Efficacy of general anesthesia as compared to spinal anesthesia for patients undergoing ventral abdominal hernia repair, a randomized controlled trial.

Objective: To compare the use of general anesthesia with spinal anesthesia in patients undergoing ventral hernia repair. Study Design: Randomized Controlled Trial. Setting: Department of Anesthesia CMC Hospital @ SMBBMU Larkana. Period: January 2018 to December 2019. Material & Methods: We included patients above the age of 18 years, who presented with initial complaint of a ventral hernia, requiring surgical intervention. The exclusion criterion was all the patients with co-morbidities like malignancy, having a BMI score of greater than 35, having known allergies to anesthetic agents, and neurologic or neuromuscular diseases. A total of n=120 patients were included in the study and randomly divided into two groups. All the data including clinical parameters, drugs administered, and relevant side effects and complications were recorded in a pre-designed proforma. Results: The study population was n= 120 patients, the mean age was 45.5 +/- 15.5 years, there were n= 42 (35%) males and n= 78 (65%) females. There were no statistically significant differences among the two groups in terms of patient’s age, gender, blood pressures and heart rate. N= 54 (90%) of the patients belonging to the spinal anesthesia group had adequate anesthesia, the rest required administration of supplemental analgesic. None of the cases in the cohort had failure of the anesthetic technique. The postoperative visual analog scale scores at various time intervals (0, 2, 4 and 8 hours post procedure) were higher in the general anesthesia group versus spinal anesthesia group (p value of <0.05). Conclusion: Patients receiving spinal anesthesia had less incidence of post-operative nausea and required less analgesics, while patients receiving general anesthesia had more stable blood pressure profiles.

Intravenous Palonosetron for Attenuation of Hypotensive Response and Bradycardia during Spinal Anaesthesia

Aim: This study was conducted to evaluate the role of intravenous (IV) palonosetron during spinal anesthesia. Method: A total of 100 patients undergoing elective lower limb and lower abdominal surgeries were randomly divided into two groups. Group P was given 0.25mg palonosetron diluted in 10 ml normal saline slowly before spinal anesthesia. Group S was given 10 ml of normal saline slowly before spinal anesthesia. Heart rate (HR) , systolic blood pressure (SBP) , diastolic blood pressure (DBP) , mean arterial pressure (MAP), oxygen saturation (SpO2) were monitored at an interval of 2 minutes for the initial 20 minutes, then at an interval of every 5 minutes till the end of the surgery. Time to reach the maximum sensory level and its regression two levels below and then till S1 was noted. The incidence of nausea, vomiting, shivering, use of intravenous mephenteramine, level of motor block and its regression were also recorded. Results: Decreases in HR were more observed in Group S and the differences were statistically significant at 25 min [p=0.048] and 30 min [p=0.047]. The decrease in MAP were observed more in Group S and statistically significant difference noted at 20 min [ p = 0.026], 25 min [ p = 0.046] and at 30 min [ p = 0.047]. The use of intravenous mephentermine [p = 0.009] and development of nausea [p = 0.049] were significantly more common in Group S, Sensory block regression was faster in group P. [p=0.054]. Conclusion: Premedication with 0.25mg IV palonosetron before spinal anesthesia reduces hypotension, bradycardia.

The Effect of Anesthesia Type During Delivery on Neonatal Otoacoustic Emission Hearing Test Results: A Tertiary Center Experience

Background Hearing is essential for the healthy development of an infant as language is one of the main stimulants of intellectual capacity. We investigate the effect of anesthesia type during delivery on neonatal otoacoustic emission (OAE) hearing test results. Methods This retrospective cross-sectional study includes 1,493 healthy, full-term (39/0–40/6 gestational weeks) newborns of healthy women and who were delivered by cesarean section. Newborns were divided into 2 groups based on their anesthesia type during delivery: 1) general anesthesia group (n=160), and 2) spinal anesthesia group (n=1333). Maternal age, anesthesia type, birth weight, gestational age at birth, neonatal gender, 1st–5th minute APGAR scores, and OAE results were compared between the groups. Results 1287 (86.2%) newborns were reported to have passed the first step of OAE; 206 (13.8%) newborns were reported to have failed the first step and passed the second test. In the general anesthesia group, 133 (83.1%) of the newborns passed the first OAE test and 27 (16.9%) newborns had false-positive results. In the spinal anesthesia group, 1,154 (86.6%) of the newborns passed the first OAE test and 179 (13.4%) newborns had false-positive results. The difference between the 2 groups by false-positive values was found to be statistically significant (p<0.001). Conclusions Type of delivery anesthesia may have an effect on the false-positive rates of OAE test results.

A Comparison of the Effect of Fractionated and Bolus Dose Injection on Spinal Anesthesia for Lower Limb Surgery: A Randomized Clinical Trial

Background: In previous clinical trials and a small number of studies, the fractional injection of anesthetics led to reduced physiological complications and hemodynamic stability and increased duration of anesthesia. Objectives: The present study intended to compare the effect of fractionated and bolus dose injection of bupivacaine and fentanyl on spinal anesthesia for lower limb fracture surgeries. Methods: In this randomized, double-blind clinical trial, 70 patients with lower limb fractures were divided into groups of bolus spinal anesthesia (Group A) and fractional spinal anesthesia (Group B). Group A received a bolus dose of 25 μg fentanyl plus 15 mg bupivacaine 0.5% intrathecally at a rate of 0.2 mL/sec and were laid down in supine position after 45 seconds. In Group B, a half dose of the mixture, i.e., 25 μg fentanyl plus 15 mg bupivacaine 0.5% mixture, was injected intrathecally, and then, the other half was injected after 45 seconds while the needle was still in place. Afterward, the patients were immediately laid down in the supine position. Hemodynamic changes in the sensory and motor blockage parameters were recorded in both groups. Results: The motor blockage onset time was shorter in Group B compared to Group A (P = 0.026). Moreover, the sensory blockage duration was longer (P = 0.035), and the highest level of sensory blockage was lower (P = 0.008) in Group B compared to Group A. Conclusions: Fractional spinal anesthesia led to a longer duration and more favorable levels of sensory blockage compared to the bolus method. In addition, hemodynamic changes and complications occurred less frequently following this procedure.

Effect of Anesthetic Technique on the Occurrence of Acute Kidney Injury after Total Knee Arthroplasty

Recent studies have reported the advantages of spinal anesthesia over general anesthesia in orthopedic patients. However, little is known about the relationship between acute kidney injury (AKI) after total knee arthroplasty (TKA) and anesthetic technique. This study aimed to identify the influence of anesthetic technique on AKI in TKA patients. We also evaluated whether the choice of anesthetic technique affected other clinical outcomes. We retrospectively reviewed medical records of patients who underwent TKA between January 2008 and August 2016. Perioperative data were obtained and analyzed. To reduce the influence of potential confounding factors, propensity score (PS) analysis was performed. A total of 2809 patients and 2987 cases of TKA were included in this study. A crude analysis of the total set demonstrated a significantly lower risk of AKI in the spinal anesthesia group. After PS matching, the spinal anesthesia group showed a tendency for reduced AKI, without statistical significance. Furthermore, the spinal anesthesia group showed a lower risk of pulmonary and vascular complications, and shortened hospital stay after PS matching. In TKA patients, spinal anesthesia had a tendency to reduce AKI. Moreover, spinal anesthesia not only reduced vascular and pulmonary complications, but also shortened hospital stay.

Comparison of Epidural and Spinal Anesthesia Techniques for Transurethral Resections

Purpose: Transurethral resections (TUR) are commonly performed for elderly population who have multiple comorbidities which can cause intraoperative and postoperative complications. The type of anesthesia has an impact on patient outcome. The aim of the study is to compare the effectiveness of epidural and spinal anesthesia techniques for TUR. Methods: A total of 158 elective TUR cases were evaluated. The patients were randomized into 2 groups: Epidural anesthesia was applied to Group I (n=82) and spinal anesthesia was applied to Group II (n=76). Both groups were compared for intraoperative hemodynamic parameters (mean arterial pressure, heart rate, peripheral oxygen saturations), total duration of hospital stay, perioperative complications, and satisfaction of the patients and surgeons. Results: The patients in the spinal anesthesia group experienced more frequent intraoperative hypotensive episodes during TUR (n=2 vs. n=10; p=0.026) and had lower mean arterial pressure values for the first 30 minutes of anesthesia compared to epidural anesthesia group. The postoperative duration of bed stay was longer in the spinal anesthesia group (402.96±49.61 min) than the epidural anesthesia group (205.91±28.27 min) (p<0.001). The patient satisfaction score was significantly higher in the epidural anesthesia group (2.54±0.63) than the spinal anesthesia group (2.23±1.22) (p=0.04) where as the surgeon satisfaction score were similar in both groups. Conclusion: Epidural anesthesia can be considered as an effective and safe technique for ambulatory interventions especially for elderly patients providing perioperative hemodynamic stability and postoperative early mobilization.

Could spinal anesthesia be a choice for retrograde intrarenal surgery

Objective: In this study, we aimed to compare cases of retrograde intrarenal surgery performed under spinal or general anesthesia through investigating relevant parameters for the first time in the literature. Material and method: In total, 86 patients with diagnosis of kidney stone who were treated by retrograde intrarenal surgery were included in this randomized controlled prospective study. In total, 43 of these operations were performed under spinal anesthesia (group I) and 43 were performed under general anesthesia (group II). The groups were compared in terms of demographic features, American Society of Anesthesiologists score, duration of operation, complication rates, postoperative visual analogue scale, postoperative hospitalization period, stone-free rates, and cost value ratios. Results: There were no significant differences between the two groups in terms of demographic findings, preoperative stone loads, postoperative stone-free rates, complication rates and postoperative hospitalization periods (p > 0.05). Postoperative visual analogue scale scores and cost value ratios were found statistically significantly lower in the spinal anesthesia group (group I) when compared with the general anesthesia group (group II; p < 0.001). Conclusion: Performing retrograde intrarenal surgery in the presence of spinal anesthesia is equally effective with general anesthesia. Spinal anesthesia also appears to be a more advantageous method due to statistically significantly lower mean postoperative pain scores and treatment cost value ratios.

The Effect of Intraoperative Sounds of Saw and Hammer on Psychological Condition in Patients with Total Knee Arthroplasty: Prospective Randomized Study

Purpose. Surgical procedures are likely to be stressful for patients and their families. Total knee arthroplasty (TKA) is a major surgical procedure used in the treatment of osteoarthritis. During this procedure the sounds of the saw and hammer may irritate the patient and adversely affect mood. The present study examines the effect of these intraoperative sounds during TKA on postoperative mood and anxiety, by comparing two different anesthetic procedures.Methods. A total of 40 patients who underwent TKA for grade IV gonarthrosis participated in the study. Patients were randomly divided into two groups: 20 patients in the general anesthesia group and 20 patients in the spinal anesthesia group. Mood and anxiety changes were evaluated using the Profile of Mood States (POMS) and State-Trait Anxiety Inventory (STAI) instruments, respectively.Results. The postoperative POMS value in the spinal anesthesia group was definitively higher than the general anesthesia group, though the difference in preoperative and postoperative POMS and STAI scores between the two groups was not significant.Conclusion. It would seem that sounds of hammer and saw have no evident negative effect on patient’s mood. Regional anesthesia is advisable for TKA patients and appropriate sedation can be administered during the operation if needed.

PERBANDINGAN LUARAN SEKSIO SESAREA DENGAN ANESTESI UMUM DAN SPINAL: PERUBAHAN KADAR HEMOGLOBIN, HEMATOKRIT IBU DAN SKOR APGAR BAYI

PERBANDINGAN LUARAN SEKSIO SESAREA DENGANANESTESI UMUM DAN SPINAL: PERUBAHAN KADARHEMOGLOBIN, HEMATOKRIT IBU DAN SKOR APGAR BAYIIfrinda Giantari, Ibnu Pranoto, Risanto SiswosudarmoABSTRACTBackground: Cesarean section is the most common surgical procedure in obstetrics. In 2008, nearly a third ofdeliveries was done by cesarean section. Two types of anestesi are used in cesarean section i.e., general andregional anestesi with their advantages and disadvantages. General anestesi is often used in emergency casesbut is often associated with greater risk of blood loss during surgery and depression of central nervous system ofthe newborn. Based on these facts, the decision of the type of anesthesia for cesarean section is still debated.Objective: To compare the effects between general and spinal anestesi in the alteration of maternal hemoglobinand hematocrit levels and the neonatal Apgar score.Method: This study was conducted at Setjonegoro Hospital Wonosobo, Banjarnegara, and Sardjito HospitalYogyakarta between September to December 2010. Patients undergoing cesarean section, who met inclusionand exclusion criteria were included in this study. Hemoglobin and hematocrit levels before and 6-12 hours aftersurgery were recorded, as well as the first minute Apgar score. Chi-square and t-test were used for statisticalanalysis.Results and Discussion: A total of 114 patients consisting of 59 cases for general anestesi and 55 for spinalgroups were recruited. They were comparable in terms ofmaternal age, age of gestation, parity, BMI and indicationof operation. Hemoglobin and hematocrit levels before surgery were also comparable.The decrease of hemoglobin level after operation in the group of general anesthesia was greater than in thespinal group (1,75 ± 1,09 mg/dL vs 1,00 ± 0,96 mg/d; p=0,00). The same was seen in the decrease of hematocritlevel (4,47 ± 2,77% vs 3,26 ± 3,04%, p=0,02). There were 28 cases of asphyxia in the group of general comparedto 22 cases in the group of spinal anestesi, but it was not statistically different (RR 1,16; 95% CI 0,81-1,65).Conclusion: The decreased level of hemoglobin and hematocrit after cesarean section in general anesthesia werehigher than spinal anesthesia group, although the difference was not clinically significant. There was no significantdifference in the incidence of asphyxia at first minute in both groups.Keywords: general anestesi, spinal anesthesia, cesarean section, hemoglobin, hematocrit, Apgar score ABSTRAKLatar belakang: Seksio sesarea merupakan prosedur operatif obstetri yang paling sering dilakukan. Pada tahun2008, hampir sepertiga dari persalinan dilakukan dengan cara seksio sesarea. Dua jenis anestesi sering digunakanyakni anestesi umum dan spinal yang masing-masing mempunyai kelebihan dan kekurangannya. Anestesi umumsering digunakan pada kasus kedaruratan meskipun sering dikaitkan dengan risiko kehilangan darah yang lebihbesar dan penekanan pada susunan syaraf pusat bayi. Anestesi spinal sering dikaitkan dengan keadaan hipotensimaternal.Tujuan: Membandingkan penurunan kadar hemoglobin dan hematokrit ibu dan skor Apgar bayi pada seksiosesarea dengan anestesi umum dan spinal.Metode: Kohort prospektif.Penelitian dilakukan di RS Setjonegoro Wonosobo, RS Banjarnegara, dan RS Sardjitopada bulan September sampai Desember 2010. Pasien yang menjalani seksio sesarea dan memenuhi kriteriainklusi dan eksklusi dimasukkan dalam penelitian ini. Sampel penelitian diikuti sesuai dengan kelompok jenisanestesi. Kadar hemoglobin dan hematokrit sebelum operasi dan 6-12 jam sesudah operasi serta skor Apgar 1menit dicatat. X-square dan t-test dipakai untuk analisis data.Hasil dan Pembahasan: Sebanyak 114 kasus seksio sesarea memenuhi kriteria kelayakan, yang terdiri dari 59kasus kelompok anestesi umum dan 55 kasus anestesi spinal. Kedua kelompok komparabel dalam hal umur,umur kehamilan, paritas BMI dan indikasi operasi. Demikian juga kadar hemoglobin dan hematokrit sebelumoperasi, tidak menunjukkan perbedaan yang bermakna. Penurunan kadar hemoglobin setelah operasi padakelompok anestesi umum lebih besar dibanding kelompok spinal (1,75 ± 1,09 mg/dL vs 1,00 ± 0,96 mg/d;p=0,00), demikian juga penurunan kadar hematocrit (4,47 ± 2,77% vs 3,26 ± 3,04%, p=0,02). Pada penilaianmenit pertama terdapat 28 kasus asfiksia (skor Apgar < 6) pada kelompok anestesi umum dan 22 kasus padakelompok anestesi spinal (RR 1,16, 95%CI 0,81-1,65), tetapi tidak bermakna secara statistik (p=0,42).Kesimpulan: Terdapat penurunan kadar hemoglobin dan hematokrit ibu yang bermakna pada kelompok yangmenjalani seksio sesarea dengan anestesi umummeskipun secara klinis tidak bermakna. Tidak terdapat perbedaanbermakna secara statistik pada kejadian asfiksia pada menit pertama.Kata kunci: anestesi umum, anestesi spinal, seksio sesarea, hemoglobin, hematokrit, skor Apgar

PERBANDINGAN NILAI APGAR NEONATUS PADA SEKSIO SESAR ANTARA ANESTESIA UMUM DAN ANESTESIA SPINAL

Anesthesia plays an important role in surgery. The use of anesthesia provides a lot of advantages in surgery as well as disadvantages under certain circumstances. In cesarean section, anesthesia can affect the condition of neonates, which can be evaluated by using Apgar score. This study aimed to compare the neonates’Apgar scores of cesarean section using general and spinal anesthesia. The method of this study was Unpair Numeric Comparative Analytic Retrospective. Inclusive criteria were elective cesarean section deliveries, aterm or gestational age 37-40 weeks, birth weight > 2500 grams, and no other surgery. There were 105 samples which were divided into two groups, GA (general anesthesia) and SA (Spinal anesthesia). Group of GA consisted of 70 samples and group of SA 35 samples. Statistical test used was Mann – Whitney test with interpretation value P < 0.05 revealed significant differences. The results showed that neonates of SA group with Apgar score >7 at the first and fifth minute were 57.14% and 100% meanwhile of GA group 28.57% and 87.14%. The average Apgar scores of SA and GA groups at the first minute were 6.43±0.74 vs 5.5±1.53 (P = 0.001) and at the fifth minute 8.43±0.74 vs 7.53±1.51. The Mann – Whitney test showed a P value 0.001. Conclusion Spinal anesthesia provided better condition for neonates compared to the general anesthesia in elective cesarean section deliveries.Keywords: cesarean section, spinal anesthesia, general anesthesia, Apgar scoreAbstrak: Anestesia berperan penting dalam tindakan pembedahan. Penggunaan anestesia memberikan banyak keuntungan dalam tindakan pembedahan namun terdapat juga kerugian – kerugian dalam kondisi tertentu. Pada seksio sesar, tindakan anestesia dapat mempengaruhi kondisi neonatus yang dapat diukur dengan nilai Apgar. Penelitian ini bertujuan untuk membandingkan nilai Apgar neonatus pada seksio sesar antara anestesia umum dan anestesia spinal. Metode penelitian bersifat retrospektif analitik komparatif numerik tak berpasangan. Kriteria inklusi ialah persalinan seksio sesar elektif, aterm atau usia kehamilan 37-40 minggu, berat badan lahir bayi >2500gr, dan pasien tanpa operasi lainnya. Sampel yang didapat berjumlah 105 neonatus yang dibagi menjadi 2 grup, GA (anestesia umum) dan SA (anestesia spinal). Grup GA terdiri dari 70 sampel dan grup SA 35 sampel. Uji statistik yang digunakan ialah uji Mann – Whitney dengan interpretasi nilai P < 0,05 dinyatakan perbedaan signifikan. Hasil penelitian memperlihatkan neonatus dengan nilai Apgar >7 pada menit ke-1 dan ke-5 sebanyak 57,14% dan 100% pada grup SA sedangkan 28,57% dan 87,14% pada grup GA. Rata – rata nilai Apgar menit ke-1 grup SA dan grup GA 6,43±0,74 vs 5,5±1,53 (P = 0,001) dan pada menit ke-5 8,43±0,74 vs 7,53±1,51. Uji Mann – whitney menunjukkan P =0,001. Simpulan. Anestesia spinal memberikan kondisi neonatus yang lebih baik dibandingkan anestesia umum pada persalinan seksio sesar elektif.Kata kunci: seksio sesar, anestesia spinal, anestesia umum, nilai Apgar.