Evaluationof psychomoter performance and quality of recovery during propofol auto. co.sedation as an alterenative to fentanyl, midazolam and ketamine co-sedation during monitored anaesthesia care

Supplemental analgesics and anxiolytics are commonly used to improve patients comfort during procedures performed under local anesthesia and sedation. Eighty female out patients ASA I or II undergoing breast biopsy procedures under local anaesthesia were participated in this study. Patients divided into four groups [n = 20 each]. They recieved either 20 mg propofol in first group, 50 micro g fentanyl, in second group, 2 mg midazolam in the third group or 30 mg ketamine in the fourth group. Two minute later propofol infused at a rate 50 micro g/kg/min. Increasing rate of propofol infusion were used as needed to treat patients response [if any] to local infiltration or surgical stimulation with maintaing respiratory and haemodynamic function. Psychomotor tests and anxiety level were performed before operation and at 30, 60, 120, 240 min post operatively. There were asignificant reduction in psychomotor tests in all groups from baseline after 30 minute postoperative but in propofol-propofol [P.P] group and fentanyl-propofol group [EP] group were associated with the most rapid recovey and least impairment compared with preoperative baseline. Ketamine-propofol [K.P] group associatel with delayed recovey in psychomotor test at 60 min post operatively, [K.P.] group showed the least level of haemodynamic instability but P.P. and F.P. groups showed the highest level of reduction of MAP and HR from baseline [P < 0.001]. Patients satisfaction were high and equal among groups

Attenuation of cardiovascular responses to electroconvulsive therapy by topical nitroglycerine

The effect of topical transdermal nitroglycerine on the cardiovascular response to electroconvulsive therapy [ECT] was studied in 20 severely depressed patients of both sexes with median age 30 +/- 7.90 [range 20 - 54] years and median weight 69.56 +/- 13.77 [range 45 - 100] kg belonging to ASA [American Society of Anesthesiologist] I, II during 40 electroconvulsive sessions under general anesthesia. Each patient received two sessions of monitored ECT separated by two days. One session was preceded by application of 30 mg nitroglycerine ointment 20 minutes before beginning of the ECT. Thus, each patient served as his or her own control. Pulse frequency, pulse width and stimulus duration were selected by the attending psychiatrist and remained similar in both sessions. Hemodynamic variables were measured during and for four minutes after ECT. Statistical analysis of data within and between patient groups proved the ability of nitroglycerine application to prevent significant rises in systolic, diastolic, mean blood pressure and rate-pressure-product during and after ECT. On the other hand, the means of heart rate showed significant increase during and after ECT compared to the basal means whether nitroglycerine was applied or not. Thus, it can be concluded that the cardiovascular dynamic responses to ECT can be attenuated effectively by application of nitroglycerine ointment. This procedure has a beneficial clinical utility particularly in patients who are at high risk of myocardial ischemia and/or stroke subjected to ECT

Flumazenil [anexate] versus non-specific benzodiazepines antagonist for recovery of patients using subjective and psychomotor assessments

80 patients were scheduled for minor surgical procedures [herniorrhaphy, cystolithotomy, excision of bladder ulcer or diagnostic cystoscope], their age ranged from 18-60 years of both sexes, they received benzodiazepines supplementation for regional anaesthesia. At the end of surgery sedation is reversed by flumazenil [Anexate], naloxone, aminophylline and placebo. The recovery was evaluated by recovery assessment of level of sedation, comprehension and co-peration, temporo-spatial orientation, cognitive and psychomotor tests and anterograde amnesia. The parameters are measured 5, 15, 30, 60, 120, 240 minutes after injection of the trial drug. Recovery score, comprehension and co-operation, orientation and psychomotor assessment showed marked and significant improvement after flumazenil in comparison with placebo, as regard the anterograde amnesia significant changes were noted between flumazenil and placebo; resedation was more with diazepam subgroups. There was no role for naloxone which was similar to placebo while aminophylline hasten the recovery from benzodiazepine sedation but more late if compared with flumazenil [30 minutes post-aminophylline versus 5 minutes post-flumazenil injection]

Koro, is it a culture bound syndrome?

Koro syndrome has been recognized by many as culture bound [Yap, 1965; and Rin, 1965]. The syndrome has been described as early as 1834 by Pao, a Chinese author. More recently, many reports in the literature casted doubt about the geographical distribution of the syndrome and its culture bound nature. The author reviewed the literature and discuss the cases diagnosed in subjects of non-Chinese origin including a case who is pure Saudi citizen with no connections with Southeast Asia whatsoever. All cases described in the non-Chinese subjects shaved an incomplete picture of the syndrome, the one noticeable difference was the abscence of the fear of death which usually accompany the main presenting symptom of shrinking penis

Maternity blues in Sharkia

To determine the prevalence of maternity blues in sample of Egyptian women we took 71 ladies whom delivered a living full-term baby in Zagazig University Hospital, we found 26 ladies [36.6%] who manifest maternity blues particularly those patients with significant items affect maternity blues like that crying baby, capability for carrying her infant, any lactation problems, desired sex, women with somatic symptoms, acceptance of pregnancy, fears to lose her atractivity to her husband, women who forced to marry her husband, motivation for marriage, husband age; and effect of problems with her husbands family before conception or with her own's family before or during conception. The patients experienced tearfulness, depression, anxiety, elation, emotional lability, irritability, insomnia and confusion. It is emphasized that the reaction in this period and needs of these patients deserved recognition, attention and follow-up