Outcome of anesthesia in elective surgical patients with comorbidities.
Eyelade Olayinka,Sanusi Arinola,Adigun Tinuola,Adejumo Olufemi
Annals of African medicine
BACKGROUND:Presence of comorbidity in surgical patients may be associated with adverse perioperative events and increased the risk of morbidity and mortality. This audit was conducted to determine the frequencies of comorbidities in elective surgical patients and the outcome of anesthesia in a Tertiary Hospital in Nigeria. MATERIALS AND METHODS:Observational study of a cross-section of adult patients scheduled for elective surgery over a 6-month period. A standardized questionnaire was used to document patients' demographics, the presence of comorbidity and type, surgical diagnosis, anesthetic technique, intraoperative adverse events, and outcome of anesthesia. The questionnaire was administered pre- and post-operatively to determine the effects of the comorbidities on the outcome of anesthesia. RESULTS:One hundred and sixty-five adult patients aged between 18 and 84 years were studied. There were 89 (53.9%) females and 76 (46.1%) males. Forty-five (27.3%) have at least one comorbidity. Hypertension was the most common (48.8%) associated illness. Other comorbidities identified include anemia (17.8%), asthma (8.9%), diabetes mellitus (6.7%), chronic renal disease (6.7%), and others. The perioperative period was uneventful in majority of patients (80.6%) despite the presence of comorbidities. Intraoperative adverse events include hypotension, hypertension, shivering, and vomiting. No mortality was reported. CONCLUSION:Hypertension was the most common comorbidity in this cohort of patients. The presence of comorbidity did not significantly affect the outcome of anesthesia in elective surgical patients.
Effects of sevoflurane or propofol combined with remifentanil anesthesia on clinical efficacy and stress response in pregnant women with pregnancy-induced hypertension.
Ren L-Q,Sun X-X,Guan Y
European review for medical and pharmacological sciences
OBJECTIVE:To compare the effects of sevoflurane or propofol combined with remifentanil anesthesia on the clinical efficacy and stress response of pregnancy-induced hypertension (PIHS) in cesarean section. PATIENTS AND METHODS:150 patients with PIHS and treated with cesarean section in our hospital from May 2015 to September 2016 were selected. All patients were randomly divided into sevoflurane-remifentanil group (n=75) and propofol-remifentanil (n=75). The elbow blood of patients in both groups were collected, the levels of Norepinephrine (NE) adrenaline (AD), cortisol and blood glucose in plasma were compared at before anesthesia induction (T0), operation 30 min (T1), end of operation (T2), 2 h after operation (T3), 24 h after operation (T4). The blood pressure control, muscle control, anesthesia onset time, maternal pain and complications were compared between the two groups. RESULTS:The patients in the sevoflurane group were superior to the propofol group (p<0.05) in terms of muscle control effect, anesthesia onset time and maternal pain. There was no significant difference between the two groups in terms of blood pressure control and anesthesia complications (p>0.05). There was no significant difference in plasma AD, NE, cortisol and blood glucose between the two groups before induction of anesthesia (p>0.05). However, the plasma markers of the two groups began to increase after anesthesia induction and reached peak at T2 or T3, returned back to preoperative level or higher than before surgery at T4. The levels of AD, NE, cortisol and blood glucose in plasma of sevoflurane group were significantly lower than those in propofol group at T1-T4 time point, the difference was statistically significant (p<0.05). CONCLUSIONS:The clinical efficacy of sevoflurane combined with remifentanil anesthesia is better than that of propofol combined with remifentanil, and it can effectively reduce the stress of pregnant women with pregnancy-induced hypertension treated with cesarean section.
A Comparative Study of Fractionated Versus Single Dose Injection for Spinal Anesthesia During Cesarean Section in Patients with Pregnancy-Induced Hypertension.
Nugroho Alfan Mahdi,Sugiarto Adhrie,Chandra Susilo,Lembahmanah Laras,Septica Rafidya Indah,Yuneva Annisaa
Anesthesiology and pain medicine
Background:Local anesthetics for spinal anesthesia in one-single injection are known to induce more severe hypotension than a fractionated dose in healthy obstetric patients. Hypotension in obstetric patients with pregnancy-induced hypertension, including preeclampsia, during spinal anesthesia, could compromise fetal well-being. Objectives:This study aimed to compare the mean arterial pressure (MAP), the total dose of ephedrine required, and level of sensory blockade between the fractionated-dose and single-dose spinal anesthesia injection in obstetric patients with pregnancy-induced hypertension who underwent a cesarean section. Methods:This single-blind randomized clinical trial was conducted from January to April 2018 after being approved by the Research Ethics Committee of Universitas Indonesia (No. 1174/UN2.F1/ETIK/2017) and recorded at ClinicalTrials.gov (NCT03693638). After obtaining informed consent, 42 parturients with hypertension in pregnancy (gestational hypertension or preeclampsia), ASA II-III, aged 18 - 40 years, and BMI of 18.5 - 35 kg/m with singleton pregnancy, who were planned for spinal anesthesia for emergency or semi-emergency cesarean section with hyperbaric bupivacaine 0.5% (Marcaine, Hospira) and fentanyl, were included in this study. All subjects were randomly divided into two groups including fractionated-dose (FD) and single-dose (SD). Results:There was no significant difference between the two groups in MAP in the first 15 minutes after anesthesia (P > 0.05) and median total dose of ephedrine required (10 (0 - 25) mg in the FD group vs. 15 (0 - 30) mg in the SD group, P = 0.30). However, in the FD group, MAP tended to be higher in the first three minutes compared to the SD group. The level of sensory blockade was mostly at T4, which was not significantly different between the groups (52.4% in FD vs. 42.9% in SD, P = 0.59). Conclusions:In obstetric patients with pregnancy-induced hypertension who underwent a cesarean section, the mean arterial pressure after spinal anesthesia was not significantly different between the fractionated dose of spinal anesthesia injection and single-dose injection. Total ephedrine required and levels of sensory blockade were not significantly different between the groups.
Evaluation of the influence of pulmonary hypertension in ultra-fast-track anesthesia technique in adult patients undergoing cardiac surgery.
Silva Paulo Sérgio da,Cartacho Márcio Portugal Trindade,Castro Casimiro Cardoso de,Salgado Filho Marcello Fonseca,Brandão Antônio Carlos Aguiar
Revista brasileira de cirurgia cardiovascular : orgao oficial da Sociedade Brasileira de Cirurgia Cardiovascular
OBJECTIVE:To evaluate the influence of pulmonary hypertension in the ultra-fast-track anesthesia technique in adult cardiac surgery. METHODS:A retrospective study. They were included 40 patients divided into two groups: GI (without pulmonary hypertension) and GII (with pulmonary hypertension). Based on data obtained by transthoracic echocardiography. We considered as the absence of pulmonary hypertension: a pulmonary artery systolic pressure (sPAP) <36 mmHg, with tricuspid regurgitation velocity <2.8 m/s and no additional echocardiographic signs of PH, and PH as presence: a sPAP >40 mmHg associated with additional echocardiographic signs of PH. It was established as influence of pulmonary hypertension: the impossibility of extubation in the operating room, the increase in the time interval for extubation and reintubation the first 24 hours postoperatively. Univariate and multivariate analyzes were performed when necessary. Considered significant a P value <0.05. RESULTS:The GI was composed of 21 patients and GII for 19. All patients (100%) were extubated in the operating room in a medium time interval of 17.58 ± 8.06 min with a median of 18 min in GII and 17 min in GI. PH did not increase the time interval for extubation (P=0.397). It required reintubation of 2 patients in GII (5% of the total), without statistically significant as compared to GI (P=0.488). CONCLUSION:In this study, pulmonary hypertension did not influence on ultra-fast-track anesthesia in adult cardiac surgery.