Ferim Günenç

Comparison of etomidate-remifentanil and propofol-remifentanil sedation in patients scheduled for colonoscopy

Objective The aim of the study was to compare haemodynamic responses, recovery and discharge times, and physician satisfaction of etomidate–remifentanil and propofol–remifentanil combinations in patients undergoing elective colonoscopy. Methods Sixty patients, aged 18–65 years, scheduled for elective colonoscopy under sedation were prospectively randomized, double blind for the study. Two minutes after the beginning of a continuous remifentanil infusion (0.1 μg kg−1 min−1), etomidate or propofol were administered. Patients in the etomidate group received a 0.05 mg kg−1 maintenance dose of etomidate after an initial dose of 0.1 mg kg−1, and patients in the propofol group received a 0.25 mg kg−1 maintenance dose of propofol after an initial dose of 0.5 mg kg−1 in order to have a Ramsay sedation score of 3–4. Basal values of heart rate, mean arterial pressure, oxygen saturation, respiratory rate and Ramsay sedation score were recorded. Values were recorded every 2 min for the first 10 min and every 5 min thereafter, until the completion of the procedure. Results Mean arterial pressure was lower at 4, 6, 8, 10, 15, 20 and 25 min in the propofol group (P = 0.001). Mean respiratory rate in the propofol group at 6, 8, 10, 15, 20, 25 min was also lower (P < 0.05). The incidence of apnoea and hypotension was significantly lower in the etomidate group (P < 0.001). Arrival time into the postoperative care unit and recovery time were shorter in the etomidate group (P = 0.001, P = 0.01, respectively). Physician satisfaction in both groups was similar. Conclusion Etomidate–remifentanil administration for sedation and analgesia during colonoscopy resulted in more stable haemodynamic responses and shorter recovery and discharge times.

The influence of epidural volume extension on spinal block with hyperbaric or plain bupivacaine for Caesarean delivery.

Background and objective: Epidural volume extension via a combined spinal‐epidural is the enhancement of a small‐dose intrathecal block by an epidural injection of physiological saline solution. We evaluated the effect of epidural volume extension on the combined spinal‐epidural technique of providing spinal anaesthesia for Caesarean section with hyperbaric or plain 0.5% bupivacaine. Methods: Patients (n = 240) with height >163 cm received 9 mg and patients <163 cm received 8 mg of bupivacaine. Each study drug was combined with 20 &mgr;g fentanyl. Using the combined spinal‐epidural technique, Group A (n = 60) received hyperbaric bupivacaine, and Group B (n = 60) received hyperbaric bupivacaine and 10 mL saline epidurally 5 min after subarachnoid injection. Group C (n = 60) received plain bupivacaine and Group D (n = 60) received plain bupivacaine and 10 mL saline epidurally 5 min after subarachnoid injection. An anaesthetist blinded to the anaesthetic solution injected examined the level of analgesia by the pinprick method and motor block with the modified Bromage scale for 30 min after subarachnoid injection, during the intraoperative period and subsequently every 15 min for 135 min during the recovery period. Results: Time to reach a sensory block at T4 was significantly shorter in Groups C and D than in Groups A (P = 0.003 and 0.017) and B (P = 0.006 and 0.048), respectively. During the intraoperative period, sensory block levels were significantly higher in Group C than in Group A. Recovery was similar in all groups; only onset was faster in Groups C and D. Conclusion: There was no effect of epidural volume extension on the profile of spinal anaesthesia with the combined spinal‐epidural technique for Caesarean section using hyperbaric or plain bupivacaine.

The laryngeal mask airway (LMA) in paediatric ophthalmic anaesthesia practice

1. Richard A. Continuous nervous system monitoring, EEG, the bispectral index, and neuromuscular transmission. AACN Clin Issue 2003; 14: 185–207. 2. Glass PS, Bloom M, Kearse L, Rosow C, Sebel P, Manberg P. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology 1997; 86: 836–847. 3. Johansen J, Sebel P. Development and clinical application of electroencephalographic bispectrum monitoring. Anesthesiology 2000; 93: 1336–1344. 4. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 8476: 307–310. 5. Liu J, Singh H, White PF. Electroencephalogram bispectral analysis predicts the depth of midazolam-induced sedation. Anesthesiology 1996; 84: 64–69. 6. Kreuer S, Biedler A, Larsen R, Altman S, Wilhelm W. Narcotrend monitoring allows faster emergence and a reduction of drug consumption in propofol–remifentanil anesthesia. Anesthesiology 2003; 99: 34–41. 7. O’Connor MF, Daves SM, Tung A, Cook RI, Thisted R, Apfelbaum J. BIS monitoring to prevent awareness during general anesthesia. Anethesiology 2001; 94: 520–522.

EMLA® does not permit pain‐free retrobulbar injection*

Background:  Retrobulbar injection can be associated with significant pain, due to both needle insertion and deposition of the local anaesthetic solution. The local anaesthetic cream EMLA® (eutectic mixture of local anaesthetics) which contains a mixture of lignocaine and prilocaine has been shown to reduce the pain associated with skin puncture. The efficacy of EMLA® in alleviating the pain of retrobulbar injection for cataract surgery was assessed in this study.

Retrospective Evaluation of Anaesthetic Techniques for Caesarean.

OBJECTIVE This study aimed to evaluate the maternal, foetal and neonatal effects of anaesthetic techniques used in caesarean sections (C/S) retrospectively over 6 years at the Hospital of Medical School of Dokuz Eylül University and to compare the results with the literature from Turkey and developed countries. METHODS After obtaining approval from the ethics committee, anaesthetic and gestational data from all caesarean operations performed over a 6-year period between 2005 and 2010 was retrospectively obtained from hospital archives. RESULTS During this period, a total of 10,819 labours was conducted and C/S ratio was 55% with 5953 patients. General anaesthesia was performed in 1479 patients (24.8%) and regional anaesthesia was performed in 4474 patients (75.2%) [Spinal anaesthesia for 1203 patients (26.9%), epidural anaesthesia for 830 patients (18.5%) and combined spinal-epidural anaesthesia for 2441 patients (54.6%)]. In 2010, regional anaesthesia ratio increased to 84.6%, whereas in 2005, it was 63.8%. Regional anaesthesia was used significantly more often in both elective and urgent patients (82% elective and 65.2% emergency). Because of failed regional anaesthesia or surgical complications, anaesthesia was changed to general anaesthesia in 215 patients (4.8%). APGAR scores in 1 and 5 min were significantly higher with regional anaesthesia when compared with general anaesthesia. CONCLUSION Regional anaesthesia rate for C/S patients in the Hospital of Medical School of Dokuz Eylül University is increased and is higher than Turkeys average; but these figures are still lower than those in the developed countries.