Anesthesia technique for outpatient facial laser resurfacing.

BACKGROUND AND OBJECTIVES: Multiple anesthetic approaches exist for full-face laser resurfacing. The purpose of this study was to describe an anesthesia technique based on combination of eutectic mixture local anesthetics (EMLA) and remifentanil sedation, that can be utilized by anesthesiologists in the ambulatory environment. STUDY DESIGN/MATERIALS AND METHODS: Fifty patients elected for facial laser resurfacing. All patients received topical anesthesia in full face with EMLA cream at 60 minutes (min) before laser procedure. On arrival at the operating room, intravenous (IV) sedation was administered with remifentanil (0.20 mcg/kg/minute), midazolam (1.5- 2 mg bolus IV), and propofol infusion (0.5-1 mg/kg/hour). The subsequent infusion rate of remifentanil was varied to maintain an adequate level of sedation and analgesia. Five minutes before the operation conclusion, the sedation infusion was discontinued. Patients were discharged after achieving a minimum criteria for recovery. RESULTS: Almost all the patients were successfully anesthetized by this combination technique, only four patients needed complementary anesthesia with regional nerve blockade. The mean level of sedation scored 2-3 on the Ramsay scale. The mean discharge time was 55 minutes. No complications were observed. CONCLUSIONS: The use of a combination of topical EMLA anesthesia and IV conscious sedation based on remifentanil provided an adequate depth of anesthesia for outpatient facial laser resurfacing without complications.

[Respiratory changes during laparoscopic cholecystectomy. A comparative study of three techniques]. / Alteraciones respiratorias durante la colecistectomía laparoscópica. Estudio comparativo de tres técnicas anestésicas.

OBJECTIVES: To analyze the repercussions of CO2 pneumoperitoneum on the ventilation of healthy patients undergoing laparoscopic cholecystectomy; to assess the influence of anesthetic technique and determine whether duration of procedure or CO2 volume are relevant factors. PATIENTS AND METHOD: Prospective study of 132 patients undergoing laparoscopic cholecystectomy. The patients were selected based on disease and level of anesthetic risk and then randomly assigned to three groups to receive anesthesia with oxygen/nitrous oxide (group I), isoflurane in O2 and air (FIO2 0.4) (group II) or propofol in continuous infusion with O2 and air (FIO2 0.4) (group III). Analgesia and muscle relaxation were the same in all groups. Monitoring included blood pressure (BP), heart rate (HR), electrocardiography (ECG), central venous pressure (CVP), capnography (PETco2), pulse oximetry (SaO2), peak airways pressure (PAP), FIO2, intra-abdominal pressure (IAP), volume in insufflated CO2 and serial gasometry. Readings were taken before pneumoperitoneum after 20 minutes and every 30 minutes until end of surgery. After surgery parameters were recorded four more times at intervals of 30 minutes. RESULTS: The groups were homogeneous. pneumoperitoneum caused a decrease in PaO2 (p < 0.001) and SaO2 and increases in PaCO2, PETco2 and CVP, although levels later stabilized. No relation was found between duration of pneumoperitoneum or CO2 volumen and any of the changes observed. Group I had the lowest mean PaO2 before pneumoperitoneum and 60 minutes later (p < 0.05). Group II had the smallest increase in PaCO2, although the difference was non significant. CONCLUSIONS: CO2 pneumoperitoneum caused ventilatory changes dependent on uptake and increased abdominal pressure. The duration and volume of CO2 used did not influence the parameters studied. The clinical significance of these changes is slight in the healthy patient. The anesthetic agents used did not have substantial effects.