BACKGROUND: The aim of the study was to evaluate the comparative effects of propofol infusion versus sevoflurane for maintenance of anesthesia with respect to hemodynamics, recovery characteristics, nausea and vomiting in patients undergoing percutaneous nephrolithotomy. METHODS: Forty American Society of Anesthesiologists physical status I-II patients, aged between 22 and 65 years were randomly divided to receive either intravenous anesthesia with propofol (group P) or sevoflurane (group S). Cardiovascular variables, peripheral oxygen saturation (SpO2), end-tidal carbon dioxide (ETCO2), bispectral index (BIS) and train-of-four (TOF) values were recorded at intervals throughout the procedure. Time to spontaneous respiration, eye opening, extubation, obey commands, hand squeezing, Aldrete Score > 9 and the incidence of postoperative nausea and vomiting were recorded. RESULTS: Early recovery times [spontaneous respiration (P = 0.002), eye opening (P = 0.006), extubation (P = 0.013), obey commands (P < 0.05), hand squeezing (P = 0.005)] were significantly longer in group P. The incidence of vomiting was significantly higher in group S (P < 0.05). Hemodynamic parameters, levels of SpO2, ETCO2, and BIS and TOF values were not significantly different between the groups (P > 0.05). CONCLUSIONS: The present study which adjusted sevoflurane concentration and propofol infusion rate according to BIS values revealed that maintenance of anesthesia with sevoflurane is associated with faster recovery than anesthesia with propofol. Propofol resulted in a significantly lower incidence of postoperative nausea and vomiting. Hemodynamic parameters and levels of SpO2 and ETCO2 were comparable between the groups during percutaneous nephrolithotomy.
Aged ; Anesthesia ; Anesthesia, Intravenous ; Carbon Dioxide ; Consciousness Monitors ; Eye ; Hand ; Hemodynamics ; Humans ; Incidence ; Methyl Ethers ; Nausea ; Nephrostomy, Percutaneous ; Oxygen ; Postoperative Nausea and Vomiting ; Propofol ; Respiration ; Vomiting

Obese subjects are more prone to sudden deaths and arrhythmias than non-obese subjects. Heart rate turbulence (HRT) impairment reflects cardiac autonomic dysfunction, in particular impaired baroreflex sensitivity and reduced parasympathetic activity. Our aim was to evaluate the cardiac autonomic function in obesity by the HRT method. Ninety obese subjects and 112 healthy subjects were included in the study. Twenty-four hours ambulatory electrocardiograms were recorded and Holter recordings were analyzed. HRT parameters, turbulence onset (TO) and turbulence slope (TS), were calculated with HRT View Version 0.60-0.1 software program. HRT were calculated in 43 obese and 43 control subjects who had at least one ventricular premature beat in their Holter recordings. We excluded 47 obese patients and 69 control subjects who showed no ventricular premature beats in their Holter recordings from the statistical analysis. There were no significant differences in TO and TS between obese and control subjects (TO obese: -1.6+/-2.2%, TO control: -2.1+/-2.6%, p>0.05; TS obese: 8.2+/-5.2, TS control: 10.1+/-6.7, p>0.05, respectively). HRT parameters seem to be normal in obese patients without comorbidities.
Adult ; Aged ; Autonomic Nervous System/*physiopathology ; Blood Pressure/physiology ; Body Mass Index ; Cholesterol/blood ; Cholesterol, LDL/blood ; Electrocardiography, Ambulatory/*methods ; Female ; Heart/*innervation ; Heart Rate/*physiology ; Humans ; Male ; Middle Aged ; Obesity/blood/*physiopathology ; Triglycerides/blood

BACKGROUND: Epidural anesthesia is one of the best options for lower abdominal and lower limb surgery. However, there have been insufficient reports regarding the use of epidural anesthesia for pilonidal sinus surgery. The present study was performed to compare the clinical profiles of epidural block performed with 0.75% levobupivacaine and 0.75% ropivacaine in this procedure. METHODS: Thirty patients undergoing pilonidal sinus surgery were randomly allocated into two groups: one group received levobupivacaine and the other received ropivacaine at 0.75% in a volume of 10 ml. Arterial blood pressure, heart rate, oxygen saturation, the onset time of analgesia and duration of block, highest sensory block level, perioperative and postoperative side effects, and patients' and surgeons' satisfaction were recorded. RESULTS: Hemodynamic stability was maintained in both groups throughout surgery. The onset time of analgesia (the time from epidural injection of local anesthetic to reach L2 sensorial block) was 6.26 +/- 3.49 min in the levobupivacaine group and 4.06 +/- 1.75 min in the ropivacaine group (P = 0.116). The duration of sensorial block (time for regression of sensory block to L2) was 297.73 +/- 70.94 min in group L and 332.40 +/- 102.22 min in group R (P = 0.110). Motor block was not seen in any of the patients in the study groups. Patients' and surgeons' satisfaction with the anesthetic technique were mostly excellent in both groups. CONCLUSIONS: In patients undergoing pilonidal sinus surgery, both levobupivacaine and ropivacaine produce rapid and excellent epidural block without leading to motor block or significant side effects. Although not statistically significant, the onset time of anesthesia was shorter and the duration of effect was longer with ropivacaine than with levobupivacaine in this study.
Analgesia ; Anesthesia ; Anesthesia, Epidural* ; Arterial Pressure ; Heart Rate ; Hemodynamics ; Humans ; Injections, Epidural ; Lower Extremity ; Oxygen ; Pilonidal Sinus*