Vol 17, No 1 (2023)

BACKGROUND: General anesthesia in vitreoretinal surgeries may be combined with ophthalmic blocks. Prolonged sub-tenon block (PSB) in extensive surgery ensures the continuous administration of a local anesthetic into the episcleral space; however, its effectiveness has not been evaluated.

OBJECTIVE: To evaluate the effectiveness of sub-tenon block for vitreoretinal surgery in general anesthesia.

MATERIALS AND METHODS: The pilot study included 24 patients. All patients underwent retinal detachment surgery under general anesthesia with sevoflurane for >90 min. Patients were randomized into two groups. In group 1, analgesia was induced with intravenous tramadol. In group 2, general anesthesia was combined with sub-tenon block, and 1% lidocaine was used continuously. Bispectral index (BIS) monitoring was employed for anesthesia depth assessment. The mean blood pressure and heart rates were estimated for the evaluation of the oculovisceral reflex block. The Student and Wilcoxon–Bonferroni criterion was used for statistical analysis, and the statistical significance level was set at α=0.05.

RESULTS: The hemodynamic and consequently the degree of oculovisceral reflexes block had no statistically significant differences between the groups. The median BIS in groups 1 and 2 were 48.1±11.1 U and 42.6±8.2 U, respectively, and the difference between these values was statistically insignificant (p >0.05). However, in group 1, the BIS increased sharply during the laser phase. At this stage, the average BIS in groups 1 and 2 were 76.7±3.2 U and 40.4±6.9 U, respectively (p=0.001).

CONCLUSION: BIS-monitoring can be used as an indicator of the effectiveness of ophthalmic regional blocks in further studies.

BACKGROUND: Laparoscopic kidney surgery is performed mostly under general anesthesia. Regional techniques, primarily epidural anesthesia / analgesia (EA), help improve the surgical results. However, EA is often accompanied by several complications and side effects. The thoracic paravertebral block (PVB) is considered a reasonable and effective alternative.

OBJECTIVE: To conduct a comparative analysis of the effectiveness of general anesthesia (GA) + PVB, GA alone, and GA + EA in laparoscopic kidney surgery.

MATERIALS AND METHODS: An open-label randomized clinical study enrolled 180 patients who underwent laparoscopic kidney surgery. By using an online tool (https//www resource.studyrandomizer.com), the patients were divided into three groups in a 1:1:1 ratio. Group 1 (n=60) underwent surgery under GA + PVB, group 2 (n=60) under GA, and group 3 under GA + EA. In each group, the intra-, and postoperative need for opioids, pain intensity on a visual analog scale (VAS) 1, 6, 12, and 24 h after surgery, and activation time were assessed. The results of the groups were compared. The frequency and nature of complications when performing and working with PVB were studied.

RESULTS: The intraoperative need for opioids was greater in the GA group and comparable in the GA + PVB and GA + EA groups (p=0.137). The postoperative pain in the PVB group remained consistently low (VAS score ≈2 points) during the observation period. In the GA group, it reached ≈5 points after 1, 6, and 12 h and ≈4 points 24 h after the surgery; in the EA group, it was ≈4 points (1, 6, and 12 h) and ≈3 points 24 h after the surgery. The prolonged PVB in the postoperative period significantly lowered the opioid need (p=0.045) and contributed to earlier activation of the patients (p=0.001). Under ultrasound control, PVB is safe, and effective.

CONCLUSION: The study showed that PVB in the complex of anesthetic support for kidney surgery provides an effective and safe anesthesia / analgesia and can be used as an alternative to EA.

BACKGROUND: Standard anesthesia monitoring during surgery only indirectly allows us to estimate achieving an effective level of analgesia sufficient to protect the patient from surgical trauma. Recently, studies have analyzed cortisol, glucose, and lactate levels during surgery in children and adults; however, data presented remain inconsistent.

OBJECTIVE: This study aimed to conduct a prospective comparative analysis of endocrine metabolic dynamic rates in orthopedic trauma surgery on the lower extremities of children.

MATERIALS AND METHODS: The study included 39 children who underwent orthopedic trauma surgery. They were divided into two groups: group 1 (n=17) underwent multicomponent balanced general anesthesia, and group 2 (n=22) received combined anesthesia (multicomponent balanced general anesthesia combined with regional blockade of the sciatic and femoral nerves). The dynamics of cortisol, glucose, and lactate indicators at three stages of the perioperative period, total amount of fentanyl, and need for an inhalation anesthetic were examined.

RESULTS: Indicators of cortisol, glucose, and lactate in mixed venous blood during surgery did not exceed the age norm in both groups. In group 1, cortisol, glucose, and lactate levels did not statistically differ at all stages of the study. In group 2, cortisol and lactate levels increased at the fifth stage (traumatic stage) of surgery, and lactate levels increased in the sixth stage (end of surgery). In intergroup comparison, the lactate level at the traumatic stage of surgery was higher in group 1 than in group 2 (p=0.048). Cortisol and glucose levels at the stages of the study did not differ significantly. The total amount of fentanyl for pain relief in group 1 was 4.1 [3.3; 5.0] µg/kg, which was 8.2 times higher than that in group 2, with 0.5 [0.4; 0.53] µg/kg (p <0.0001).

CONCLUSION: Both anesthesia methods ensure stable levels of cortisol, glucose, and lactate, and adequate level of analgesia at all stages of surgery; however, the use of a conduction blockade as a component of combined anesthesia provides more pronounced antinociceptive protection and reduces surgical stress in children.

BACKGROUND: Acute pancreatitis is a potentially life-threatening disease, which is based on a severe inflammatory process and enzymatic autolysis of the pancreas. Currently, there is no effective medical treatment for acute pancreatitis. Its therapy is based on early infusion, adequate anesthesia, enteral nutrition, antibiotic therapy for infected pancreatic necrosis, and sanitizing procedures for the development of purulent and septic complications. In the last decade, experimental, and clinical studies have proven the powerful anti-inflammatory effect of the inhalation anesthetic sevoflurane. Sevoflurane reduces inflammation, both by blocking the nuclear factor kappa-bi and reducing the release of reactive oxygen species and pro-inflammatory cytokines.

CLINICAL CASES DESCRIPTION: We used inhaled sevoflurane in three patients with acute pancreatitis. For one inhalation, 5 mL of sevoflurane was used and poured into a 200-mL container. The duration of one inhalation was approximately 40 min, during which time the anesthetic had completely evaporated. The maximum concentration of sevoflurane in exhaled air reached 0.4–0.5%, which did not cause the patient to fall asleep. Inhalations were performed three times a day for 2 days. In all patients, the pain syndrome decreased by three times according to the visual analog scale on day 1. The level of amylase on day 2 decreased by 2.5 times. The leukocyte count decreased by 20%. On day 2, all patients developed intestinal motility, and the patients were transferred from the anesthesiology-reanimation department to the surgical department. All the patients recovered.

CONCLUSION: The inhalation of sevoflurane alleviated the pain syndrome, reduced amylase levels, and improved intestinal motility in acute pancreatitis.