Publications (5)4.27 Total impact
- [Show abstract] [Hide abstract] ABSTRACT: The Bispectral Index (BIS), a parameter derived from the electroencephalograph, has been shown to correlate with increasing sedation and loss of consciousness. This study was designed to investigate whether using BIS would improve anaesthetic drug management and immediate recovery after anaesthesia. 160 patients undergoing abdominal surgery were studied. The patients were randomised to receive either propofol or sevoflurane anaesthesia. In each group 40 patients were anaesthetised with BIS monitoring and 40 without BIS. In BIS groups, propofol and sevoflurane dose was adjusted to achieve a target BIS values between 40-60 during the whole procedure. Drug consumption, intraoperative responses, times of recovery after anaesthesia and a "Clinical Quality Scale of Recovery" score were recorded from blinded observators. Demographic data were similar between groups. BIS monitoring improved the immediate recovery after propofol anaesthesia, while no significant differences were observed in patients receiving sevoflurane. The consumption of both propofol and sevoflurane significantly decreased (30 and 40%, respectively). There was no significant differences in the incidence of intraoperative responses between groups. The BIS groups had a higher percentage of patients with better ICU assessments. BIS monitoring decreased the consumption of both propofol and sevoflurane and facilitated the immediate recovery after propofol anaesthesia. Intraoperative course was not changed. These findings indicate that the use of BIS may be a valuable guide of the intraoperatively administration of propofol and sevoflurane.
- [Show abstract] [Hide abstract] ABSTRACT: The analgesic efficacy and tolerance of tramadol, particularly via oral administration, were evaluated in 180 patients (age range 18–69 years), undergoing ambulatory surgery and superselective spinal anaesthesia. The patients were divided into three groups (A, B and C). 40 drops of tramadol were administered to the subjects of group A 30 min before surgery; the same dose was administered to the patients of group B after surgery; no supplementary analgesia was administered to the group C. Intraoperatively, the respiratory and cardiovascular parameters were monitored in each group. Intraoperatively and postoperatively the degree of analgesia was evaluated by using a visual analogue score (VAS) and a four step verbal scale (FSVS). The results showed a significantly superior and prolonged analgesic effect in the groups treated with tramadol, particularly if it was administered before surgery. Furthermore an excellent profile of drug tolerance with no significant side effects, especially respiratory depression, were observed.
- [Show abstract] [Hide abstract] ABSTRACT: Background and objectives: selective spinal anaesthesia (SSA) is preferable in day hospital surgery. The present investigation aims to confirm the usefulness and safety of this technique. Methods: 250 patients (ASA I–II, mean age 42 ± 3 years) scheduled for day-hospital surgery were enrolled in our study. The puncture was performed with the patients in a lateral position, the ill side down; for proctological surgery the puncture was performed in a sitting position. A 27G Whitacre needle was always used and 1% hyperbaric bupivacaine was administered in 30 s or more, preceded by a single dose of fentanyl (20 μg) injected very slowly. The position was maintained for 10 min. Hemodynamic parameters (SBP, DBP, HR) and pulsoximetry were recorded before anaesthesia (T0), 5 min after subarachnoid injection (T1) and then every 15 min (Tn) up to the completion of the surgical procedure. In the last 100 patients enrolled in our study haemodynamic data (CI, EF, SVRI, MAP,HR) were recorded by using a non invasive bioimpedenzometric method, before anaesthesia (Ta), after 15 min (Tb), 60 min (Tc) and 240 min (Td). The postoperative course was evaluated from the end of surgery on, with regard to analgesic consumption and residual analgesic degree. The incidence of adverse effects was evaluated. Results: the level and degree of anaesthesia was excellent in 183 and good in 67 patients. SBP, DBP, HR and pulsoximetry showed an excellent stability during the study. Haemodynamic stability was confirmed by data obtained with bioimpedenzometry that showed significant variations in CI (P < 0.001), SVN (P < 0.0001) at Tb and Tc as to basal five values. Postoperative analgesia was excellent and the incidence of side effects very low. Conclusions: we believe that the method is suitable for day-hospital surgery because it is easy to execute and provides an excellent degree of surgical anaesthesia, cardiovascular stability, postoperative analgesia and patient safety.
- [Show abstract] [Hide abstract] ABSTRACT: The aim of this study was to compare the efficacy and safety of two anesthesia techniques, combined epidural/general anesthesia (CEGA) versus total intravenous anesthesia (TIVA), for laparoscopic cholecystectomy. Forty patients were randomly assigned to one of two different groups: group A received TIVA and group B received CEGA. At preset times during the operation, systolic and diastolic arterial pressure, heart rate, oxygen saturation (SaO2) and end-tidal carbon dioxide (Etco2) were monitored. Postoperatively, recovery (Steward's test) and analgesia (visual analog scale [VAS] pain scores) were assessed, as well as the incidence of adverse effects. The groups were comparable as to demographic data and duration of surgery and of anesthesia. Intraoperative parameters also showed no statistical differences. Both groups had a rapid recovery (Steward score of 6 within 12 minutes), but group B showed better recovery scores at 4 minutes. Postoperative pain was well controlled in both groups, but group B exhibited better scores at postoperative hour 2. The incidence of postoperative side effects was low in both groups. The use of CEGA for laparoscopic cholecystectomy seems to be effective and safe and to offer some advantages as compared to TIVA alone. CEGA can control pain due to CO2-induced peritoneal irritation, providing excellent intra- and postoperative analgesia. CEGA does not require the use of intraoperative intravenous opioids and shortens recovery time, without increasing the incidence of side effects.
- [Show abstract] [Hide abstract] ABSTRACT: The aim of this work was to assess which anaesthetic technique is more suitable to the performance of videolaparocholecystectomy (VLC), particularly seeking for a faster and more comfortable recovery, although saving the maximum safety of the patient. A comparative investigation between two different anaesthetic techniques was carried out in 40 patients scheduled for VLC; the procedure's average length was 110.3 +/- 32.8 minutes and pneu- moperitoneum was obtained with 12-15 mmHg of CO2. Patients (32 females and 8 males, average age 52.3 +/- 8 years and ASA class 1, 2, 3, were randomized in two groups. The first group was administered total intravenous anaesthesia (TIVA): propofol+ fentanyl+pancuronio bromide; the second one received balanced narcosis:TPS+ Isoflurane+Pancuronio bromide. The following parameters were monitored at set times: SAP, DAP, HR and EtCO2; statistical analysis was performed by analysis of variance. The quality of recovery was assessed by Steward's test and analyzed by Student's "t" test. The data obtained from analysis of the intraoperative parameters showed no significant differences between the two groups; on the contrary a statistically significant difference was found with regard to the quality of recovery (p > 0.5 at 5' from the extubation). Thus, the comparative study showed the efficacy and safety of both techniques, but TIVA allowed a faster and more comfortable awakening with shorter time to recovery of consciousness. This, together with the reduced requirements of analgesic drugs in the postoperative period and the lack of air pollution, seems to suggest that TIVA is to be preferred for laparoscopic surgery.
University of Naples Federico IINapoli, Campania, Italy