Spinal Anesthesia Versus General Anesthesia for Elective Lumbar Spine Surgery: A Randomized Clinical Trial

BACKGROUND Either general or regional anesthesia can be used for lumbar disk surgery. The common anesthetic technique is general anesthesia (GA). The aim of this study was to compare the intra and postoperative outcomes of spinal anesthesia (SA) with GA in these patients. METHOD: Seventy-two patients were enrolled in the study. They were randomized into two groups with 37 patients in GA Group and 35 ones in SA Group. The heart rate (HR), mean arterial pressure (MAP), blood loss, surgeons satisfaction with the operating conditions, the severity of postoperative pain based on visual analogue scale (VAS) and analgesic use were recorded. RESULTS: The mean blood loss was significantly less in the SA Group compared to GA Group (p < 0.05). Intraoperative maximum blood pressure and heart rate changes were significantly less in SA Group (p < 0.05). The surgeons satisfaction was significantly more in the SA Group (p < 0.05). The number of patients who used postoperative analgesic as well as postoperative mean VAS was significantly less in SA Group in comparison with GA group (p < 0.05 for both CONCLUSIONS: Our study showed that SA was superior to GA in providing postoperative analgesia and decreasing blood loss while maintained better perioperative hemodynamic stability without increasing adverse side effects. KEYWORDS: Anesthesia, General, Spinal, Lumbar Surgery DOI: 10.7176/JHMN/88-04 Publication date: April 30th 202

Comparison of the Effects of Target-Controlled Propofol Infusion and General Anesthesia with Isoflurane on Postoperative Cognitive Functions in Controlled Hypotensive Anesthesia

Background/aim: We evaluated anesthesia depth, cerebral oxygenation and postoperative cognitive functions with NIRS and BIS monitoring and Mini-Mental State Examination (MMSE) score.Materials and methods: We studied 60 patients in Al –zahra teaching hospital over 18 years of age, with a preoperative MMSE test score of 23 and above. Hemodynamic parameters, BIS and bilateral NIRS values were recorded. The mean arterial pressure (MAP) value was kept between 55-65 mmHg. MMSE test was repeated 1 hour before and 24 hours postoperatively.Results: The extubation time was shorter. Aldrete recovery score and NIRS values were was higher and blood pressure and heart rate values were lower in the desflurane group. There was a moderate positive correlation between blood pressure values and NIRS in a certain part of the operation in the isoflurane group. In the propofol group, 5 patients had a more than 20% decrease in rSO2. In MMSE test score, there was no decrease in both groups in the preoperative and postoperative period.Conclusion: We think that, the isoflurane group be preferred as a priority with less remifentanil expenditure, lower blood pressure values, higher rSO2 values, no 20% decrease in rSO2 values, faster extubation, and statistically significant early recovery.Bispectral index, isoflurane, Controlled hypotension, Near-infrared spectroscopy, Postoperative cognitive dysfunction, Propofol, Mini mental scoreion DOI: 10.7176/JHMN/95-04 Publication date: November 30th 2021

A Prospective Randomised Double Blind Study of Intrathecal Fentanyl and Dexmedetomidine Added to Low Dose Bupivacaine for Spinal Anesthesia for Lower Abdominal Surgeries

Background and Aims.The potentiating effect of short acting lipophilic opioid fentanyl and a more selective α2 agonist dexmedetomidine is used to reduce the dose requirement of bupivacaine and its adverse effects and also to prolong analgesia. In this study, we aimed to find out whether quality of anaesthesia is better with low dose bupivacaine and fentanyl or with low dose bupivacaine and dexmedetomidineMethods.This prospective randomised double-blinded study was carried out in a AL-Zahra teaching Hospital a 150 patients by randomly allocating them into two groups using a computer generated randomisation table. Group F (n = 75) received bupivacaine 0.5% heavy (0.8 ml)+fentanyl 25 μg (0.5 ml) + normal saline 0.3 ml and Group D (n = 75) received bupivacaine 0.5% heavy (0.8 ml) + dexmedetomidine 5 μg (0.05 ml) + normal saline 0.75 ml, aiming for a final concentration of 0.25% of bupivacaine (1.6 ml), administered intrathecally. Time to reach sensory blockade to T10 segment, peak sensory block level (PSBL), time to reach peak block, time to two segment regression (TTSR), the degree of motor block, side-effects, and the perioperative analgesic requirements were assessed.Results.there were no significant differences between the groups in the time to reach T10 segment block (P > 0.05) and TTSR (P > 0.05);time to reach PSBL (P < 0.05) and modified Bromage scales (P < 0.05) were significant. PSBL (P = 0.000) and time to first analgesic request (P = 0.000) were highly significant. All patients were haemodynamically stable and no significant difference in adverse effects was observed.Conclusion .Both groups provided adequate anaesthesia for all lower abdominal surgeries with haemodynamic stability. Dexmedetomidine is superior to fentanyl since it facilitates the spread of the block and offers longer post-operative analgesic duration. Keywords: Dexmedetomidine, fentanyl, low dose bupivacaine, opioids, spinal anaesthesia DOI: 10.7176/JHMN/90-09 Publication date:June 30th 202