RESUMO
The purpose of this article review is to investigate whether or not nerve blocks are beneficial in minimizing the amount of postoperative anesthetic and analgesic medication required, hence improving patient outcomes and reducing healthcare costs. This review investigates several different kinds of nerve blocks, their administration techniques, and the anatomical and physiological aspects that influence nerve block effectiveness. It analyzes the impact of nerve blocks on opioid use, postoperative pain scores, and the incidence of opioid-related adverse effects by compiling the findings of numerous large-scale, randomized, controlled trials. Infection, hematoma, nerve injury, and systemic toxicity are some potential complications of nerve blocks discussed in the article. It concludes with recommendations for optimizing nerve block techniques in clinical practice and identifies areas that require further research, such as the development of new anesthetics and the identification of patient subgroups that would benefit the most from nerve blocks. In addition, it provides recommendations for optimizing nerve block techniques in clinical practice.
RESUMO
The purpose of this study was to investigate the general anesthetic requirements in patients with continuous endotracheal-laryngopharynx topical anesthesia using medicine injecting endotracheal tube during surgery. A total of 78 patients with American Society of Anesthesiologists (ASA) physical status I-II were randomly divided into test group and control group. After anesthesia, patients were injected by 1.5 mL of 1% Tetracaine for topical anesthesia, and later injected similarly at hourly intervals during surgery while patients in control group were non-injected. There was no statistical significance in values of SBP, DBP, MAP, HR and plasma concentrations of E, NE and Cor at same time point between the two groups during operation (P>0.05). There was no statistical significance in value of BIS at T0-T5 between the two groups (P>0.05). However, value of BIS at T6 in test group was significantly higher than that in control group (69.7±2.1 vs. 58.6±2.3, P<0.01). Doses of sevoflurane, propofol sufentanil and cisatracurium used up in test group decreased by 12.3% (P<0.01); 12.7% (P<0.01); 14.5% (P<0.01) and 4.9% (P>0.05) than those in control group, respectively. Continuous endotracheal-laryngopharynx topical anesthesia using 1% Tetracaine via medicine-injecting endotracheal tube can significantly decrease general anesthetic requirements of surgery.
RESUMO
Background Transsphenoidal resection of pituitary tumors is the neurosurgical procedure of choice to excise most of the tumors of the sellar/suprasellar region. The main goals of anesthesia are maintenance of hemodynamic stability, provision of conditions that facilitate good surgical exposure, and a prompt and smooth emergence to allow neurological and visual assessment. Dexmedetomidine (Dex), a selective α-2 agonist, is known to maintain cardiovascular stability and anxiolysis and provide pain relief. Therefore, we hypothesized that intraoperative Dex will attenuate hemodynamic response to nasal speculum (NS) insertion, decrease analgesic requirement, and hasten postoperative recovery. Materials and Methods This prospective, randomized, double-blind, placebo-controlled study was conducted in 60 adult patients of either sex, American Society of Anesthesiologists status I or II undergoing elective pituitary surgery for excision of pituitary adenoma. Randomization was done into two groups; Group D ( n = 30) received Dex bolus 1 µg/kg over 10 minutes, followed by 0.5 µg/kg/h, and group control Group C ( n = 30) received normal saline (0.9%) in a similar manner. A standard anesthesia technique comprising fentanyl, propofol, rocuronium, sevoflurane, nitrous oxide, and oxygen was used. Intraoperative monitoring was uniform and standardized in all the patients; cardiovascular perturbations, if any, were noted and managed appropriately. After completion of surgery, tracheal extubation was performed, and emergence time, extubation time, modified Aldrete score, sedation, pain, time for first analgesic, nausea, vomiting, and shivering were recorded. Results In both the groups, an increase in heart rate and blood pressure occurred at the time of laryngoscopy and intubation, NS insertion, and extubation, but it was more in Group C ( p < 0.05). In Group D, intraoperative requirement of analgesic, neuromuscular relaxant, and inhalational anesthetic was lesser compared with Group C. Emergence time as well as visual analog scale at emergence was less in Group D. Conclusions Intraoperative Dex infusion is a reasonable choice in patients undergoing transsphenoidal pituitary surgery.