Transcervical Tubal Catheterization For Corneal Tubal Blockage: A Prospective Controlled Trial
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- Category: Vol. 77, December 2009
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Transcervical Tubal Catheterization For Corneal Tubal Blockage: A Prospective Controlled Trial,AHMAD N.H. ASKALANI
Abstract
Background: This study was designed to evaluate the immunity condition of cancer patients and to assess the efficiency of combined bilateral superficial and deep cervical plexus blocks with general anesthesia in patients undergoing total laryngectomy with respect to the immune response.
Method: The patients (40) were allocated randomly to one of two groups: General Anesthesia Group (GA) (n=20) and Combined Group (regional and general anesthesia) (n=20). After assessment of the airway, propofol was titrated slowly until loss of verbal contact is achieved, after assessment of adequacy of ventilation, vecuronium 0.1mg/Kg was given for muscle relaxation, fentanyl was given in a dose 1ug/kg and then a cuffed endotracheal tube was inserted. The maintenance of anesthesia in both groups was achieved by sevoflurane with fresh gas flow 5 L/min. In combined group, after achieving satisfactory level of anesthesia, the patients received combined bilateral superficial and deep cervical plexus block. The hemodynamic goals were to maintain the mean arterial pressure (MAP) at 60-65mmHg by adjusting the sevoflurane concen-tration and the use of esmolol. The consumption of sevoflurane and the Frequency of use of esmolol were evaluated in both groups. Intraoperative blood loss was assessed. Venous blood samples for measurement of serum SIL-2R and IL-2 levels were obtained before induction of anesthesia, at the end of surgery, and in the mornings of 1st and 5th postoperative days. In addition, serum samples also were collected from 40 healthy volunteers (mean age 39 yr, 30 male and 10 female) for comparison.
Results: The number of patients requiring supplemental fentanyl, and the mean end tidal sevoflurane concentration were significantly increased in GA group. All patients in GA group required supplemental esmolol to achieve the target MAP, in contrast only 5 patients in the combined group required supplemental esmolol (p<0.001). A reduction in blood loss was observed in the combined group during the surgical procedure (p<0.05). As regards, the immune response, Serum SIL-2R were significantly elevated (p<0.005), whereas the serum IL-2 levels were significantly reduced (p<0.005) in both groups compared to those of the healthy persons. Also there was no significant difference in the 2 values between the two groups preoperatively. The mean serum SIL-2R and IL-2 levels at the end of operation (T2), 1st day (T3) and 5th day postoperative values (T4), were comparable to preoperative values (T1) between the two groups. On the morning of the 1st postoperative day (T3), and 5th postoperative day (T4) there were significant differences in the 2 parameters in both groups as compared with the preoperative values; the mean serum levels of SIL-2R had increased (p<0.05), whereas IL-2 levels had declined (p<0.01) but there was less significant increase in the mean serum SIL-2R levels and less significant decrease in the mean serum IL-2 levels in the combined group than in the GA alone group (p-value 0.001).
Conclusion: Cancer larynx is associated with a state of immuno-suppression. surgical procedure performed with GA combined with regional anesthesia had less depressant effects on the immune response in the immediate postoperative period.