- Email: [email protected]
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Posters
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Miscellaneous
89
Miscellaneous 26. Ultrasound in the anesthesia locoregional: curve of learning A. Marques, E. Romero, M. Richard, N. Collado, J. Silla [email protected] Hospital Malvarosa, Valencia, Spain The ultrasound applied to the anesthesia locoregional offers potentially clear clinical benefits. It allows a clear visualization and location of the nerves, allowing to indicate the best place to us for the insertion of the needle and this correct location in the proximity of the same one without injuries y/o nervous damages, avoiding complications as the injection intravascular and / or puncture pleural, observation in real time the deposit of the A.L. about the nerve, facilitating the identification of the structures in patients in whom the palpation and identification can turn out to be very laborious. Nevertheless the ultrasound is unfamiliar for the majority of the anesthesiologists, what can mean an impediment and a rejection to this utilization. To develop a curve of learning divided in levels that allows, that overcome these phases can realize ’Technology Of Blockade Locoregional Guided by Ultrasound”. Material and Methods: (1)Service of radiology. An optional assigned collaborator two hours in day from one morning to the week for three weeks (2) Ultrasonund portable SONOSITE (3) Models. Initially the members of Anesthesia service. Levels: 1 ° level: compression and identification of the anatomical structures 2 ° level: hand-eye coordination to align the needle to the ultrasound beam. Results: From January that we initiate the process, nearly 80 % of the personnel has overcome successfully it 1alevel, finding difficulties in 2 a level practically 50 % of the service that though there is reproduced by means of nerve stimulation the proximity of the top of the needle not visualize the sufficient thing by ultrasound. Conclusions: The contribution of the ultrasound supposes already an indisputable advance; nevertheless it is necessary to establish guides of learning to incorporate these advances of routine form in our operating rooms.
32. Comparison between combined general and epidural anesthesia and general anesthesia alone with respect to hemodynamic stability, stress response and sevoflurane requirement A. Ersoy, A. Altan, A. Turkmen, A. Bilen, S. Kamali [email protected] Okmeydani Training Hospital, Istanbul, Turkey Introduction: Combined administration of epidural local anesthesic agents together with general anesthesic agents(iv or inhalational) is a frequently used method in abdominal and thoracic surgery. In this study, our aim was to compare general⫹ epidural anesthesia (G⫹E) with general anesthesia alone (G) in patients who had major abdominal surgery with respect to hemodynamic stability, stress response and sevoflurane requirement. Methods: Thirty ASA I-II group patients(age range 40-73), who were prepared for major abdominal surgery in general surgery clinics, have randomly been divided into two groups of fifteen cases each(n⫽15). Induction was carried out with propofol, cisatracurium and fentanil and maintenance with N2O ⫹O2 ⫹ sevoflurane in both groups.20 ml ropivacaine(7.5%) was administered epidurally before induction in group G⫹E. Parameters such as heart rate, systolic arterial pressure, peripherical O2 saturation were recorded preoperatively and at 1,5,10,20,40,60,90,120 and 150 minutes after incision, at extubation and 5 minutes after extubation. Blood cortisol and glucose levels were monitored perioperatively. In case of a response to surgical stimulus sevoflurane concentration have been increased by 0.5%. Results: Cortisol values at 60 minutes after induction of anesthesia and 5 minutes after extubation in groupG were found to be significantly increased when compared to group G⫹E. Peroperative sevoflurane requirement was lower in G⫹E. Heart rate and systolic arterial pressure values were lower in group G⫹E compared to group G. Conclusions: In the general⫹ epidural anesthesia group, we have observed that hemodynamic stability has been preserved and stress response and sevoflurane requirement have decreased. General ⫹ epidural anesthesia in major abdominal surgery is a method superior to general anesthesia alone.
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Miscellaneous
89
Miscellaneous 26. Ultrasound in the anesthesia locoregional: curve of learning A. Marques, E. Romero, M. Richard, N. Collado, J. Silla [email protected] Hospital Malvarosa, Valencia, Spain The ultrasound applied to the anesthesia locoregional offers potentially clear clinical benefits. It allows a clear visualization and location of the nerves, allowing to indicate the best place to us for the insertion of the needle and this correct location in the proximity of the same one without injuries y/o nervous damages, avoiding complications as the injection intravascular and / or puncture pleural, observation in real time the deposit of the A.L. about the nerve, facilitating the identification of the structures in patients in whom the palpation and identification can turn out to be very laborious. Nevertheless the ultrasound is unfamiliar for the majority of the anesthesiologists, what can mean an impediment and a rejection to this utilization. To develop a curve of learning divided in levels that allows, that overcome these phases can realize ’Technology Of Blockade Locoregional Guided by Ultrasound”. Material and Methods: (1)Service of radiology. An optional assigned collaborator two hours in day from one morning to the week for three weeks (2) Ultrasonund portable SONOSITE (3) Models. Initially the members of Anesthesia service. Levels: 1 ° level: compression and identification of the anatomical structures 2 ° level: hand-eye coordination to align the needle to the ultrasound beam. Results: From January that we initiate the process, nearly 80 % of the personnel has overcome successfully it 1alevel, finding difficulties in 2 a level practically 50 % of the service that though there is reproduced by means of nerve stimulation the proximity of the top of the needle not visualize the sufficient thing by ultrasound. Conclusions: The contribution of the ultrasound supposes already an indisputable advance; nevertheless it is necessary to establish guides of learning to incorporate these advances of routine form in our operating rooms.
32. Comparison between combined general and epidural anesthesia and general anesthesia alone with respect to hemodynamic stability, stress response and sevoflurane requirement A. Ersoy, A. Altan, A. Turkmen, A. Bilen, S. Kamali [email protected] Okmeydani Training Hospital, Istanbul, Turkey Introduction: Combined administration of epidural local anesthesic agents together with general anesthesic agents(iv or inhalational) is a frequently used method in abdominal and thoracic surgery. In this study, our aim was to compare general⫹ epidural anesthesia (G⫹E) with general anesthesia alone (G) in patients who had major abdominal surgery with respect to hemodynamic stability, stress response and sevoflurane requirement. Methods: Thirty ASA I-II group patients(age range 40-73), who were prepared for major abdominal surgery in general surgery clinics, have randomly been divided into two groups of fifteen cases each(n⫽15). Induction was carried out with propofol, cisatracurium and fentanil and maintenance with N2O ⫹O2 ⫹ sevoflurane in both groups.20 ml ropivacaine(7.5%) was administered epidurally before induction in group G⫹E. Parameters such as heart rate, systolic arterial pressure, peripherical O2 saturation were recorded preoperatively and at 1,5,10,20,40,60,90,120 and 150 minutes after incision, at extubation and 5 minutes after extubation. Blood cortisol and glucose levels were monitored perioperatively. In case of a response to surgical stimulus sevoflurane concentration have been increased by 0.5%. Results: Cortisol values at 60 minutes after induction of anesthesia and 5 minutes after extubation in groupG were found to be significantly increased when compared to group G⫹E. Peroperative sevoflurane requirement was lower in G⫹E. Heart rate and systolic arterial pressure values were lower in group G⫹E compared to group G. Conclusions: In the general⫹ epidural anesthesia group, we have observed that hemodynamic stability has been preserved and stress response and sevoflurane requirement have decreased. General ⫹ epidural anesthesia in major abdominal surgery is a method superior to general anesthesia alone.