20 Jun 12
By P Hayden and S Cowman
Contin Educ Anaesth Crit Care Pain 2011;11:177-180
Laparoscopic techniques offer major benefits to the patient such as minimized incision size and trauma with reduced postoperative discomfort, shortened recovery rates, and a lower incidence of postoperative wound infections. These factors all contribute to shorter in-patient stay and reduced perioperative morbidity. Consequently, many major procedures that once required prolonged postoperative recovery such as anterior resection of the rectum or radical cystectomy are now increasingly performed using laparoscopic techniques to improve patient outcomes.1
However, laparoscopic surgery is not without its own specific risks, either due to the risks associated with individual laparoscopic techniques or due to the physiological changes associated with the creation of a pneumoperitoneum. As a result, anaesthetic techniques for laparoscopic surgery must be refined to anticipate these differences from open surgery.
19 Jun 12
By T Tan, R Bhinder, M Carey, L Briggs
Anesth Analg 2010;111:83-85
There have been recent studies suggesting that patients anesthetized with propofol have less postoperative pain compared with patients anesthetized with volatile anesthetics.
In this randomized, double-blind study, 80 patients undergoing day-case diagnostic laparoscopic gynecological surgery were either anesthetized with IV propofol or sevoflurane. The primary outcome measured was pain on a visual analog scale.
Patients anesthetized with propofol had less pain compared with patients anesthetized with sevoflurane (P = 0.01). There was no difference in any of the other measured clinical outcomes.
The patients anesthetized with propofol appeared to have less pain than patients anesthetized with sevoflurane.
30 Dec 11
By R Jokela, J Ahonen, M Tallgren, P Marjakangas, K Korttila
Anesth Analg 2009;109:607-615
Apart from being antiemetic, glucocorticoids have an analgesic property. The optimal dose of dexamethasone in the management of pain after surgery has not been established. In this placebo-controlled, dose-finding study, we evaluated the analgesic effect of three doses of dexamethasone after laparoscopic hysterectomy.
We randomized 129 women scheduled for laparoscopic hysterectomy to receive placebo, dexamethasone 5 mg (D5), 10 mg (D10), or 15 mg (D15) IV before the induction of anesthesia. The patients were anesthetized with propofol and remifentanil in a standardized manner. Until the first postoperative morning, postoperative pain was managed with IV oxycodone using patient-controlled analgesia. The visual analog scale scores for pain and side effects, and the amounts of the analgesics were recorded for 3 days after surgery.
The total dose of oxycodone (0–24 h after surgery) was smaller in the D15 (0.34 mg/kg [0.11–0.87]) group than in the placebo group (0.55 mg/kg [0.19–1.13]) (P = 0.003). The doses of oxycodone during Hours 0–2 after surgery were smaller in the D10 (0.17 mg/kg [0.03–0.36]) and D15 (0.17 mg/kg [0.03–0.35]) groups than in the placebo (0.26 mg/kg [0.10–0.48]) (P = 0.001, D10 versus placebo; P < 0.001, D15 versus placebo) group. During Hours 2–24 after surgery, however, the doses of oxycodone were equal in the placebo, D5, D10, and D15 groups (0.31 mg/kg [0.03–0.78], 0.22 mg/kg [0.03–0.92], 0.24 mg/kg [0.05–0.87], and 0.20 mg/kg [0–0.65], respectively). The visual analog scale scores for pain at rest, in motion, or at cough did not differ in the study groups. The incidence of dizziness was lower in the D15 group than in the placebo group (P = 0.001), the D5 group (P = 0.006), and the D10 group (P = 0.030) during the first 24 h after surgery. During the later course of recovery, the incidence of dizziness did not differ among the four study groups.
IV dexamethasone 15 mg before induction of anesthesia decreases the oxycodone consumption during the first 24 h after laparoscopic hysterectomy. During first 2 h after surgery, dexamethasone 10 mg reduces the oxycodone consumption as effectively as the 15 mg dose.
29 Dec 11
By Mario R. Concha, V Mertz, L I Cortínez, K A González, J Butte
Anesth Analg 2009;109:114-118
Pulse wave analysis (PWA) allows cardiac output (CO) measurement after calibration by transpulmonary thermodilution. A PWA system that does not require previous calibration, the FloTrac/Vigileo (FTV), has been recently developed. We compared determinations of CO made with the FTV to simultaneous measurements using transesophageal echocardiography (TEE).
Ten ASA I-II patients scheduled for laparoscopic colorectal surgery were studied. A radial 20-gauge cannula was inserted and connected to a hemodynamic monitor and a FTV system for PWA and determination of CO (COPWA). TEE CO (COTEE) was determined as previously described. Measurements were made after intubation, 5 min after establishing the lithotomy position, 5 min after establishing pneumoperitoneum, every 30 min, or each time mean arterial blood pressure decreased below basal values. Statistical analysis was made with the Bland and Altman method.
Eighty-eight measurements were compared. The COTEE values ranged from 3.23 to 12 Lt/min (mean 6.21 ± 1.85). Values for COPWA ranged from 2.9 to 8.5 Lt/min (mean 4.84 ± 1.14). Bias was 1.17 and limits of agreement −2.02 and 4.37. The percentage error between all COTEE and COPWA measurements was 40% (27%-50%) mean (range).
During laparoscopic colon surgery, clinically important differences were observed between CO determinations made with TEE and FTV.