS in the first 24 hours postoperatively (P < .05). The number of the patients requiring rescue analgesics was lower in the Block group than the Control group. The difference was statistically significant at the t1, t2, and t5 time intervals (P > .05). CONCLUSIONS: Preoperative SPGB is an effective option to reduce POP and the need for rescue analgesics for patients undergoing SRP. CLINICAL TRIAL NUMBER: NCT04020393.

Evaluation of the attitudes of surgeons about regional anesthesia: a survey study.

BACKGROUND: The intraoperative attending anaesthesiologist ultimately makes decisions about the anaesthesiology technique to be performed, but the attitudes of surgeons and preferences of patients on this subject may affect their choice. In this questionnaire-based study, we aimed to evaluate the attitudes and behaviors of surgeons about the use of regional anaesthesia (RA) in surgical operations. METHODS: Surgeons from different surgical branches with residencies at 4 different hospitals were asked to complete questionnaires that included reasons for preferring (12 reasons) and not preferring (13 reasons) the use of RA techniques for surgeries, using a 5-point Likert scale. RESULTS: A total of 156 surgeons from 4 hospitals, out of 167 surgeons who were approached to participate in the study, completed the questionnaire. The most commonly observed reason for a preference towards regional anaesthesia among the surgeons was the risk of general anaesthesia for patients with an American Society of Anesthesiologists (ASA) risk class of III and above. The second most commonly observed reason was for protection from the complications of general anaesthesia, and the third most commonly observed reason was the lower risk of thromboembolisms with regional anaesthesia. The most commonly observed reasons for not choosing regional anaesthesia were found to be incompatibility of the patients and patients' fears of feeling pain during surgery. CONCLUSION: We conclude that programmes for informing surgeons and educating patients about the advantages of RA may increase the preference ratio among surgeons and decrease patients' refusals to choose this procedure.

The Impact of Sheath Size in Miniaturized Percutaneous Nephrolithotomy in Adult Patients; A Matched-pair Analysis.

PURPOSE: The miniaturized percutaneous nephrolithotomy (mPNL) can be performed by using a very wide range of different access sheaths (14-22 Fr).It has been well known that tract size is one of the main parameters affecting the complication rates in PNL. We aimed to compare 21 Fr with 16.5 Fr mPNL tract sizes in adult patients. MATERIAL AND METHODS: From May 2013 to April 2018, 604 patients with kidney stone underwent mPNL in our department. The study was designed as retrospective and match-pair analysis was the preferred method for the formation of groups.  The 21 Fr mPNL cases were matched with 16.5 Fr mPNL cases at a 1:1 ratio, according to the patients' age, gender, body mass index, American Society of Anesthesiologists (ASA) score, stone characteristics (stone size, opacity and localization) and hydronephrosis. Patients with solitary kidney, renal anomalies, musculoskeletal abnormalities, and pediatric patients (< 18 years old) were excluded from the study. Both groups (21 Fr and 16.5 Fr) were compared in terms of demographics, stone characteristics, operative data and post-operative outcomes. RESULTS: A total of 260 patients were included in the study (130; 21 Fr mPNL group and 130; 16.5 Fr mPNL group). The operation time was significantly shorter in 21 Fr group (21 Fr; 85.2±37.5, 16.5 Fr; 101.7±37.7 minutes, p: 0.001). Complete stone clearance rates were 76.9% and 62.3% in 21 Fr and 16.5 Fr mPNL, respectively (p: 0.01). There was no significant difference between the groups in terms of overall operative and post-operative complications. However, in subgroups analysis, post-operative fever was higher in 16,5 Fr mPNL (4 patients in 16.5 Fr, no patients in 21 Fr group, p: 0.044); steinstrasse, renal colic and post-operative JJ stent requirement rates were higher in 21 Fr mPNL procedure (p: 0.018, p: 0.031 and p: 0.046, respectively). The hospitalization time was significantly higher in 21 Fr (p: 0.01). CONCLUSIONS: Although 21 Fr mPNL procedure has advantages such as better success rates and shorter operation time, some post-operative complications (steinstrasse, renal colic, post-operative JJ stent requirement) are against of 21 Fr mPNL when compared with 16.5 Fr mPNL procedure. Further randomized prospective studies with larger patient volume are needed to confirm these results.

Analysis of Anesthesia Administration in the Endoscopy Unit in Terms of Patient Profile and Complications: Retrospective Study.

OBJECTIVE: This study aimed to analyze patients undergoing endoscopic interventions in terms of comorbid diseases, preoperative anesthesia management predictions, intraoperative-postoperative complications and requirements for intensive care. METHOD: Records of patients who underwent procedures under anesthesia in the endoscopy unit were retrospectively screened. The patients' preoperative anesthesia evaluation, intraoperative anesthesia, and postoperative recovery data and intensive care monitoring requirements were recorded. The data obtained were analyzed statistically. RESULTS: It was identified that the preoperative risk prediction of patients was statistically significant for intraoperative and postoperative monitoring. Comorbid disease and high age were determined to increase the requirements for intensive care after the procedure. Increased need for qualified admission was determined in patients with desaturation and hypotension. CONCLUSION: A prerequisite for reliable administration of anesthesia is having detailed information about the patient and being prepared for possible complications. When examined from this aspect, analysis of the patient profile undergoing procedures in the endoscopy unit is important. In our study, we revealed the presence of elderly patients and comorbid disease(s) in the patient group who underwent procedures in this unit. The need for detailed preliminary evaluation of the patients undergoing these types of procedure and requirements for intensive care after the procedure, if necessary, should definitely be considered.

Use of the gastro-laryngeal tube in endoscopic retrograde cholangiopancreatography cases under sedation/analgesia.

BACKGROUND/AIMS: In this study, we aimed to analyze the effects of Gastro-Laryngeal Tube (GLT) use on intraoperative and postoperative hemodynamic parameters, comfort of the procedure, and patients' satisfaction in endoscopic retrograde cholangiopancreatography (ERCP). MATERIALS AND METHODS: A total of 80 patients between the ages of 20 and 75 years who were scheduled for elective ERCP were enrolled. The patients were randomly assigned to two groups: groups N and G. Those in group N underwent the procedure with sedation without any airway instruments and those in group G underwent procedure after sedation and airway management with GLT. Intraoperative and postoperative vital signs as well as the satisfaction of the patients were recorded. RESULTS: The duration to esophageal visualization was found to be significantly higher in group N (16 s) than in group G (7 s) (p=0.001). The mean Visual Analogue Scale for Pain (VAS) was significantly higher in group G (1.85) than in group N (0.45) (p=0.016). Group G had higher endoscopist satisfaction scores than group N. The incidence of desaturation during ERCP was significantly higher in group N (60%) than in group G (0%) (p=0.000). CONCLUSION: In conclusion, ERCP should be performed under optimal conditions to avoid the occurrence of unwanted complications, such as aspiration-related disorders. Therefore, according to the structural properties of GLT, sedation anesthesia application with GLT in ERCP will be safer, more comfortable, and more effective.

Variables determining the development of colistin-associated renal impairment.

AIM: The aim of this study was to identify the predictors of acute renal injury associated with colistin treatment. METHODS: The patients who received treatment with colistin for more than 3 days were included in this retrospective cohort study. Acute renal injury was defined by the RIFLE (Risk Injury Failure Loss End stage renal disease) criteria. Patients whose serum creatinine levels increased at least 1.5-fold compared with baseline value were considered as cases with renal injury. The independent variables determining the development of acute renal injury were investigated by survival analysis. RESULTS: A total of 112 cases [67 (59.8 %) were male, median age 64 (range: 18-93) years] were included in the study. Acute renal injury occurred in 66 (58.9 %) patients. Renal injury developed in first 7 days of the colistin therapy in 52 (78.8 %) cases and at day 8-23 in 14 (21.2 %) cases. On the day with highest levels of creatinine, 25 (22.3 %), 17 (15.2 %), and 33 (29.5 %) cases were in 'Risk', 'Injury', and 'Failure' group, respectively, according to RIFLE criteria. We identified three independent risk factors predicting acute colistin-induced renal injury: advanced age, low serum albumin levels, and high serum total bilirubin levels [odds ratio (confidence interval) = 1.022 (1.006-1.037), 0.643 (0.415-0.994), and 1.129 (1.014-1.257), respectively]. CONCLUSIONS: The advanced age, low serum albumin levels, and high serum total bilirubin levels are independent risk factors for colistin-induced nephrotoxicity.

Opioid-free total intravenous anesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: a prospective, randomized, double-blinded study / Anestesia venosa total livre de opioides, com infusões de propofol, dexmedetomidina e lidocaína para colecistectomia laparoscópica: estudo prospectivo, randomizado e duplo-cego / Anestesia venosa total libre de opiáceos, con infusiones de propofol, dexmedetomidina y lidocaína para la colecistectomía laparoscópica: estudio prospectivo, aleatorizado y doble ciego

BACKGROUND AND OBJECTIVES: Intraoperative use of opioids may be associated with postoperative hyperalgesia and increased analgesic consumption. Side effects due to perioperative use of opioids, such as postoperative nausea and vomiting may delay discharge. We hypothesized that total intravenous anesthesia consisting of lidocaine and dexmedetomidine as an opioid substitute may be an alternative technique for laparoscopic cholecystectomy and would be associated with lower fentanyl requirements in the postoperative period and less incidence of postoperative nausea and vomiting. METHODS: 80 Anesthesiologists I-II adults were scheduled for elective laparoscopic cholecystectomy. Patients were randomly allocated into two groups to have either opioid-free anesthesia with dexmedetomidine, lidocaine, and propofol infusions (Group DL) or opioid-based anesthesia with remifentanil, and propofol infusions (Group RF). All patients received a standard multimodal analgesia regimen. A patient controlled analgesia device was set to deliver IV fentanyl for 6 h after surgery. The primary outcome variable was postoperative fentanyl consumption. RESULTS: Fentanyl consumption at postoperative 2nd hour was statistically significantly less in Group DL, compared with Group RF, which were 75 ± 59 µg and 120 ± 94 µg respectively, while it was comparable at postoperative 6th hour. During anesthesia, there were more hypotensive events in Group RF, while there were more hypertensive events in Group DL, which were both statistically significant. Despite higher recovery times, Group DL had significantly lower pain scores, rescue analgesic and ondansetron need. CONCLUSION: Opioid-free anesthesia with dexmedetomidine, lidocaine and propofol infusions may be an alternative technique for laparoscopic cholecystectomy especially in patients with high risk for postoperative nausea and vomiting. .

JUSTIFICATIVA E OBJETIVOS: O uso de opioides no período intraoperatório pode estar associado à hiperalgesia e ao aumento do consumo de analgésicos no período pós-operatório. Efeitos colaterais como náusea e vômito no período pós-operatório, por causa do uso perioperatório de opioides, podem prolongar a alta. Nossa hipótese foi que a anestesia venosa total com o uso de lidocaína e dexmedetomidina em substituição a opioides pode ser uma técnica opcional para a colecistectomia laparoscópica e estaria associada a uma menor solicitação de fentanil e incidência de náusea e vômito no período pós-operatório. MÉTODOS: Foram programados para colecistectomia laparoscópica eletiva 80 pacientes adultos, estado físico ASA I-II. Os pacientes foram randomicamente alocados em dois grupos para receber anestesia livre de opioides com infusões intravenosas (IV) de dexmedetomidina, lidocaína e propofol (Grupo DL) ou anestesia baseada em opioides com infusões de remifentanil e propofol (Grupo RF). Todos os pacientes receberam um regime padrão de analgesia multimodal. Um dispositivo de analgesia controlada pelo paciente foi ajustado para liberar fentanil IV por seis horas após a cirurgia. O desfecho primário foi o consumo de fentanil no pós-operatório. RESULTADOS: O consumo de fentanil na segunda hora de pós-operatório foi significativamente menor no grupo DL do que no Grupo RF, 75 ± 59 µg e 120 ± 94 µg, respectivamente, mas foi comparável na sexta hora de pós-operatório. Durante a anestesia, houve mais eventos hipotensivos no Grupo RF e mais eventos hipertensivos no grupo DL, ambos estatisticamente significativos. Apesar de apresentar um tempo de recuperação mais prolongado, o Grupo DL apresentou escores de dor e consumo de analgésicos de resgate e de ondansetrona significativamente mais baixos. CONCLUSÃO: A anestesia livre de opioides com infusões de dexmedetomidina, lidocaína e propofol pode ser uma técnica opcional para a colecistectomia laparoscópica, ...

JUSTIFICACIÓN Y OBJETIVOS: El uso de opiáceos en el período intraoperatorio puede estar asociado con la hiperalgesia y con el aumento del consumo de analgésicos en el período postoperatorio. Los efectos colaterales como náuseas y vómito en el período postoperatorio, debido al uso perioperatorio de opiáceos, pueden retrasar el alta. Nuestra hipótesis fue que la anestesia venosa total con el uso de lidocaína y dexmedetomidina como reemplazo de los opiáceos puede ser una técnica alternativa para la colecistectomía laparoscópica y estaría asociada con un requerimiento menor de fentanilo y con una menor incidencia de náuseas y vómito en el período postoperatorio. MÉTODOS: Ochenta pacientes adultos, estado físico ASA I-II, fueron programados para colecistectomía laparoscópica electiva. Los pacientes fueron divididos aleatoriamente en 2 grupos para recibir anestesia libre de opiáceos con infusiones de dexmedetomidina, lidocaína y propofol (grupo DL), o anestesia basada en opiáceos con infusiones de remifentanilo y propofol (grupo RF). Todos los pacientes recibieron un régimen estándar de analgesia multimodal. Un dispositivo de analgesia controlada por el paciente fue ajustado para liberar el fentanilo intravenoso durante 6 h después de la cirugía. El resultado primario fue el consumo de fentanilo en el postoperatorio. RESULTADOS: El consumo de fentanilo en la segunda hora del postoperatorio fue significativamente menor en el grupo DL que en el grupo RF, 75 ± 59 µg y 120 ± 94 µg, respectivamente, pero se pudo comparar en la sexta hora del postoperatorio. Durante la anestesia hubo más eventos hipotensivos en el grupo RF y más eventos hipertensivos en el grupo DL, ambos estadísticamente significativos. A pesar de presentar un tiempo de recuperación más prolongado, el grupo DL tuvo puntuaciones de dolor y consumo de analgésicos de rescate y de ondansetrón significativamente más bajos. CONCLUSIÓN: La anestesia libre de opiáceos con infusiones de ...

[Opioid-free total intravenous anesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: a prospective, randomized, double-blinded study]. / Anestesia venosa total livre de opioides, com infusões de propofol, dexmedetomidina e lidocaína para colecistectomia laparoscópica: estudo prospectivo, randomizado e duplo-cego.

BACKGROUND AND OBJECTIVES: Intraoperative use of opioids may be associated with postoperative hyperalgesia and increased analgesic consumption. Side effects due to perioperative use of opioids, such as postoperative nausea and vomiting may delay discharge. We hypothesized that total intravenous anesthesia consisting of lidocaine and dexmedetomidine as an opioid substitute may be an alternative technique for laparoscopic cholecystectomy and would be associated with lower fentanyl requirements in the postoperative period and less incidence of postoperative nausea and vomiting. METHODS: 80 Anesthesiologists I-II adults were scheduled for elective laparoscopic cholecystectomy. Patients were randomly allocated into two groups to have either opioid-free anesthesia with dexmedetomidine, lidocaine, and propofol infusions (Group DL) or opioid-based anesthesia with remifentanil, and propofol infusions (Group RF). All patients received a standard multimodal analgesia regimen. A patient controlled analgesia device was set to deliver IV fentanyl for 6h after surgery. The primary outcome variable was postoperative fentanyl consumption. RESULTS: Fentanyl consumption at postoperative 2nd hour was statistically significantly less in Group DL, compared with Group RF, which were 75±59µg and 120±94µg respectively, while it was comparable at postoperative 6th hour. During anesthesia, there were more hypotensive events in Group RF, while there were more hypertensive events in Group DL, which were both statistically significant. Despite higher recovery times, Group DL had significantly lower pain scores, rescue analgesic and ondansetron need. CONCLUSION: Opioid-free anesthesia with dexmedetomidine, lidocaine and propofol infusions may be an alternative technique for laparoscopic cholecystectomy especially in patients with high risk for postoperative nausea and vomiting.

Opioid-free total intravenous anesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: a prospective, randomized, double-blinded study.

BACKGROUND AND OBJECTIVES: Intraoperative use of opioids may be associated with postoperative hyperalgesia and increased analgesic consumption. Side effects due to perioperative use of opioids, such as postoperative nausea and vomiting may delay discharge. We hypothesized that total intravenous anesthesia consisting of lidocaine and dexmedetomidine as an opioid substitute may be an alternative technique for laparoscopic cholecystectomy and would be associated with lower fentanyl requirements in the postoperative period and less incidence of postoperative nausea and vomiting. METHODS: 80 Anesthesiologists I-II adults were scheduled for elective laparoscopic cholecystectomy. Patients were randomly allocated into two groups to have either opioid-free anesthesia with dexmedetomidine, lidocaine, and propofol infusions (Group DL) or opioid-based anesthesia with remifentanil, and propofol infusions (Group RF). All patients received a standard multimodal analgesia regimen. A patient controlled analgesia device was set to deliver IV fentanyl for 6h after surgery. The primary outcome variable was postoperative fentanyl consumption. RESULTS: Fentanyl consumption at postoperative 2nd hour was statistically significantly less in Group DL, compared with Group RF, which were 75 ± 59 µg and 120 ± 94 µg respectively, while it was comparable at postoperative 6th hour. During anesthesia, there were more hypotensive events in Group RF, while there were more hypertensive events in Group DL, which were both statistically significant. Despite higher recovery times, Group DL had significantly lower pain scores, rescue analgesic and ondansetron need. CONCLUSION: Opioid-free anesthesia with dexmedetomidine, lidocaine and propofol infusions may be an alternative technique for laparoscopic cholecystectomy especially in patients with high risk for postoperative nausea and vomiting.