The Effect of Propofol and Fentanyl as Compared with Sevoflurane on Postoperative Vomiting in Children after Adenotonsillectomy

Postoperative vomiting (PV) after adenotonsillectomy in children is a common problem with an incidence as high as 40–80%. Only few studies in the recent literature compared the effect of different anesthetic techniques concerning PV in children. The aim of this study was to compare the incidence of PV in two groups of children who underwent two different general anesthesia techniques in order to determine what type of anesthetic technique is more related to less PV. The clinical trial included 50 children (physical status ASA I, 3–12 years old) divided into 2 groups and monitored for PV 24 hours following the surgery. Group one (G1) consisted of 25 children who underwent general anesthesia with gas mixture 60% nitrous oxide and 40% oxygen and anesthetic propofol, opioid fentanyl and muscle relaxant vecuronium intravenously and group two (G2) included 25 children to whom volatile anesthesia with sevoflurane in the same gas mixture was given. Demographic characteristics (gender, age, weight, history of motion sickness and earlier PV) as well as surgical data (length of surgery and anesthesia, intraoperative blood loss) were recorded. There were no significant differences considering demographic characteristics and surgical data between the investigated groups. The incidence of PV was relatively low 3 children (12%) in G1 group and 5 children (20%) in G2 group. Statistically there was no significant difference between the groups regarding the incidence of PV and both anesthetic techniques can be used equally safe regarded to PV

Spinal Anesthesia at the L2–3 and L3–4 Levels: Comparison of Analgesia and Hemodynamic Response

Aim of this study was to evaluate level of analgesia and hemodynamic response to spinal anesthesia obtained by administering 15 mg 0.5% isobaric bupivacaine at L2–3 vs. L3–4 interspace for inguinal herniorrhaphy, since studies comparing analgesia and hemodynamic response at the L2–3 vs. L3–4 interspaces are lacking. In a prospective, randomized clinical study that encountered 72 patients undergoing elective inguinal herniorrhaphy randomly allocated in to two equal groups L2–3 (N=36) and L3–4 (N=36) according to lumbar interspace where intrathecal injection of bupivacaine was administered. Analgesia was evaluated by intraoperative »rescue« fentanyl requirements, the absence of pain and the maximal visual analogue scale (VAS) scores reached per patient during the operation. The severity of intraoperative pain was quantified by a 10 cm VAS scale (VAS 0: no pain to 10: worst pain imaginable) every 5 minutes after skin incision until the end of the operation. VAS>3 was treated with intravenous fentanyl 25 μg. Hemodynamic response was monitored and evaluated, heart rate was continuously monitored as well as, baseline systolic, diastolic and mean arterial pressure prior to induction and every 5 minute after applying spinal anesthesia until surgical completion. Intraoperative fentanyl requirements were significantly higher in group L3–4 (L2–3 0%, 97.5% confidence interval [CI] 0.0–0.11 vs. L3–4 17%, 95% CI 0.07–0.32, p=0.025). Absence of pain was significantly higher in L2–3 group at the beginning of the operation (L2–3 89%, 95% CI 0.74–0.96 vs. L3–4 67%, 95% CI 0.50–0.79, p=0.047). The maximal VAS scores reached per patient during the operation in L2–3 group were lower then in L3–4 group (L2–3 median [M] 0, range [R] 0–3, L3–4 M 0, R 0–8, p=0.014). There were no significant differences (p>0.05) in the incidence of hypotension (L2–3 19%, 95% CI 0.09–0.35 vs. L3–4 17%, 95% CI 0.07–0.32) and bradycardia (L2–3 19%, 95% CI 0.09–0.35 vs. L3–4 8%, 95% CI 0.02–0.23). Spinal anesthesia with isobaric bupivacaine administered in L2–3 interspace for inguinal herniorrhaphy provides superior analgesia and equal hemodynamic stability as compared to neuroaxial anesthesia administered in the L3–4 interspace

Effects of high intraoperative inspired oxygen on postoperative nausea and vomiting in gynecologic laparoscopic surgery

Study objective: To assess the efficacy of intraoperative different inspired oxygen fractions (FIO2) of 0.8 and 0.5 when compared with standard FIO2 0.3 in prevention of postoperative nausea and vomiting (PONV). Design: A prospective, controlled, randomized, double-blind study. Setting: General hospital, postanesthesia care unit (PACU) and gynecologic floor room. Patients: 120 ASA physical status I and II women, aged 21 to 76 y, undergoing elective gynecologic laparoscopic surgery. Interventions: Patients were randomized to receive gas mixture of 30% oxygen in air (FI O2=0.3, group G30), 50% oxygen in air (FIO2=0.5, group G50) or 80% oxygen in air (FIO2=0.8, group G80), n=36 in each group. A standardized sevoflurane general anesthesia, postoperative pain management and antiemetic regimen were used. Measurements: The incidence of nausea, vomiting or both was assessed for early (0-2h) and late PONV (2-24h) along with the use of rescue antiemetic, degree of nausea and severity of pain. Main results: There was no overall difference in the incidence of PONV at early and late assessment periods among the three groups. Patients in G80 had significantly less vomiting than G30 at 2 hours, 3% (1/36) vs. 22% (8/36), respectively, P=0.028. Nausea scores, rescue antiemetic use, pain scores and opioid consumption were not different among the groups. Conclusion: High intraoperative FIO2 of 0.8 and FIO2 of 0.5 does not prevent PONV in patients without antiemetic prophylaxis. Intraoperative FIO2 of 0.8 has beneficial effect on early vomiting only

The effect of propofol and fentanyl as compared with sevoflurane on postoperative vomiting in children after adenotonsillectomy

Postoperative vomiting (PV) after adenotonsillectomy in children is a common problem with an incidence as high as 40-80%. Only few studies in the recent literature compared the effect of different anesthetic techniques concerning PV in children. The aim of this study was to compare the incidence of PV in two groups of children who underwent two different general anesthesia techniques in order to determine what type of anesthetic technique is more related to less PV. The clinical trial included 50 children (physical status ASA I, 3-12 years old) divided into 2 groups and monitored for PV 24 hours following the surgery. Group one (G1) consisted of 25 children who underwent general anesthesia with gas mixture 60% nitrous oxide and 40% oxygen and anesthetic propofol, opioid fentanyl and muscle relaxant vecuronium intravenously and group two (G2) included 25 children to whom volatile anesthesia with sevoflurane in the same gas mixture was given. Demographic characteristics (gender, age, weight, history of motion sickness and earlier PV) as well as surgical data (length of surgery and anesthesia, intraoperative blood loss) were recorded. There were no significant differences considering demographic characteristics and surgical data between the investigated groups. The incidence of PV was relatively low 3 children (12%) in G1 group and 5 children (20%) in G2 group. Statistically there was no significant difference between the groups regarding the incidence of PV and both anesthetic techniques can be used equally safe regarded to PV

WORD RECOGNITION TEST AFTER GENERAL ANESTHESIA: THE INFLUENCE OF PREVIOUS ANESTHESIA

Opća anestezija utje.e na pam.enje. U ovoj smo studiji istraživali prepoznavanje riječi prije i poslije opće anestezije, uspoređujući pacijente sa višestrukim anestezijama i pacijente kojima je to bila prva anestezija. U ispitivanje su uključeni samo pacijenti ASA I ili II prosječne dobi od 50 godina, najmanje srednje stručne spreme. Ukupno 51 ispitanik bio je podijeljen u dvije različite skupine. Prva je obuhvaćala pacijente koji nikada prije nisu bili pod anestezijom, dok se druga sastojala od pacijenata koji su barem jednom u životu bili pod anestezijom. Svi su primili iv midazolam 2-3 mg, tiopental 5 mg/kg, fentanil 2 Ęg/kg i pankuronium 0,1 mg/kg. Ventilirani su mehanički mješavinom kisika i dušičnog oksidula u omjeru 70:30. Kao inhalacijski anestetik koristilo se isofluran 0,5-1%. Pacijenti obih skupina testirani su u dva navrata. Za statističku analizu koristio se Ô2 test (1). Razlike u to.nom prepoznavanju ključnih riječi prije i poslije opće anestezije u obje skupine nisu bile statistički značajne. Mnoge studije navode da su anestezija i kirurški zahvati povezani s umanjenjem kognitivnih sposobnosti što u 10%-14% starijih pacijenata traje .3 mjeseca. Autori zaključuju da prijašnja anestezija zajedno s ovom konkretnom anestezijom ne utječe na rezultat testa prepoznavanja riječi.Among other higher brain functions such as consciousness and learning, general anesthesia also affects memory. A number of information retrieval tests are performed to determine the effects of drugs on explicit memory. In this study, we investigated the recognition of words before and after general anesthesia in subjects having and not having received anesthesia on one or more occasions before the present one. The study included 51 patients, ASA physical status I or II, median age 50, at least high-school graduates, without head trauma, known psychiatric or memory disorder, and taking no psychoactive medication. A standardized anesthesia technique, a single surgical procedure and a defined study-test interval were used. We designed our own test as a combination of story recall test and brief word learning test, both widely used in psychological and psychiatric examination. There was no significant difference in word recognition before and after general anesthesia in either patient group. Many studies indicate that anesthesia and surgery are associated with cognitive impairment lasting for ³3 months in 10%-14% of elderly patients. We hypothesized that general anesthetics can cause prolonged cognitive alterations. Study results showed that previous anesthesia in addition to the current one had no significant influence on the word recognition test

The Effect of Propofol and Fentanyl as Compared with Sevoflurane on Postoperative Vomiting in Children after Adenotonsillectomy

A B S T R A C T Postoperative vomiting (PV) after adenotonsillectomy in children is a common problem with an incidence as high a

Analysis of the In Vitro Secretory Activity of Human Pituitary Adenomas: Modification of Corticotropin Release from Adenoma Tissue Explant Cultures by Addition of a Human Plasma Ultrafiltrate Bioactive Fraction

Peer Reviewe

A new gastric juice peptide, BPC - an overview of stomach (stress) organoprotection hypothesis and BPC befitial effects

The possibility that the stomach affected by general stress pathology initiates a conteracting response has not been considered in the stress theory until recently. In this, the stomach as the most sensitive part of gastrointestinal tract, the largest neuroendocrine organ in the body, has been suggested to be a crutial point, from where a full stress response against all noxius stress pathology could be purposefully initiated, mediated and organized. The end result would be a strong protection of all organs invaded by "stress". Consistent with this assumption, this coping response is best explained in terms of "organoprotection" and endogenous organoprotectors (e.g. prostaglandins, somatostatin, dopamine) are proposed as mediators. Such an endogenous counteraction could even be afforded by their suitable application. According to this concept, a new gastric juice peptide, M.W. 40, 000, named BPC, was recently isolated. In this, a 15 amino acid fragment (BPC 157) tought to be essential for this activity was fully characterized and effectively investigated. As it had previously been demonstrated for many organoprotective agents using different models of various tissue lesions, despite the poorly understood final mechanism, practically all organ systems appear to be included into BPC beneficial activity. Relative to the reference standards, these effects have been achieved in many species using very low dosages (mostly ug and ng/kg range) after intraperitoneal, intragastrical as well as intramucosal (local) application. The effect was obvious already after one application. A long lasting activity was also demonstrated. Likewise, it was highly efficacious when applied in many experiments simultaneously with noxious agent or in the already established damage conditions, as well as chronically during a prolonged period. Therefore, it seems that BPC treatment does not share any of the so far known limitations for "conventional organoprotectors". No influence on different basal parameters and no toxicity were observed. Thus, whether these findings would provide a purposeful breakthrough into the stress thepry and whether BPC, as a likely endogenous free radical scavenger and organoprotection mediator, would be a useful prototype of a new class of drugs, organoprotective agents, remains to be seen