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Background:Bispectral index (BIS) used for intra-operative depth assessment under general anesthesia (GA) can be altered by different factors. This study was designed to detect the alteration in BIS reading with two different Trendelenburg (TBG) tilt in laparoscopically assisted vaginal hysterectomy (LAVH) procedure.Materials and Methods:A prospective, double-blinded, randomized controlled study was designed involving 40 American Society of Anesthesiologists Grade I and II female patients, aged 35-60 years, scheduled to undergo LAVH under GA. Patients were divided into two groups with TBG >30° and TBG <30°. BIS readings; systolic and diastolic blood pressure, heart rate were recorded in supine position. Patients were then shifted to desired TBG position either (>30°) or (<30°) as per group allotment. Data were recorded at 30 min intervals and all the patients were followed upto 24 h postoperatively for any recall.Results:A rise in BIS value was noticed, when position was changed from supine to head down in both groups. During comparison between two groups with different angulations, TBG >30° showed a higher BIS value than TBG <30°. This statistically significant (P < 0.05) trend was observed at all the 30, 60, 90, and 120th min interval. Interestingly, BIS values returned to preoperative levels following adopting final supine position. No incidence of awareness was reported in both the series throughout the study.Conclusion:Though awareness remains unaltered BIS value gets increased with higher angle of inclination in TBG position during LAVH operation.

The aim of this study is to assess the use of intraoperative transvaginal ultrasonography (TVS) to locate deep myomas that were not identified on laparoscopic view. The design of this study is a prospective observational study. This study was conducted in private Advanced Endoscopy and Infertility Treatment Centre, Kerala, India. The study comprised of 84 patients who underwent laparoscopic myomectomy from January 2011 to December 2013 in whom intraoperative TVS was used as an intervention. The number of additional deeper myomas removed was calculated, and recurrence at 1 year was calculated. The total number of myomas enucleated was 390, and the additional myomas enucleated after intraoperative TVS were 94. The recurrence of myomas at 1-year follow-up was 7.1 %. Intraoperative TVS was helpful to the surgeon for identifying deeper myomas making the surgery more effective.

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