Evaluating the analgesic efficacy of two anesthetic techniques during arthroscopic knee surgery

Background and Purpose: The aim of the study was to compare unilateral spinal and local anesthesia with respect to intraoperative and postoperative pain control, safety and complications for knee arthroscopies in outpatients. Methods: We studied 70 ASA I or II patients scheduled for outpatient knee arthroscopic surgery. The patients were allocated into two groups to receive either local (LA group = 35) or unilateral spinal (SA group = 35) anesthesia during a year period. The unilateral SA group received hyperbaric bupivacaine 7.5 mg (1.5 mL). The LA group received portal injection (5 mL lidocaine 2% with adrenaline) and intra-articular injection into the knee (10 mL lidocaine 2% with adrenaline). The following parameters were assessed: perioperative pain (10 cm VAS: 0 = no pain, 10 = extreme pain), surgical operating conditions, patient satisfaction score (1=very satisfied, 4=very unsatisfied), postoperative analgesia, and time to discharge. Results: In the LA group, 94.3% (33/35) of patients experienced no pain throughout the procedure. Only two (5.7%) patients required conversion to general anesthesia. In the unilateral SA group, one patient required conversion to general anesthesia. The need for postoperative analgesics was higher in the unilateral SA group compared with the LA group (p<0.01). The mean postoperative stay was significantly shorter in the LA than the unilateral SA group (p<0.05). The rate of complications differed significantly between the LA and unilateral SA groups (p<0.05). Conclusion: LA provides good pain relief following arthroscopic knee surgery compared to conventional unilateral spinal anesthesia. Major LA advantages are hemodynamic stability, patient satisfaction and faster anesthetic recovery

Local or Spinal Anesthesia in Acute Knee Surgery

The aim of the study was to assess the efficacy, safety and complications of two anesthetic techniques including local and spinal anesthesia. A total of 436 patients received local (LA group=250) or spinal (SA group=186) anesthesia during a year period. SA group received 0.5% Bupivacaine 5 mg/mL. LA group received portal injection (5 mL lidocaine 2% with adrenaline) and intra-articular injection into the knee (10 mL lidocaine 2% with adrenaline). The following parameters were assessed: intraoperative pain (10 cm VAS: 0=no pain, 10=extreme pain), surgical operating conditions, patient satisfaction score (1=very satisfied, 4=very unsatisfied), postoperative analgesia, and time to discharge. In LA group, 97.6% (244/250) of patients experienced no pain throughout the procedure. Only six (2.4%) patients required conversion to general anesthesia. In SA group, two patients required conversion to general anesthesia. In both groups, 93.6% of patients were either satisfied or very satisfied with their anesthesia. The need of postoperative analgesics was higher in SA compared with LA group (p=0.001). The mean postoperative stay was significantly shorter in LA than in SA group (p=0.001). Ninety-four percent of LA and only 68% of SA patients were discharged from the hospital within 2 hours of the procedure. The rate of complications differed significantly between LA and SA groups (p=0.037). Outpatient arthroscopy of the knee under local anesthesia is a simple, reliable, and safe alternative to spinal anesthesia, for patients in whom intraarticular disorders requiring diagnostic arthroscopy and arthroscopic surgery

Anaesthesia in Dental Medicine

Uvod. Većina stomatoloških zahvata radi se u lokalnoj anesteziji (90%). Razlozi za to su jednostavna priprema bolesnika, ambulantno liječenje i rijetke komplikacije. No postoje bolesnici i stanja kod kojih zahvat nije moguće učiniti u lokalnoj anesteziji. Svrha je ovoga rada utvrditi indikacije i komplikacije opće anestezije u stomatoloških bolesnika. Materijali i metode. Analizirano je 864 bolesnika u razdoblju od godine 2001. - 2004. u KB “Dubrava” u kojih je učinjen stomatološki zahvat. U preoperativnoj pripremi bolesnicima su potrebni laboratorijski nalazi, EKG, anamneza te pedijatrijski ili internistički pregled. Premedicirani su atropinom i midazolamom intramuskularno, a vrsta anestezije je određena prema vrsti zahvata, dobi i općem bolesnikovu stanju. Rezultati. Analizirano je 864 bolesnika u razdoblju od godine 2001. 2004. u KB “Dubrava” u kojih je učinjen operativni zahvat. Indikacije za opću anesteziju bila su djeca, duševno zaostale osobe i osobe s upalom mekih tkiva usne šupljine. Ekstrakcije zuba rađene su u inhalacijskoj anesteziji na masku (692), a bolesnici s višestrukim popravcima zuba bili su intubirani (172).Tijekom anestezije mjeren je krvni tlak, EKG, periferna saturacija kisikom i koncentracija CO2. Bolesnici su postoperativno praćeni 6 sati i nakon toga otpušteni kući ako nisu imali komplikacija. Komplikacije su bile rijetke: laringo i bronhospazam u 3 bolesnika, aritmije u 5, mučnina i povraćanje u 6, a postoperacijske ekscitacije pojavile su se u 3 bolesnika. Zaključak. Djeca i duševno zaostale osobe bile su najčešće indikacije za opću anesteziju u stomatologiji. Komplikacije su se pojavile u 17 bolesnika (1,8 %), što je prihvatljiv rizik za tu vrstu zahvata.Introduction. The majority of dental procedures are carried out under local anaesthesia (90%). Reasons for this are the simple preparation of the patient, out-patient treatment and rare complications. However, there are patients and conditions for which such procedures are impossible to perform under local anaesthesia. Aim. The aim of this study was to determine the indications and complications of general anaesthesia in dental patients. Materials and methods. We analysed 864 patients during a period from 2001 to 2004 in the University Hospital Dubrava, in whom dental operations were performed. In preoperative preparation patients require laboratory findings, ECG, case history and paediatric or internist examination. They are premedicated with atropine and midazola intramuscularly, and the type of anaesthesia determined according to the type of operation, age and general condition of the patient. Results. During the period from 2001 to 2004 864 patients were analysed in the University Hospital Dubrava, in whom an operation was performed. Indications for general anaesthesia were children, mentally retarded persons and those with inflamed soft tissues of the oral cavity. Teeth extractions were performed under inhalation anaesthesia on a mask (692), and patients with multiple dental repairs were intubated (172). During anaesthesia blood pressure, ECG, peripheral saturation with oxygen and CO2 concentration was measured. The patients were monitored for 6 hours after the operation, after which they were released from hospital if there were no complications. Complications were rare: laryngo and bronchospasm in 3 patients, arrhythmia in 5, nausea and vomiting in 6, and postoperational excitation occurred in 3 patients. Conclusion. Children and mentally retarded persons were the most frequent indications for general anaesthesia in dental medicine. Complications occurred in 17 patients (1.8%) which is an acceptable risk for this type of operation

Specificities of anesthesia in bariatic surgery

Kirurgija pretilosti je jedna od najučinkovitijih metoda u liječenju patološke pretilosti. Ti bolesnici zbog različitih anatomskih i fizioloških promjena uzrokovanih debljinom i pridruženim bolestima predstavljaju poseban izazov za anesteziologe. U ovom preglednom članku dajemo kratak pregled sadašnjih znanja vezanih uz pretilost i perioperacijsko vođenje bolesnika predviđenih za barijatričke operacijske zahvate.Bariatric surgery is one of the most effective methods for treating patients with morbid obesity. Obese patients present challenge for the anaesthesiologist because of the various anatomic and physiological changes related to obesity and associated comorbid diseases. In this review we give a brief overview of current knowledge related to obesity and perioperative management of patients scheduled for bariatric surgery

Specificities of anesthesia in bariatic surgery

Kirurgija pretilosti je jedna od najučinkovitijih metoda u liječenju patološke pretilosti. Ti bolesnici zbog različitih anatomskih i fizioloških promjena uzrokovanih debljinom i pridruženim bolestima predstavljaju poseban izazov za anesteziologe. U ovom preglednom članku dajemo kratak pregled sadašnjih znanja vezanih uz pretilost i perioperacijsko vođenje bolesnika predviđenih za barijatričke operacijske zahvate.Bariatric surgery is one of the most effective methods for treating patients with morbid obesity. Obese patients present challenge for the anaesthesiologist because of the various anatomic and physiological changes related to obesity and associated comorbid diseases. In this review we give a brief overview of current knowledge related to obesity and perioperative management of patients scheduled for bariatric surgery

Lung ultrasonography for early detection of extravascular lung water overload in intensive care patients early afer surgery: a preliminary study

Aim. To investigate whether lung ultrasound can be used to detect extravascular lung water overload in the intensive care unit early afer surgery. Methods. Tis prospective study involved 60 patients without known cardiac or pulmonary diseases admitted to the intensive care unit at our Hospital afer elective abdominal or vascular surgery. PaO2/FiO2 ratio, and appearance of B-lines were determined upon admission to the intensive care unit and at 6, 12, and 24 h later. Fluid overload was defned as the presence of Blines ≤7 mm. Tissue oxygenation impairment was defned as a PaO2/FiO2 ratio < 200. Results. Fluid overload was detected in 42 patients (70%). Te dense B-lines predicted fuid overload around the same time as drop of PaO2/FiO2 ratio (p = 0.115). Appearance of dense B lines correlated strongly with PaO2/FiO2 ratio (p < 0.001). Conclusion. Our preliminary results suggest that lung ultrasonography may be a promising non-invasive method for early detection of extravascular lung water overload in spontaneous breathing intensive care patients soon afer surgery. Our fndings should be verifed in larger studies

Local or spinal anesthesia in acute knee surgery [Bol pri kirurškoj artroskopiji koljena kod lokalne versus spinalne anestezije]

The aim of the study was to assess the efficacy, safety and complications of two anesthetic techniques including local and spinal anesthesia. A total of 436 patients received local (LA group=250) or spinal (SA group=186) anesthesia during a year period. SA group received 0.5% Bupivacaine 5 mg/mL. LA group received portal injection (5 mL lidocaine 2% with adrenaline) and intra-articular injection into the knee (10 mL lidocaine 2% with adrenaline). The following parameters were assessed: intraoperative pain (10 cm VAS: 0=no pain, 10=extreme pain), surgical operating conditions, patient satisfaction score (1=very satisfied, 4=very unsatisfied), postoperative analgesia, and time to discharge. In LA group, 97.6% (244/250) of patients experienced no pain throughout the procedure. Only six (2.4%) patients required conversion to general anesthesia. In SA group, two patients required conversion to general anesthesia. In both groups, 93.6% of patients were either satisfied or very satisfied with their anesthesia. The need of postoperative analgesics was higher in SA compared with LA group (p=0.001). The mean postoperative stay was significantly shorter in LA than in SA group (p=0.001). Ninety-four percent of LA and only 68% of SA patients were discharged from the hospital within 2 hours of the procedure. The rate of complications differed significantly between LA and SA groups (p=0.037). Outpatient arthroscopy of the knee under local anesthesia is a simple, reliable, and safe alternative to spinal anesthesia, for patients in whom intraarticular disorders requiring diagnostic arthroscopy and arthroscopic surgery

PARANEOPLASTIC LIMBIC ENCEPHALITIS

Paraneoplastički limbički encefalitis (PLE) je stanje karakterizirano oštećenjem ili disfunkcijom središnjeg živčanog sustava bez znakova izravne zahvaćenosti živčanog sustava tumorskim stanicama. Budući da se klinički očituje čitavim nizom neuropsihijatrijskih simptoma koji najčešće prethode pojavi maligne bolesti ponekad je vrlo teško postaviti dijagnozu, a zbog oponašanja psihijatrijske bolesti postoji mogućnost da se maligna bolest i previdi. Iako se radi o relativno rijetkom neurološkom poremećaju, upravo zbog povezanosti s malignom bolešću i teškoći u postavljanju dijagnoze u ovom ćemo članku dati kratki pregled literature i sažeti sadašnja znanja o paraneoplastičkom limbičkom encefalitisu.Paraneoplastic limbic encephalitis (PLE) is a condition characterized by nervous system damage or dysfunction without indication that the nervous system is directly affected by tumor cells. Since it is clinically presented with an array of neuropsychiatric symptoms that usually precede the occurrence of malignant disease; and because of mimicking a psychiatric disease; it can sometimes make the diagnosis difficult and can be overlooked. Typical presentations consist of progressive confusion and deficits in short-term memory; which worsen over days to weeks. The current hypothesis on the pathogenesis of PLE implicates an autoimmune process involving antigens shared by tumor cells and neuronal cells in limbic structures. It has been considered that the autoantibodies cross-react with antigens on normal cells such as the neurons; resulting in cytotoxicity; or they can form complexes with a circulating antigen to induce organ damage through immune complex deposition. The treatment of PLE involves underlying cancer removal by surgery; chemotherapy; radiotherapy or hormonal treatment; and immunosuppressive therapy. Unfortunately; this therapy combination is still generally unsatisfactory. Although PLE is a relatively rare neurologic disorder; because of its association with malignancies and difficulty in diagnosing; this article gives a brief review of the literature and summarizes current knowledge of this syndrome

Intraoperative ventilator settings and their association with postoperative pulmonary complications in neurosurgical patients: post-hoc analysis of LAS VEGAS study

Background: Limited information is available regarding intraoperative ventilator settings and the incidence of postoperative pulmonary complications (PPCs) in patients undergoing neurosurgical procedures. The aim of this post-hoc analysis of the 'Multicentre Local ASsessment of VEntilatory management during General Anaesthesia for Surgery' (LAS VEGAS) study was to examine the ventilator settings of patients undergoing neurosurgical procedures, and to explore the association between perioperative variables and the development of PPCs in neurosurgical patients. Methods: Post-hoc analysis of LAS VEGAS study, restricted to patients undergoing neurosurgery. Patients were stratified into groups based on the type of surgery (brain and spine), the occurrence of PPCs and the assess respiratory risk in surgical patients in Catalonia (ARISCAT) score risk for PPCs. Results: Seven hundred eighty-four patients were included in the analysis; 408 patients (52%) underwent spine surgery and 376 patients (48%) brain surgery. Median tidal volume (VT) was 8 ml [Interquartile Range, IQR = 7.3-9] per predicted body weight; median positive end-expiratory pressure (PEEP) was 5 [3 to 5] cmH20. Planned recruitment manoeuvres were used in the 6.9% of patients. No differences in ventilator settings were found among the sub-groups. PPCs occurred in 81 patients (10.3%). Duration of anaesthesia (odds ratio, 1.295 [95% confidence interval 1.067 to 1.572]; p = 0.009) and higher age for the brain group (odds ratio, 0.000 [0.000 to 0.189]; p = 0.031), but not intraoperative ventilator settings were independently associated with development of PPCs. Conclusions: Neurosurgical patients are ventilated with low VT and low PEEP, while recruitment manoeuvres are seldom applied. Intraoperative ventilator settings are not associated with PPCs