Thoracic epidural anesthesia and blood glucose levels in diabetic patients undergoing cardiopulmonary bypass under insulin infusion according to the Portland protocol.

BACKGROUND: We investigated the effect of thoracic epidural anesthesia on perioperative blood glucose levels in diabetic patients undergoing cardiopulmonary bypass by continuous insulin infusion according to the Portland Protocol. MATERIAL AND METHODS: Diabetic patients undergoing surgery with cardiopulmonary bypass were assigned to receive either general anesthesia alone (n=40) or general anesthesia with thoracic epidural anesthesia (n=18). Patient data were retrospectively reviewed from prospective chart records used in our anesthesia clinic. In all study patients, insulin infusion with the Portland Protocol was used to maintain stable blood glucose levels. We evaluated blood glucose levels in both groups at 6 time points including before surgery, before cardiopulmonary bypass, during cardiopulmonary bypass, immediately following cardiopulmonary bypass, and on the first and second postoperative days. The amounts of insulin required at the intraoperative period and during two postoperative days were compared between two groups. RESULTS: Groups were similar with respect to the duration of cardiopulmonary bypass, aortic cross-clamping, surgery, and blood glucose levels at any of the 6 time points, mean insulin requirements during intraoperative period and mean insulin requirements and blood glucose levels during the first 2 postoperative days (General anesthesia alone, 189+/-29 mg/dl vs. General anesthesia with thoracic epidural anesthesia, 191+/-19 mg/dl; p=0.782). CONCLUSIONS: In diabetic patients undergoing cardiopulmonary bypass receiving insulin infusion by the Portland Protocol for glycemic control, thoracic epidural anesthesia provides no additional benefit for maintaining blood glucose levels during surgery.

Ropivacaine 0.25% is as effective as bupivacaine 0.25% in providing surgical anaesthesia for lumbar plexus and sciatic nerve block in high-risk patients: preliminary report.

Ropivacaine is potentially less cardiotoxic and neurotoxic than bupivacaine. The aim of this study was to compare the effectiveness of ropivacaine 0.25% and bupivacaine 0.25% for surgical anaesthesia and postoperative analgesia during lumbar plexus and sciatic nerve block in high-risk patients. We performed combined lumbar plexus and sciatic nerve blockade on 62 consecutive ASA III or IV patients undergoing unilateral hip or femur surgery. The first 30 patients received bupivacaine (Group 1) and the remaining 32 patients received ropivacaine (Group 2). Perioperative management was otherwise similar The groups were compared for the time of onset of the block, additional analgesics and sedatives required, time from end of surgery to the first analgesic requirement and the need for rescue analgesia. Ninety percent (29/32) of the patients in the ropivacaine group and 86% (26/30) of the patients in the bupivacaine group reached surgical anaesthesia. The time from the end of the surgery to the first analgesic requirement was similar between the two groups (10.3 +/- 5.2 hours for ropivacaine, 11.2 +/- 4.6 hours for bupivacaine). There was no statistically significant difference between the two groups in any of the measured variables (P > 0.05). The results of this preliminary study suggest that ropivacaine 0.25% is as effective as bupivacaine 0.25% when used for blocking lumbar plexus and sciatic nerve in high-risk patients undergoing hip or femur surgery.