[Use of flurbiprofen before emergence from anesthesia relieves pain during immediate postoperative period after laparoscopic inguinal hernia repair].

BACKGROUND: Reduced postoperative pain is considered one of the benefits of laparoscopic inguinal hernia repair (LHR). We investigated the need for intravenous flurbiprofen axetil (FA) before emergence from anesthesia in patients who had undergone LHR. METHODS: Forty adult patients who were prepared for LHR were randomly divided into the FA group (FA 1 mg x kg(-1) administered at the end of surgery, n = 20) and the control group (no FA administration, n = 20). Postoperative pain was evaluated by the Prince Henry Pain Score (PHPS) as well as by the frequency of on-demand use of nonsteroidal antiinflammatory drugs (NSAIDs). RESULTS: The PHPS on arrival at the ward was significantly lower in the FA group than the control group. Additionally, none of the patients of the FA group required NSAIDs in the first two hours of postoperative period, compared with 6 patients (30%) of the control group. However, at 4 hours postoperatively, none of the patients of both groups suffered pain at rest and the PHPS was similar in the two groups. CONCLUSIONS: Although postoperative pain after LHR is mild and disappears rapidly, FA administration before emergence from anesthesia is necessary for management of pain during the immediate postoperative period.

[Intraoperative asystole in a patient with concealed sick sinus syndrome: a case report].

We report a patient with concealed sick sinus syndrome who developed intraoperative bradycardia and asystole. An 81-year-old man was scheduled to undergo total gastrectomy under general and epidural anesthesia. There was no history of syncope, and preoperative 12-lead ECG showed normal sinus rhythm. Anesthesia was induced with propofol and remifentanil, maintained with sevoflurane, remifentanil and thoracic epidural infusion of lidocaine, fentanyl and levobupivacaine. Bradycardia was detected on ECG 110 minutes after the start of surgery. Intravenous atropine (0.5 mg, repeated up to a total dose of 1.5 mg) was ineffective in restoring a normal heart rhythm. Ten minutes later, the ECG changed to asystole lasting for about 15 seconds. Regular chest compression and intravenous administration of dopamine (5 microg x kg(-1) x min(-1)) resulted in successful recovery of sinus rhythm. Postoperative ECG showed sinus rhythm. The final diagnosis by a cardiologist was concealed sick sinus syndrome. Many anesthetic agents have some effects on the cardiac conduction system. Remifentanil may have played a role in the development of asystole in this patient. The existence of concealed sick sinus syndrome should be kept in mind even in patients who show no clinical abnormalities on preoperative assessment.