Background: Carotid endarterectomy (CEA) is an established surgical procedure for patients with high-grade carotid artery stenosis. Cerebral hypoperfusion after clamping the carotid artery can lead to the development of new strokes or worsen existing damage. Near-infrared spectroscopy (NIRS) provides continuous and non-invasive monitoring of cerebral oxygenation, allowing for early detection of cerebral ischemia due to hypoperfusion in critical patients and a reduction in early complications. Postoperative cognitive dysfunction (POCD) refers to changes in cognitive function following surgery and anesthesia. Methods: In this prospective and observational study, our aim is to evaluate whether cerebral desaturation, as assessed by NIRS, contributes to the occurrence of POCD. Hemodynamic and NIRS assessments were recorded at various time points: baseline, post-intubation, pre-clamping, 5th and 10th minutes after carotid clamping, 5th minutes after unclamping, pre-extubation, and the end of the operation. The Mini-Mental Status Examination was administered to patients on the day before surgery and the second day after surgery. Results: Cerebral desaturation was observed in 33% of patients. Regional cerebral oxygen saturation (rSO2) showed a slight decrease in the early stages after clamping the carotid artery. During the clamping period, rSO2 values increased, and by the end of the operation, they had returned to baseline or even exceeded baseline levels. We did not identify any cases of POCD during the early postoperative periods. Conclusions: NIRS is a practical and effective method for detecting cerebral hypoperfusion. However, based on our study, we were unable to establish a correlation between NIRS values and the occurrence of POCD.
Background: This study aimed to compare the effectiveness of readily available and less expensive inhalational anesthetics in combination with local anesthetics as pre-emptive analgesia with inhalational anesthesia and intravenous opioids in maintaining favorable operating conditions, ensuring hemodynamic stability, improving surgeon satisfaction, and evaluating the correlation with postoperative analgesia. In addition, the study recorded and compared the incidence of postoperative nausea between the two anesthesia approaches. Methods: A total of twenty-four patients scheduled for external dacryocystorhinostomy were randomly assigned to two groups: Group G, which received general anesthesia with intravenous opioid and local infiltration of saline, and Group L, which received general anesthesia with intravenous saline and local infiltration of a mixture of lidocaine/bupivacaine with epinephrine. The primary outcomes assessed were intraoperative and early postoperative pain control, intraoperative anaesthetic requirements, intraoperative bleeding, extubation time, and time to reach the modified Aldrete scoring system. Secondary outcomes included evaluations of patient satisfaction and surgeon satisfaction. Results: Both groups were matched regarding age, sex, BMI and duration of surgery. There was significant difference between the studied groups regarding SBP and DBP at 10 minutes post induction, mean intra operative and post extubation, but there was no significant change when comparing blood pressure at different durations. There was significant difference between groups regarding HR at 10 minutes post induction, mean intra operative and post extubation and also there was significant change when comparing blood pressure within each group. Regarding extubation time, intra operative bleeding, ISO and first-time needed analgesia, there was a significant difference between both groups with longer extubating time, more bleeding and more ISO in the G group. Also, L group needed analgesia after longer duration (150min) than group G (24.5min). Conclusions: Combined local anaesthesia containing adrenaline with general anaesthesia in external dacryocystorhinostomy is associated with better intraoperative and early postoperative pain control when compared to general anaesthesia alone with an intravenous opioid, which decreases the intraoperative anaesthetic requirement and allows rapid recovery.
