Robotic laparoscopic radical cystectomy inhalational versus total intravenous anesthesia: a pilot study

Robotic assistance may refine laparoscopic radical cystectomy. Steep Trendelenburg tilt [TT] and pneumoperitoneum [PP] are challenging anesthesia maneuvers. In view of those maneuvers, would inhalational anesthesia or total intravenous anesthesia [TIVA] be the more appropriate anesthetic management for this kind of surgery?. This issue is under consideration in this clinical trial. 15 patients scheduled for robotic laparoscopic radical cystectomy [RLRC] were randomly allocated into two groups to be anesthetized by either isoflurane anesthesia [ISO n = 8] or ketamine-midazolam-fentanyl total intravenous anesthesia [TIVA n = 7]. The hemo-respiratory dynamics, oxygenation and biochemical variables were monitored taking into consideration the system organ function as primary outcomes, and operative conditions and recovery profile as secondary outcomes. PP and TT increased the mean arterial and airway pressures and decreased lung compliance, and were associated with respiratory acidemia, while changes in heart rate remained within normal range. The duration of PP was shorter in TIVA patients but mean arterial pressure was higher than ISO group. ISO was associated with increased plasma concentrations of prothrombin, fibrinogen and aspartate aminotransferase. Though the number of patients is small in this study [n = 15], it nevertheless brings to light the advantages of TIVA during the robotic laparoscopic radical cystectomy [RLRC], by shortening the duration of PP without an increase in prothrombin and fibrinogen concentrations. A larger number of clinical trial are needed to further clarify this issue

optimal sedation of propofol versus midazolam in geriatrics during regional anaesthesia for hip orthopedic surgery

The main goals of intraoperative sedation are anxiolysis, hypnosis and amnesia. These objectives are required to produce a calm comfortable, but communicative patient. The sedation of a geriatric represents a continuum. These patients can move easily from light level of sedation to obtundation. The distinction between conscious sedation and deep sedation is made for the purpose of describing the proper level of physiologic monitoring. Midazolam and propofol are the most popular sedative agents due to their attractive pharrnacokinetic profile and wide therapeutic index. This study was carried out on 40 old patients above 60 years scheduled for hip surgical correction under spinal anaesthesia. They were randomely class into two equal groups according to the sedative regimen used. The propofol was used in one group at initial dose 1-1.5 mg/kg followed by ascending infusion scale5-50 ug/ kg/min. every 5 minutes. The midazolam was used in the second group at initial dose 10-20 ug/kg followed by ascending infusion scale 0.2-2 ug/kg/min every 5 minutes. The infusion rate adjusfed till reach the optimum sedation score [=3] in both groups. Sedation and recovery [durations and degrees] were assessed by Ramsay sedation scale and recovery room score respectively. The haemodynamics and concomitent events were recorded. This study showed the sign lower haemodynamic data of propofol group in comparison with the midazolam one, but with superior titrability, at the optimum sedation level, and faster recovery time. The midazolam group is superior in its amnestic action with less paradoxical agitation but with delayed recovery and difficult titrability at the desired sedation level like propofol

Evaluation of neuromuscular blocking effect of cisatracurium in patients with liver cirrhosis

Cisatracurium is one of the ten stereoisomers of atracurium, it is a potent intermediate duration non-depolarizing neuromuscular blocking agent. and its pharmacokinetics and pharmacodynamics are similar to atracurium. it is degraded in plasma by Hofmann degradation and ester hydrolysis. In this study we evaluated its neuromuscular blocking effect in patients with bilharzial liver cirrhosis. We studied 20 patients which were divided into 2 groups, 10 patients each, the patients of the first group were ASA, I or II and patients of the second group had hepatic cirrhosis child II all patients received thiopentone sodium, cisatracurium 0.1mg/kg, then intubation was done and anaesthesia was maintained with N20: O2 and halothane with controlled ventilation. There was significant prolongation in the onset time of relaxation after injection of the bolus dose in hepatic patients, however there was insignificant difference between the two groups as regard the duration of neuromascular block or total dose of cisatracurium. So, we can conclude that cisatracurium is a suitable muscle relaxant in patients with liver cirrhosis