Regional Anaesthesia versus General Anaesthesia in Endovascular Aneurysm Repair: The Surgical Nursing Interventions

Minimally invasive surgical techniques are a revolutionary and innovative approach to the practice of surgery. Endovascular aneurysm repair (EVAR) may offer a number of significant advantages in comparison with conventional open surgical repair. The purpose of this study was to compare regional anaesthesia (RA) and general anaesthesia (GA) in EVAR, and to describe the surgical nursing interventions. This included a retrospective analysis of 160 consecutive patients (age 55 to 96 years) who underwent EVAR under: epidural anaesthesia (EDA = 60 patients), combined spinal and epidural anaesthesia (Combined = 40 patients) and GA = 60 patients. Results were successful in all patients and no mortality was noticed. Among the GA group, 11 patients needed ICU support while only 5 from the other 2 groups. Furthermore, a statistically significant difference regarding median hospital stay was also noticed in favour of the regional group. In conclusion, RA is a safe and effective anaesthetic method for endovascular repair of abdominal aneurysms, offering several advantages including simplicity, haemodynamic stability, less need for ICU management and reduced hospital stay. The anaesthetic nurse can play a major role in the management of this anaesthesia throughout the procedure

Effects of the Enhanced Recovery Program on the Recovery and Stress Response in Patients with Cancer Undergoing Pancreatoduodenectomy

Aim the study was the comparison of enhanced recovery after surgery (ERAS) versus conventional care (CON) protocols in patients undergoing pancreatoduodenectomy with regard to pain intensity, emotional response (optimism/sadness/stress), and stress biomarker levels (adrenocorticotropopic hormone, cortisol). We conducted a prospective two-group randomized controlled study with repeated measures in 85 patients with cancer pancreatoduodenectomy. In the ERAS group (N = 44), the ERAS protocol was followed, compared with the CON group (N = 41). We assessed pain with the numeric rating scale and a behavioral scale (Critical Care Pain Observation Tool), emotional responses (numeric rating scale), and serum adrenocorticotropopic hormone and cortisol levels at three time points: T1, admission day; T2, day of surgery; and T3, discharge day (ERAS) or the fifth day of stay (CON). Data were analyzed by linear mixed modeling to account for repeated measurements. We observed decreased postoperative pain in ERAS patients after adjusting for confounders (p =.002) and a trend for less complications. No significant associations with stress/emotional responses were noted. Only age, but not protocol, appeared to have a significant effect on adrenocorticotropopic hormone levels despite a significant interaction with time toward increased adrenocorticotropopic hormone levels in the ERAS group. In conclusion, despite its fast track nature, ERAS is not associated with increased stress in patients undergoing pancreatoduodenectomy and is associated with decreased pain