Serap Karacalar

Spinal-Epidural Anesthesia Versus General Anesthesia in the Management of Percutaneous Nephrolithotripsy

OBJECTIVE To compare the efficacy between combined spinal-epidural block and general anesthesia in patients undergoing percutaneous nephrolithotripsy (PNL). METHODS A total of 180 patients undergoing PNL were randomly allocated to receive spinal-epidural anesthesia plus intravenous patient-controlled anesthesia with tramadol or general anesthesia (propofol induction, maintenance with sevoflurane) plus intravenous patient-controlled anesthesia with tramadol (G group). Hemodynamic changes, postanesthesia care unit (PACU) discharge times, times to home readiness, side effects, patient and endoscopist satisfaction, postoperative pain (scored from 0 to 10 on a visual analog scale), and analgesic medication were recorded. RESULTS Rates of hypotension (p = 0.06) and bradycardia (p = 0.14) did not differ between the groups. Compared with the G group, duration of PACU and the time to home readiness (p = 0.001 for each) were shorter in the spinal-epidural group. The incidence of nausea was higher in the G group (p = 0.001); vomiting and pruritus rates were similar between groups. No patient had respiratory depression. The spinal-epidural group had better patient satisfaction (p = 0.001) and lower pain scores (p = 0.001). The G group required more diclofenac during the first 48 h (p = 0.001). CONCLUSIONS In patients undergoing PNL, spinal-epidural anesthesia and analgesia gave greater patient satisfaction, shorter times for PACU and home readiness, and less postoperative pain. Spinal-epidural anesthesia is an attractive alternative to general anesthesia in these patients.

What is the ideal glucose regime in children undergoing extensive hepatic resection

70%. The patient did well under general anesthesia and underwent the tracheostomy procedure without difficulty. The patient was induced with sevoflurane and easily intubated with a 3.0 mm tracheal tube. He was stable during the entire procedure and postoperatively was transferred back to the NICU and mechanically ventilated for respiratory support. David Boswell James Mayhew Department of Anesthesiology, Texas Tech Health Science Center, Lubbock, TX, USA (email: david.boswell@ttuhsc.edu)