Anesthesia in surgery for epilepsy

OBJECTIVES: To evaluate the efficacy of general anesthesia during epileptic surgery. MATERIAL AND METHODS: A retrospective study of 64 patients who received general anesthesia during epileptic surgery. In the preoperative period, anticonvulsive medication was adjusted in accordance with plasma levels and withdrawn entirely 8 hours before surgery. After premedication with droperidol and fentanyl, a balanced anesthetic technique was applied, based on pentothal, pancuronium (or vecuronium), fentanyl, N2O and isoflurane. Continuous monitoring of ECG, arterial blood pressure, pulse oximetry, ET CO2 and neuromuscular function. Isoflurane was stopped for 10 min after the opening of the duramadre so that ECoG could be recorded and methohexital or propofol was given in some cases in order to activate the epileptogenic focus. Muscular relaxation was restored intraoperatively following the study of somatosensory evoked potentials. Immediate and later complications related to anesthesia or surgery were recorded. RESULTS: The surgical procedure performed in most cases was temporal or frontal resection, with a mean duration for anesthesia of 377 +/- 50 min and for surgery of 318 +/- 50 min. Only one patient received local anesthesia and no hemodynamic changes were observed. Perioperative complications were cerebral edema (4 cases), arrhythmia (2 cases) and bronchospasm (1 case). Postoperative complications were as follows: 3 of 9 patients undergoing callosotomy required mechanical ventilation for 24 hours, 4 patients experienced language alterations, 3 wounds were infected, 2 cases of hemiplegia were observed, 1 status epilepticus occurred after administration of propofol and there was 1 case of respiratory distress. Anticonvulsive medication was given parenterally after surgery. CONCLUSIONS: General anesthesia is a safe and effective method for epileptic surgery, with local anesthesia providing additional sedation for isolated cases. Appropriate treatment requires an understanding of the pharmacokinetics and pharmacodynamics of the drugs used, as well as knowledge of the condition and the anticonvulsive medications used.     

Robot arm in laparoscopic surgery

Currently laparoscopic surgery is limited by several factors. One of them is the precise handling of optics. Up to now, in our hospital 52 laparoscopic operations have been done with a voice-controlled robot arm to handle the optics in gallbladder, stomach, large bowel and hernia operations. The visual field is determined by the surgeon. In all cases handling of the robot arm was precise and the voice response exact and without technical problems. Twenty-nine operations were done by one operator as "solo surgeries". In 20 further cases there was one assistant. A robot arm can be used successfully without problems by any laparoscopic surgeon in any operating theater.     

Measurements in emergency laparoscopic surgery

The paper deals with the advantages of the techniques of abdominal surgical interventions by using a laparoscope. It suggests that the diagnostic feasibilities of laparoscopy should be expanded by inserting the transducers that yield reliable data on the status of the viscera.     

Complications of laparoscopic surgery

The potential complications of a laparoscopic procedure include those related to laparoscopy and those related to the specific operative procedure. The majority of these complications occur during the early learning phase for laparoscopy. They also may occur, however, during procedures performed by surgeons who have considerable laparoscopic experience. As new applications for laparoscopy continue to emerge, it is important for the surgeon to be familiar with the possible complications associated with the various laparoscopic procedures. Only through an appreciation of the potential complications of a procedure can their overall incidence be reduced to a minimum.     

Anesthesia for surgery of pituitary tumors

Transsphenoidal operations for pituitary tumors have dramatically decreased the morbidity of pituitary surgery in a group of patients with many potential anesthetic problems. Although a good preoperative endocrine workup and anticipation of problems are the key to ensuring a good outcome, it remains a challenge to the "art" of neuroanesthesia to produce a smooth and safe anesthetic.     

Lymphatic staging by laparoscopic surgery

Lymphadenectomy is mandatory in vesical and prostatic tumours for a precise staging of candidates to radical surgery. Presentation of our series of 18 ilioobturative lymphadenectomies between May 1992 and February 1993, performed in 14 prostate carcinoma and 4 vesical tumours. As most interesting results, the average number of nodes removed, which was 8, and the discovery of nodular affectation in 5 cases, understaged by the non-invasive procedures, are highlighted; likewise, the reduction in surgery duration up to the current frame of 80 to 120 minutes must be emphasized. Mortality due to the procedure was null. We believe that laparoscopic lymphadenectomy should be the choice technique in the staging of tumoral dissemination in the ilioobturative domain.     

Postoperative fatigue after laparoscopic surgery

Postoperative fatigue (POF) appears to be less following laparoscopic surgery but this has not been proven previously. This study compared a group of patients who had undergone open cholecystectomy with a group undergoing laparoscopic cholecystectomy. Postoperative fatigue was found to be decreased in duration in the patients having laparoscopic surgery, returning to pre-operative fatigue levels by 14 days, compared to 28 days for open surgery. Postoperative pain in the first 24 h and the early metabolic response to surgery were similar for both groups. The authors conclude that laparoscopic surgery is associated with decreased POF and that this is unlikely to be accounted for by a decrease in the early metabolic response to surgery.