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Central Nerve Blocks
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Central Nerve Blocks 48. High thoracic epidural anaesthesia in coronary surgery L. Salvi, V. Mazzanti, C. Beverini, S. Gregu, E. Sisillo [email protected] Dept. Anaesthesia & ICU. IRCCS Centro Cardiologico Monzino, Milan, Italy Background: It is still a matter of controversy whether establishing high-thoracic epidural anaesthesia (HTEA) as a supplement to general anaesthesia may correspondingly translate into an improvement of perioperative outcomes in patients undergoing coronary artery bypass (CABG) surgery. Methods: Among 1411 patients subjected to CABG surgery (both on- and off-pump), 414 (29.3%) received HTEA combined with inhalation anaesthesia (HTEA), while 997 (70.7%) underwent total intravenous anaesthesia (TIVA). Through a 19-gauge flexibletip polyurethane catheter, inserted at the T1-T2 or T2-T3 interspace, HTEA was induced (0.1 mL kg-1of 0.5% ropivacaine and sufentanil 2.5 mcg mL-1 ) and maintained (0.1 mL kg-1 h-1infusion of 0.2% ropivacaine and sufentanil 1 mcg mL-1). General anaesthesia included fentanil 2-3 mcg kg-1, thiopental 3-6 mg kg-1, pancuronium 0.1 mg kg-1 and inhalation of sevoflurane. The TIVA technique consisted on thiopental 3 mg/kg as induction drug followed by sufentanil up to 5 mg/kg, continuous propofol infusion (3 mg/kg/h) and pancuronium 0.1 mg/kg. Early postoperative inhospital outcomes were compared between propensity-matched pairs of 389 patients from each group. Results: Patients were well matched in preoperative and operative features; only the average NYHA class was different between groups (1.9 ⫾ 0.58 vs. 2.0 ⫾ 0.60 in HTEA and TIVA patients, respectively, p⫽0.036). Postoperative mortality, ICU stay, myocardial infarction, stroke, acute renal failure were not statistically different in the two groups of patients. On the other hand, patients treated with HTEA had shorter ventilation times (5.8 ⫾ 3.11 vs. 6.9 ⫾ 5.0 hours, HTEA and TIVA, respectively, p⬍0.001); additionally, vasoconstrictors were more frequently used in case of HTEA, while vasodilators were prevalent with TIVA. Conclusions: Both HTEA and TIVA provided good early outcomes after coronary bypass grafting; no differences in hard outcomes were detected between these two strategies. However, HTEA seems to be associated with shorter ventilation times.
51. Morphological changes in spinal cord neurones after spinal anaesthesia with 2 and 5% lidocaine K.J. Repin, N.S. Davidova [email protected] Department of Anesthesiology, Ural Medical Academy, Ekaterinburg, Russia Backgrounds and Goals: Recent laboratory and clinical surveys demonstrate potential neurotoxic effect of local anaesthetics used in spinal anaesthesia (SPA). Great amount of surveys shows that Lidocaine is potentially more neurotoxic than others. Mostly it is connected with 5% Lidocaine used for SPA. The aim of our survey was morphological studying motoneurones and their derivates as the most sensitive part of Central Nervous System after SPA using 2% and 5% Lidocaine. Methods: After our ethical committee permission 9 male rats of Vistar lane were included in randomized, placebo-controlled, blind survey. They were divided chaotically in three groups. To the first group- 0,5 ml normal solution, to the second group – 0.7 ml 2% isobaric Lidocaine, to the third group – 0.3 ml 5% isobaric Lidocaine were injected intratecally after the light Ether narcosis. The rats were anatomized after 24 hours. Spinal cords and nerve roots were taken and prepared for light and electronic microscopic observation. Results: In optical and electronic-microscopic research in the first group (0.9% NaCl) no morphological changes were found in neurones and their derivates. In the second group (Lidocaine 2%) optical microscopy results were close to normal. Some solitary neurones had light rareness and clarity of Nissler’s granularity. In the third group (Lidocaine5%) moderate hypochromia of sporadic neurones, small hypostasis prevascular and precellular were found. Changes in myelenated nervous fibers dominated in Lidocaines groups. In Lidocaine 5% group in nervous cells bodies the hyperchromatosis with destruction of mitochondrial endocellular elements and endoplazmatic chain cisterns was prevailing form of irreversible changes. Conclusion: We received data of Spinal neurones intracellular elements destruction while using 5% Lidocaine. Such ultra structural neurone changes lead to disorder their function and can cause neuron loss. For this reason we should avoid using 5% Lidocaine in SPA clinical practice.
Free Papers
•
Central Nerve Blocks
FREE PAPERS
Central Nerve Blocks 48. High thoracic epidural anaesthesia in coronary surgery L. Salvi, V. Mazzanti, C. Beverini, S. Gregu, E. Sisillo [email protected] Dept. Anaesthesia & ICU. IRCCS Centro Cardiologico Monzino, Milan, Italy Background: It is still a matter of controversy whether establishing high-thoracic epidural anaesthesia (HTEA) as a supplement to general anaesthesia may correspondingly translate into an improvement of perioperative outcomes in patients undergoing coronary artery bypass (CABG) surgery. Methods: Among 1411 patients subjected to CABG surgery (both on- and off-pump), 414 (29.3%) received HTEA combined with inhalation anaesthesia (HTEA), while 997 (70.7%) underwent total intravenous anaesthesia (TIVA). Through a 19-gauge flexibletip polyurethane catheter, inserted at the T1-T2 or T2-T3 interspace, HTEA was induced (0.1 mL kg-1of 0.5% ropivacaine and sufentanil 2.5 mcg mL-1 ) and maintained (0.1 mL kg-1 h-1infusion of 0.2% ropivacaine and sufentanil 1 mcg mL-1). General anaesthesia included fentanil 2-3 mcg kg-1, thiopental 3-6 mg kg-1, pancuronium 0.1 mg kg-1 and inhalation of sevoflurane. The TIVA technique consisted on thiopental 3 mg/kg as induction drug followed by sufentanil up to 5 mg/kg, continuous propofol infusion (3 mg/kg/h) and pancuronium 0.1 mg/kg. Early postoperative inhospital outcomes were compared between propensity-matched pairs of 389 patients from each group. Results: Patients were well matched in preoperative and operative features; only the average NYHA class was different between groups (1.9 ⫾ 0.58 vs. 2.0 ⫾ 0.60 in HTEA and TIVA patients, respectively, p⫽0.036). Postoperative mortality, ICU stay, myocardial infarction, stroke, acute renal failure were not statistically different in the two groups of patients. On the other hand, patients treated with HTEA had shorter ventilation times (5.8 ⫾ 3.11 vs. 6.9 ⫾ 5.0 hours, HTEA and TIVA, respectively, p⬍0.001); additionally, vasoconstrictors were more frequently used in case of HTEA, while vasodilators were prevalent with TIVA. Conclusions: Both HTEA and TIVA provided good early outcomes after coronary bypass grafting; no differences in hard outcomes were detected between these two strategies. However, HTEA seems to be associated with shorter ventilation times.
51. Morphological changes in spinal cord neurones after spinal anaesthesia with 2 and 5% lidocaine K.J. Repin, N.S. Davidova [email protected] Department of Anesthesiology, Ural Medical Academy, Ekaterinburg, Russia Backgrounds and Goals: Recent laboratory and clinical surveys demonstrate potential neurotoxic effect of local anaesthetics used in spinal anaesthesia (SPA). Great amount of surveys shows that Lidocaine is potentially more neurotoxic than others. Mostly it is connected with 5% Lidocaine used for SPA. The aim of our survey was morphological studying motoneurones and their derivates as the most sensitive part of Central Nervous System after SPA using 2% and 5% Lidocaine. Methods: After our ethical committee permission 9 male rats of Vistar lane were included in randomized, placebo-controlled, blind survey. They were divided chaotically in three groups. To the first group- 0,5 ml normal solution, to the second group – 0.7 ml 2% isobaric Lidocaine, to the third group – 0.3 ml 5% isobaric Lidocaine were injected intratecally after the light Ether narcosis. The rats were anatomized after 24 hours. Spinal cords and nerve roots were taken and prepared for light and electronic microscopic observation. Results: In optical and electronic-microscopic research in the first group (0.9% NaCl) no morphological changes were found in neurones and their derivates. In the second group (Lidocaine 2%) optical microscopy results were close to normal. Some solitary neurones had light rareness and clarity of Nissler’s granularity. In the third group (Lidocaine5%) moderate hypochromia of sporadic neurones, small hypostasis prevascular and precellular were found. Changes in myelenated nervous fibers dominated in Lidocaines groups. In Lidocaine 5% group in nervous cells bodies the hyperchromatosis with destruction of mitochondrial endocellular elements and endoplazmatic chain cisterns was prevailing form of irreversible changes. Conclusion: We received data of Spinal neurones intracellular elements destruction while using 5% Lidocaine. Such ultra structural neurone changes lead to disorder their function and can cause neuron loss. For this reason we should avoid using 5% Lidocaine in SPA clinical practice.