Comparison of the Anesthetic Techniques

regional Steady blood pressure within normal limits during surgery is one of the markers of the ideal and skillful anesthesia. Yet, reduced blood pressure is advantageous in some settings because it can contribute to a reduction in overall blood loss and improve the surgical field conditions. Controlled hypotension during anesthesia or hypotensive anesthesia is often used in major maxillofacial operations. Since hypotensive anesthesia carries the risk of hypoperfusion to important organs and tissues, mainly the brain, heart, and kidneys, it cannot be applied safely in all patients. In this paper we review the medical literature regarding hypotensive anesthesia during major maxillofacial surgery, the means to achieve it, and the risks and benefits of this technique, in comparison to normotensive anesthesia. We compared proseal, supreme, and i-gel supraglottic airway devices in terms of oropharyngeal leak pressures and airway morbidities in gynecological laparoscopic surgeries. One hundred and five patients undergoing elective surgery were subjected to general anesthesia after which they were randomly distributed into three groups. Although the oropharyngeal leak pressure was lower in the i-gel group initially (mean ± standard deviation; 23.9 ± 2.4, 24.9 ± 2.9, and 20.9 ± 3.5, resp.), it was higher than the proseal group and supreme group at 30 min of surgery after the trendelenburg position (25.0 ± 2.3, 25.0 ± 1.9, and 28.3 ± 2.3, resp.) and at the 60min of surgery (24.2 ± 2.1, 24.8 ± 2.2, and 29.5 ± 1.1, resp.). The time to apply the supraglottic airway devices was shorter in the i-gel group (12.2 (1.2), 12.9 (1.0), and 6.7 (1.2), resp., 𝑃 = 0.001 ). There was no difference between the groups in terms of their fiber optic imaging levels. pH was measured at the anterior and posterior surfaces of the pharyngeal region after the supraglottic airway devices were removed; the lowest pH values were 5 in all groups. We concluded that initial oropharyngeal leak pressures obtained by i-gel were lower than proseal and supreme, but increased oropharyngeal leak pressures over time, ease of placement, and lower airway morbidity are favorable for i-gel. procedure used in the treatment of osteoarthritis. During this procedure the sounds of the saw and hammer may irritate the patient and adversely affect mood. The present study examines the effect of these intraoperative sounds during TKA on postoperative mood and anxiety, by comparing two different anesthetic procedures. Methods . A total of 40 patients who underwent TKA for grade IV gonarthrosis participated in the study. Patients were randomly divided into two groups: 20 patients in the general anesthesia group and 20 patients in the spinal anesthesia group. Mood and anxiety changes were evaluated using the Profile of Mood States (POMS) and State-Trait Anxiety Inventory (STAI) instruments, respectively. Results . The postoperative POMS value in the spinal anesthesia group was definitively higher than the general anesthesia group, though the difference in preoperative and postoperative POMS and STAI scores between the two groups was not significant. Conclusion . It would seem that sounds of hammer and saw have no evident negative effect on patient’s mood. Regional anesthesia is advisable for TKA patients and appropriate sedation can be administered during the operation if needed. Purpose . The size 1 I-gel, recommended for small infants and neonates weighing 2–5 kg, has recently been released. There are no prospective studies available that assess the insertion conditions, sealing pressures, or ventilation quality of it. This study was designed to compare the performance of recently released size 1 I-gel with size 1 ProSeal LMA. Methods . Fifty infants and neonates, ASA I-II were included in this prospective, randomized, and controlled study. Patients were divided into two groups for placing I-gel or ProSeal LMA. The primary outcome was airway leak pressure, and secondary outcomes included insertion time, insertion success and conditions, initial airway quality, fiberoptic view of the larynx, and complications. Results . There were no significant differences in terms of airway leak pressure between the I-gel ( 27.44 ± 5.67 ) and ProSeal LMA ( 23.52 ± 8.15 ) ( 𝑃 = 0.054 ). The insertion time for the I-gel was shorter ( 12.6 ± 2.19 s) than for the ProSeal LMA ( 24.2 ± 6.059 s) ( 𝑃 = 0.0001 ). Insertion success and conditions were similar in groups. We encountered few complications. Conclusion . Our study demonstrates that the size 1 I-gel provided an effective and satisfactory airway as the size 1 ProSeal LMA. It may be a good alternative supraglottic airway device for use in small infants and neonates. This trial is registered with: ClinicalTrials.gov NCT01704118. Background . The local anaesthetics used in day-case spinal anaesthesia should provide short recovery times. We aimed to compare hyperbaric prilocaine and bupivacaine in terms of sensory block resolution and time to home readiness in day-case spinal anaesthesia. Methods .Fiftypatientsundergoingperianalsurgerywererandomizedintotwogroups.Thebupivacaine-fentanylgroup (Group B) received 7.5mg, 0.5% hyperbaric bupivacaine + 20 𝜇 g fentanyl in total 1.9mL. The prilocaine-fentanyl group (Group P) received 30 mg, 0.5% hyperbaric prilocaine + 20 𝜇 g fentanyl in the same volume. Results . Time to L1 block and maximum block was shorter in Group P than in Group B (Group P 4.6 ± 1.3 min versus Group B 5.9 ± 01.9 min, 𝑃 = 0.017 , and Group P 13.2 ± 7.5 min versus Group B 15.3±6.6 min, 𝑃 = 0.04 ). The time to L1 regression and S3 regression of the sensorial block was significantly shorter in Group P than in Group B ( 45.7 ± 21.9 min versus 59.7 ± 20.9 min, 𝑃 = 0.024 , and 133.8 ± 41.4 min versus 200.4 ± 64.8 min, 𝑃 < 0.001 ). The mean time to home readiness was shorter for Group P than for Group B ( 155 ± 100.2 min versus 207.2 ± 62.7 min (𝑃 < 0.001) ). Conclusion . Day-case spinal anaesthesia with hyperbaric prilocaine + fentanyl is superior to hyperbaric bupivacaine in terms of earlier sensory block resolution and home readiness and the surgical conditions are comparable for perianal surgery. Background. Dislocation of epidural catheters (EC) is associated with early termination of regional analgesia and rare complications like epidural bleeding. We tested the hypothesis that maximum effort in fixation by tunneling and suture decreases the incidence of catheter dislocation. Methods. Patients scheduled for major surgery ( 𝑛 = 121 ) were prospectively randomized in 2 groups. Thoracic EC were subcutaneously tunneled and sutured (tunneled) or fixed with adhesive tape (taped). The difference of EC length at skin surface level immediately after insertion and before removal was determined and the absolute values were averaged. Postoperative pain was evaluated by numeric rating scale twice daily and EC tips were screened microbiologically after removal. Results. Both groups did not differ with respect to treatment duration (tunneled: 109 hours ± 46, taped: 97 ± 37 ) and postoperative pain scores. Tunnelingsignificantlyreducedaverageextent(tunneled:3 mm ± 7,taped: 10±18 )andincidenceofclinicallyrelevantECdislocation ( > 20mm, tunneled: 1/60, taped: 9/61). Bacterial contamination showed a tendency to be lower in patients with tunneled catheters (8/59, taped: 14/54, 𝑃 = 0.08 ). Conclusion. Thorough fixation of EC by tunneling and suturing decreases the incidence and extent of dislocation and potentially even that of bacterial contamination.

Regional anesthesia techniques provide important advantages compared with general anesthesia in some surgical procedures [1,3]. Regional anesthesia is not only performed for adequate anesthesia in the surgical procedures. There are other advantages for the use of regional anesthesia techniques including excellent pain control, reduced side effects, decreased blood loss, improved cardiac and pulmonary function, and shortened stay in the postanesthesia care unit [1][2][3][4]. Low doses of spinal anesthesia and intraarticularly administered analgesic provided a better pain relief, a shorter discharge time, and a higher satisfaction for outpatient arthroscopic knee surgery [2]. Epidural technique as a regional anesthesia is one of the important methods for multimodal postoperative pain control [1,3]. Hypotensive epidural anesthesia is another technique that decreased blood loss in hip surgeries [1]. Caudal anesthesia is commonly performed in pediatric patients for surgical anesthesia and postoperative analgesia. Regional anesthesia would provide excellent pain control and improve outcomes such as decrease in side effects, improvement of pulmonary function, prevention of chronic pain, or reduction in hospital stay. Thus the regional anesthetic techniques and outcome using regional anesthesia for postoperative pain have becoming one of the important fields [4,5].
Total intravenous anesthesia (TIVA) has been used in some surgeries and it has been compared with other anesthesia techniques. TIVA with propofol can make a positive contribution to preventing ischemia-reperfusion-associated increases in MDA and IMA in tourniquet-related ischemia reperfusion in arthroscopic knee surgery. In scoliosis surgery, the use of TIVA with propofol and remifentanil is associated with decreased neuroendocrine stress responses in the perioperative period when compared with inhalation anesthesia.
Regional intravenous anesthesia (RIVA) is generally preferred for patients who will have upper extremity surgery due to advantages such as providing a blood-free surgery site, rapid onset and termination of the anesthetic effect, lack of necessity of severe sedation, and general anesthesia and easy application. In addition some analgesic drugs to local anesthetics in intravenous regional anesthesia (IVRA) have been published. The addition of 3 mg/kg paracetamol and 50 mg dexketoprofen to lidocaine as adjuvant in RIVA applied for hand and/or forearm surgery created a significant difference clinically.
Nerve blocks are used for postoperative analgesia. Interscalene brachial plexus block (ISB) is used to provide both anesthesia and analgesia for shoulder surgery. In a study the authors showed that the same volume and concentration of bupivacaine and ropivacaine (30 mL of 0.5%) for interscalene brachial plexus block anesthesia produced similar surgical block. When continuing the block with a patient-controlled 2 The Scientific World Journal interscalene analgesia infusion, 0.15% bupivacaine and ropivacaine provided adequate pain relief, similar side effects, and high patient satisfaction after shoulder surgery.
This special issue contains five clinical studies and a review article related to comparison of anesthetic techniques. In the review article the benefits and risks of hypotensive anesthesia during major maxillofacial surgery were compared to those of normotensive anesthesia. The authors reported that controlled hypotension during anesthesia or hypotensive anesthesia is often used in major maxillofacial operations. Reduced blood pressure is advantageous in some settings because it can contribute to a reduction in overall blood loss and improve the surgical field conditions. Since hypotensive anesthesia carries the risk of hypoperfusion to important organs and tissues, mainly the brain, heart, and kidneys, it cannot be applied safely in all patients.
In a clinical study, spinal and general anesthesia were compared for the impact of the surgical environment, especially the sounds of saw and hammer in the operating room, on patient's mood and anxiety after the operation in total knee arthroplasty (TKA). It was reported that sounds of hammer and saw had no evident negative effect on patient's mood and, in operations performed with spinal anesthesia, the patients were found to be more satisfied so that, with known advantages, regional anesthesia was advisable for TKA patients and appropriate sedation can be administered during the operation if needed.
Two clinical studies are related to the comparison of supraglottic airway devices. The aim of a clinical study was to compare the performance of recently released size 1 I-gel with size 1 ProSeal LMA, which is proven to be superior to the classical LMA for small infants and neonates. The study demonstrated that the size 1 I-gel provided an effective and satisfactory airway as the size 1 ProSeal LMA. It may be a good alternative supraglottic airway device for use in small infants and neonates. However, further studies are needed to determine whether it is reliable for aspiration because of the absence of a gastric drainage tube in this size. Another study compared ProSeal, Supreme, and I-gel supraglottic airway devices in terms of oropharyngeal leak pressures and airway morbidities in gynecological laparoscopic surgeries. It was reported that ProSeal, Supreme, and I-gel provided a safe airway in paralyzed and pressure-controlled ventilation administered gynecological laparoscopic surgeries. While initial oropharyngeal leak pressures obtained by I-gel were lower than ProSeal and Supreme, increased oropharyngeal leak pressures over time, ease of placement, and lower airway morbidity were favorable for I-gel.
The local anesthetics used in day-case spinal anesthesia should provide short recovery times. In a clinical study hyperbaric prilocaine and bupivacaine were compared in terms of sensory block resolution and time to home readiness in day-case spinal anesthesia. In the study it was reported that day-case spinal anesthesia with prilocaine 30 mg + 20 g fentanyl provided faster sensory block resolution and home readiness compared to 7.5 mg bupivacaine + 20 g fentanyl and the surgical conditions were comparable for perianal surgery.
Dislocation of epidural catheters (EC) may cause early termination of postoperative regional analgesia. In a clinical study the hypothesis that maximum effort in fixation by catheter tunneling and suture decreases the incidence of its dislocation was tested. It was reported that thorough tunneling and suture of thoracic epidural catheters significantly reduced incidence and extent of catheter dislocation and potentially that of bacterial contamination.
The outcomes of the comparison of anesthetic techniques are multifarious. In the future more researches are needed to explain the potential mechanisms for these outcomes.