Effects of combined general anesthesia and thoracic epidural analgesia on cytokine response in patients undergoing laparoscopic cholecystectomy

Background: Severe postoperative pain is not often experienced in laparoscopic cholecystectomy. Anesthesia, surgery, and pain are stressful and cause different reactions in neuro‑immuno‑endocrine systems. Many factors such as the pharmacological effect of the drugs used, as well as the type and depth of anesthesia, can affect these reactions.Objective: The aim of this study was to evaluate the effect of the combination of general anesthesia and thoracic epidural analgesia (TEA) on cytokine reaction in laparoscopic cholecystectomy.Study Design: Prospective, randomized clinical comparative study.Materials and Methods: Sixty adult patients scheduled for elective laparoscopic cholecystectomy were divided into four groups. Group saline (Group S), group fentanyl (Group F), group bupivacaine (Group B), and group levobupivacaine (Group L) were infused with saline, saline and fentanyl, bupivacaine and fentanyl, and levobupivacaine and fentanyl, respectively, via epidural catheter before surgical incision.Results: There were no differences among groups in the demographic features, heart rate, mean arterial pressure, and peripheral oxygen saturation values. Group L had lower visual analogue scale value compared to the other postoperative groups (P < 0.01). In all groups, interleukin‑6 (IL‑6), IL‑8, and IL‑10 levels started to increase at 2 h and returned to the basal level at 24 h. IL levels increased in most of the epidural saline‑administered group compared to other groups (P < 0.05).Conclusion: Combined general anesthesia and TEA provided pain control and hemodynamic stability more efficiently during the first 24 h of the intraoperative and postoperative period by suppressing cytokine levels. However, we determined that this effect was more obvious with the local anesthetic and opioid combination.Keywords: Bupivacaine, combined‑general‑epidural anesthesia, inflammatory cytokines, laparoscopic cholecystectomy, levobupivacain

Effects of user experience and method in the inflation of endotracheal tube pilot balloon on cuff pressure

Context: Endotracheal tube cuff pressure (ETCP) is recommended to be maintained between 20.30 cmH2O limits. While insufficient inflation of ETC may cause aspirations, over.inflation of it may lead to damage in tracheal epithelium.Aims: We planned to investigate the effects of user experience and cuff pressure inflation method differences following endotracheal tube cuff pressure and complaints about it.Patients and Methods: Two hundred and fifty patients planned for general anaesthesia were included in this study. ETC was inflated by users with different experience according to leakage or pilot balloon palpation techniques. ETCPs were measured by manometer at three periods (5 and 60 minutes after endotracheal intubation, and before extubation). Complaints about it were recorded in post anaesthetic care unit and 24 hours postoperatively.Results: Though we found experience of user had significant effect on the ETCP regulations, we observed inflation methods did not have any effect. However we found ETCP was higher than normal range with experienced users. A correlation was observed between cuff pressure and anaesthesia duration with postoperative complaints.Conclusions: Our study concluded that the methods used do not have any significant advantage over one another. While ETC inflated at normal pressure increases as userfs experience increases, experience alone is not enough in adjusting ETCP. A manometer should be used in routine inflation of ETC instead of conventional methods. CP and anaesthesia duration have correlations with some postoperative complaints.Key words: Endotracheal tube cuff pressure, experience of user, inflation method

Comparison of anaesthetic cost in open and laparoscopic appendectomy

Context: Appendectomy is generally conducted as open or by laparoscopic surgical techniques under general anesthesia.Aims: This study aims to compare the anesthetic costs of the patients, who underwent open or laparoscopicappendectomy under general anesthesia.Settings and Design: The design is retrospective and records of 379 patients who underwent open or laparoscopicappendectomy under general anesthesia, falling under the category of I‑III risk group according to the American Societyof Anesthesiologists (ASA) classification between the years 2011 and 2013, and aged 18-77.Subjects and Methods: Open (Group I) or laparoscopic (Group II) appendectomy operation under general anesthesiawere evaluated retrospectively by utilizing hospital automation and anesthesia observation records. This study evaluatedthe anesthesia time of the patients and total costs (Turkish Lira ₺, US dollar $) of anesthetic agents used (induction,maintenance), necessary medical materials (connecting line, endotracheal tube, airway, humidifier, branule, aspirationprobe), and intravenously administered fluids were evaluated.Statistical Analysis Used: We used Statistical Package for the Social Sciences software (SPSS version 17.0) forstatistical analysis.Results: Of the patients, 237 were males (62.53$) in Group I and 83.09 ± 26.85₺ (41.29 ± 13.34$) inGroup II (P > 0.05). A correlation was observed between cost and operation times (P = 0.002, r = 0.158).Conclusions: Although a statistical difference was not established in this study in terms of time and costs inappendectomy operations conducted as open and laparoscopically, changes may occur in time in market conditionsof drugs, patent rights, legal regulations, and prices. Therefore, we believe that it would be beneficial to update andrevise cost analyses from time to time.Keywords: Cost, cost comparison laparoscopic appendectomy, open appendectom