The Effect of Combined Spinal Epidural Anesthesia on Shoulder Pain in Laparoscopic Extraperitoneal Hernia Surgery.

BACKGROUND: Shoulder pain is a condition that seriously discomforts patients and develops caused by a peritoneal tear in laparoscopic extraperitoneal hernia repair (TEP) surgeries. Although surgeons generally prefer general anesthesia for the TEP technique, many studies have been carried out on the use of regional anesthesia in recent years. In our study, we aimed to investigate the efficacy and safety of the combined spinal/epidural anesthesia (CSEA) method to prevent shoulder pain in the TEP technique. METHODS: The patients who operated with the TEP procedure were divided into 2 groups; SA (group 1) and CSEA (group 2). The 2 patient groups were compared in terms of sex, age, body mass index, duration of surgery, total operation time, patient satisfaction, pain scores, length of hospital stay, adverse effects, intraoperative, and postoperative complications. RESULTS: The number of patients in group 1 was 42 and group 2 was 40. The mean operation time was recorded as 55.9 and 80.2 minutes in groups 1 and 2, respectively, which was statistically significantly shorter in group 1 (P<0.001). Postoperative pain was significantly less in group 2 for the 4th hour (P<0.0001) and the 12th hour (P=0.047). There was no difference between the 2 groups in terms of peritoneal tear (P=0.860). Intraoperative and postoperative shoulder pain was significantly less in group 2 (P=0.038, P=0015, respectively). CONCLUSION: CSEA is an effective and safe anesthesia method for preventing shoulder pain that develops after TEP surgeries.

Robotic assited perineal prostatectomy (RAPP) as a new era for anesthesiology: It's effects on hemodynamic parameters and respiratory mechanics.

Robotic-assisted perineal prostatactomy(RAPP) is a new alternative surgical technique, in prostate cancer patients especially with a history of intra-abdominal surgery. The aim of this study is to examine the effects of the challenging patient position and CO2 insufflation in perineal space during RAPP on both hemodynamic parameters and respiratory mechanics. Hemodynamic and respiratory parameters of 30 patients who underwent RAPP and 31 patients who underwent Robotic-assisted laparoscopic prostatectomy (RALP) for prostate cancer between 2017 and 2019 were retrospectively evaluated. Comparison between RAPP and RALP patients showed that anesthesia, surgery and insufflation times were shorter in RAPP patients (p < 0.05). Blood pCO2 level was higher, and the pH decrease was more prominent in the RAPP patients 30 and 60 min after perineal CO2 insufflation (p < 0.05). The mean arterial pressures, driving pressure, Ppeak and Pplato values were statistically higher in the RALP patients and 60 min after insufflation while static and dynamic lung compliance values were found to be lower. Our results showed that blood pCO2 level may severely increase after perineal CO2 insufflation. The fact that respiratory mechanics are less affected despite the difficult patient position for lungs in RAPP patients, the presence of higher CO2 level supports that the perineal CO2 insufflation plays a more important role in increased CO2 level. Considering these changes, especially the sudden increase in the risk of CO2 level, close follow-up and timely intervention by anesthesiology can ensure all changes remain in a clinically safe range.

The effect of anesthetic agents on intraocular pressure during laparoscopic gynecological surgery performed in the Trendelenburg position: A randomized clinical trial.

BACKGROUND: Intraocular pressure (IOP) increases due to pneumoperitoneum and the Trendelenburg position during laparo-scopic surgery. Apart from ketamine and suxamethonium, anesthetic agents generally reduce IOP by various extents. The present study investigated the effects of combinations of four anesthetic agents on IOP during laparoscopic gynecological surgery. METHODS: Patients (n=100) were assigned to one of the four groups: Group 1 (n=25; pentothal induction + desflurane/remifen-tanil maintenance), Group 2 (n=25; propofol induction + sevoflurane/remifentanil maintenance), Group 3 (n=25; propofol induction + desflurane/remifentanil maintenance), and Group 4 (n=25; pentothal induction + sevoflurane/remifentanil maintenance). The IOPs recorded before anesthesia induction, after intubation, after carbon dioxide insufflation, in the Trendelenburg position, and after ex-tubation were compared among the groups. Hemodynamic parameters were also evaluated. RESULTS: Induction in Group 2 and Group 3 used propofol. When the IOP in the Trendelenburg position was compared with the IOP before induction, there was no statistically significant difference in Groups 2 and 3 (p>0.05). In Groups 1 and 4, pentothal was used for induction. The IOP in Groups 1 and 4 was statistically significantly higher in the Trendelenburg position than it was before induction (0.027-0.001). CONCLUSION: To minimize the variation in IOP in the Trendelenburg position during laparoscopic gynecological surgeries, we recommend the use of propofol for induction, independent of desflurane or sevoflurane use.

Relationship of MRI-measured pelvimetric dimensions and surgical positions with anaesthesia parameters in robotic perineal prostatectomy. / Influencia entre las dimensiones pélvicas medidas por RMN y las posiciones quirúrgicas en parámetros anestésicos durante la prostatectomía radical robótica perineal.

INTRODUCTION AND OBJECTIVE: Theaim of this study was to determine the effect formedby pelvic diameters preoperatively measured throughmultiparametric magnetic resonance imaging (mp-MRI) and different surgical positions on anesthesiaparameters used during perineal robot-assisted radicalprostatectomy (p-RARP). MATERIALS AND METHODS: Six different pelvimetricdimensions were determined preoperatively.Respiratory and hemodynamic variables of the patientswere measured separately and repeatedly in thesupine position, exaggerated lithotomy position at thebeginning of the 15° Trendelenburg position and the60th minute of insufflation. RESULTS: There was a significant increase in thepartial pressure of oxygen (PaO2) in the exaggeratedlithotomy position compared to the supine position.There was no significant change in the partial pressureof carbon dioxide (PCO2) in the exaggerated lithotomyposition compared to the supine position. In the 60thminute of insufflation, there was a significant increasein the PCO2 compared to the supine and exaggerated lithotomy positions. There was no statistically significantchange in the end-tidal carbon dioxide tension(EtCO2), with surgical position or insufflation time. Asignificant negative correlation was observed betweenthe distance of the ischial spines (ISD) and PCO2 change,and a significant positive correlation was observedbetween the angle of the symphysis pubis-seminalvesicles (ASS) and PCO2 change. A significant positivecorrelation was observed between the ASS value andEtCO2 change between the 60th minute of insufflationand exaggerated lithotomy position. CONCLUSION: In our study, the effect caused by differingpelvimetric diameters, surgical positions, andduration of anesthesia during p-RARP on anesthesiaparameters were shown.

INTRODUCCIÓN Y OBJETIVO: Determinarel efecto de los diámetros pélvicos preoperatoriosmedidos a través de la resonancia magnética multiparamétrica(RMNmp) y las diferentes posicionesquirúrgicas en los parámetros anestésicos durante laprostatectomía radical perineal. MATERIAL Y MÉTODOS: Se midieron seis dimensionespélvicas preoperatorias diferentes. Las variablesrespiratorias y hemodinámicas se midieron de formaseparada y repetida en las posiciones de decúbito supino,litotomía forzada al inicio del Trendelemburg a15º y a los 60min de insuflación. RESULTADOS: Se registró un aumento significativo dela presión parcial de oxigeno (PaO2) en litotomía forzada comparada a la posición de decúbito supino. Nohubo cambios significativos en la presión de dióxidode carbono (PCO2) en litotomía forzada comparada condecúbito supino. A los 60min de insuflación, hubo unaumento significativo de la PCO2 comparado con decúbitosupino y litotomía forzada. No hubo cambiossignificativos en la presión máxima de CO2 al final dela espiración (EtCO2) con las posiciones o el tiempo deinsuflación. Se observó una correlación negativa entrela distancia entre las espinas isquiáticas (EEII) y elcambio de PCO2, mientras que se observó correlaciónpositiva entre el ángulo de la sínfisis del pubis-vesículasseminales y el cambio de PCO2. Una correlaciónpositiva se observó entre el valor del ángulo sínfisispubis-vesículas seminales y EtCO2 con respecto a lainsuflación al minuto 60 y la litotomía forzada. CONCLUSIÓN: En nuestro estudio se demuestra lainfluencia de los diámetros pélvicos, las posicionesquirúrgicas y la duración de la anestesia en los parámetrosanestésicos durante la prostatectomía radicalrobótica perineal.

Supine Percutaneous Nephrolithotomy in a Patient with Solitary Lung: A Case Report and Literature Review.

Percutaneous nephrolithotomy (PNL) surgeries are performed with different patient positions, anesthesia methods and different-sized access sheaths in order to reduce the complication rates. Supine positioned PNL can be performed safely in the high-risk group patients with comorbidities. Herein, we present a patient who had a past surgical history of right pneumonectomy and underwent a supine PNL procedure under regional anesthesia for a staghorn renal stone in the right kidney.

The effect of robotic surgery on intraocular pressure and optic nerve sheath diameter: a prospective study.

BACKGROUND AND OBJECTIVES: To investigate the effect of the steep Trendelenburg position (35° to 45°) and carbon dioxide (CO2) insufflation on optic nerve sheath diameter (ONSD), intraocular pressure (IOP), and hemodynamic parameters in patients undergoing robot-assisted laparoscopic prostatectomy (RALP), and to evaluate possible correlations between these parameters. METHODS: A total of 34 patients were included in this study. ONSD was measured using ultrasonography and IOP was measured using a tonometer at four time points: T1 (5minutes after intubation in the supine position); T2 (30minutes after CO2 insufflation); T3 (120minutes in steep Trendelenburg position); and T4 (in the supine position, after abdominal exsufflation). Systolic and diastolic arterial pressure, heart rate, and end-tidal CO2 (etCO2) were also evaluated. RESULTS: The mean IOP was 12.4mmHg at T1, 20mmHg at T2, 21.8mmHg at T3, and 15.6mmHg at T4. The mean ONSD was 4.87mm at T1, 5.21mm at T2, 5.30mm at T3, and 5.08 at T4. There was a statistically significant increase and decrease in IOP and ONSD between measurements at T1 and T4, respectively. However, no significant correlation was found between IOP and ONSD. A significant positive correlation was found only between ONSD and diastolic arterial pressure. Mean arterial pressure, heart rate, and etCO2 were not correlated with IOP or ONSD. CONCLUSIONS: A significant increase in IOP and ONSD were evident during RALP; however, there was no significant correlation between the two parameters.