[N2O-free sevoflurane anesthesia. Clinical evaluation]. / Anestesia con sevoflurane "N2O free". Valutazione clinica Studio multicentrico.

BACKGROUND: The characteristics of sevoflurane make it able to be used without N2O avoiding its undesirable effects to this associates. The aim of the study is to evaluate the clinical characteristics of sevoflurane anesthesia "N2O free" in comparison to sevoflurane anesthesia with N2O. METHODS: 920 patient undergoing elective surgery in 12 centers were included in this study. All the patients were monitored with routine monitoring. The patients were randomized in two groups: group Air in which the anesthesia was maintained with sevoflurane in Air:O2; group N2O in which the anesthesia was maintained with sevoflurane in N2O:O2. Opioids were administered as necessary (changes of the heart rate and/or of the arterial pressure > 20% in comparison to the baseline values). For each patient we evaluated the consumption of opioids, the time from discontinuation of the sevoflurane and the extubation and full recovery, defined as presence of a complete cognitive function; the quality of awakening, the incidence of postoperative nausea and vomiting (PONV) and the quality of postoperative analgesia. RESULTS: We didn't observe differences between the two groups. In conclusions, omitting N2O during sevoflurane anesthesia can be considered a safe technique, avoiding the acute and chronic side effects associated with the use of N2O, without modifying the intraop consumption of opioid, the recovery and the early postoperative incidence of nausea, vomiting and analgesia.

Anaesthesia for liver transplantation in cystic fibrosis patients.

INTRODUCTION: Cystic fibrosis (CF) is a disease caused by an inherited genetic defect. While pulmonary and pancreatic abnormalities predominate the clinical spectrum, other organ involvement is common, including liver. The severity of liver disease does not appear to be related to the severity of exocrine pancreatic or lung function. We discuss anaesthesia in four CF patients undergoing liver transplantation. METHODS: We studied haemodynamic and oxygenation modifications during anaesthesia in four patients affected by CF with end-stage liver disease and mild to moderate pulmonary abnormalities. The patients received pancreatic enzyme prior to transplantation and two had insulin-dependent diabetes mellitus. All patients were treated with broad-spectrum antibiotic therapy. After a waiting time ranging one week to three months, all patients were successfully transplanted. General anaesthesia was induced with fentanyl, thiopental and pancuronium, and maintained with isoflurane supplemented by fentanyl in O2:air. Haemodynamic and oxygenation evaluations were made during the main phases of the transplant. After the intubation and at the end of the procedure all patients received a broncho-alveolar toilet through fiberoptic bronchoscopy. RESULTS: During anaesthesia for liver transplantation, PaO2 increased proportionally to the decreasing of Qs/Qt. In postoperative follow-up, Fev1 and FVC improved from preoperative time in all patients. In conclusion, even if cystic fibrosis is a multisystem disease, liver transplantation can be offered to CF patients with endstage liver disease and mild to moderate pulmonary function abnormalities. The four patients are still alive, enjoying good health. The improved respiratory function and quality of life of these children is remarkable.