Does previous endoscopic subureteric injection (STING) effect the outcomes of robot-assisted laparoscopic ureteral reimplantation surgery (RALUR) in children?

BACKGROUND

There is lack of evidence on the success of robot-assisted laparoscopic ureteral reimplantation (RALUR) for the treatment of vesicoureteral reflux (VUR) who had prior intervention.

OBJECTIVE

This study aimed to evaluate the effect of previous unsuccessful STING on the outcomes of RALUR in children.

STUDY DESIGN

A total of 67 children treated with RALUR by a single surgeon for the treatment of VUR were scanned between February 2018 and April 2022. Two patients were excluded from the final data analysis due to the presence of a megaureter. Patients were divided into two groups: those with a history of STING (Group A - n:14) and those without STING (Group B - n:51). Patient characteristics, previous numbers of injections, console time, total operative time, perioperative and postoperative complications and clinical success data were collected. Clavien Dindo and Satava complication scales were used as the standard record of peri and postoperative complications. Radiographic success was defined as absence of reflux detected on postoperative voiding cystourethrography, whereas clinical success was defined as the absence of a febrile urinary tract infection during the follow-up. Mann-Whitney U and Chi-square tests and Fisher exact test were used where appropriate.

RESULTS

A total of 36 (55.3%) female versus 29 (44.6%) male patients were operated for 96 refluxive ureters. Nearly half of the patients were with bilateral VUR (n = 31). The mean follow-up was 20.2 ± 15.4 months. The median age of patients was 59 ± 31 (range: 28-132 months) versus 46 ± 33.1 (range: 7-206 months) for groups A and B respectively (p = 0.22). Gender, age, peri- and postoperative complication rates, and clinical success were comparable between the two groups. The median operative time and the console time was significantly higher in children with history of STING (op time: 142.5 ± 27.4 versus 120 ± 24.9 min (p = 0.008), console time: 117.5 ± 28.2 versus 100 ± 24.5 min (p = 0.011) for groups A and B, respectively. A total of six complications (9.2%) occurred with none of them were greater than Clavien grade 3b. The overall clinical success rate was 97%, with 2 cases of clinical failure. In both cases, VCUG demonstrated absence of VUR.

DISCUSSION

The outcomes of our study provided that RALUR is effective with more than 95% success rates despite failed endoscopic injection procedures.

CONCLUSION

The previous history of STING neither changes the success nor the complication rates of RALUR. However, this can lead to more challenging surgery by increasing the total operative times.

Assistant port is unnecessary for robotic-assisted laparoscopic pyeloplasty in children: a comparative cohort study

OBJECTIVE

To compare the postoperative outcomes including the cosmetic results of robotic-assisted laparoscopic pyeloplasty (RALP) performed with and without assistant port in pediatric population.

METHODS

47 patients with ureteropelvic junction obstruction consecutively underwent RALP were stratified as: three-port (Group 1, n = 26) and four-port (Group 2, n = 21). In Group 1, no assistant port was placed and double-J stent was introduced with the aid of an angiocatheter via the percutaneous route. In group 2, an assistant port was placed. The Patient and Observer Scar Assessment Scale (POSAS), the Vancouver Scar Scale(VSS), Satava, Clavien classification systems, and success rates were compared.

RESULTS

We found similar success rates for both groups (group 1:96.2%, group 2:100%). Two groups were similar in terms of improvement in the postoperative anteroposterior diameter of the renal pelvis and parenchymal thickness. There was no difference in terms of perioperative and postoperative complication rates (group 1:19.2%, group 2:9.5%). The total PSAS was significantly lower in Group 1 (p < 0.008). No difference was observed for VSS and OSAS.

CONCLUSIONS

Using an assistant port does not improve the success or complications of RALP, while the cosmetic outcomes are inferior to three-port RALP in children. We suggest avoiding the use of assistant port during RALP in children.

Risk factors for febrile urinary tract infections in the first year after pediatric renal transplantation

Urinary tract infection is the most common infectious complication following kidney transplant. Anatomic abnormalities, bladder dysfunction, a positive history of febrile urinary tract infection, and recipient age are reported risk factors. The aim of this study was to determine the risk factors for fUTI, which necessitated hospitalization in the first year after renal transplantation in our pediatric transplant population. A retrospective review of 195 pediatric patients who underwent kidney transplant between 2008 and 2017 from a single institution was performed. All patients admitted to the hospital with fUTI were marked for further analyses. The risk factors including age, gender, dialysis type, history of urologic disorders, and preoperative proteinuria for fUTI in the first year after kidney transplantation and graft survivals were investigated. Independent-sample t test and chi-square tests were used for univariate analysis. Exhaustive CHAID algorithm was used for multivariate analysis. The data of 115 male and 80 female patients were retracted. The mean ages of our cohort for males and females were 9.5 ± 5.1 and 10 ± 4.8 years, respectively. The age of the patients at transplant and their gender were found to be a statistically significant risk factors for developing fUTIs. Multivariate analysis showed that fUTI was common in female patients and a subgroup of male patients who had preoperative proteinuria, but no neurogenic bladder had higher risk compared with male patients without proteinuria. Patient surveillance and antibiotic prophylaxis algorithms can be developed to prevent febrile urinary tract infections seen after pediatric kidney transplantation in risky population.

The Fate of Residual Fragments After Retrograde Intrarenal Surgery in Long-Term Follow-up

PURPOSE

We aimed to describe the natural history of stone fragments ? 7 mm that remained after retrograde intrarenalsurgery (RIRS) in long-term follow-up.

MATERIALS AND METHODS

We retrospectively reviewed 142 medical records of patients who had residual fragments (RFs) ? 7 mm after RIRS. Patients were divided into 2 groups according to the size of RFs as ? 4 mm (group 1) and 5 - 7 mm (group 2). Patients' demographic data, stone characteristics, perioperative data and complications were recorded. Re-growth of RFs, spontaneous passage, renal colic, infection and re-operation rates were our main variables.

RESULT

A total of 142 patients (86 in group 1 / 56 in group 2) were followed for mean 54.45 ± 14.24 and 56.22 ± 10.28 months. Mean size of RFs was 2.85 ± 1.22 mm in group 1 and 6.81 ? 2.21 mm in group 2. Mean number of RFs were 1.1 ± 0.2 in group 1 and 2.4 ± 1.6 in group 2 (P = .035). Spontaneous passage rate of RFs were 30.23% and 17.85% in group 1 and 2, respectively (P = .032). No difference was observed in the re-growth rate of RFs between the two groups (P = .094). Although no difference was observed in re-growth of RFs between the groups, patients in group 2 were more likely to experience stone-related events such as renal colic and re-intervention rate (P = .034, P = .029; respectively).

CONCLUSION

Our results demonstrate that RFs > 4 mm take higher risk in terms of stone-related events and shouldbe followed up more closely.

Comparison of intravesical (Cohen) and extravesical (Lich-Gregoir) ureteroneocystostomy in the treatment of unilateral primary vesicoureteric reflux in children

INTRODUCTION

Various intravesical and extravesical techniques have been described for the surgical correction of vesicoureteral reflux (VUR). Among those techniques Cohen (intra-vesical) and Lich-Gregoir (extra-vesical) are the most commonly used ones. However, there are limited studies that compare those two surgical techniques in the literature.

OBJECTIVE

In this study, we aim to compare the outcomes of the open intravesical and extravesical procedures for unilateral primary VUR in children.

METHODS

We analyzed the records of 118 consecutive children with primary VUR who underwent open ureteral reimplantation surgery by single surgeon from January 2011 to October 2015 at our institution. Among them, intravesical reimplantation was group A, and extravesical reimplantation procedure was group B. We retrospectively analyzed the clinical data of both groups, including age, sex, preoperative reflux grade, presence of lower urinary tract symptoms (LUTS), operative time, postoperative complications and hospitalization period. Success of surgery was defined as the resolution of the VUR as determined by voiding cystourethrography 6 -12 months after surgery. All the parameters were statistically compared.

RESULTS

A total of 58 patients were found eligible for the study. In 23 cases intravesical (group A) and in 35 cases extravesical (group B) procedure were performed. The operative time in group A was significantly higher than group B (110.3±16.9 and 87±29.8 min, respectively, p = 0.002). The mean hospital stay was also longer in group A (2.8±0.8 and 1.2±0.6 days, respectively, p = 0.007). The ureteral catheterization periods were 14.1±6.1 days for group A and there was no ureteral catheter placement in group B. The success rate of the two groups were comparable (100% vs 94.9%, p = 0.513). No intraoperative complications were detected in either group. The number of febrile urinary tract infections were similar between the groups after a mean follow up of 18.2 months (p = 0.746).

DISCUSSION

Our results confirmed that both Cohen and Lich-Gregoir procedures had equivalent success and complication rates. Lich-Gregoir technique was found superior to Cohen technique in terms of hospital stay and operative time. Moreover, it avoids the necessity of urethral and ureteral stenting which probably might increase the comfort of the patients postoperatively. The main limitations of our study are unrecorded pain scores and amount of analgesics taken the after surgery and retrospective analysis of the data.

CONCLUSION

Both the open intravesical and extravesical ureteroneocystostomy procedures are equally effective in the treatment of primary unilateral VUR. Any of the techniques can be opted by the surgeons depending on their surgical experience.

Comparison of Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery in Treating 20-40 mm Renal Stones

PURPOSE

To compare the outcomes of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) in treating renal stones between 20 and 40 mm in diameter.

MATERIALS AND METHODS

146 patients, who were treated with RIRS and 146 patients, who were treated with PCNL for renal stones between 20 and 40 mm in diameter were compared retrospectively using a matched-pair analysis. The operative and post-operative outcomes of both groups were analyzed retrospectively.

RESULTS

The mean age, gender, body mass index and stone laterality were similar between the groups. The mean stone size was 28.39 &plusmn; 4.67 mm for the PCNL group and 25.08 &plusmn; 6.07 mm for the RIRS group (P =.21). The mean operative times were statistically longer in the RIRS group, whereas the fluoroscopy times, hospitalization times and post-operative visual analogue scores were statistically higher in the PCNL group. The stone- free rates (SFR) after a single procedure were 91.7% in the PCNL group and 74% in the RIRS group (P = .04). After auxiliary procedures, the overall SFRs reached 94.4% for the PCNL group and 92.3% for the RIRS group (P = .52). No major complications were observed for both groups. Minor complication (Clavien 1-3) rates were 6.8% and 3.4% for the PCNL and RIRS group, respectively (P =.18).

CONCLUSION

RIRS has some advantages over PCNL such as shorter hospitalization times, shorter fluoroscopy times and less post-operative pain in treating renal stones between 20 and 40 mm in diameter. However, PCNL has a higher SFR with only a single session.

Different preloading protocols with constant ephedrine infusion in the prevention of hypotension for elective cesarean section under spinal anesthesia

Ninety ASA I or II parturients were randomly allocated to three groups: group 10RL, 15RL and 20RL to receive 10, 15 and 20 mL/kg of Ringer's lactate (RL) respectively within 15 minutes (min) before the spinal block. Spinal anesthesia was performed with hyperbaric bupivacaine 12 mg, morphine 100 microg and fentanyl 10 microg. The operating table was tilted to the left and an IV infusion of ephedrine of 3 mg/min was immediately started and continued until umbilical cord clamping in all groups. Hypotension was defined as a drop in mean arterial pressure (MAP) of more than 20% from baseline : this was treated with 10 mg ephedrine IV. The incidence of hypotension was 60%, 36.7% and 13.4% in group 10RL, 15RL and 20RL, respectively (p<0.05). Additional ephedrine dose was the lowest in group 20RL compared to the other groups (p<0.05). The total amount of ephedrine was 49.9 +/- 13.5, 46.4 +/- 13.4 and 38.4 +/- 8.5 mg in group 10RL, 15RL and 20RL, respectively (p <0.05). The incidence of nausea and vomiting in group 20RL was significantly less than in group 10RL (p = 0.02). It was concluded that preloading with 20 mL/kg of RL prior to spinal anesthesia followed by constant ephedrine infusion 3 mg/min after spinal block reduced the incidence of hypotension and of nausea and vomiting and decreased the total amount of ephedrine.

Anesthesia for cesarean delivery in the term pregnant following acute onset severe intracranial superior sagittal sinus thrombosis

Intracranial venous thrombosis is rarely seen prior to delivery. We present our anesthetic management of a term parturient with an acute onset severe superior sagittal sinus thrombosis urgently referred to us. General anesthesia was performed in order to avoid potential increased risk of morbidity after spinal anesthesia in this particular parturient.

Survey of Turkish practice evaluating the management of postdural puncture headache in the obstetric population (1)

Many surveys and meta-analysis concerning the management of postdural puncture headache (PDPH) in the obstetric population were published in the literature. Therefore, we aimed to determine the current practice and ideas in the management of PDPH in the Turkish obstetric population and to provide awareness of the responders about new solutions with a survey. The response rate was 70%. The management strategies against accidental dural puncture during epidural insertion were to leave the catheter in situ as a spinal catheter (36%, n = 28) or to re-site it at a different level (64%, n = 50). Although these results might reflect the current practice of this small sample, in order to follow the changes in these strategies and to catch almost a standard approach for the prevention and management of PDPH which is a serious complication affecting morbidity in this particular population, further surveys including most of the centers are required.

Efficacy of patient-controlled epidural analgesia after initiation with epidural or combined spinal-epidural analgesia

BACKGROUND

The aim of the present study was to compare the efficacy of patient-controlled epidural analgesia after initiation with either epidural or combined spinal-epidural analgesia.

METHODS

Forty ASA I parturients at 37-42 weeks' gestation and cervical dilatation <6 cm were randomly allocated to receive either epidural analgesia (group EA) or combined spinal-epidural analgesia (group CSEA). Analgesia was initiated with a 7-mL epidural bolus 0.1% bupivacaine containing fentanyl 50 mug (group EA, n=20) or with intrathecal fentanyl 20 mug (group CSEA, n=20). In both groups, analgesia was provided by a 5-mL bolus on demand via PCEA with a 10-min lock-out interval and a 15-mL/h limit.

RESULTS

No significant differences were observed in the rate of cervical dilatation, delivery type or duration of delivery between the groups. The time to first analgesic demand was shorter in the CSEA than in the EA group. Total bupivacaine dose was comparable in both groups, but total fentanyl dose in group CSEA was significantly lower than that of group EA because of the initial dose used for the induction of EA and CSEA. The incidence of pruritus in group CSEA was significantly higher than in group EA.

CONCLUSION

Both regional analgesia techniques followed by demand-only PCEA provided efficient pain relief for labor without changing the duration of labor or rate of cesarean section.

Temporal variation of oxidant stress in critically ill patients

AIM

Our aim was to investigate indicators of lipid peroxidation via observing temporal changes or daily fluctuations in cytoprotective enzymes such as superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX), and serum components possessing antioxidant activity against free radicals and malondialdehyde (MDA) such as uric acid. This study was conducted in a small number of critically ill patients versus healthy volunteers in order to design an effective antioxidant therapy regimen under oxidative stress.

METHODS

Six critically ill patients and 6 young healthy volunteers were recruited. Blood samples were collected 6 times a day with 4 h intervals starting from 8 a.m. From the blood samples, SOD and GSH-PX activities and uric acid and MDA levels were determined. One-way ANOVA and unpaired t-test were used to assess differences within and between the groups, respectively. A two dimensional table curve cosine formulation was performed to elucidate rhythmycity.

RESULTS

No significant differences were found in SOD and GSH-PX activities or uric acid levels within the 24 h period or between the groups. MDA levels were significantly higher in the study group at 8 p.m. than that of control group (P<0.05), but no significant difference was found within the 24 h period. We showed that GSH-PX activities in control and study groups revealed temporal variation, whereas uric acid levels varied temporally only in the study group.

CONCLUSION

We concluded that there are signs of oxidative stress in ICU patients that vary in time but further studies are required in order to design appropriate antioxidant treatments.

Use of BIS monitor during anaesthesia of a narcoleptic patient for avoiding possible delayed emergence

Anaesthesia for a narcoleptic patient is not a common practice of anaesthesioligists' daily working life. Therefore special problems related to narcolepsy should be considered pre-, peroperatively and during emergence. The aim of presenting this case report is to emphasize the importance of BIS monitor use in a narcoleptic patient undergoing surgery under general anaesthesia to avoid possible prolonged emergence.

An unmasked neurological pathology (schwannoma) following spinal anesthesia

A neurological deficit occurred following spinal anaesthesia that unmasked a relatively important neurological pathology. Spinal anesthesia was performed between L3 and L4 by midline approach at the first attempt. Postoperative clinical examination of the patient showed sensory loss below the T5 segment. Whenever new neurological signs are seen after regional anesthesia, further investigations should be done immediately for differential diagnosis. - ÖZET - Spinal anestezi sonrası gelişen oldukça önemli bir nörolojik patolojiyi kapsayan olgu sunuldu. Spinal anestezi ilk girişimde L3-4 arasından orta hattan gerçekleştirildi. Postoperatif klinik muayenesinde T5 segmentinin altında duyusal kayıp tespit edildi. Rejyonel anestezi sonrası ne zaman yeni nörolojik bulgular gözlenirse ayırıcı tanı için hemen ileri tetkikler yapılmalıdır.

Prevention strategy for post dural puncture headache

We report the anesthetic management of a parturient after an unintentional dural puncture while performing epidural anaesthesia for caesarean section and the strategy to prevent postdural puncture headache (PDPH). We injected the cerebrospinal fluid (CSF) back into the subarachnoid space and then administered intrathecal 1.5 mL 0.5% hyperbaric bupivacaine and fentanyl 20 microg to maintain CSF volume via epidural needle. The epidural catheter was inserted following re-identification of the epidural space for possible epidural top-up requirement and postoperative pain relief. After adding 3 mL of 0.5% isobaric bupivacaine via epidural catheter, sensory block level reached at T4 bilaterally. No PDPH was observed.

Interaction of lidocaine with reactive oxygen and nitrogen species

BACKGROUND AND OBJECTIVE

To investigate the ability of lidocaine to inhibit reactive oxygen and/or nitrogen species generation by either human leukocytes or cell-free systems via luminol- and lucigenin-enhanced chemiluminescence.

METHODS

Venous blood was obtained from healthy volunteers and leukocytes were isolated, from which chemiluminescence was generated. Also, chemiluminescence, induced by H(2)O(2), HOCl, peroxynitrite or ferrous iron, was generated in cell-free systems.

RESULTS

Lidocaine produced a concentration-dependent inhibition in chemiluminescence generated by leukocytes (92 +/- 1%, 1 mM). In cell-free experiments, lidocaine (1 mM) markedly inhibited chemiluminescence of xanthine-xanthine oxidase (24 +/- 3%), while it slightly suppressed hypochlorous acid-induced chemiluminescence (9 +/- 2%). Peroxynitrite-induced luminol- and lucigenin-enhanced chemiluminescence were also inhibited by lidocaine at 1 mM (19 +/- 3% and 48 +/- 8%, respectively). Lidocaine did not affect chemiluminescence generated by FeSO(4). However, lidocaine produced a biphasic effect on H(2)O(2)-induced chemiluminescence (37 +/- 5% inhibition at 0.01 mM and 61 +/- 17% activation at 1 mM).

CONCLUSIONS

Lidocaine can elicit direct scavenging activity at high concentrations that might be important at or near the site of injection in local anaesthetic use.

Seasonal variation in the effect of a fixed dose of heparin on activated clotting time in patients prepared for open-heart surgery

We investigated the effect of an injected bolus of 5 mg kg(-1) heparin at one circadian stage (08:30 to 11:00) on blood coagulation during different months of the year. Activated clotting times (ACTs) were assessed before and 5 min after heparin dosing to ensure extracorporeal circulation during open-heart surgery. The ACT data of 1083 presumably day-active Turkish patients (816 men and 267 women, mostly older than 46 years) who underwent coronary bypass surgery between 08:30 and 11:00 in the years from 1994 to 1997 were analyzed for annual rhythmicity. The ACT values obtained just before and 5 min after heparinization were subjected to cosinor analysis using a 365.25-day period to assess seasonality in basal ACT level and heparin effect. A small-amplitude annual rhythm with a wintertime peak was documented in the morning ACT in the group of 1083 patients. Rhythms of similar magnitude and staging were also detected in heparin effect on ACT in the 1083 patients and in subgroups categorized by gender. Circannual rhythmicity in the heparin effect on ACT was also documented in the elderly (> or = 45 years old), but not young (18-45 years old) patients. The annual mean effect of heparin on the ACT was statistically significantly greater in younger than older patients. The relatively low-amplitude circannual rhythm in heparin effect on ACT (approximately 10% of the annual mean) is not viewed as being meaningful in patient preparation for bypass surgery for the 5 mg kg(-1) level of heparin dose.

Epidural anaesthesia for Caesarean section in a patient with Devic's Syndrome

The anaesthetic management of a 29-year-old paraplegic woman suffering from Devic's Syndrome scheduled to undergo Caesarean section under epidural anaesthesia is presented. The case is discussed with particular reference to the risk of autonomic hyperreflexia.

Cerebral hypoperfusion after cardiac surgery and anesthetic strategies: a comparative study with high dose fentanyl and barbiturate anesthesia

BACKGROUND

Postoperative delirium is a common sequel of cardiopulmonary bypass that is hard to diagnose correctly, difficult to predict and almost impossible to prevent and to treat. The aim of this study is to evaluate the frequency of postoperative cognitive disorders and cerebral hypoperfusion in patients receiving either high dose fentanyl or thiopentone anesthesia in cardiac surgery.

METHODS

50 unpremedicated patients, Class IIb-NYHA (25 patients in each group suffering from single critical LAD disease) undergoing elective coronary artery bypass grafting surgery were randomly allocated into two groups either to receive fentanyl 50 microg/kg with diazepam 0.1 mg/kg (Group 1) or thiopentone 7 mg/kg (Group 2) for the induction of anesthesia. Anesthesia was maintained with fentanyl 2 microg/kg/hr and diazepam 0.05 mg/kg/hr infusion in Group 1 throughout the procedure. In Group 2, it was maintained with enflurane 0.7-1.5% before and after cardiopulmonary bypass (CPB) and with thiopentone 3 mg/kg/hr infusion during CPB. Neuropsychiatric evaluation (STAI-T, min mental state examination-MMSE and Zung tests), EEG and SPECT rCBF (Single Photon Emission Computed Tomography Regional Cerebral Blood Flow) studies were performed preoperatively, early and late postoperatively. The patients that were diagnosed to have postoperative cerebral hypoperfusion also underwent computed tomography scanning postoperatively.

RESULTS

Eleven patients (9 from fentanyl and 2 from thiopentone group) were diagnosed to have cerebral hypoperfusion with respect to SPECT rCBF studies. Seven of these patients (5 from fentanyl and 2 from thiopentone) were diagnosed to be in a state of delirium clinically with MMSE tests.

CONCLUSION

High dose fentanyl anesthesia causes significant predisposition to postoperative cerebral hypoperfusion when compared with barbiturate anesthesia in cardiac surgery. Hypoperfusion as demonstrated by SPECT rCBF studies may play an important role in the pathophysiology of mental disorders, i.e., postoperative delirium.

Pulmonary microvascular injury following general anaesthesia with volatile anaesthetics--halothane and isoflurane: a comparative clinical and experimental study

Pulmonary microvascular injury has become a recently studied phenomenon that may be responsible for most of the complications associated with the lungs. Thirty patients undergoing partial hemilaminectomy or discectomy due to hernia of nucleus pulposus underwent Tc-99m HMPAO lung clearance as well as Tc-99m pertechnetate lung scintigraphy pre-operatively, and following general anaesthesia with halothane and isoflurane (third, fourth and tenth post-operative days). The results were compared with conventional techniques and haemodynamic parameters during the peri-operative period. In order to demonstrate acute phase changes under general anaesthesia and to perform pathological examinations, 21 New Zealand rabbits underwent radionuclide studies with Tc-99m HMPAO or Tc-99m pertechnetate. Lung biopsies were also performed. Despite no significant differences in any of the conventional diagnostic techniques, Tc-99m pertechnetate lung scintigraphy was performed for both the halothane and isoflurane groups, and Tc-99m HMPAO lung clearance was performed for the isoflurane group pre- or post-operatively. Tc-99m HMPAO lung clearance was impaired significantly in the halothane group on the third post-operative day (half time: 6.4 +/- 1.6 pre-operative and 13.76 +/- 3.3 s, P < 0.001) decreasing to pre-operative levels on the tenth post-operative day. Acute phase exposure to halothane was characterized with extremely abnormal Tc-99m HMPAO lung clearance in rabbits with respect to isoflurane, diminishing to control levels on the third day (half time: 8.7 +/- 86 control and 28.65 +/- 4.6, P < 0.001). Pathological examinations also demonstrated endothelial damage on acute exposure in the halothane group. General anaesthesia with halothane may give rise to alveolar microvascular injury, which generally seems to be underdiagnosed and may lead to serious post-operative complications.