scholarly journals Preoperative regional scalp block versus intraoperative intravenous fentanyl for attenuating intraoperative surgical stress response to supratentorial craniotomy in adult patients under general anaesthesia

2020 ◽  
Vol 11 (4) ◽  
Author(s):  
Ahmed Beniamen Mohamed Hussien ◽  
ZakiTahaSaleh ◽  
Hala Abdel Sadek Al attar ◽  
Yasser Mohamed Nasr
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Stress Response ◽  
General Anaesthesia ◽  
Surgical Stress ◽  
Control Group ◽  
Surgical Stress Response ◽  
Intravenous Fentanyl ◽  
Supratentorial Craniotomy ◽  
Scalp Block

During brain tumour resection a lot of noxious stimuli are released resulting in a significant hemodynamic and stress response, its control is challenging during anaesthesia, and can be evaluated by monitoring blood pressure (BP), heart rate (HR) Attenuating autonomic cardiovascular responses to pain resulting from skull pinning, skin incision, and craniotomy are considered significant benefits of Regional Scalp Block (RSB) in addition to reducing postoperative analgesic requirements. This study aims to evaluate the effect of preoperative regional scalp block (RSB) versus intraoperative intravenous fentanyl for attenuating intraoperative surgical stress response to supratentorial craniotomy in adult patients under general anaesthesia. The study included 30 patients randomly distributed into two equal groups with 15 patients in each, Group A: Preoperative RSB was done after induction of general anaesthesia and before skull pinning, Group C: Control group: patients were given conventional intraoperative analgesia in the form of intravenous fentanyl with no block. This study included patients with Supratentorial brain tumours were admitted to Zagazig University Hospitals. Patients have been gathered over two years duration from march 2018 to march 2020. The results showed that there were highly significant differences between RSB group and control group. Preoperative RSB showed advantages over Standard analgesia in terms of better attenuation of stress response to pain in the form of heart rate and blood pressure intraoperatively, decrease opioid consumption, lower Visual Analogue Score (VAS), Preoperative RSB can be performed easily in a short time with very high success rate allowing better intraoperative control of haemodynamics, less postoperative pain. We recommend using preoperative RSB in supratentorial craniotomy as a gold standard in our hospital to get the advantages mentioned above.

scholarly journals INFLUENCE OF INTRAOPERATIVE FLUID THERAPY ON STRESS RESPONSE IN PAEDIATRIC ORTHOPAEDIC SURGERY

2021 ◽  
Vol 11 (1(39)) ◽  
pp. 22-27
Author(s):  
Іryna Kyselova
Keyword(s):  
Insulin Resistance ◽  
Blood Pressure ◽  
Heart Rate ◽  
Stress Response ◽  
Fluid Therapy ◽  
Orthopaedic Surgery ◽  
Surgical Stress ◽  
Surgical Stress Response ◽  
Group 2 ◽  
Paediatric Orthopaedic

Introduction. Optimization of the intraoperative fluid therapy is one of the elements of the ERAS program. The strategy of avoiding fluid overload has shown positive results in adults, but still remains unexplored in children. Fluid requirements in children are higher than in adults and they vary with age. It’s still not clear whether it is possible or not to extrapolate the data of studies obtained in adults to children and to use similar recommendations. The aim of this study is to compare intraoperative fluid approaches from the point of view of surgical stress response in children undergoing orthopaedic surgery. Material and Methods: The study included 60 pediatric patients over 1 year of age who had undergone orthopaedic surgery. Рatients were stratified into two groups depending on the volume of intraoperative base crystalloid infusion. First group of patients received <7 ml/kg/h crystalloids, and the second group of patients received > 7 ml/kg/h. We evaluated intraoperatively changes of blood pressure, heart rate, urine output, Hb, Ht, blood glucose, acidbase status. After surgery we estimated lactate, insulin, insulin resistance index HOMA-IR (homeostatic model assessment) and insulin sensitivity index QUICKI. Mean data was compared with Mann-Whitney U-test. Results of the study: After stratification two groups were identified. The first group of patients (n=30) received 10.7 ± 3.03 ml/kg/h and the second one 2 (n=30) – 5.07 ± 1.15 ml/kg/h of intraoperative crystalloid fluids as a basic fluid therapy. We did not find significant changes in blood pressure, heart rate, Hb, Ht, acid-base status in both groups. But the urine output was decreased in the group 2 (0.43 ± 0.59 ml/kg/h) in comparison with the group 1 (1.16 ± 0.89, p=0.009). The concentration of blood glucose was insignificantly increased in both groups, but the level of insulin and HOMA-IR was significantly higher in group 2 (insulin 5.39 ± 3.93 vs 8.94 ± 6.15 mU/L, p=0.006; HOMAIR 1.30 ± 1.05 vs 2.39 ± 2.14, p=0.004), and index QUICKI was lower (0.39 ± 0.05 vs 0.35 ± 0.04, p=0.004). We also found the tendency to lactation increase in group 2 (1.46 ± 0.62 vs 1.90 ± 0.69, p=0.07), even though that was not significant. Conclusion: This study revealed the tendency to insulin resistance of tissues as one of the signs of a surgical stress response in children who were limited in intraoperative fluid therapy during orthopaedic surgery. Results of the study suggest that the limitation of intraoperative fluids is not applicable for children, and the volume of base crystalloids must be more than at least 7 ml/kg/h during paediatric orthopaedic surgery. Further research is necessary to determine what minimum volume is acceptable in other types of paediatric surgeries.

scholarly journals STRESS-LIMITING ANESTHESIA IN OPHTHALMOSURGERY

World Science ◽  
2021 ◽  
Author(s):  
Mynka N. V. ◽  
Kobelyatskyy Yu. Yu.
Keyword(s):  
Blood Glucose ◽  
Stress Response ◽  
General Anesthesia ◽  
Surgical Stress ◽  
Pain Syndrome ◽  
Control Group ◽  
Surgical Trauma ◽  
Complete Protection ◽  
Surgical Stress Response ◽  
Anesthesia Group

Despite the significant advances made by modern anesthesiology in the perioperative management of patients, surgical interventions are still accompanied by a high proportion of complications and even deaths. At the same time, it is known that in 50% of cases mortality and serious postoperative complications could be prevented. After performing a thorough study of the factors affecting the increase in hospitalization and postoperative recovery (Kehlet H., 1997; Kehlet H., Wilmore D., 2002), it was determined that the surgical stress response is the most significant inducer of dysfunction of various organs. and systems. To date, it has been established that general anesthesia in its classical sense does not allow achieving complete protection of the patient from surgical trauma. More complete protection can be achieved by combining general anesthesia with regional blockages and adjuvant drugs with stress-protective properties. In the present study, we compared the severity of the surgical stress response and pain syndrome in patients operated on under conditions of multicomponent balanced general anesthesia (group K) with patients who received a stress-limiting anesthesia regimen (group DB). In both groups, multicomponent anesthesia was performed, in group K, sibazone was used for sedation, in group DB, dexmedetomidine was used. Also, patients of the DB group underwent regional blockade (blockade of the pterygo-palatine fossa) before surgery. The main criteria for evaluating the results were: hemodynamic stability, blood glucose, the level of venous blood leukocytes and the severity of pain according to the VAS in the postoperative period. Both schemes made it possible to avoid pronounced fluctuations in hemodynamic and gas exchange parameters at all stages of the study. When analyzing blood glucose and leukocyte counts, it was found that patients in the control group had a more significant deviation of both indicators from the preoperative level than in the stress-limiting anesthesia group. In the study of pain syndrome, it was determined that in the control group the level of pain according to the VAS was higher at all stages of the study compared to patients in the group of stress-limiting anesthesia.

scholarly journals THE INFLUENCE OF COMPLEX IMPLEMENTATION OF THE ERAS PROGRAM ON THE SURGICAL STRESS RESPONSE FACTORS IN PEDIATRIC PATIENTS UNDERGOING ELECTIVE LIMB SURGERY

2021 ◽  
pp. 28-37
Author(s):  
I.V. KYSELOVA ◽  
A.V. BILIAIEV
Keyword(s):  
Blood Glucose ◽  
Stress Response ◽  
Postoperative Period ◽  
Enhanced Recovery ◽  
Surgical Stress ◽  
Length Of Hospital Stay ◽  
Control Group ◽  
Study Group ◽  
Surgical Stress Response ◽  
Beta Hydroxybutyrate

Surgical stress response, fluid and nutritional balance, and pain management are among the key factors influencing on the postoperative period. These areas are reflected in the Enhanced Recovery After Surgery (ERAS) concept, which is based on a set of measures aimed at minimizing the surgical stress response. The lack of ERAS recommendations for the pediatric population of surgical patients prompts to search for a solution of adaptation and implementation of the ERAS programs in children. The aim of the study. To determine the effectiveness of the complex application of the enhanced recovery after surgery by studying its influence on the factors of the surgical stress response in pediatric patients undergoing limp surgery. Materials and methods. The prospective randomized study included 47 patients aged 1 to 17 years. In the study group (n = 22), the ERAS program was used, which consisted of 14 components of preoperative, intraoperative and postoperative measures. In the control group (n = 25), the complex of all ERAS components was not purposefully applied. We compared glycaemic stress index (GSI) and length of hospital stay after surgery (LOS) as a primary outcome; secondary outcomes were fasting time after drinking fluids before induction of anesthesia, estimated fluid deficiency just before induction of anesthesia, hemodynamic parameters, the need for opioids during and after surgery, blood glucose and beta-hydroxybutyrate in the beginning and in the end of the surgery and next day morning after surgery, postoperative nausea and vomiting. Results. GSI was significantly less in the study group (1,62 ± 0,78 vs 2,12 ± 0,93, р=0,046). LOS in the study group was 37.5% less than in the control group (p = 0.002). The period of preoperative fasting and fluid deficit in the patients of the study group were shorter. The needs of fentanyl intraoperatively in the study group was 47% less (p<0.001). At the beginning of surgery, the study group had a higher blood glucose concentration and a higher systolic blood pressure. At the end of surgery, blood glucose and beta-hydroxybutyrate in the study group was lower than in the control group. In the postoperative period, 9% of patients in the study group and 36% of patients in the control group complained of nausea (p = 0.041). Linear regression analysis showed a linear relationship between the LOS after surgery and the GSI (R=0,515, R2=0,266, B=2,156, 95% CI 1,04 – 3,27, p<0,001). Results. The implementation of the ERAS program to children 1-17 years old undergoing elective limp surgery may reduce the effect of the surgical stress reaction by reducing the period of preoperative fasting, fluid deficiency, the needs of opioids and postoperative nausea. Minimizing the surgical stress response may facilitate the achievement of hospital discharge criteria and shorten the length of hospital stay in the postoperative period.

scholarly journals Comparison of esmolol versus combination of esmolol and fentanyl in preventing cardiovascular stress response to intubation

2017 ◽  
Vol 4 (1) ◽  
pp. 49
Author(s):  
Rahul Bhalke ◽  
Maroti S. Karale ◽  
Umesh Deshmukh
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Stress Response ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Cardiovascular Responses ◽  
Intravenous Fentanyl ◽  
Group 2 ◽  
Post Intubation ◽  
Group 1

<p><strong> </strong></p><p class="abstract"><strong>Background:</strong> A number of cardiovascular responses occur during laryngoscopy and intubation which can have serious consequences during anaesthesia.We planned to conduct a study to evaluate effectiveness of intravenous Esmolol and intravenous Fentanyl in attenuating hemodynamic stress response to laryngoscopy and endotracheal intubation.</p><p class="abstract"><strong>Methods:</strong> A prospective, observational, randomized, double blind comparative clinical study, conducted on 60 cases of ASA grade I/II patients undergoing elective abdominal surgery under general anesthesia. The data obtained was divided in the two groups based on drug used 5 min prior to induction, Group 1 (I.V. Esmolol 2 mg/kg) and Group 2 (I.V. Esmolol 2 mg/kg &amp; I.V. Fentanyl 2 µg/kg). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were measured at various time intervals.</p><p class="abstract"><strong>Results:</strong> There was no significant difference in HR, SBP, DBP, MAP after premedication and induction in both the groups. However at intubation, both groups showed an increase in HR, SBP, DBP and MAP but the rise was attenuated in both groups. Increase in HR was more in group 1 as compared to group 2 and it was statistically significant at 01 and 02 minutes post intubation. The increase in SBP was statistically significant at 00, 01 and 02 minutes post intubation. The increase in MAP was statistically significant immediately after induction, at 00, 01, 02, 05 and 10 minutes post intubation.  </p><p class="abstract"><strong>Conclusions:</strong> Combination of intravenous Esmolol and intravenous Fentanyl is more effective in attenuating heart rate, systolic, diastolic and mean arterial pressure response to intubation than intravenous Esmolol alone.</p>

scholarly journals Single-centre, double-blind, randomised, parallel-group, superiority study to evaluate the effectiveness of general anaesthesia and ultrasound-guided transversus thoracis muscle plane block combination in adult cardiac surgery for reducing the surgical stress response: clinical trial protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e051008
Author(s):  
A A Gde Putra Semara Jaya ◽  
Aida Rosita Tantri ◽  
Aldy Heriwardito ◽  
Arif Mansjoer
Keyword(s):  
Stress Response ◽  
General Anaesthesia ◽  
Heart Surgery ◽  
Surgical Stress ◽  
Open Heart Surgery ◽  
Randomised Control Trial ◽  
Open Heart ◽  
Double Blind ◽  
Surgical Stress Response ◽  
The Difference

IntroductionAdult open-heart surgery is a major surgery that causes surgical stress response and activation of the immune system, contributing further to postoperative complications. Transversus thoracis muscle plane block (TTPB) may potentially benefit in reducing the surgical stress response. This study aims to know the effectiveness of preoperative TTPB in adult open-heart surgery for reducing the surgical stress response.Methods and analysisThis study is a prospective, double-blind, randomised control trial comparing the combination of general anaesthesia and TTPB versus general anaesthesia only in adult open-heart surgery. Forty-two eligible subjects will be randomly assigned to the TTPB group or control group. The primary outcomes are the difference between the two groups in the means of postoperative cortisol and interleukin-6 plasma levels at 24 hours and 48 hours after cardiac intensive care unit admission. The secondary outcomes are the difference between the two groups in the means of total 24-hour postoperative morphine consumption and time of first postoperative patient-controlled analgesia (PCA) dose.Ethics and disseminationThe study protocol and informed consent forms have been reviewed and approved by the Ethics Committee of Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital. The result will be released to the medical community through presentation and publication in peer-reviewed journals.Trial registration numberNCT04544254.

scholarly journals A randomized controlled study of intravenous esmolol to attenuate the cardiovascular responses to laryngoscopy and endotracheal intubation

2020 ◽  
Vol 8 (3) ◽  
pp. 1103
Author(s):  
Ninad Deepak Chodankar ◽  
Bhagyashree Shivde
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
General Anaesthesia ◽  
Endotracheal Intubation ◽  
Elective Surgery ◽  
Cardiovascular Responses ◽  
Controlled Study ◽  
Control Group ◽  
Significant Difference ◽  
Control Group Group

Background: Objective is to compare the efficacy of intravenous Esmolol to attenuate the cardiovascular responses to laryngoscopy and endotracheal intubation with control group.Methods: Study was done on 60 adults, ASA grade I or II normotensive patients, undergoing elective surgery under general anaesthesia and willing to participate. These patients where be randomly allocated in to either group C (Control) or E (Esmolol). Group ‘C’ Control group. Group ‘E’, patients were given intravenous Esmolol 1.5 mg/kg 2 minutes before start of laryngoscopy. All patients were premedicated, induced and intubated using Thiopentone and Succinyl Choline as per the protocol. Heart Rate (HR), SBP, DBP and MAP were recorded at baseline (taken half an hour prior to anaesthesia), Before sedation, After induction but before intubation, Immediately after endotracheal intubation and Thereafter at 1, 2, 3, 4, 5 and 10 minutes.Results: Heart rate was lower in Group E as compared to Group C, and there was statistically significant difference immediately after intubation till 4 minutes after intubation. While Blood pressure was lower in Group E as compared to Group C, and there was statistically significant difference only immediately after intubation.Conclusions: In Normotensive patients requiring general anaesthesia with laryngoscopy and intubation, authors conclude that intravenous Esmolol 1.5 mg/kg attenuated Heart rate response but fails to satisfactorily prevent rise in blood pressure.

Impact of Bilateral St36 and Pc6 Electroacupuncture on the Depth of Sedation in General Anaesthesia

2015 ◽  
Vol 33 (2) ◽  
pp. 103-109 ◽  
Author(s):  
Yiding Chen ◽  
Hongwei Zhang ◽  
Yumin Tang ◽  
Jingjun Shu
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Abdominal Surgery ◽  
Equilibrium State ◽  
General Anaesthesia ◽  
Control Group ◽  
Acupuncture Points ◽  
Time Points ◽  
The Impact ◽  
Narcotrend Index

Objective To investigate the impact of electroacupuncture (EA) at bilateral acupuncture points ST36 and PC6 on the level of sedation in general anaesthesia. Methods 40 patients undergoing abdominal surgery were randomly divided into two groups: EA combined with general anaesthesia (EA group, n=20) and general anaesthesia control group (n=20). The bilateral acupuncture points ST36 and PC6 were selected in both groups. Target-controlled infusion (TCI) of propofol was used for the induction and maintenance of general anaesthesia to reach an equilibrium state of Narcotrend Index (NT index). In the EA group, EA was performed with a Hans EA device. In the control group, general anaesthesia was performed without EA stimulation. In both groups, heart rate (HR), mean blood pressure (MAP) and NT index were recorded at corresponding time points up to 30 min after the end of acupuncture. Results The NT indices of the EA group showed a downward trend after EA stimulation (p=0.01). From 15 min after the start of EA stimulation the NT indices of the EA group were significantly lower than those of the control group (p<0.05). HR and MAP of the two groups showed no significant differences at any time points (p≥0.05). Conclusions EA stimulation at bilateral ST36 and PC6 significantly deepens the sedation level of general anaesthesia in patients with propofol TCI, has little impact on haemodynamics and provides significant delayed sedation effects.

scholarly journals Comparison of the efficacy of combined epidural anesthesia with general anaesthesia alone to attenuate hemodynamic responses and perioperative analgesia in laparoscopic cholecystectomy patients

2019 ◽  
Vol 7 (7) ◽  
pp. 2696
Author(s):  
Aishwarya Bandewar ◽  
Shweta Naik ◽  
Manish Kokne ◽  
Sugampreet Kaur
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Laparoscopic Cholecystectomy ◽  
Stress Response ◽  
Diastolic Blood Pressure ◽  
General Anaesthesia ◽  
Epidural Anesthesia ◽  
Postoperative Analgesia ◽  
Hemodynamic Responses ◽  
Recovery Score

Background: The aim of the study was to compare the efficacy of combined GA-Epidural Anesthesia (CEGA) with GA alone to attenuate hemodynamic responses and perioperative analgesia.Method: Authors conducted a prospective, randomized, double blind study, in which 60 patients undergoing laparoscopic cholecystectomy. Group A received (n=30) received GA and Group B (n=30) received combined GA and Epidural Anaesthesia (CEGA). Authors analyzed the effect of combined epidural general anaesthesia as compared to plain general anaesthesia with regard to hemodynamic parameters (heart rate, systolic and diastolic blood pressure), intraoperative anaesthetic requirement (intraoperative requirement of propofol), recovery score and postoperative analgesia (VAS score).Results: Authors found significant decrease in the heart rate, systolic and diastolic blood pressure in response to stress response to pneumoperitoneum in combined epidural general anaesthesia (CEGA) group compared to plain general anaesthesia (GA) group. Total amount of propofol required intraoperatively was less in CEGA group than in GA group. Recovery score and pain score (VAS) score were also compared which were better in CEGA group than in GA group. There were no significant intraoperative and postoperative complications noted in both the groups.Conclusion: Authors concluded that the use of epidural along with general anaesthesia helps in attenuating hemodynamic changes due to stress response to pneumoperitoneum, which results in maintaining stable intraoperative and postoperative hemodynamics during laparoscopic cholecystectomy surgery. Combining epidural to general anaesthesia results in rapid recovery as compared to plain general anaesthesia and also helps in providing good postoperative analgesia.

The Effects of a Caffeine Placebo and Experimenter Expectation on Blood Pressure, Heart Rate, Well-Being, and Cognitive Performance

2001 ◽  
Vol 6 (1) ◽  
pp. 15-25 ◽  
Author(s):  
Harald Walach ◽  
Stefan Schmidt ◽  
Yvonne-Michelle Bihr ◽  
Susanne Wiesch
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cognitive Task ◽  
Well Being ◽  
Control Group ◽  
Double Blind ◽  
Main Effect ◽  
The Difference ◽  
Being There ◽  
To Receive

We studied the effect of experimenter expectations and different instructions in a balanced placebo design. 157 subjects were randomized into a 2 × 4 factorial design. Two experimenters were led to expect placebos either to produce physiological effects or not (pro- vs. antiplacebo). All subjects except a control group received a caffeine placebo. They were either made to expect coffee, no coffee, or were in a double-blind condition. Dependent measures were blood pressure, heart rate, well-being, and a cognitive task. There was one main effect on the instruction factor (p = 0.03) with the group “told no caffeine” reporting significantly better well-being. There was one main effect on the experimenter factor with subjects instructed by experimenter “proplacebo” having higher systolic blood pressure (p = 0.008). There was one interaction with subjects instructed by experimenter “proplacebo” to receive coffee doing worse in the cognitive task than the rest. Subjects instructed by experimenter “antiplacebo” were significantly less likely to believe the experimental instruction, and that mostly if they had been instructed to receive coffee. Contrary to the literature we could not show an effect of instruction, but there was an effect of experimenters. It is likely, however, that these experimenter effects were not due to experimental manipulations, but to the difference in personalities.

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