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Original Research

Does Depth of Anesthesia Effect Clinical Results of Patients Who Underwent Radical Cystectomy in Accordance with Eras Protocols?


1 Department of Anesthesiology and Reanimation, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
2 Department of Anesthesiology and Reanimation, Cerkezkoy State Hospital, Tekirdağ, Turkey
 


DOI : 10.33719/yud.2023-18-3-1350497
New J Urol. 2023;18(3):230-239.

Abstract

Objective: To investigated whether low and high MAC (Minimum Aleveolar Concentration) level of anesthesia have an effect on the depth of anesthesia, clinical results paremeters in patients underwent radical cystectomy in accordance with ERAS (Enhanced Recovery After Surgery) protocols

Material and Methods: Retrospective data of 41 patients underwent radical cystectomy between 2019-2022 were collected, 35 of them were included.  The patients were divided  in two groups: Group H (1 MAC, n:18) and Group L (0.5 MAC, n:17). All patients were prepared and managed in line with ERAS protocols. Perioperative and early postoperative parameters including depth of anesthesia which was followed by PSI (Pneumonia Severity Index) and SR (Supression Ratio), preoperative and postoperative 24th hours Mini Mental Test results, post-anesthesia care unit (PACU) unit admission and duration and complications were compared.

Results: The mean age of the patients (61 and 65 years, in the Group H and L, respectively) were similar (p=0.234) in both groups. PSI was found to be significantly lower in Group H at the 60th, 120th minutes and fascia closure (p=0.004, p=0.001, and p=0.000 respectively). PSI <25 duration was significantly higher in group H (139.0±186.7 and 17.6±54.8 in group H and L, respectively, p=0.001). The duration of SR>0was significantly higher in Group H (p=0.000). Both anesthesia (474 min) and surgery (432 min) times were significantly higher in Group H (p=0.013 and 0.029 respectivelly). Nausea and vomiting at 12 hours postoperatively was also common in Group H (p=0.008). The rest of parameters that compared were similar, including the minimental test.

Conclusion: The MAC values did not significantly affect perioperative and early postoperative outcomes. While high MAC level MAC level generates a deeper anesthesia, low MAC level seems an effective alternative providig a lower inhalation anestesia agent consumption.

Keywords: ERAS, radical cystectomy, MAC, anesthesia


Abstract

Objective: To investigated whether low and high MAC (Minimum Aleveolar Concentration) level of anesthesia have an effect on the depth of anesthesia, clinical results paremeters in patients underwent radical cystectomy in accordance with ERAS (Enhanced Recovery After Surgery) protocols

Material and Methods: Retrospective data of 41 patients underwent radical cystectomy between 2019-2022 were collected, 35 of them were included.  The patients were divided  in two groups: Group H (1 MAC, n:18) and Group L (0.5 MAC, n:17). All patients were prepared and managed in line with ERAS protocols. Perioperative and early postoperative parameters including depth of anesthesia which was followed by PSI (Pneumonia Severity Index) and SR (Supression Ratio), preoperative and postoperative 24th hours Mini Mental Test results, post-anesthesia care unit (PACU) unit admission and duration and complications were compared.

Results: The mean age of the patients (61 and 65 years, in the Group H and L, respectively) were similar (p=0.234) in both groups. PSI was found to be significantly lower in Group H at the 60th, 120th minutes and fascia closure (p=0.004, p=0.001, and p=0.000 respectively). PSI <25 duration was significantly higher in group H (139.0±186.7 and 17.6±54.8 in group H and L, respectively, p=0.001). The duration of SR>0was significantly higher in Group H (p=0.000). Both anesthesia (474 min) and surgery (432 min) times were significantly higher in Group H (p=0.013 and 0.029 respectivelly). Nausea and vomiting at 12 hours postoperatively was also common in Group H (p=0.008). The rest of parameters that compared were similar, including the minimental test.

Conclusion: The MAC values did not significantly affect perioperative and early postoperative outcomes. While high MAC level MAC level generates a deeper anesthesia, low MAC level seems an effective alternative providig a lower inhalation anestesia agent consumption.

Keywords: ERAS, radical cystectomy, MAC, anesthesia

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