The optimal concentration of bupivacaine and levobupivacaine for labor pain management using patient-controlled epidural analgesia: a double-blind, randomized controlled trial.

BACKGROUND: The study aim was to evaluate the efficacy and safety of different low concentrations of two local anesthetics for labor analgesia using patient-controlled epidural analgesia. METHODS: A double-blind, randomized controlled trial recruiting healthy nulliparous women was conducted from 2014 to 2017. Epidural analgesia was provided using local anesthetic and fentanyl. Patients were allocated to six groups, according to the concentration of bupivacaine or levobupivacaine (0.0625%, 0.1%, 0.125%). Analgesic efficacy, vital parameters, and side effects were evaluated at different time points. Satisfaction was evaluated using verbal and written scores. The primary outcome was the total dose of local anesthetic used. RESULTS: Two-hundred-and-thirty-seven cases were analyzed. The total dose of local anesthetic was significantly lower in the two lower concentration groups (P <0.0001). The rate of cesarean section was lower in 0.1% bupivacaine versus 0.1% levobupivacaine (P=0.005), 0.125% levobupivacaine (P=0.049) and 0.125% bupivacaine (P=0.002) groups. Pain breakthrough, patient-controlled and rescue boluses were significantly different between groups (P=0.03, P=0.003 and P <0.0001 respectively). The rate of motor block increased with higher concentrations (P=0.033), but the incidence of other maternal and fetal side effects was not significantly different. Satisfaction with labor analgesia did not differ across groups. Satisfaction score 72 hours after delivery was significantly lower than that two hours after delivery (P <0.0001). CONCLUSIONS: Higher local anesthetic concentration resulted in higher total doses infused and greater motor block. Labor analgesia was less effective when the lowest concentrations were used, but patient satisfaction was unaffected.

Pre-operative evaluation of adults undergoing elective noncardiac surgery: Updated guideline from the European Society of Anaesthesiology

The purpose of this update of the European Society of Anaesthesiology (ESA) guidelines on the pre-operative evaluation of the adult undergoing noncardiac surgery is to present recommendations based on the available relevant clinical evidence. Well performed randomised studies on the topic are limited and therefore many recommendations rely to a large extent on expert opinion and may need to be adapted specifically to the healthcare systems of individual countries. This article aims to provide an overview of current knowledge on the subject with an assessment of the quality of the evidence in order to allow anaesthesiologists all over Europe to integrate - wherever possible - this knowledge into daily patient care. The Guidelines Committee of the ESA formed a task force comprising members of the previous task force, members of ESA scientific subcommittees and an open call for volunteers was made to all individual active members of the ESA and national societies. Electronic databases were searched from July 2010 (end of the literature search of the previous ESA guidelines on pre-operative evaluation) to May 2016 without language restrictions. A total of 34 066 abtracts were screened from which 2536 were included for further analysis. Relevant systematic reviews with meta-analyses, randomised controlled trials, cohort studies, case-control studies and cross-sectional surveys were selected. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the level of evidence and to grade recommendations. The final draft guideline was posted on the ESA website for 4 weeks and the link was sent to all ESA members, individual or national (thus including most European national anaesthesia societies). Comments were collated and the guidelines amended as appropriate. When the final draft was complete, the Guidelines Committee and ESA Board ratified the guidelines.(AU)

Comparison of the cardiovascular and respiratory effects and sevoflurane requirement in dogs premedicated with two doses of medetomidine and butorphanol undergoing surgical sterilization.

The aim of this study was to compare the cardiovascular and respiratory effects and sevoflurane requirement in dogs premedicated with two doses of medetomidine and butorphanol undergoing surgical sterilization. The dogs were randomly assigned to two different groups: group 1 received a lower dose of medetomidine (0.014 mg/kg) and butorphanol (0.14 mg/kg) and group 2 received a higher dose of medetomidine (0.024 mg/kg) and butorphanol (0.24 mg/kg). Anesthesia was induced with intravenous propofol and maintained with sevoflurane 2% in pure oxygen. Heart rate, SpO2, respiratory rate, EtCO2, esophageal temperature, systolic and diastolic arterial blood pressures, capillary refill time, reflexes (palpebral, pedal), jaw tone, and eye position (straight, down) were assessed. Anesthesia was monitored continuously by an anesthesiologist, and variables were recorded every 5 min. During general anesthesia, the median sevoflurane (SVO) concentrations and the median HR were significantly lower in group 2 than group 1 (p<0.05). The median HR was 96.3 (85.8-100.8) in group 1, whereas in group 2 it was 77.0 (67.5-84.6) (p<0.05). It might be concluded that the higher dose of medetomidine and butorphanol allows the use of a lower sevoflurane concentration during routine surgical treatments and ensures stable work of the cardiovascular and respiratory systems.

Effects of sevoflurane vs. propofol on mitochondrial functional activity after ischemia-reperfusion injury and the influence on clinical parameters in patients undergoing CABG surgery with cardiopulmonary bypass.

The aim of the study was to evaluate the effects of sevoflurane and propofol on the activity of mitochondrial function related to ischemia-reperfusion injury, myocardial damage biomarkers release and clinical parameters in the postoperative period. Seventy-two patients scheduled for elective coronary artery bypass graft surgery with cardiopulmonary bypass were randomized into two groups: 36 patients received sevoflurane during anesthesia (Group S) and 36 patients received propofol (Group P). To investigate the functional activity of mitochondria, we used skinned fibers prepared from biopsies of right atrial tissue before cardioplegia and after the aorta cross-clamp removal (within 10-15 minutes after reperfusion). Patients' clinical data (length of stay in ICU, hemodynamic parameters, duration of mechanical ventilation (MV) and the amount of lactate and troponin I in the blood serum) were evaluated postoperatively. The results showed that, before cardioplegia and after reperfusion, there was no significant difference in the mitochondrial routine and State 3 respiration rates between the groups. The effect of cytochrome c was higher in Group P. Troponin I concentration at the 12(th) hour after the surgery was 2.2 ± 0.8 ng/mL in Group S and 3.5 ± 1.1 ng/mL in Group P (p<0.001). There were no significant differences in the duration of mechanical ventilation, hemodynamic parameters and length of stay in the ICU between the groups. We conclude that sevoflurane slightly protects the mitochondrial outer membrane from ischemia-reperfusion injury and the loss of cytochrome c, yet has the similar effect on clinical parameters in the postoperative period when compared to propofol.