Search

Background: There is limited data comparing the impact of spinal anaesthesia (SA) and general anaesthesia (GA) on perioperative lung function. Here we assessed the differences of these two anaesthetic techniques on perioperative lung volumes in normal-weight (BMI < 25) and overweight (BMI 25-30) patients using spirometry., Methods: We prospectively studied 84 consenting patients having operations in the vaginal region receiving either GA (n = 41) or SA (n = 43). Both groups (GA and SA) were further divided into two subgroups each (normal-weight vs. overweight). We measured vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), midexpiratory (MEF25-75) and peak expiratory flow rates (PEFR) at the preoperative assessment (baseline), after premedication, after effective SA, and 20 min, 1 h, 2 h and 3 h after the operation (last measurement after patient mobilization)., Results: Premedication was associated with a small but significant decrease in lung volumes in direct correlation with BMI (-5%). Spinal anaesthesia resulted in a significant reduction in lung volumes in overweight as opposed to normal-weight patients. Postoperatively, lung volumes were significantly more reduced following GA than SA as indicated by differences in mean VC (SD) of -12 (6)% vs. -6 (5)% 20 min after the end of the operation in the normal-weight and -18 (5)% vs. -10 (5)% in the overweight patients. There was a significant impact of BMI on postoperative respiratory function, which was significantly more important in the GA group than in the SA group, and recovery of lung volumes was more rapid in the normal-weight patients than in the overweight patients, particularly in the SA group., Conclusion: In gynaecological patients undergoing vaginal surgery, the impact of anaesthesia on postoperative lung function as assessed by spirometry was significantly less after SA than GA, particularly in overweight patients.

Background: The combined effect of age, weight, height, and vertebral column length (VCL) on the distribution of isobaric 0.5% bupivacaine within the subarachnoid space is unclear. The aim of the present study was to evaluate the combined influence of these patient variables on the upper sensory level and on its predictability., Methods: In 100 patients who were above the age of 49 years, the age, weight, height, VCL, body surface (BS), and body mass index (BMI) were noted. Spinal puncture and subarachnoid drug administration were standardized. Cephalad spread of spinal anaesthesia (SA) was assessed by loss of temperature sensation and pinprick discrimination 15, 30, 60, 90, and 120 min following subarachnoid injection of 18 mg of plain 0.5% bupivacaine. Linear regression analysis was performed for each of the patient variables and the cephalad segmental spread of anaesthesia. Multiple regression analysis was used to test for combined correlation between patient variables and the sensory level of SA., Results: No linear correlation was found between the patient variables and the sensory level of anaesthesia. In contrast, multiple regression analysis revealed that age (P<0.01), weight (P<0.05), and height (P<0.01) significantly contributed to the spread of anaesthesia. A squared multiple comparison coefficient between 0.10 and 0.21, however, is an indication that the predictive value of the combined variables remained rather low., Conclusion: Multiple regression analysis revealed that age, weight, and height significantly correlated with the sensory level after subarachnoid injection of plain bupivacaine. The low predictive value suggests that patient factors other than age, weight, or height add to cephalad spread of SA.

Background: In elderly patients undergoing ophthalmic surgery the loss of co-operation due to over-sedation, induced by drugs given preoperatively, may jeopardise the success of microsurgery performed under regional anaesthesia. The aim of this study was to compare the psychotropic effects of bromazepam and clorazepate-dipotassium, two benzodiazepines with predominantly anxiolytic and only weak sedative action., Methods: A randomised, placebo-controlled, double-blind study was designed to include 60 patients, ASA physical status II-III, older than 60 years scheduled for ophthalmic surgery under regional anaesthesia. The patients were randomised to receive either bromazepam (3 mg) or clorazepate-dipotassium (20 mg) or placebo. The study drugs were given at 10 p.m. the night before surgery and 90 min before surgery. Using the State-Trait Anxiety Inventory (STAI), the patient's anxiety was assessed at the end of the preoperative visit, on the next morning before the study drug was given and on arrival at the operating theatre., Results: Bromazepam induced a marked anxiolytic effect as documented by a significant reduction in the STAI State values after both applications (P<0.01). Clorazepate did not differ from placebo at any evaluation time with regard to the STAI and haemodynamic values. Sedative effects and oxygen saturation (SpO2) were comparable in all groups., Conclusion: Bromazepam is superior to clorazepate in its anxiolytic action and suitable as preoperative medication in the elderly patient because of lack of overt sedative effects.

Principle goals of sedation for eye surgery are to provide patient comfort and to allow the patient to stay calm during both retrobulbar injection and surgery. Insufficient sedation may not prevent the patient from moving during retrobulbar injection, whereas very deep sedation may result in respiratory complications during surgery. The aim of the present study was to evaluate the effectiveness and suitability of a combination of diazepam and propofol for sedation for both application of retrobulbar block and subsequent elective eye surgery. One-hundred and fifty patients were randomly allocated to receive either diazepam, propofol or a combination of both drugs before retrobulbar injection. Tolerance of retrobulbar injection and comfort during the surgical procedure were assessed by comfort scores using a nominal analogue scale between 1 (worst possible condition) and 6 (best conceivable condition). Side effects related to sedation were recorded. The combination of diazepam and propofol resulted in the highest comfort scores for both retrobulbar block (5.3 +/- 0.3) and the surgical procedure (5.4 +/- 0.4). Diazepam alone did not produce adequate sedation for retrobulbar block (3.1 +/- 0.3), whereas comfort scores during surgery were significantly higher (5.3 +/- 0.3) compared to propofol alone (3.6 +/- 0.4). No severe side effects induced by sedation were noted in any of the study groups. The combination of diazepam and propofol proved able to provide a reliable degree of sedation with minimal side effects for both retrobulbar block and surgery. The combination was clearly superior to the sedation induced by propofol or diazepam alone.