Subarachnoid sufentanil as sole agent vs standard spinal bupivacaine in transurethral resection of the bladder.

AIM: The aim of the study was to determine whether intrathecal sufentanil alone provides an adequate analgesia for patients undergoing transurethral resection of the bladder (TURB) and to compare it to standard spinal bupivacaine anesthesia in terms of motor and sensory blockade, discharge time and side effects. METHODS: Sixty-two patients were blindly and randomly assigned to receive either intrathecal bupivacaine (10 mg of 0.5% hyperbaric bupivacaine) or intrathecal sufentanil (15 microg). Motor and sensory blockade was evaluated using a modified Bromage scale as well as cold and pinprick tests. Severity of pain was assessed by means of a 10-point verbal analog scale. RESULTS: We found that the mean duration of sensory blockade was similar for both sufentanil and bupivacaine patients but the quality of analgesia induced by sufentanil alone was poor as compared with spinal bupivacaine anesthesia. CONCLUSION: The subarachnoid administration of sufentanil 15 mg seems to be inadequate for TURB surgery. In addition, the advantage of a faster recovery we observed in sufentanil patients is minimized by the occurrence of a troublesome symptom such as pruritus. On the other hand, spinal bupivacaine produces an undesirable motor blockade exceeding, in our opinion, the requirement for TURB procedure.

The use of di-hydroxypropylphenol (propophol) in endoscopic procedures.

The authors illustrate different endoscopic procedures that may require anaesthesiological assistance through analgo-sedation procedures. Analgo-sedation is useful to the patient and to the endoscopist that can carry out the exam more rapidly and in optimal conditions. The technique employed consists in the administration of propophol, starting with an initial bolus of the drug followed by a continuous perfusion to maintain the hypnotic state. Monitoring of cardiovascular and respiratory parameters shows a great reliability of the drug and effectiveness of the method.

Variation of acid-base balance, glycemia, electrolytes and ETCO2 after fast i.v. infusion of 5% fructose and/or glucose.

Intraoperative fluid infusion has precise goals and the rapid infusion of some solutions can induce important modifications of homeostatic parameters, which must be known. Rapid infusion of fructose and glucose 5% solutions has been carried out and modifications of acid-base balance, glycemia, serum electrolytes, ETCO2 have been registered. The administration of fructose 5% determines a mixed acidosis while the administration of glucose does not cause this phenomenon; the administration of both carbohydrates reduces serum chloride and sodium, while serum potassium rises only after fructose infusion and glycemia only after glucose infusion. All the variations described reach significant levels.

Laparoscopic surgery complications: pneumothorax and pneumomediastinum. Description of two cases.

After having illustrated the surgical "advantages" of laparoscopic procedures, the authors discuss the negative aspects of this technique on the anaesthesiological management of the patient. Two cases of pneumothorax during Nissen fundoplicatio are illustrated and the deranged parameters, that allow a precocious diagnosis, are extensively analyzed.

Transcutaneous ethanol injection in hepatocarcinoma: problems in analgesia and sedation.

Therapeutic ethanol injection into primitive or secondary hepatic tumours if performed in "one shot" causes a great deal of pain. For this reason an analgesic/sedation protocol was devised. This relies on the administration of ketorolac-propofol-nitrogen oxide mixture that has been used to treat patients with neoplastic hepatic diseases. A 20 patient series is described. Analgesic protocol was very effective and the only drawbacks were a residual sleepiness than in part is probably dependent on ethanol emigration into the bloodstream and consequently to the central nervous system depression.

Analgesia and sedation with propofol-NSAIDs for day-hospital extracorporeal shock wave lithotripsy (ESWL).

After a brief history of extracoporeal therapies for calculosis, with particular attention devoluted to renal calculosis and to the instruments that consent these therapeutic alternatives, the authors report the results obtained with a technique of analgesia and sedation. The drugs employed are two NSAIDs, keto-prophene and ketorolac tromethamine associated with propofol. The main advantages consist in the limited cardiovascular and respiratory depression, typical of the first minutes of administration of propofol and the rapid return of a complete functional autonomy in relative brief time intervals, with possibility of dismissing the patient after 4 hours from che end of treatment.

[Clinical evaluation of a method of total intravenous anesthesia in various types of surgical patients]. / Valutazione clinica di una metodica di anestesia endovenosa totale in talune categorie di pazienti chirurgici.

Inhaled anaesthetic agents (gases and vapours) may be detrimental to the health of patients and cause a chronic operating room air pollution. Therefore, the authors expound the results obtained using a total intravenous anesthesia technique including propofol to induce and maintain hypnosis integrated with pancuronium bromide, droperidol and fentanyl. Patients have been ventilated with mixture of air and oxygen 30%. This technique has been tried in 60 cases of various kind of elective surgical patients obtaining very good results: in 40% of cases the anaesthetic level was excellent, while in some patients it was not adequate on account of intraoperative pressure increases. This technique of total intravenous anesthesia deserves wider use on account of the good tolerance to propofol, the excellent awakening without postoperative troubles (nausea and vomiting).

Anaesthetics modulate tumour necrosis factor alpha: effects of L-carnitine supplementation in surgical patients. Preliminary results.

Both anaesthetics and surgical trauma could strongly affect the production of tumour necrosis factor alpha (TNFalpha). During in vitro experiments the authors found that anaesthetics modulate the production of TNFalpha by peripheral blood mononuclear cells. Notably, Pentothal strongly increased the production of the cytokine as compared to both lipopolysacchride treated and control mononuclear cells, whereas in supernatants from Leptofen driven mononuclear cells TNFalpha was strongly reduced. On the other hand, Pavulon did not significantly affect the cytokine production. In the in vivo study, in an attempt to ameliorate the metabolic response to surgical trauma, L-carnitine was administered to 20 surgical patients, then the circulating TNFalpha was measured. The results indicate that the levels of circulating TNFalpha were strongly increased following surgery and that L-carnitine administration resulted in a strong reduction of TNFalpha. Thus, the data suggest that L-carnitine could be helpful in protecting surgical patients against dysmetabolism dependent on dysregulated production of TNFalpha.

[Clinical evaluation of the efficacy of Ro 15-1788, Anexate after balanced intravenous anesthesia with flunitrazepam and fentanyl]. / Valutazione clinica dell'efficacia del Ro 15-1788, Anexate dopo anestesia endovenosa bilanciata condotta con flunitrazepam e fentanil.

Benzodiazepines are widely used as neuroleptics in anaesthesia, but they give rise to drowsiness at the end of surgery. Anexate is an imidazobenzodiazepine with specific antagonistic activity for benzodiazepines. We have administered 0.2 mg i.v. of the drug to 20 adult patients after anaesthesia with tiopentale (250 mg), pancuronium bromide (0.07 mg.kg-1), flunitrazepam (2 mg) and fentanyl (0.10 mg); after the first dose fentanyl was administered (0.10 mg) about every 30 minute. Analgesia was supplemented with nitrous oxide 66%. Blood pressure and heart rate did not changes significantly after Anexate; respiratory volume increased significantly in all cases (ANOVA P less than 0.001). Consciousness was rapidly resumed in all cases and patients demonstrated to be oriented in time and space soon after Anexate. In 14 out of 20 patients drowsiness reappeared after about 30 minute and further doses of 0.1 mg of the drug (to a maximum of 0.4 mg in some cases) were necessary. Side effects were rare and slight, their occurrence depending on the speed of administration. In our opinion a total dose of 0.3 to 0.4 mg Anexate is need to fully antagonize the sedative effect of 2 mg flunitrazepam.