BACKGROUND: Postoperative nausea and vomiting (PONV) is the major complication related to general anesthesia, occurring in 60–80% of patients after thyroidectomy. The objective of this study was to compare the effects of an intraoperative dexmedetomidine infusion with remifentanil, as anesthetic adjuvants of balanced anesthesia, on PONV in patients undergoing thyroidectomy. METHODS: Eighty patients scheduled for thyroidectomy were randomized into the following two groups: 1) The dexmedetomidine group (Group D), who received an initial loading dose of dexmedetomidine (1 µg/kg over 10 min) during the induction of anesthesia, followed by a continuous infusion at a rate of 0.3–0.5 µg/kg/h; 2) the remifentanil group (group R), who received remifentanil at an initial target effect site concentration of 4 ng/ml during the induction of anesthesia, followed by a target effect site concentration of 2–3 ng/ml. PONV was assessed during the first 24 hours in 2 time periods (0–2 h and 2–24 h). The pain intensity, sedation score, extubation time, and hemodynamics were also assessed. RESULTS: During the 2 time periods, the incidence and severity of PONV in group D were significantly lower than in group R. In addition, the need for rescue antiemetics was significantly lower in group D than in group R. The effect of dexmedetomidine on postoperative pain relief (2–24 h) was superior to that of remifentanil. The hemodynamics were similar in both groups, whereas eye opening and extubation time were delayed in group D. CONCLUSIONS: Adjuvant use of intraoperative dexmedetomidine infusion may be effective for the prevention of PONV.
Adjuvants, Anesthesia ; Anesthesia ; Anesthesia, General ; Antiemetics ; Balanced Anesthesia* ; Dexmedetomidine* ; Hemodynamics ; Humans ; Incidence ; Pain, Postoperative ; Postoperative Nausea and Vomiting* ; Thyroidectomy*

BACKGROUND: Microvascular decompression with retromastoid craniotomy carries an especially high risk of postoperative nausea and vomiting. In this study, we compare the antiemetic efficacy of ramosetron and ondansetron in patients undergoing microvascular decompression with retromastoid craniotomy. METHODS: Using balanced anesthesia with sevoflurane and remifentanil infusion, ondansetron 8 mg (group O, n = 31) or ramosetron 0.3 mg (group R, n = 31) was administered at the dural closure. The incidence and severity of postoperative nausea and vomiting, required rescue medications and the incidence of side effects were measured at post-anesthetic care unit, 6, 24 and 48 hours postoperatively. Independent t-tests and the chi-square test or Fisher's exact test were used for statistical analyses. RESULTS: There were no differences in the demographic data between groups, except for a slightly longer anesthetic duration of group R (P = 0.01). The overall postoperative 48 hour incidences of nausea and vomiting were 93.6 and 61.3% (group O), and 87.1 and 51.6% (group R), respectively. Patients in group R showed a less severe degree of nausea (P = 0.02) and a lower incidence of dizziness (P = 0.04) between 6 and 24 hours. CONCLUSIONS: The preventive efficacy of ramosetron when used for postoperative nausea and vomiting was similar to that of ondansetron up to 48 hours after surgery in patients undergoing microvascular decompression with retromastoid craniotomy. A larger randomized controlled trial is needed to confirm our findings.
Antiemetics* ; Balanced Anesthesia ; Chi-Square Distribution ; Craniotomy* ; Dizziness ; Humans ; Incidence ; Microvascular Decompression Surgery* ; Nausea ; Ondansetron* ; Postoperative Nausea and Vomiting ; Vomiting

BACKGROUND: The effects of anesthetics on postoperative stress response remains not fully understood. We evaluated the effects of sevoflurane-remifentanil balanced anesthesia and propofol-remifentanil total intravenous anesthesia (TIVA) on postoperative interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-alpha), cortisol, and laboratory test values for patients with stomach cancer. METHODS: Forty patients were randomly assigned to sevoflurane-remifentanil group (group S) and propofol-remifentanil group (group P). Anesthesia was maintained with balanced anesthesia (group S) or TIVA (group P). We measured the IL-6, TNF-alpha, cortisol and performed laboratory tests before (T1) and after surgery (T2). RESULTS: Concentration of IL-6 and cortisol increased (group S: 1.89 +/- 1.69 pg/ml to 47.11 +/- 44.37 pg/ml, 10.68 +/- 4.89 pg/ml to 14.93 +/- 6.79 pg/ml, group P: 1.74 +/- 1.60 pg/ml to 61.58 +/- 48.65 pg/ml, 9.96 +/- 4.40 pg/ml to 14.27 +/- 7.43 pg/ml, respectively) postoperatively in both groups, but there were not different between group S and group P. There were no differences of TNF-alpha between T1 and T2 in both groups. Changes of other laboratory values were indifferent between groups. CONCLUSIONS: The effects of sevoflurane-remifentanil balanced anesthesia and propofol-remifentanil TIVA on postoperative stress responses in patients with stomach cancer were not different. Further investigations are required to assess the effects of anesthetics on other stress response profiles and such significances.
Anesthesia ; Anesthesia, Intravenous* ; Anesthetics ; Balanced Anesthesia* ; Humans ; Hydrocortisone ; Interleukin-6 ; Propofol ; Stomach Neoplasms* ; Tumor Necrosis Factor-alpha

BACKGROUND: Pulse transit time (PTT), the time it takes a pulse wave to travel from one arterial site to another, is a noninvasive indicator of arterial stiffness. The main objective of our study was to compare two common anesthetic techniques using PTT in order to explore which technique would bring more vascular distention. METHODS: Sixty female patients, ages 18-65, classified by ASA 1 or 2 undergoing general anesthesia, were randomly allocated into two groups, S and P. Group S (n = 30) was inducted with 2 mg/kg of propofol and remifentanil 5.0 ng/ml. Group P (n = 30) was inducted with propofol 4.0 ug/ml and remifentanil 4.0 ng/ml using a target controlled infusion (TCI) pump. Group S was anesthetically maintained with sevoflurane at 1.0 MAC and 1.0 ng/ml remifentanil while group P was anesthetically maintained with propofol 3.0 ug/ml and remifentanil 1.0 ng/ml for 10 minutes. PTT values were obtained by measuring the distance between the electrocardiographic R wave, which approximates the opening of the aortic valve, to the radial artery. Three consecutive values of prePTT, postPTT, and corresponding vital signs were measured and recorded before and 10 minutes after anesthetic induction. RESULTS: PrePTT in group S and group P was 240.18 +/- 3.66 and 239.32 +/- 3.69 ms, respectively. Ten minutes after anesthetic induction, postPTT in group S increased to 284.16 +/- 4.37 ms while postPTT in group P increased to 278.7 +/- 4.53 ms (P > 0.05). However, despite the slope of group S (43.98 +/- 22.18) being greater than group P (39.38 +/- 18.39), the difference between the two groups was statistically insignificant (P = 0.2239). CONCLUSIONS: Changes in PTT values were statistically insignificant regarding arterial distension in patients anesthetized with target controlled infusion of propofol compared to those with balanced anesthesia with sevoflurane.
Anesthesia, General ; Aortic Valve ; Balanced Anesthesia ; Electrocardiography ; Female ; Humans ; Inhalation* ; Propofol* ; Pulse Wave Analysis* ; Radial Artery ; Ultrasonography ; Vascular Stiffness ; Vital Signs

BACKGROUND: The ultrasound-guided oblique subcostal transversus abdominis plane (OSTAP) block provides a wider area of sensory block to the anterior abdominal wall than the classical posterior approach. We compared the intra-operative analgesic efficacy of OSTAP block with conventional intravenous (IV) morphine during laparoscopic cholecystectomy. METHODS: Forty adult patients undergoing laparoscopic cholecystectomy under standard general anesthesia, were randomly assigned for either bilateral OSTAP block using 1.5 mg/kg ropivacaine on each side (n = 20) or IV morphine 0.1 mg/kg (n = 20). The intra-operative pulse rate, systolic and diastolic blood pressure and mean arterial blood pressure were monitored every five minutes. Repetitive boluses of IV fentanyl 0.5 microg/kg were given as rescue analgesia when any of the above-mentioned parameters rose more than 15% from the baseline values. Time to extubation was documented. Additional boluses of IV morphine 0.05 mg/kg were administered in the recovery room if the recorded visual analogue score (VAS) was more than 4. Nausea and vomiting score, as well as sedation score were recorded. RESULTS: The morphine group required more rescue fentanyl as compared to the OSTAP block group but the difference was not significant statistically. Time to extubation was significantly shorter in the OSTAP block group (mean [SD] 10.4 [2.60] vs 12.4 [2.54] min; P = 0.021). Both methods provided excellent analgesia and did not differ in postoperative morphine requirements. No between-group differences in sedation score and incidence of nausea and vomiting were demonstrated. CONCLUSIONS: Ultrasound-guided OSTAP block has an important role as part of balanced anesthesia. It is as efficacious as IV morphine in providing effective analgesia during laparoscopic cholecystectomy.
Abdominal Wall ; Adult ; Amides ; Analgesia ; Anesthesia, General ; Arterial Pressure ; Balanced Anesthesia ; Blood Pressure ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Fentanyl ; Heart Rate ; Humans ; Incidence ; Morphine ; Nausea ; Prospective Studies ; Recovery Room ; Vomiting

OBJECTIVETo investigate the effect of dexmedetomidine on oxygenation function in adult patients with balanced anesthesia by propofol-fentanyl under one-lung ventilation (OLV).

METHODSTwenty-two patients undergoing thoracic operation were randomly divided into the study group and control group, both receiving propofol and fentanyl balanced anesthesia. In the study group, additional infusion of dexmedetomidine (0.3 µg/kg loading dose, 0.3 µg·kg(-1)·h(-1) maintenance dose) was administered, and the patients in the control group received only normal saline. Arterial blood samples were obtained at 4 time points from each patient during anesthesia for blood gas analysis.

RESULTSIn the study group, the pH values remained stable, the oxygenation index tended to decline progressively, but the incidence of hypoxemia was low; in the control group, the pH value and oxygenation index both declined progressively with a higher incidence of hypoxemia.

CONCLUSIONDexmedetomidine can better maintain the oxygenation function of OLV patients in balanced anesthesia by propofol and fentanyl, and its mechanism may be related to the decreased dose of propofol used.

Adult ; Balanced Anesthesia ; Blood Gas Analysis ; Dexmedetomidine ; pharmacology ; Female ; Fentanyl ; Humans ; Male ; Middle Aged ; One-Lung Ventilation ; Propofol

BACKGROUND: Recently, balanced anesthesia (BA: halogenated volatile anesthetics + remifentanil) has been useful for abdominal surgery. The authors therefore performed a retrospective study about the difference in the dose of vasoactive drugs and rocuronium according to the general anesthesia type. METHODS: BA was compared with inhalational anesthesia (IA: halogenated volatile anesthetics + N2O) and total intravenous anesthesia (TIVA: propofol + remifentanil). The records of a total of 415 patients (IA : TIVA : BA = 126 : 157 : 132) who received open gastrectomy between 2004 to 2010 were analyzed. The types of vasoactive drugs and dosage as well as infusion time were calculated. The total amounts of vasoactive drugs were scored by two different methods. Infusion drugs were scored as 30 points, whereas bolus drugs were scored as 5 points. Drug score is the total sum of each score, where each drug score point split either into Plus or Minus. Plus means raising the blood pressure whereas Minus means the opposite. For rocuronium dosage, a total of 286 patients (IA : TIVA : BA = 89 : 78 : 119) who met the criteria were enrolled, and this formula was used (total rocuronium/weight/time, microg/kg/hr). RESULTS: The BA group showed a lower (P = 0.01) Minus score (1.8 +/- 4.0) compared to the IA group (3.6 +/- 5.2). Less amount of rocuronium (P = 0.001) was administered in the BA (327 +/- 72 microg/kg/hr), compared to the IA (368 +/- 93 microg/kg/hr) and TIVA (356 +/- 81 microg/kg/hr). CONCLUSIONS: BA seems to require less hypotensive agent and rocuronium compared with IA and TIVA for open gastrectomy. But, well-designed prospective studies are required.
Androstanols ; Anesthesia ; Anesthesia, General ; Anesthesia, Intravenous ; Anesthetics ; Balanced Anesthesia ; Blood Pressure ; Gastrectomy ; Humans ; Piperidines ; Propofol ; Retrospective Studies

We report a case of an erroneously elevated bispectral index (BIS) during robot assisted thyroidectomy using an electromyographic endotracheal tube (EMG tube), which is safe and useful for laryngeal electromyographic monitoring. Ten minutes after start of the operation, a sudden increase of BIS value up to 98 was noticed. The BIS values were not decreased to < 65 with supplemental anesthetics. The anesthetic method was changed from total intravenous anesthesia to balanced anesthesia. The BIS sensor and monitor were changed and other models were used. These interventions did not alter BIS values. BIS levels remained between 60 and 70 throughout the main procedure and intermittently increased to the mid-90s without any trace of poor signal quality. At the end of the surgery, the BIS values returned to normal range. The patient did not complain of intraoperative recall. Knowledge of potential interference from the use of an EMG tube must be considered when interpreting BIS.
Anesthesia, Intravenous ; Anesthetics ; Balanced Anesthesia ; Humans ; Organothiophosphorus Compounds ; Reference Values ; Thyroidectomy

BACKGROUND: Endoscopic thyroidectomy was recently introduced and has been rapidly accepted by surgeons and patients. The present study was conducted to estimate and compare the incidences of postoperative nausea and vomiting (PONV) after endoscopic thyroidectomy using two different anesthetic methods: sevoflurane based balanced anesthesia; total intravenous anesthesia (TIVA). METHODS: Ninety nine female patients that were scheduled to undergo elective endoscopic thyroidectomy under general anesthesia were enrolled. These patients were randomly allocated to receive sevoflurane based balanced anesthesia (BA group) or propofol-remifentanil anesthesia (TIVA group). PONV was evaluated using a 4-point Likert scale, and pain using a visual analogue scale (VAS; range 0 to 100) for 0-2, 2-6, and 6-24 hours postoperatively. At 24 hours postoperatively, overall patient satisfaction regarding PONV and pain were recorded. RESULTS: The incidence of PONV was 14.6% in the TIVA group and 51.3% in the BA group. The incidence of nausea at 0-2 and 2-6 hours postoperatively was lower in the TIVA group than in the BA group (4.2% vs. 35.9%, 6.3% vs. 23.1%, respectively), but no between-group difference was observed at 6-24 hours postoperatively (8.3% vs. 5.1%). Antiemetic usage at 0-2 and 2-6 hours was lower in the TIVA than the BA group (4.2% vs. 38.5%, 6.3% vs. 23.1%), but no between-group difference was observed for 6-24 hours (6.3% vs. 7.7%). There were no differences in pain or in patient satisfaction. CONCLUSIONS: After endoscopic thyroidectomy, total intravenous anesthesia with propofol-remifentanil is associated with less PONV during the early postoperative period (0-6 hours) than sevoflurane based balanced anesthesia.
Anesthesia ; Anesthesia, General ; Anesthesia, Intravenous ; Balanced Anesthesia ; Female ; Humans ; Incidence ; Methyl Ethers ; Nausea ; Patient Satisfaction ; Postoperative Nausea and Vomiting ; Postoperative Period ; Thyroidectomy

BACKGROUND: There is growing interest in the anesthetic approach using total intravenous anesthesia (TIVA) with propofol and remifentanil for the prevention of postoperative nausea and vomiting (PONV). The aim of this study was to compare between the two anesthetic techniques for preventing PONV in the patients undergoing mastoidectomy with tympanoplasty. METHODS: After obtaining informed consent, 62 patients aged between 20 to 60 years undergoing elective mastoidectomy and tympanoplasty were randomized into two equal study groups: group P/R (n = 31) included patients undergoing TIVA with propofol and remifentanil, and group S/R (n = 31) included patients undergoing balanced anesthesia with sevoflurane and remifentanil. The incidences of PONV and complete response (no PONV, no rescue) were assessed at 1 and 24 h after surgery, using the Rhodes Index. Also, the usage of rescue antiemetics and pain intensity were recorded. RESULTS: The Rhodes Index including the occurrence score, distress score and experience score was significantly lower in the P/R group compared to that in the S/R group during the study period (P < 0.05), and the incidence of complete response was significantly higher in the P/R group compared to that in the S/R group, during the first 24 h after surgery. 4 patients in the S/R group requested antiemetics during the first 1 h after surgery. There were no significant differences in pain intensity among groups. CONCLUSIONS: Compared to balanced anesthesia with sevoflurane and remifentanil, TIVA with propofol and remifentanil was followed by significantly lower incidence and severity of PONV.
Aged ; Anesthesia ; Anesthesia, Intravenous ; Antiemetics ; Balanced Anesthesia ; Humans ; Incidence ; Informed Consent ; Methyl Ethers ; Piperidines ; Postoperative Nausea and Vomiting ; Propofol ; Tympanoplasty