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Fayyad A, Said M, Hasan M, Saleh M. Total laparoscopic hysterectomy and bilateral salpingo-oophrectomy for stage 1 endometrial carcinoma under regional anaesthesia. Gynecol Oncol Rep 2023; 48:101222. [PMID: 37576356 PMCID: PMC10422116 DOI: 10.1016/j.gore.2023.101222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/02/2023] [Accepted: 06/04/2023] [Indexed: 08/15/2023] Open
Abstract
Total Laparoscopic hysterectomy is most commonly performed under general anesthesia. In elderly patients with severe medical co-morbidities and endometrial malignancy, laparoscopic surgery under general anesthesia can be hazardous. In such patients, regional anesthesia is safe, and can be the only option. We present a case of 75-year old women with severe lung fibrosis, chronic obstructive airway disease and heart failure who presented with severe post-menopausal bleeding and was diagnosed with endometrial carcinoma. She was considered unfit for general anesthesia. After multidisciplinary team meeting, the patient underwent total laparoscopic hysterectomy, bilateral salpingo-oophrectomy and peritoneal washings under regional anaesthesia. The procedure was successful and the patient was discharged 24 h later. In this case report, we demonstrate the anesthetic and surgical techniques for total laparoscopic hysterectomy under regional anesthesia. In the presence of dedicated multidisciplinary team, laparoscopic hysterectomy for endometrial carcinoma under regional anesthesia is safe and feasible.
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Affiliation(s)
- Abdalla Fayyad
- Fayyad Centre for Minimal Access Surgery and Endometriosis, Amman, Jordan
| | | | - Moath Hasan
- General Surgery, Khalidi Hospital, Amman, Jordan
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Kumar V. Current indications for spinal anesthesia-a narrative review. Best Pract Res Clin Anaesthesiol 2023; 37:89-99. [PMID: 37321771 DOI: 10.1016/j.bpa.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 03/14/2023] [Accepted: 04/05/2023] [Indexed: 06/17/2023]
Abstract
Spinal anesthesia is a commonly performed regional anesthesia technique by most anesthesiologists worldwide. This technique is learned early during training and is relatively easy to master. Despite being an old technique, spinal anesthesia has evolved and developed in various aspects. This review attempts to highlight the current indications of this technique. Understanding the finer aspects and knowledge gaps will help postgraduates and practicing anesthesiologists in designing patient-specific techniques and interventions.
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Affiliation(s)
- Vinoth Kumar
- Department of Anaesthesiology, Ganga Medical Centre and Hospitals Pvt Ltd, 313, Mettupalayam Road, Coimbatore, 641043, India.
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3
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Gündoğdu E, Mat E, Aboalhasan Y, Yıldız G, Başol G, Tolga Saraçoğlu K, Arslan G, Kale A. V-NOTES hysterectomy under spinal anaesthesia: A pilot study. Facts Views Vis Obgyn 2022; 14:275-282. [DOI: 10.52054/fvvo.14.3.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Spinal anaesthesia has not been widely adopted for laparoscopic surgeries until now. There are a few studies that have shown that spinal anaesthesia is at least as safe as general anaesthesia. The need for additional analgesics can be reduced by utilising early postoperative analgesic effects of spinal anaesthesia, and maximum benefit can be obtained from minimally invasive approaches when V-NOTES surgery is performed under spinal anaesthesia.
Objective: Combining V-NOTES with spinal anaesthesia to improve minimally invasive surgical techniques and provide maximum benefit to patients.
Materials and methods: Patients who were found to have benign pelvic organ pathologies, required a hysterectomy and were considered suitable for V-NOTES hysterectomy under spinal anaesthesia were included in this study. Spinal anaesthesia was achieved with 12.5 mg 0.5% hyperbaric bupivacaine in the sitting position. Perioperative events and complications related to spinal anaesthesia were noted. Postoperatively, the pain was evaluated using a visual analogue scale at the 6th, 12th, and 24th hours.
Main outcome measures: To evaluate the feasibility and safety of spinal anaesthesia in VNOTES hysterectomy and to increase the advantages of minimally invasive surgical procedures. Results: No conversion to conventional laparoscopy or laparotomy was required in all six operated patients. Conversion from spinal anaesthesia to general anaesthesia was unnecessary, and no major perioperative incident occurred in any of the cases.
Conclusion: In the current study by our team, we demonstrated that V-NOTES hysterectomy could be performed safely under spinal anaesthesia in well-selected patients. The need for additional analgesics can be reduced by utilising early postoperative analgesic effects of spinal anaesthesia, and maximum benefit can be obtained from minimally invasive approaches when VNOTES surgery is performed under spinal anaesthesia.
What is new? V-NOTES hysterectomy could be performed safely under spinal anaesthesia in well-selected patients.
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Della Corte L, Mercorio A, Palumbo M, Viciglione F, Cafasso V, Candice A, Bifulco G, Giampaolino P. Minimally invasive anesthesia for laparoscopic hysterectomy: a case series. Arch Gynecol Obstet 2022; 306:2001-2007. [PMID: 35931899 PMCID: PMC9362356 DOI: 10.1007/s00404-022-06727-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/26/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Regional anesthesia (RA) is considered as a "minimally invasive technique" to achieve anesthesia. To assess the feasibility and the perioperative outcomes of laparoscopic hysterectomy in regional anesthesia from the point of view of the surgeon, anesthesiologist and patient. METHODS A retrospective search was performed to identify patients who underwent laparoscopic hysterectomy under RA from April 2020 to September 2021. Five patients affected by benign gynecological disease (atypical endometrial hyperplasia or uterine leiomyomas) were included. RESULTS The postoperative pain, nausea, and vomiting (PONV) and the antiemetic/analgesic intake were evaluated. Postoperative surgical and anesthesiological variables were recorded. Duration of surgery was 84 ± 4.18 and no conversion to GA was required. According to VAS score, the postoperative pain during the whole observation time was less than 4 (median). A faster resumption of bowel motility (≤ 9 h) and patient's mobilization (≤ 4 h) were observed as well as a low incidence of post-operative nausea and vomit. Early discharge and greater patient's satisfaction were recorded. Intraoperatively pain score was assessed on Likert scale during all the stages of laparoscopy in RA, with only 2 patients complaining scarce pain (= 2) at pneumoperitoneum. CONCLUSION RA showed to have a great impact on surgical stress and to guarantee a quicker recovery without compromising surgical results. RA technique could be a viable option for patients undergoing laparoscopic hysterectomy.
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Affiliation(s)
- Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.
| | - Antonio Mercorio
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Mario Palumbo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Francesco Viciglione
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Valeria Cafasso
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Agostino Candice
- Department of Anesthesiology and Intensive Care Medicine, Policlinico - Federico II University Hospital, Naples, Italy
| | - Giuseppe Bifulco
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Pierluigi Giampaolino
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
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Hwang JH, Kim BW. Comparative study on gasless laparoscopy using a new device versus conventional laparoscopy for surgical management of postmenopausal patients. J Minim Access Surg 2022; 18:346-352. [PMID: 35708378 PMCID: PMC9306136 DOI: 10.4103/jmas.jmas_82_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To compare gasless laparoscopy with conventional laparoscopy for the surgical management of postmenopausal patients. Methods: The medical records of 80 postmenopausal patients who underwent laparoscopic surgeries between February 2016 and February 2020 were reviewed. Forty patients underwent gasless laparoscopy and 40 patients underwent conventional single-port access (SPA) laparoscopy. The two groups were compared in terms of surgical outcomes. Results: Of 80 patients, 42 underwent adnexal surgeries and 38 underwent uterine surgeries such as total hysterectomy or myomectomy. Between the gasless SPA and conventional SPA laparoscopic groups, no significant differences were observed in terms of age, body mass index, parity or history of previous abdominal surgery. The mean retraction setup time from skin incision was 6.8 ± 1.2 min with gasless laparoscopic surgery. There was no significant difference in mean total operation times for the gasless (71.3 ± 31.4 min) and conventional (82.5 ± 36.4 min) groups. There was also no significant difference between the groups in terms of operation type, laparotomy conversion rate or duration of hospitalisation. There were no major complications in either group. Conclusions: Gasless laparoscopy is a safe and feasible alternative to conventional laparoscopy for postmenopausal women.
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Affiliation(s)
- Jong Ha Hwang
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon Metropolitan City, South Korea
| | - Bo Wook Kim
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon Metropolitan City, South Korea
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Hwang JH, Kim BW. Comparison of General Anesthesia and Combined Spinal and Epidural Anesthesia for Gasless Laparoscopic Surgery in Gynecology. JSLS 2022; 26:JSLS.2022.00004. [PMID: 35815325 PMCID: PMC9215695 DOI: 10.4293/jsls.2022.00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives Laparoscopic surgeries in gynecologic field have been performed under general anesthesia (GA) due to the respiratory changes caused by pneumoperitoneum and Trendelenburg position. Therefore, this study aimed to compared general anesthesia and combined spinal and epidural anesthesia (CSEA) for gasless laparoscopic surgery in gynecologic field. Methods We matched patients with type of surgery who underwent gasless single port access (SPA) laparoscopic surgery under general anesthesia and CSEA. The medical records of 90 patients between March 1, 2018 and June 30, 2020 were reviewed. Gasless laparoscopic surgery was performed in all patients with a SPA using a J-shaped retractor. Results No significant differences were observed for age, body mass index, parity, and previous abdominal surgery between GA and CSEA groups. During operation under CSEA, six patients (20%) experienced nausea/vomiting. Hypotension (systolic blood pressure < 90 mmHg) was observed in five patients (16.7%). Intravenous analgesics was administrated in four of the patients (13.3%) who suffered from shoulder pain or abdominal discomfort. One patient developed bradycardia. The duration of hospital admission was shorter in the CSEA group than in the GA group (p = 0.014). There was no difference between the groups in terms of surgery type, surgical specific finding, operation time, estimated blood loss, laparotomy conversion rate and use of additional trocar. No major complications such as urologic, bowel, or vessel injuries were found in both groups. Conclusions CSEA is a safe and feasible technique for application in nonobese patients undergoing gasless laparoscopic surgery in gynecologic field.
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Affiliation(s)
- Jong Ha Hwang
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| | - Bo Wook Kim
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
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Opfermann P, Marhofer P, Springer A, Metzelder M, Zadrazil M, Schmid W. A prospective observational study on the feasibility of subumbilical laparoscopic procedures under epidural anesthesia in sedated spontaneously breathing infants with a natural airway. Paediatr Anaesth 2022; 32:49-55. [PMID: 34582607 PMCID: PMC9292952 DOI: 10.1111/pan.14302] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/20/2021] [Accepted: 09/26/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Laparoscopic procedures are usually performed under general anesthesia with a secured airway including endotracheal intubation or supraglottic airways. AIMS This is a prospective study of the feasibility of subumbilical laparoscopic procedures under epidural anesthesia in sedated, spontaneous breathing infants with a natural airway. METHODS We consecutively enrolled 20 children <3 years old with nonpalpable testes scheduled for diagnostic laparoscopy with or without an ensuing orchidopexy, inguinal revision, or Fowler-Stephens maneuver. Inhalational induction for venous access was followed by sedation with propofol and ultrasound-guided single-shot epidural anesthesia via the caudal or thoracolumbar approach using 1.0 or 0.5 ml kg-1 ropivacaine 0.38%, respectively. The primary outcome measure was block success, defined as no increase in heart rate by >15% or other indicators of pain upon skin incision. RESULTS Of the 20 children (median age: 10 months; IQR: 8.3-12), 17 (85%) were anesthetized through a caudal and 3 (15%) through a direct thoracolumbar epidural, 18 (90%) underwent a surgical procedure and 2 (10%) diagnostic laparoscopy only. Five patients (25%) received block augmentation using an intravenous bolus of fentanyl (median dose: 0.9 µg kg-1 ; IQR: 0.8-0.95) after the initial prick test and before skin incision. There was no additional need for systemic pain therapy in the operating theater or recovery room. No events of respiratory failure or aspiration were observed. CONCLUSIONS In experienced hands, given our success rate of 100%, epidural anesthesia performed in sedated spontaneously breathing infants with a natural airway can be an alternative strategy for subumbilical laparoscopic procedures.
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Affiliation(s)
- Philipp Opfermann
- Department of Anesthesia, General Intensive Care Medicine and Pain TherapyMedical University of ViennaViennaAustria
| | - Peter Marhofer
- Department of Anesthesia, General Intensive Care Medicine and Pain TherapyMedical University of ViennaViennaAustria,Department of Anesthesia and Intensive Care MedicineOrthopaedic Hospital SpeisingViennaAustria
| | - Alexander Springer
- Department of SurgeryDivision of Pediatric SurgeryMedical University of ViennaViennaAustria
| | - Martin Metzelder
- Department of SurgeryDivision of Pediatric SurgeryMedical University of ViennaViennaAustria
| | - Markus Zadrazil
- Department of Anesthesia, General Intensive Care Medicine and Pain TherapyMedical University of ViennaViennaAustria
| | - Werner Schmid
- Department of Anesthesia, General Intensive Care Medicine and Pain TherapyMedical University of ViennaViennaAustria
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Major AL, Jumaniyazov K, Yusupova S, Jabbarov R, Saidmamatov O, Mayboroda-Major I. Laparoscopy in Gynecologic and Abdominal Surgery in Regional (Spinal, Peridural) Anesthesia, the Utility of the Technique during COVID-19 Pandemic. MEDICINES (BASEL, SWITZERLAND) 2021; 8:60. [PMID: 34677489 PMCID: PMC8541053 DOI: 10.3390/medicines8100060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/07/2021] [Accepted: 10/12/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND laparoscopic surgery is mainly performed in general anesthesia. Symptomatic patients infected with COVID-19 needing surgery are however at higher risk for COVID-19 complications in general anesthesia than in regional anesthesia. Even so, Covid transfection is a hazard to medical personnel during the intubation procedure and treatment drugs may be in shortage during a pandemic. Recovery and hospital stay are also shorter after laparoscopy. Laparoscopy performed in regional anesthesia may have several advantages in limiting Covid. METHODS international literature on the risk of COVID-19 complications development was searched. 3 topics concerning laparoscopic surgery were reviewed: (1) Achievements in laparoscopy; (2) Advantages of regional anesthesia compared to general anesthesia; (3) Feasibility to perform laparoscopy in regional anesthesia in COVID-19 pandemic. The authors reviewed abstracts and full-text articles concerning laparoscopic surgery, gynecology, anesthesia and COVID-19. Studies published in PubMed, Embase, Cochrane Library and found in Google Scholar before 1st FEB, 2021 were retrieved and analyzed. RESULTS a total of 83 studies were found, all of them written in English. 17 studies could be found in gynecology and in general surgery about laparoscopy with regional anesthesia. In Covid time only one study compared laparoscopic surgery in general anesthesia to laparotomy and another study laparotomy in general anesthesia to regional anesthesia. Laparoscopy showed no disadvantage compared to laparotomy in Covid pandemic and in another study laparotomy in general anesthesia was associated with higher mortality and more pulmonary complications. Trendelenburg position can be a threat if used by inexperienced personnel and can induce unintended anesthesia of breathing organs. On the other hand Trendelenburg position has advantages for cardiovascular and pulmonary functions. Pneumoperitoneum of low CO2 pressure is well tolerated by patients. CONCLUSIONS elective surgery should be postponed in symptomatic Covid patients. In inevitable emergency surgery intubation anesthesia in COVID-19 pandemic is as far as possible to be avoided. In COVID-19 pandemic, regional anesthesia is the preferred choice. The optimum may be the combination of laparoscopic surgery with regional anesthesia. Reducing the pneumoperitoneum is a good compromise for the comfort of patients and surgeons. A special case is gynecology, which needs to be performed in Trendelenburg position to free pelvic organs.
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Affiliation(s)
- Attila Louis Major
- Femina Gynecology Centre, CH-1205 Geneva, Switzerland
- Department of Obstetrics & Gynecology, University of Fribourg, CH-1700 Fribourg, Switzerland
| | - Kudrat Jumaniyazov
- Department of Obstetrics and Gynecology, Urgench Branch of Tashkent Medical Academy, Urgench 220100, Uzbekistan; (K.J.); (S.Y.); (R.J.)
| | - Shahnoza Yusupova
- Department of Obstetrics and Gynecology, Urgench Branch of Tashkent Medical Academy, Urgench 220100, Uzbekistan; (K.J.); (S.Y.); (R.J.)
| | - Ruslan Jabbarov
- Department of Obstetrics and Gynecology, Urgench Branch of Tashkent Medical Academy, Urgench 220100, Uzbekistan; (K.J.); (S.Y.); (R.J.)
| | - Olimjon Saidmamatov
- Faculty of Tourism and Economics, Urgench State University, Urgench 220100, Uzbekistan
| | - Ivanna Mayboroda-Major
- Department of Gynecology and Obstetrics, University Hospital of Geneva, CH-1205 Geneva, Switzerland
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Cavens L, Baekelandt J, Van de Putte P, De Mulder P. Spinal anaesthesia for a NOTES (Natural Orifice Transluminal Endoscopic Surgery) total hysterectomy in a pre-lung transplant patient : a case report. ACTA ANAESTHESIOLOGICA BELGICA 2021. [DOI: 10.56126/72.1.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We describe the first case of a vaginal NOTES total hysterectomy under spinal anesthesia in the head- down position without sedation or additive analgesia in a patient with end-stage COPD. This report adds to the growing evidence that neuraxial techniques are a good alternative for general anesthesia in select cases for laparoscopic surgery.
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Kaya Uğur B, Pirbudak L, Öztürk E, Balat Ö, Uğur MG. Spinal versus general anesthesia in gynecologic laparoscopy: A prospective, randomized study. Turk J Obstet Gynecol 2020; 17:186-195. [PMID: 33072423 PMCID: PMC7538827 DOI: 10.4274/tjod.galenos.2020.28928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/01/2020] [Indexed: 01/13/2023] Open
Abstract
Objective: To compare spinal anesthesia (SA) with general anesthesia (GA) in gynecologic laparoscopic surgery regarding anesthetic parameters and patient satisfaction together with an assessment of total oxidant, antioxidant levels, and Oxidative Stress index (OSI). Materials and Methods: Sixty patients who were planned to undergo gynecologic laparoscopy were randomized into group G (GA) and group S (SA). Demographics, adverse events and anesthetic parameters were recorded before induction, after induction, and at the 5th, 10th, 15th, 30th, 60th, 90th, and 120th minutes. Patients and surgeons completed questionnaires. Total antioxidant capacity (TAC), total oxidant level (TOL), and OSI were measured. Results: There was no difference between the groups in terms of hemodynamic parameters except heart rate at 30th minute and mean arteral pressure at 10th, 15th, 30th, and 60th minute (p<0.05). The postoperative arterial blood pH value was lower in group S (p=0.021). Intraoperative hypotension was lower in group S (p=0.038). There was more intraoperative hypotension in group S when compared with group G (p=0.038). Postoperative analgesic consumption was higher and onset of postoperative pain was shorter in group G (p=0.001 for both). There was no difference between the groups in terms of patient and surgeon satisfaction. There was no difference in terms of TAC, TOL, and OSI between the groups (p=0.862, p=0.940, and p=0.728, respectively). Conclusion: SA may become a reliable alternative to GA in gynecologic laparoscopy when hemodynamic and respiratory parameters, patient and surgeon satisfaction, as well as total oxidant, antioxidant levels, and OSI are considered.
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Affiliation(s)
- Berna Kaya Uğur
- Gaziantep University Faculty of Medicine, Department of Anesthesiology and Reanimation, Gaziantep, Turkey
| | - Lütfiye Pirbudak
- Gaziantep University Faculty of Medicine, Department of Anesthesiology and Reanimation, Gaziantep, Turkey
| | - Ebru Öztürk
- Gaziantep University Faculty of Medicine, Department of Obstetrics and Gynecology, Gaziantep, Turkey
| | - Özcan Balat
- Gaziantep University Faculty of Medicine, Department of Obstetrics and Gynecology, Gaziantep, Turkey
| | - Mete Gürol Uğur
- Gaziantep University Faculty of Medicine, Department of Obstetrics and Gynecology, Gaziantep, Turkey
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Bhattacharya K. Role of Regional Anaesthesia in Laparoscopy During COVID-19. Indian J Surg 2020; 82:289-290. [PMID: 32837067 PMCID: PMC7274937 DOI: 10.1007/s12262-020-02444-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/29/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Kaushik Bhattacharya
- CAPFs Composite Hospital BSF Kadamtala, G616, Uttorayon, Matigara, Siliguri, West Bengal 734010 India
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Raimondo D, Borghese G, Mastronardi M, Mabrouk M, Salucci P, Lambertini A, Casadio P, Tonini C, Meriggiola MC, Arena A, Tarozzi G, Seracchioli R. Laparoscopic surgery for benign adnexal conditions under spinal anaesthesia: Towards a multidisciplinary minimally invasive approach. J Gynecol Obstet Hum Reprod 2020; 49:101813. [PMID: 32426576 PMCID: PMC7229474 DOI: 10.1016/j.jogoh.2020.101813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 11/23/2022]
Abstract
In general surgery locoregional anaesthesia increased laparoscopy advantages. 28 women submitted to gynaecological laparoscopy for benign adnexal conditions. 13 patients under spinal anaesthesia, 15 under general anaesthesia. Less postoperative pain and reduced need f opioids in the spinal anaesthesia arm. Earlier mobilization and return of bowel function in the spinal anaesthesia arm.
Background Laparoscopic gynaecological surgery is commonly performed under general anaesthesia with endotracheal intubation. In general surgery, locoregional anaesthesia was applied to laparoscopic procedures, increasing minimally invasive surgery advantages. Aims To assess and compare postoperative pain after laparoscopic adnexal procedures for benign conditions under spinal anaesthesia (SA) versus general anaesthesia (GA). Furthermore, anaesthesiologic, surgical and clinical data were evaluated in both groups. Materials and Methods This is a prospective cohort study performed in a tertiary level referral centre for minimally invasive gynaecological surgery (Gynaecology and Human Reproduction Physiopathology, University of Bologna). Women scheduled for adnexal laparoscopic surgery for benign conditions between February and May 2019 were assigned to receive either SA or GA with endotracheal intubation. A sample size of 13 women per group was needed to detect a 2-point difference in pain scores. Main findings 13 women were enrolled in the SA arm, 15 in the GA arm. In the SA cohort, the most common intraoperative adverse event was shoulder pain, reported by 3/12 women. At 1, 8, 12, 24 and 48 h after surgery pain was significantly lower in the SA arm (p < .05). Patients submitted to SA experienced no need for opioid drugs administration, unlike those receiving GA. Patients’ mobilization and return of bowel function were noted significantly earlier in the SA group (p < .05). Conclusions SA is a feasible, safe and effective anaesthesiologic technique for laparoscopic gynaecological procedures for benign conditions, allowing a better control of postoperative pain. Women undergoing SA achieve earlier mobilization and bowel canalization. During the Covid-19 pandemics, SA could be useful in reducing the need for invasive procedures on respiratory tract.
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Affiliation(s)
- Diego Raimondo
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy
| | - Giulia Borghese
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy
| | - Manuela Mastronardi
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy
| | - Mohamed Mabrouk
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy.,Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Alexandria, Champollion street, Al Mesallah Sharq, Qesm Al Attarin, Alexandria Governorate, Egypt.,Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Cambridge Clinical School, Box 223, The Rosie Hospital, Robinson Way, Cambridge CB2 0SW, United Kingdom
| | - Paolo Salucci
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy
| | - Agnese Lambertini
- Anaesthesiology and Resuscitation Unit, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy
| | - Paolo Casadio
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy
| | - Claudia Tonini
- Anaesthesiology and Resuscitation Unit, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy
| | - Maria Cristina Meriggiola
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy
| | - Alessandro Arena
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy
| | - Giulia Tarozzi
- Anaesthesiology and Pain Medicine Unit, Dipartimento dell'Emergenza-Urgenza, S. Orsola Hospital, University of Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Renato Seracchioli
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy
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Chauvet P, Storme B, Bonnin M, Legros M, Pinot A, Canis M, Bourdel N. Laparoscopic adnexectomy under regional anaesthesia: It is possible! J Gynecol Obstet Hum Reprod 2020; 49:101803. [PMID: 32413522 DOI: 10.1016/j.jogoh.2020.101803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 04/29/2020] [Accepted: 05/04/2020] [Indexed: 12/01/2022]
Abstract
At present, the majority of laparoscopic operations are performed under general anaesthesia, as it controls surgical pain and improves patient comfort using pneumoperitoneum and the Trendelenburg position. However, some laparoscopic procedures, such as adnexectomies, can potentially be performed under epidural anaesthesia with a purposefully selected and motivated patient managed by prepared surgical and anaesthesia care teams working together effectively. This study reports the case of a 63-year-old female patient with major respiratory failure who underwent laparoscopic bilateral adnexectomies under epidural anaesthesia.
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Affiliation(s)
- Pauline Chauvet
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Place Lucie Aubrac, Clermont-Ferrand, France; Faculty of Medicine, ISIT-University of Auvergne, Place Henri Dunant, Clermont-Ferrand, France.
| | - Brigitte Storme
- Department of Perioperative Medicine, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Martine Bonnin
- Department of Perioperative Medicine, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Maxime Legros
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Place Lucie Aubrac, Clermont-Ferrand, France
| | - Anne Pinot
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Place Lucie Aubrac, Clermont-Ferrand, France
| | - Michel Canis
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Place Lucie Aubrac, Clermont-Ferrand, France; Faculty of Medicine, ISIT-University of Auvergne, Place Henri Dunant, Clermont-Ferrand, France
| | - Nicolas Bourdel
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Place Lucie Aubrac, Clermont-Ferrand, France; Faculty of Medicine, ISIT-University of Auvergne, Place Henri Dunant, Clermont-Ferrand, France
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Zagorac Z, Zivic R, Milanovic M, Vekic B, Dakovic B, Bukumiric Z, Radovanovic D. Changes in liver function tests after laparoscopic cholecystectomy with low- and high-pressure pneumoperitoneum. Eur Surg 2019. [DOI: 10.1007/s10353-019-0568-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Spinal/epidural block as an alternative to general anesthesia for laparoscopic appendectomy: a prospective randomized clinical study. Wideochir Inne Tech Maloinwazyjne 2018; 13:148-156. [PMID: 30002746 PMCID: PMC6041592 DOI: 10.5114/wiitm.2018.72684] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 10/14/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction Laparoscopic appendectomy (LA) has been generally performed under general anesthesia. Laparoscopic appendectomy is rarely performed under regional anesthesia because of pneumoperitoneum-related problems. Aim To compare spinal/epidural anesthesia (SEA) and general anesthesia (GA) during LA with respect to perioperative and postoperative adverse events and postoperative pain. Material and methods Fifty patients, aged 18–65, who underwent LA, were randomly allocated to two groups: the GA (n = 25) and SEA (n = 25) groups. Perioperative and postoperative adverse events, postoperative pain level, and patient satisfaction were compared between the groups. Results None of the patients needed conversion to an open procedure or conversion from SEA to GA. In the SEA group we encountered shoulder pain in 6 (24%) patients, abdominal discomfort/pain in 4 (16%) patients, anxiety in 4 (16%) patients, and hypotension in 2 (8%) patients intraoperatively. Also, post-spinal headache was observed in 5 (20%) patients in the SEA group. Postoperative right shoulder pain was significantly higher in the GA group compared to the SEA group (32% vs. 8%; p = 0.037). In the SEA group the incidence of urinary retention and in the GA group the incidence of postoperative nausea and vomiting (PONV) were higher, but these differences were not statistically significant. The postoperative surgical pain level was significantly lower in the SEA group (p < 0.001). Conclusions Spinal/epidural anesthesia is effective and safe in ASA I healthy patients undergoing LA. Less postoperative pain, PONV and shoulder pain are the advantages of SEA compared to GA.
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Kahn B, Boazak M, Ragazino J, Sineath RC, Kapral T. An Additive Mix? Acute Urinary Retention in a Patient With Benign Prostatic Hyperplasia Treated With Suboxone, Lurasidone, and Trazodone. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2018; 16:292-298. [PMID: 31975924 PMCID: PMC6493095 DOI: 10.1176/appi.focus.20180007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Treatment of psychiatric patients is frequently complicated by medical comorbidities, complex pharmacologic regimens, and side effects occurring secondarily to those regimens. Acute urinary retention is an infrequently discussed side effect of such regimens. This report describes the development of acute urinary retention (AUR) in a 60-year-old man with a history of benign prostatic hyperplasia. The patient developed AUR during treatment with combination buprenorphine/naloxone, trazodone, and lurasidone. We discuss the potential relationship of these agents to the development of this patient's AUR, the complicated neurochemical dynamic of the voiding process, and the pathologic consequences that psychotropic agents can have on that process.
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Affiliation(s)
- Benjamin Kahn
- Mr. Kahn, Dr. Boazak, Dr. Ragazino, and Mr. Sineath are with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA; Dr. Kapral is with the Department of Psychiatry, Atlanta Veterans Affairs Medical Center, Atlanta, GA
| | - Mina Boazak
- Mr. Kahn, Dr. Boazak, Dr. Ragazino, and Mr. Sineath are with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA; Dr. Kapral is with the Department of Psychiatry, Atlanta Veterans Affairs Medical Center, Atlanta, GA
| | - James Ragazino
- Mr. Kahn, Dr. Boazak, Dr. Ragazino, and Mr. Sineath are with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA; Dr. Kapral is with the Department of Psychiatry, Atlanta Veterans Affairs Medical Center, Atlanta, GA
| | - R Craig Sineath
- Mr. Kahn, Dr. Boazak, Dr. Ragazino, and Mr. Sineath are with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA; Dr. Kapral is with the Department of Psychiatry, Atlanta Veterans Affairs Medical Center, Atlanta, GA
| | - Troy Kapral
- Mr. Kahn, Dr. Boazak, Dr. Ragazino, and Mr. Sineath are with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA; Dr. Kapral is with the Department of Psychiatry, Atlanta Veterans Affairs Medical Center, Atlanta, GA
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Comparison of the effects of spinal epidural and general anesthesia on coagulation and fibrinolysis in laparoscopic cholecystectomy: a randomized controlled trial: VSJ Competition, 2 nd place. Wideochir Inne Tech Maloinwazyjne 2017; 12:330-340. [PMID: 29062459 PMCID: PMC5649509 DOI: 10.5114/wiitm.2017.70249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/20/2017] [Indexed: 02/06/2023] Open
Abstract
Introduction Laparoscopic cholecystectomy (LC) is usually performed under general anesthesia. Recently, laparoscopic cholecystectomy under regional anesthesia has become popular, but this creates a serious risk of thromboembolism because of pneumoperitoneum, anesthesia technique, operative positioning, and patient-specific risk factors. Aim This randomized controlled trial compares the effects of two different anesthesia techniques in laparoscopic cholecystectomy on coagulation and fibrinolysis. Material and methods This randomized prospective study included 60 low-risk patients with deep vein thrombosis (DVT) who underwent elective LC without thrombo-emboli prophylaxis. The patients were randomly divided into two groups according to the anesthesia technique: the general anesthesia (group 1, n = 30) and spinal epidural anesthesia (group 2, n = 30) groups. Measurement of the prothrombin time (PT), thrombin time (TT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), and blood levels of D-dimer (DD) and fibrinogen (F) were recorded preoperatively (pre), at the first hour (post 1) and 24 h (post 24) after the surgery. These results were compared both between and within the groups. Results The mean age was 51.5 ±16.7 years (range: 19–79 years). Pneumoperitoneum time was similar between group 1 (33.8 ±7.8) and group 2 (34.8 ±10.4). The TT levels significantly declined postoperatively in both groups. The levels of PT, aPTT, INR, D-dimer and fibrinogen dramatically increased postoperatively in both groups. Conclusions While there was not any DVT, there was a significant decline in TT. There was a dramatic rise in the PT, INR, D-dimer, fibrin degradation products (FDP), and fibrinogen following LC. This may be attributed to the effects of pneumoperitoneum and anesthesia techniques on portal vein flow.
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Liang C, Wei J, Cai X, Lin W, Fan Y, Yang F. Efficacy and Safety of 3 Different Anesthesia Techniques Used in Total Hip Arthroplasty. Med Sci Monit 2017; 23:3752-3759. [PMID: 28767640 PMCID: PMC5549712 DOI: 10.12659/msm.902768] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background This study compared the efficacy and safety of 3 different anesthesia techniques used in total hip arthroplasty (THA). Material/Methods We allocated 198 patients preparing to undertake THA into 3 groups: general anesthesia group (GA group, n=66), caudal epidural anesthesia group (CEA group, n=66), and spinal-epidural anesthesia group (SEA group, n=66). We compared postoperative adverse effects occurring in patients of the 3 anesthesia groups. The Visual Analog Scale (VAS) score, Minimum Mental State Examination (MMSE) score, and β-amyloid (Aβ) expression were calculated to determine the effects of different anesthesia on the postoperative pain and cognitive dysfunction of patients. Results The CEA and SEA groups had lower rates of perioperative adverse effects than in the GA group. Patients in the GA group required significantly higher administration of analgesics after the surgery than those in CEA and SEA groups. Higher Aβ expression levels and VAS scores, as well as lower MMSE scores, were also seen in the GA group compared with the other 2 groups. Conclusions CEA and SEA were more effective than GA in THA, and CEA seemed to be a better anesthesia technique than SEA.
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Affiliation(s)
- Chengwei Liang
- Department of Orthopedic Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China (mainland)
| | - Jionglin Wei
- Department of Anesthesiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China (mainland)
| | - Xiaoxi Cai
- Department of Orthopedic Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China (mainland)
| | - Weilong Lin
- Department of Orthopedic Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China (mainland)
| | - Yongqian Fan
- Department of Orthopedic Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China (mainland)
| | - Fengjian Yang
- Department of Orthopedic Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China (mainland)
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Donmez T, Erdem VM, Uzman S, Yildirim D, Avaroglu H, Ferahman S, Sunamak O. Laparoscopic cholecystectomy under spinal-epidural anesthesia vs. general anaesthesia: a prospective randomised study. Ann Surg Treat Res 2017; 92:136-142. [PMID: 28289667 PMCID: PMC5344803 DOI: 10.4174/astr.2017.92.3.136] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/06/2016] [Accepted: 10/06/2016] [Indexed: 01/26/2023] Open
Abstract
Purpose Laparoscopic cholecystectomy (LC) is usually performed under the general anesthesia (GA). Aim of the study is to investigate the availability, safety and side effects of combined spinal/epidural anesthesia (CSEA) and comparison it with GA for LC. Methods Forty-nine patients who have a LC plan were included into the study. The patients were randomly divided into GA (n = 25) and CSEA (n = 24) groups. Intraoperative and postoperative adverse events, postoperative pain levels were compared between groups. Results Anesthesia procedures and surgeries for all patients were successfully completed. After the organization of pneumoperitoneum in CSEA group, 3 patients suffered from shoulder pain (12.5%) and 4 patients suffered from abdominal discomfort (16.6%). All these complaints were recovered with IV fentanyl administration. Only 1 patient developed hypotension which is recovered with fluid replacement and no need to use vasopressor treatment. Postoperative shoulder pain was significantly less observed in CSEA group (25% vs. 60%). Incidence of postoperative nausea and vomiting (PONV) was less observed in CSEA group but not statistically significant (4.2% vs. 20%). In the group of CSEA, 3 patients suffered from urinary retention (12.5%) and 2 patients suffered from spinal headache (8.3%). All postoperative pain parameters except 6th hour, were less observed in CSEA group, less VAS scores and less need to analgesic treatment in CSEA group comparing with GA group. Conclusion CSEA can be used safely for laparoscopic cholecystectomies. Less postoperative surgical field pain, shoulder pain and PONV are the advantages of CSEA compared to GA.
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Affiliation(s)
- Turgut Donmez
- Department of General Surgery, Lutfiye Nuri Burat State Hospital, Istanbul, Turkey
| | - Vuslat Muslu Erdem
- Department of Anesthesiology and Reanimation, Lutfiye Nuri Burat Goverment Hospital, Istanbul, Turkey
| | - Sinan Uzman
- Department of Anesthesiology and Reanimation, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Dogan Yildirim
- Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Huseyin Avaroglu
- Department of General Surgery, Lutfiye Nuri Burat State Hospital, Istanbul, Turkey
| | - Sina Ferahman
- Department of General Surgery, Cerrahpasa Medicine Faculty, Istanbul University, Istanbul, Turkey
| | - Oguzhan Sunamak
- Department of General Surgery, Haydapasa Numune Training and Research Hospital, Istanbul, Turkey
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Bhargava D, Vadapalli K. Is epidural volume extension (EVE) the evolved form of combined spinal epidural (CSE) anesthesia? Med J Armed Forces India 2015; 71:405-6. [DOI: 10.1016/j.mjafi.2015.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Indexed: 11/26/2022] Open
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Verma RN. Letter to the Editor. Med J Armed Forces India 2015; 71:304-5. [PMID: 26288505 DOI: 10.1016/j.mjafi.2015.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- R N Verma
- Associate Professor, Dept of Anaesthesia, Critical Care & Pain Management, Armed Forces Medical College, Pune 40, India
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