General Anesthesia and General Anesthesia Combined With Thoracic Epidural Anesthesia
Condition: Thoracal Epidural Block
Study type: Interventional

Summary: 
      It was aimed to investigate whether epidural anesthesia added to general anesthesia has an
      effect on neuromuscular block.
    

Detailed description: 
      The study was carried out with patients who were evaluated preoperatively in the Department
      of Anesthesiology and Reanimation, Department of Anesthesiology, Faculty of Medicine, Yuzuncu
      Yıl University. Sixty ASA I-II group patients, aged between 18-65 and scheduled for gastric
      ca operation, were included in the study. Severe heart, lung, liver disease, kidney failure,
      bleeding diathesis, fever, infection, allergy to drugs to be used, those who refused to
      participate in the study, patients with hypothermic and acid-base disorders, electrolyte
      disorders such as hypokalemia, hypocalcemia, antibiotics, anticonvulsants, Those taking
      antiarrhythmic and cholinesterase inhibitors were excluded from the study.

      The cases were divided into 2 groups by the envelope method, 30 people will be included in
      the general anesthesia group (GA), and 30 people will be included in the general anesthesia
      and thoracic epidural anesthesia group (GAE). After the patients who did not receive
      premedication were taken to the operating room, standard monitoring was provided with ECG,
      non-invasive arterial pressure, peripheral oxygen saturation. Peripheral vein cannulation was
      performed with a 20 gauge i.v. catheter, and a 4 mL/kg 0.9% NaCl infusion was started. In
      Group GAE, after preoperative asepsis was achieved, cutaneous-subcutaneous local anesthetic
      was infiltrated through the T7-9 space. The epidural space was determined by the loss of
      resistance method with a 16 gauge Tuohy epidural needle, and an 18 gauge epidural catheter
      was placed in the epidural space at a 4 cm angle in the cranial direction. The location of
      the catheter was confirmed by applying a test dose of 3 mL 2% lidocaine containing 5μ/ml
      adrenaline. After 5 minutes, 5 ml of 0.125% bupivacaine was given and the patient was placed
      in the supine position immediately afterwards. Electrodes were placed for TOF monitoring
      after thoracic epidural catheterization in the GAE group. Anesthesia induction was applied to
      all patients with 1mg/kg lidocaine, 1μcg/kg fentanyl, 2mg/kg propofol, 0.6mg/kg rocuronium.
      When the Train of four (TOF) value was 0, patients were intubated with an endotracheal tube
      (7-7.5 endotracheal tube (ETT) for women, 8-8.5 ETT for men). In maintenance, desflurane at
      8% concentration was applied in a mixture of 50% O2 + 50% air. The time to reach 25% of the
      TOF value for both groups was noted. 0.1mg/kg rocuronium was added to patients who reached
      0.25. The number of additional muscle relaxant requirements was recorded. In the GAE group, 5
      ml of epidural drug was given every hour. In the GA group, 0.05mg/kg morphine was given 30
      minutes before the end of the operation. Considering the time it took for the TOF value to
      reach 70%, the inhaler anesthetics were terminated and the patients with a TOF value of 90%
      were extubated.
    

Intervention name(s): Neuromuscular blocker usage
Intervention type(s): Procedure
Intervention description(s): The patients were followed up, the total amount of muscle relaxant used was determined, intraoperative effects and postoperative analgesic usage
Other intervention name(s): Train of four (TOF); Blood pressure; Heart rate; Oksygen saturation; Visual analog scale
Intervention MeSH terms: Neuromuscular Blocking Agents
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomized prospective, controlled study
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Screening