The effects of 5-degree, 10-degree and 20-degree reverse Trendelenburg positions on intraoperative bleeding and postoperative Edemea and ecchymosis around the eye in open rhinoplasty.

PURPOSE: In this study, we investigated the effect of reverse Trendelenburg position (RTP), with five, ten, and twenty degrees, on intraoperative bleeding and postoperative edema and ecchymosis around the eye in open rhinoplasty operations. MATERIALS AND METHODS: Ninety patients undergoing open rhinoplasty were divided into three groups, 5° angle RTP (Group 5; n = 30), 10° angle RTP (Group 10; n = 30), and 20° angle RTP (Group 20; n = 30). After 3 min of preoxygenation, anesthesia was induced with 3 mg.kg-1 propofol, 1 µg.kg-1 fentanyl, and 0.6 mg/kg rocuronium for muscle relaxation. Maintenance of anesthesia was provided with a minimum alveolar concentration of 1-1.5 with sevoflurane, 1:1 O2/N2O. Hemodynamic variables, intraoperational bleeding, postoperative 1st, 3rd and 7th days ecchymosis and edema around the eyes of the patients were compared between the groups. RESULTS: Edema changes on postoperative 1st, 3rd and 7th days and ecchymosis changes around the eyes on postoperative 1st and 3rd days in Group 20 were found significantly lower than Group 5 (p < 0.017). Besides, the change of ecchymosis on the postoperative 1st day was found significantly lower in Group 20 compared to Group 10 (p < 0.017). The amount of intraoperative bleeding and surgical field evaluation score were found to be significantly lower in Group 10 and Group 20 compared to Group 5 (p < 0.017). CONCLUSION: We concluded that in open rhinoplasty surgeries, 20° degree RTP reduces intraoperative blood loss and provides a more bloodless surgical field, as well as reducing edema and ecchymoses around the eyes in the postoperative period.

Comparison of different end-tidal carbon dioxide levels in preventing postoperative nausea and vomiting in gynaecological patients undergoing laparoscopic surgery.

The aim of this study was to compare different end-tidal carbon dioxide (EtCO2) levels to prevent postoperative nausea and vomiting (PONV) caused by increased intracranial pressure due to pneumoperitoneum and Trendelenburg position in gynaecological laparoscopic surgery. A total of 60 female patients aged 25-50 years who would undergo laparoscopic gynaecological surgery under general anaesthesia were randomised into two groups: group A (EtCO2: 26 - 35 mmHg, n = 30) and group B (EtCO2: 36 - 45 mmHg, n = 30). In both groups, ONSD and EtCO2 of the patients were measured at baseline after anaesthesia induction (Tb), at 5 min after pneumoperitoneum (TPP5), and at 10 min intervals after Trendelenburg position (TPP10, TPP20, TPP30). At 5 (TD5) and 10 min (TD10) after deflation, ONSD measurements were repeated. The incidence and severity of PONV of the patients, and antiemetic drugs used in both groups were assessed in the postoperative period. In the intraoperative follow-up periods, TPP5 and subsequent EtCO2 values, as well as TPP10 and subsequent ONSD values, were significantly higher in group B and the incidence of nausea, the PONV scores and the incidence of rescue antiemetic use significantly lower in group A than in group B (p<.001 for all). This result indicates that low EtCO2 levels have beneficial effects on ICP and PONV in laparoscopic gynaecological operations.Impact statementWhat is already known on this subject? Laparoscopic gynaecologic surgery has been a more preferred technique. The incidence of postoperative nausea and vomiting (PONV) after laparoscopic gynaecologic surgery is remarkably high. In the prevention of PONV after gynaecologic laparoscopic surgery, single and multiple drug therapies and methods have been used.What the results of this study add? Postoperative nausea and vomiting caused by intracranial pressure (ICP) increase due to carbon dioxide pneumoperitoneum and Trendelenburg position in gynaecologic laparoscopic surgeries were decreased in the early postoperative period by low end-tidal carbon dioxide levels in the intraoperative period. It was shown that low end-tidal carbon dioxide levels have beneficial effects on ICP and PONV in laparoscopic gynaecologic operations.What the implications are of these findings for clinical practice and/or further research? This result indicates that low end-tidal carbon dioxide levels have beneficial effects on ICP and PONV in laparoscopic gynaecologic operations.

Evaluation of the perioperative effects of dexmedetomidine on tympanoplasty operations.

PURPOSE: This randomized double-blind study aimed to evaluate the effects of dexmedetomidine on hemodynamic parameters and the quality of surgery and recovery criteria in tympanoplasty operations. MATERIALS AND METHODS: A total of 75 patients 18-55 years undergoing tympanoplasty, who were graded as American Society of Anesthesiologists physical status I-II, were randomly divided into three groups. Group 1 included patients receiving remifentanil alone, Group 2 included patients receiving dexmedetomidine + remifentanil and Group 3 included patients receiving dexmedetomidine + ½ remifentanil. Anesthesia was induced with propofol and cisatracurium. For maintenance of anesthesia, a mixture of 2-2.5% sevoflurane, 40-60% oxygen/air was used. The groups were compared in terms of hemodynamic parameters, surgical area, recovery criteria, modified Aldrete, pain scores, additional analgesic requirements and adverse effects. RESULTS: Mean arterial pressure and heart rate values of Group 1 were higher at the time of intubation, incision, spontaneous breathing and extubation compared to Group 2 and Group 3. Surgical field satisfaction was higher in Group 2 and Group 3 than Group 1. Spontaneous breathing, eye opening and verbal cooperation times were shorter in Group 3 compared to Group 2. Eye opening and verbal cooperation times were longer in Group 2 compared to Group 1. The 30-minute modified Aldrete scores was higher in Group 3 compared to Group 1. There was no difference between the groups in terms of postoperative pain and adverse effects. CONCLUSION: The use of dexmedetomidine during tympanoplasty operations may provide better hemodynamic control and surgical view, may provide faster recovery and may reduce remifentanil consumption.

Effects of perioperative magnesium sulfate with controlled hypotension on intraoperative bleeding and postoperative ecchymosis and edema in open rhinoplasty.

PURPOSE: This randomized, double-blind study was planned to evaluate the effect of perioperative magnesium sulfate with controlled hypotension on intraoperative bleeding, postoperative ecchymosis and edema, and side-effects. MATERIALS AND METHOD: Forty-nine patients undergoing open rhinoplasty were divided into two groups - magnesium sulfate and control. The magnesium sulfate group received 30-50 mg·kg-1 intravenously as a bolus before induction of anesthesia, followed by 10-20 mg·kg-1 h-1 by continuous intravenous infusion during surgery. Anesthesia was induced with propofol 3 mg·kg-1, fentanyl 15 µg·kg-1 and cisatracurium 0.6 mg·kg-1. Mean arterial pressure was maintained at 50 to 60 mmHg under controlled hypotensive anesthesia with magnesium sulfate titration. Hemodynamic variables, operational bleeding, early postoperative side-effects and postoperative first-, third- and seventh-day ecchymosis and edema were compared between the groups. Ecchymosis and edema were evaluated using a graded scale from 0 to 4. RESULTS: In the magnesium sulfate group, mean arterial pressure decreased during most of the perioperative period. Intraoperative bleeding also decreased. A distinct reduction in ecchymosis and edema was observed in both the upper and lower eyelids on the first, third and seventh days. Patients in the magnesium sulfate group also had a more peaceful postoperative course with less postoperative nausea vomiting, and shivering. CONCLUSION: Magnesium sulfate with controlled hypotension can lower ecchymosis and edema of the upper and lower eyelids in rhinoplasty surgery by reducing bleeding.

Does Tourniquet Time or Pressure Contribute to Intracranial Pressure Increase following Tourniquet Application?

OBJECTIVE: The aim of this study was to determine whether an early increase in intracranial pressure (ICP) following the deflation of a tourniquet is related to the tourniquet time (TT) or tourniquet pressure (TP) and to identify a safe cut-off value for TT or TP. MATERIALS AND METHODS: Patients who underwent elective orthopedic lower-extremity surgery under general anesthesia were randomized into 2 groups: group A (inflation with a pneumatic TP of systolic blood pressure + 100 mm Hg; n = 30) and group B (inflation using the arterial occlusion pressure formula; n = 30). The initial and maximum TPs, TT, and sonographic measurements of optic-nerve sheath diameter (ONSD) and end-tidal CO2 values were taken at specific time points (15 min before the induction of anesthesia, just before, and 5, 10, and 15 min after the tourniquet was deflated). RESULTS: The initial and maximum TPs were found to be significantly higher in group A than in group B. At 5 min after the tourniquet deflation, there was a significant positive correlation between TT and ONSD (r = 0.57, p = 0.0001). When ONSD ≥5 mm was taken as a standard criterion, the safe cut-off value for the optimal TT was found to be < 67.5 min (sensitivity 87% and specificity 59.5%). CONCLUSION: The ICP increase in the early period after tourniquet deflation was well correlated with TT but not with TP. TT of ≥67.5 min was found to be the cut-off value and is considered the starting point of the increase in ICP after tourniquet deflation.

Effects of tourniquet usage in lower extremity surgery on optic nerve sheath diameter

Background/aim: The aim of this study was to evaluate changes in intracranial pressure following tourniquet deflation using noninvasive ultrasonographic optic nerve sheath diameter (ONSD) measurements. Materials and methods: Our study included 59 adult patients between the ages of 18 and 65 years from the American Society of Anesthesiologists (ASA) I/II risk groups who were scheduled to undergo elective orthopedic surgery of the lower extremities using a tourniquet under general anesthesia. ONSD and end-tidal CO2 (ETCO2) were measured 5 times: 15 min prior to the anesthesia induction; just prior to the deflation of the tourniquet; and at 5, 10, and 15 min after the deflation. Additionally, age, sex, weight, height, ASA score, and duration of operation and tourniquet usage were recorded. Results: The ONSD value measured 5 min after the deflation was significantly higher than all of the remaining measurements. There was a significant correlation between the ONSD and ETCO2 measurements at 5 and 10 min after deflation (r = 0.61, 95% CI 0.42-0.75, P < 0.0001 and r = 0.30, 95% CI 0.04-0.51, P < 0.05, respectively). Conclusion: The ultrasonographic ONSD measurements, which were obtained using a simple and noninvasive approach, increased significantly following tourniquet deflation, and this increase was correlated with an increase in ETCO2.

Relation between neutrophil-to-lymphocyte ratio with epidural analgesia timing and thoracotomy pain.

OBJECTIVE: This study investigated the relationship of the pre-operative neutrophil/lymphocyte ratio (NLR) to the timing of epidural analgesia administration and post-operative acute and chronic pain in thoracotomy. MATERIALS AND METHODS: The study was conducted on 60 patients, with NLR ≥ 2 (Group A) and NLR < 2 (Group B). Each group was divided into subgroups pre-emptive analgesia (Group P) and control group (Group C). Epidural analgesic solution was administered as a bolus before the surgical incision in Group P and at the end of the operation in Group C. NRS was questioned postoperatively at the 2nd, 4th, 8th, 12th, 24th h, 1st, and 3rd months and also additional analgesic needs were recorded. RESULTS: In Group A, the pain scores of the patients who received pre-emptive epidural analgesia were lower at the post-operative 2nd, 4th, and 8th h and analgesic consumption was less in the post-operative first 24 h. CONCLUSION: It was observed that pre-emptive epidural analgesia reduced pain levels and additional analgesic consumption in the acute post-operative period in patients with pre-operative NLR ≥ 2.

OBJETIVO: Este estudio investigó la relación de la relación neutrófilos/linfocitos (NLR) preoperatoria con el momento de la administración de la analgesia epidural y el dolor agudo y crónico posoperatorio en la toracotomía. MATERIALES Y MÉTODOS: El estudio se realizó en 60 pacientes, como NLR ≥ 2 (Grupo A) y NLR < 2 (Grupo B). Cada grupo se dividió en subgrupos de analgesia preventiva (Grupo P) y grupo control (Grupo C). La solución analgésica epidural se administró en bolo antes de la incisión quirúrgica en el Grupo P y al final de la operación en el Grupo C. La NRS se cuestionó posoperatoriamente a las 2, 4, 8, 12, 24 horas, 1 y 3 meses también adicionales Se registraron las necesidades analgésicas. RESULTADOS: En el Grupo A, los puntajes de dolor de los pacientes que recibieron analgesia epidural preventiva fueron menores a las 2, 4 y 8 horas postoperatorias y el consumo de analgésicos fue menor en las primeras 24 horas postoperatorias. CONCLUSIÓN: Se observó que la analgesia epidural preventiva redujo los niveles de dolor y el consumo adicional de analgésicos en el postoperatorio agudo en pacientes con NLR preoperatorio ≥ 2.

The effect of pre-operative sleep quality on post-operative pain and emergence agitation: prospective and cohort study.

OBJECTIVE: Our study aimed to investigate the effect of pre-operative sleep quality on post-operative pain and emergence agitation. MATERIALS AND METHODS: Our study was performed 80 patients with American Society of Anesthesiologists I-II and 18-65 years of age. The patients were divided into poor (Group A, n = 40) and good sleep quality (Group B, n = 40). All patients were operated on under standard general anesthesia. The emergence agitation and pain status of all groups were evaluated in the recovery room and post-operative period. RESULTS: There was no significant difference between the groups regarding demographic data. Post-operative numeric rating scale scores and analgesic consumption were significantly higher in Group A than in Group B (p < 0.05). There was no significant difference between the groups regarding post-operative emergence agitation and extubation quality (p > 0.05). CONCLUSION: In our study, poor pre-operative sleep quality increases post-operative pain and analgesic consumption; however, emergence agitation is not associated with sleep quality in the pre-operative period.

OBJETIVO: Nuestro estudio tuvo como objetivo investigar el efecto de la calidad del sueño preoperatorio sobre el dolor posoperatorio y la agitación de emergencia. MATERIALES Y MÉTODOS: Nuestro estudio se realizó en 80 pacientes con ASA I-II y de 18 a 65 años de edad. Los pacientes se dividieron en mala (grupo A, n = 40) y buena calidad del sueño (grupo B, n = 40). Todos los pacientes fueron operados bajo anestesia general estándar. La agitación de emergencia y el estado del dolor de todos los grupos se evaluaron en la sala de recuperación y en el período postoperatorio. RESULTADOS: No hubo diferencia significativa entre los grupos con respecto a los datos demográficos. Las puntuaciones NRS postoperatorias y el consumo de analgésicos fueron significativamente más altos en el Grupo A que en el Grupo B (p < 0.05). No hubo diferencia significativa entre los grupos con respecto a la agitación de emergencia postoperatoria y la calidad de la extubación (p > 0.05). CONCLUSIÓN: En nuestro estudio, la mala calidad del sueño preoperatorio aumenta el dolor posoperatorio y el consumo de analgésicos; sin embargo, la agitación de emergencia no se asocia con la calidad del sueño en el período preoperatorio.

The effect of the endotracheal tube cuff shape on post-operative sore throat in surgeries longer than 120 min in supine position.

BACKGROUND: This study aimed at comparing the effects of cylindrical- and conical-cuff endotracheal tubes (ETTs) inflated with saline on cuff pressures, post-operative sore throat, and post-operative analgesic consumption in surgeries taking longer than 120 min. OBJECTIVE: This study aimed at comparing the effects of cylindrical- and conical-cuff endotracheal tubes (ETTs) inflated with saline on cuff pressures, post-operative sore throat, and post-operative analgesic consumption in surgeries taking longer than 120 min. METHODS: The study was performed on a total of 100 patients, aged 18-65 years, in the ASA I-III risk group, with cylindrical cuff (Group C, n = 50) and conical cuff (Group T, n = 50) ETT patients. Cuff pressure values of all patients were recorded. RESULTS: The cuff pressure values at all measurement times and maximum cuff pressure value were significantly lower in Group T than in Group C (p < 0.05). In the post-operative 24-h period, sore throat and total analgesic consumption were significantly lower in Group T than in Group C (p < 0.05). CONCLUSION: conical cuff ETTs prevent the increase in intraoperative cuff pressures, reduce the incidence of post-operative sore throat, and accordingly reduce post-operative analgesic consumption compared to cylindrical cuff ETTs.

ANTECEDENTES: El objetivo de este estudio fue comparar los efectos de los tubos endotraqueales (ETT) de manguito cilíndrico y cónico inflados con solución salina sobre las presiones del manguito, el dolor de garganta postoperatorio y el consumo de analgésicos postoperatorios en cirugías de más de 120 min de duración. OBJETIVO: Comparar los efectos de los tubos endotraqueales de manguito cilíndrico y cónico inflados con solución salina sobre las presiones del manguito, el dolor de garganta posoperatorio y el consumo de analgésicos posoperatorios en cirugías de más de 120 minutos de duración. MÉTODO: El estudio se realizó en 100 pacientes con edades entre 18 y 65 años, con riesgo ASA I-III, con tubo endotraqueal de manguito cilíndrico (grupo C, n = 50) o manguito cónico (grupo T, n = 50). RESULTADOS: Los valores de presión del manguito en todos los tiempos de medición y el valor máximo de presión del manguito fueron significativamente más bajos en el grupo T que en el grupo C (p < 0.05). En el período de 24 horas del posoperatorio, el dolor de garganta y el consumo total de analgésicos fueron significativamente menores en el grupo T que en el grupo C (p < 0.05). CONCLUSIONES: Los tubos endotraqueales de manguito cónico previenen el aumento de las presiones intraoperatorias del manguito, reducen la incidencia de dolor de garganta posoperatorio y, en consecuencia, disminuyen el consumo de analgésicos posoperatorios en comparación con los de manguito cilíndrico.

The effect of different anesthesia techniques on cerebral oxygenation in thoracic surgery.

OBJECTIVE: One-lung ventilation may cause negative changes in the oxygenation of cerebral tissue which results in post-operative cognitive dysfunction. We compared the potential effects of total intravenous anesthesia and inhalation general anesthesia techniques on cerebral tissue oxygenation. MATERIALS AND METHODS: In this prospective double-blind trial, patients whose standard anesthesia induction was done were randomly divided into two groups as group total intravenous anesthesia using propofol (Group T, n = 30) and group inhalation general anesthesia using sevoflurane (Group I, n = 30) based on anesthesia maintenance. The intraoperative cerebral oxygen saturation and pre-post-operative mini-mental status test scores of the patients were monitored and recorded. RESULTS: Baseline characteristics were similar between the two groups. The decrease of cerebral oxygen saturation more than 20% in total intravenous anesthesia group was significantly higher than inhalation group (p < 0.05). In both groups, the mini-mental status test values at the post-operative 3rd h were significantly lower than the pre-operative and post-operative 24th h values (p < 0.05). CONCLUSIONS: Inhalation general anesthesia provided better cerebral tissue oxygenation in thoracic surgery with one-lung ventilation compared to total intravenous anesthesia. However, there was no significant correlation between the presence of desaturation and post-operative cognitive dysfunction.

OBJETIVO: La ventilación unipulmonar puede provocar cambios negativos en la oxigenación del tejido cerebral que se traduce en una disfunción cognitiva postoperatoria. Comparamos los efectos potenciales de la anestesia total intravenosa y las técnicas de anestesia general por inhalación en relación con la oxigenación del tejido cerebral. MATERIAL Y MÉTODOS: En este ensayo prospectivo doble ciego, los pacientes en los que se realizó una inducción estándar de anestesia se dividieron aleatoriamente en dos grupos: grupo de anestesia intravenosa total con propofol (Grupo T, n = 30) y grupo de anestesia general por inhalación con sevoflurano (Grupo I, n = 30) basados en el mantenimiento de la anestesia. Se controlaron y registraron la saturación de oxígeno cerebral intraoperatoria y las valoraciones de la miniprueba de estado mental preoperatoria de los pacientes. RESULTADOS: Las características de base fueron similares entre los dos grupos. La disminución de la saturación de oxígeno cerebral de más del 20% en el grupo de anestesia intravenosa total fue significativamente mayor que en el grupo de inhalación (p < 0.05). En ambos grupos, los valores de la mini prueba del estado mental al cabo de la 3a. hora del período posoperatorio fueron significativamente más bajos que los valores preoperatorios y posoperatorios registrados al cabo de 24 horas (p < 0.05). CONCLUSIONES: La anestesia general por inhalación facilitó una mejor oxigenación del tejido cerebral en la cirugía torácica con ventilación unipulmonar en comparación con la anestesia intravenosa total. Sin embargo, no hubo una correlación significativa entre la presencia de desaturación y la disfunción cognitiva posoperatoria.

The clinical use of ultra - Wide field imaging and intravenous fluorescein angiography in infants with retinopathy of prematurity.

PURPOSE: To investigate the potential benefits and practicality of ultra - wide field (UWF) imaging and intravenous UWF fluorescein angiography (IV UWF - FA) in infants with retinopathy of prematurity (ROP) using an Optos® California device. METHODS: This retrospective study involved 46 infants with a history of ROP who underwent UWF imaging with or without IV UWF - FA. ROP characteristics were identified using UWF color imaging. Retinal vascular findings following treatment were also assessed at IV UWF - FA analysis. All imaging sessions were performed under topical anesthesia without sedation. Main outcomes were the appearance of ROP at UWF color imaging and IV UWF-FA analysis, including status of ROP, neovascularizations, presence of plus disease, retinal vascular details, and resolution after treatment. RESULTS: Seven (three girls) of the 46 infants (22 girls) underwent IV UWF-FA. Twelve IV UWF-FA sessions were performed in total. The oldest infant during IV UWF-FA analysis was at 55 postmenstrual weeks. Clinical characteristics of disease were easily identified at UWF color imaging. IV UWF-FA images also clearly revealed non-perfused retinal areas, fluorescein leakage, macular edema, retinal vascular abnormalities, and the status of the peripheral vascular termini. Complications of IV UWF-FA occurred in one infant in the form of patchy yellow skin discoloration around the injection site which completely disappeared on the first day following the procedure. CONCLUSIONS: Providing a high resolution panoramic view of the retina in a single image capture with no need for contact with the cornea appear to represent potential advantages of UWF imaging in infants with ROP. IV UWF-FA also seems to be a safe procedure which can be performed under topical anesthesia and that shows detailed retinal vascular alterations in patients with ROP.

Sedoanalgesia modality during laser photocoagulation for retinopathy of prematurity: Intraoperative complications and early postoperative follow-up.

BACKGROUND: Laser photocoagulation (LPC) is a surgical procedure used in the treatment of premature retinopathy that may cause retinal detachment and blindness if not diagnosed and treated early. The anesthesia method used in LPC varies from sedoanalgesia to general anesthesia and airway management varies from spontaneous ventilation to endotracheal intubation. In this study, we aimed to evaluate the effectiveness of sedoanalgesia applications and this anesthesia procedure concerning intraoperative and postoperative complications by avoiding intubation and mechanical ventilation in premature infants with a fragile population. METHODS: This retrospective study included 89 patients who underwent laser photocoagulation under anesthesia for premature retinopathy. Patients' demographic characteristics, preoperative risk factors, anesthesia technique, especially airway management, changes in ventilation status during surgery, intraoperative complications, postoperative complications, and intensive care follow-up, were recorded and analyzed statistically. RESULTS: Two of the 89 patients who underwent laser photocoagulation were excluded from this study because they were followed up intubated. The number of patients who received mask ventilation due to intraoperative complications was 12 (13.8%). The mean operation time was 36.2±10.1 minutes. In 86.2% (n=75) of the patients, the surgical procedure was completed with sedoanalgesia while maintaining spontaneous ventilation. CONCLUSION: Sedoanalgesia application during the surgical intervention of patients with Retinopathy of Prematurity (ROP) requiring early diagnosis and emergency treatment will minimize intraoperative and postoperative complications. We believe that sedoanalgesia as an anesthetic method can be applied as an effective alternative method while preserving spontaneous ventilation.

Comparison of Metoprolol and Tramadol with Remifentanil in Endoscopic Sinus Surgery: A Randomised Controlled Trial.

OBJECTIVE: Controlled hypotension is commonly induced during functional endoscopic sinus surgery to limit mucosal bleeding. This may be detrimental to elderly patients and patients with arterial stenosis. The aim of this pilot study was to determine if a normotensive anaesthetic technique with sufficient analgesia and without profound vasodilation may reduce intraoperative bleeding and incidence of adverse haemodynamic effects associated with vasodilation and variable rate continuous infusions. METHODS: In this double-blind randomised controlled trial in a tertiary care centre, a total of 88 patients were randomised to receive intravenously either 0.1 mg kg-1 metoprolol and 1 mg kg-1 tramadol following anaesthesia induction (MT group) or a bolus dose of 0.5 µg kg-1 remifentanil following anaesthesia induction, followed by 0.25-0.5 µg kg-1 min-1 remifentanil infusion (R group). The primary outcome was quality of surgical field and incidence of adverse haemodynamic effects. The secondary outcomes were time to achieve intraoperative bleeding score <3, bleeding rate and changes in cerebral regional oximetry. RESULTS: A total of 105 patients were recruited, in which 88 were randomised. The median intraoperative bleeding score was similar (1, interquartile range: 1-1, p=0.69). The mean bleeding rate was lower in the MT group, although the difference was not significant (p=0.052, 95% CI 0 to 8.8). Hypotension, bradycardia and cerebral desaturation in the MT group were not observed compared to hypotension in 3 (7%), bradycardia in 18 (41%) and cerebral desaturation in 2 (5%) patients in the R group (p=0.241, p<0.001, p=0.474, respectively). CONCLUSION: Providing sufficient analgesia and eliminating stress response can provide stable heart rate and good surgical field with no need for additional hypotension. This normotensive technique may be useful in patients with stenotic arteries or ischaemic organ diseases.

Efficacy of continuous epidural analgesia versus total intravenous analgesia on postoperative pain control in endovascular abdominal aortic aneurysm repair: a retrospective case-control study.

We reviewed our experience to compare the effectiveness of epidural analgesia and total intravenous analgesia on postoperative pain control in patients undergoing endovascular abdominal aortic aneurysm repair. Records of 32 patients during a 2-year period were retrospectively investigated. TIVA group (n = 18) received total intravenous anesthesia, and EA group (n = 14) received epidural anesthesia and sedation. Pain assessment was performed on all patients on a daily basis during rest and activity on postoperative days until discharge from ward using the numeric rating scale. Data for demographic variables, required anesthetic level, perioperative hemodynamic variables, postoperative pain, and morbidities were recorded. There were no relevant differences concerning hospital stay (TIVA group: 14.1 ± 7.0, EA group: 13.5 ± 7.1), perioperative blood pressure variability (TIVA group: 15.6 ± 18.1, EA group: 14.8 ± 11.5), and perioperative hemodynamic complication rate (TIVA group: 17%, EA group: 14%). Postoperative pain scores differed significantly (TIVA group: 5.4 ± 0.9, EA group: 1.8 ± 0.8, P < 0.001). Epidural anesthesia and postoperative epidural analgesia better reduce postoperative pain better compared with general anesthesia and systemic analgesia, with similar effects on hemodynamic status.

The effectiveness of preemptive thoracic epidural analgesia in thoracic surgery.

BACKGROUND: The aim of this study is to investigate the effectiveness of preemptive thoracic epidural analgesia (TEA) comparing conventional postoperative epidural analgesia on thoracotomy. MATERIAL AND METHODS: Forty-four patients were randomized in to two groups (preemptive: Group P, control: Group C). Epidural catheter was inserted in all patients preoperatively. In Group P, epidural analgesic solution was administered as a bolus before the surgical incision and was continued until the end of the surgery. Postoperative patient controlled epidural analgesia infusion pumps were prepared for all patients. Respiratory rates (RR) were recorded. Patient's analgesia was evaluated with visual analog scale at rest (VASr) and coughing (VASc). Number of patient's demands from the pump, pump's delivery, and additional analgesic requirement were also recorded. RESULTS: RR in Group C was higher than in Group P at postoperative 1st and 2nd hours. Both VASr and VASc scores in Group P were lower than in Group C at postoperative 1st, 2nd, and 4th hours. Patient's demand and pump's delivery count for bolus dose in Group P were lower than in Group C in all measurement times. Total analgesic requirements on postoperative 1st and 24th hours in Group P were lower than in Group C. CONCLUSION: We consider that preemptive TEA may offer better analgesia after thoracotomy.