BACKGROUND AND OBJECTIVES: The aim of this study was to compare the efficacy and safety of two anesthesia techniques, combined epidural/general anesthesia (CEGA) versus total intravenous anesthesia (TIVA), for laparoscopic cholecystectomy. METHODS: Forty patients were randomly assigned to one of two different groups: group A received TIVA and group B received CEGA. At preset times during the operation, systolic and diastolic arterial pressure, heart rate, oxygen saturation (SaO2) and end-tidal carbon dioxide (Etco2) were monitored. Postoperatively, recovery (Steward's test) and analgesia (visual analog scale [VAS] pain scores) were assessed, as well as the incidence of adverse effects. RESULTS: The groups were comparable as to demographic data and duration of surgery and of anesthesia. Intraoperative parameters also showed no statistical differences. Both groups had a rapid recovery (Steward score of 6 within 12 minutes), but group B showed better recovery scores at 4 minutes. Postoperative pain was well controlled in both groups, but group B exhibited better scores at postoperative hour 2. The incidence of postoperative side effects was low in both groups. CONCLUSIONS: The use of CEGA for laparoscopic cholecystectomy seems to be effective and safe and to offer some advantages as compared to TIVA alone. CEGA can control pain due to CO2-induced peritoneal irritation, providing excellent intra- and postoperative analgesia. CEGA does not require the use of intraoperative intravenous opioids and shortens recovery time, without increasing the incidence of side effects.

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[Monitoring cardiac output: esophageal doppler vs thermodilution].

OBJECTIVE: Evaluation of continuous cardiac output monitoring based on the esophageal Doppler in the critically ill. DESIGN: Prospective clinical investigation. SETTING: An intensive care unit of an University hospital. PATIENTS: Ten critically ill patients who needed pulmonary artery catheterization. MEASUREMENTS: Cardiac output was monitored continuously by a transesophageal Doppler device, consisting of an esophageal probe and a bedside microprocessor that calculated cardiac output using a new algorithm. Standard bolus thermodilution technique (10 ml of saline solution) was used to compare the continuous Doppler cardiac output measurement with the intermittent bolus measurement. MAIN RESULTS: A total of 50 pairs of intermittent (bolus) cardiac output and continuous (Doppler) cardiac output measurements were obtained from the 10 patients. The mean value of CO measured with TD was 5.81 +/- 0.83, while using esophageal Doppler was 5.84 +/- 0.81. The correlation coefficient of the two methods was r = 0.93. The Bland and Altman showed 95% of agreement limits as +0.52 and -0.64 L/min. CONCLUSIONS: Continuous monitoring of cardiac output using esophageal Doppler has proven to be safe, accurate, and precise when compared with the standard intermittent bolus thermodilution technique. The continuous monitoring technique improves our armamentarium for more intensive monitoring of the critically ill patients.

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