Clonidine versus midazolam as a premedication in paediatric strabismus surgery

Forty-paediatric patients ASA physical status I and II aged 3 to 12 years scheduled for strabismus surgery were included in the study. Patients were randomly divided into two equal groups: 20 patients each. Clonidine group where patients received oral clonidine 4 micro Kg[-1] [maximum 300 micro] 90 minutes before induction of anaesthesia and midazolam group where patients received oral midazolam 0.5 mg. Kg[-1] [maximum 15 mg] 30 minutes before induction. The two groups were comparable as regards age, weight, durations of surgery and anaesthesia and number of ocular muscles operated. There was significant increase in heart rate and MABP in clonidine group compared with baseline values and compared with midazolam group at the time of separation from parents and at the time of induction of anaesthesia with P< 0.05. The modified Yale preoperative anxiety scale was significantly higher in clonidine group compared with baseline value and compared with midazolam group at the time of separation from parents and at the time of induction of anaesthesia with P< 0.001. The number and percentage of patients not accepting the facemask was higher in clonidine group 15 [75%] compared with midazolam group 6 [30%] with P<0.001. There was insignificant difference between two groups as regard the level of excitement at the time of mergence from anaesthesia. The time of first postoperative analgesic dose was significantly longer in clonidine group with P=0.0014. The incidence of postoperative vomiting was significantly less in clonidine group with P<0.05. No unscheduled admission for any reason was recorded in this study. There was insignificant difference between the two groups as regard the time of discharge from the hospital. Oral midazolam provided optimum pre-anaesthetic anxiolysis, with better parental separation and acceptance of facemask during induction compared with oral clonidine. The postoperative analgesic sparing effect of clonidine together with reduction in postoperative emesis did not shorten the hospital stay. The use of oral midazolam as a pre-anaesthetic medication was better than oral clonidine in children undergoing strabismus surgery

effect of low dose dopamine on intraocular pressure

Fifty patients with postoperative impaired renal function evidenced by resistant oliguria were included in the study. All patients received dopamine infusion less than 5 micro.kg[-1] .min[-1]. After instilling benoxinate hydrochloride [Novesin 0.4%] eye drops, the Perkins tonometer was used to measure the intraocular pressure [IOP]. Patients were divided into two groups according to their ventilation. Group I: non-mechanically ventilated patients, and group II: mechanically ventilated patients. Twelve patients were excluded from the study, nine in group I and three in group II, due to stoppage of dopamine infusion, change-in the ventilatory status or due to the use of mannitol infusion. The two groups were comparable as regards age, weight and dopamine infusion dose. In the non-ventilated group, there was an insignificant difference as regards changes in the heart rate, mean arterial blood pressure [MABP], central venous pressure [CVP] and degree of sedation compared with control values at any time of measurement. A significant increase in IOP during dopamine infusion in both eyes compared with control values was detected [P<0.001]. In the ventilated group, there was an insignificant difference as regards changes in the heart rate, MABP, CVP, PaCO[2], positive end expiratory pressure [PEEP] and degree of sedation compared with control values at any time of measurement. However, there was a significant increase in IOP during the period of dopamine infusion in both eyes compared with control values [P<0.001]. The increase in IOP during the period of dopamine infusion was significantly higher in the ventilated compared to the non-ventilated group [P< 0.001]. The infusion of low dose of dopamine was associated with a significant increase in IOP in both eyes whether the patients were mechanically ventilated or not. Yet, the increase in IOP was greater in the mechanically ventilated group. Dopamine infusion should be cautiously given in patients with preexisting ocular hypertension or with traumatic eye injury. Monitoring of IOP during dopamine infusion is recommended in those patients especially during mechanical ventilation

Induced preconditioning of cardiac performance in coronary bypass surgery

Twenty ASA III and IV adult patients scheduled for elective coronary artery surgery were included in the study. Anesthesia was induced and maintained with either sevoflurane [sevoflurane group; n = 10] or propofol [propofol group; n = 10]. All preoperative cardiac medications were continued until the morning of surgery. There were significant decreases in mean arterial blood pressure, cardiac index and ejection fraction after CPB in propofol group compared with sevoflurane. Further, the plasma creatine kinase myocardial isoenzyrne concentrations were significantly higher in propofol group but did not approach the critical values needed for diagnosis of myocardial infarction. It is concluded that, sevoflurane appears to be associated with better hemodynamic stability before and after CPB than propofol. This could be attributed to cardioprotective effect of sevoflurane during ischemia and reperfusion

effect of preoperative betamethasone on the postoperative morbidity after tonsillectomy in children

This work was carried out on 80 paediatric patients aged 2-10 years scheduled for tonsillectomy or adenotonsillectomy surgery. All the patients were ASA I and II. Patients were randomly divided into 2 groups [40 patients each]: group I [control group I and group II betamethasone group], where 7 mg of betamethasone was injected intramuscularly deep in gluteal muscle, betamethasone was injected after induction of anaesthesia and before the start of surgery, children who received antiemetics, antihistaminics or steroids within 24 hours before surgery were excluded from the study. All children received oral midazolam 0.5 mg.kg-1 [maximum dose 20 mg] as a premedication 20-30 minutes before anticipated induction. Standard anaesthetic technique was used in all patients. Lactated Ringer 's solution was infused at a rate of 25 ml. kg-1. Tramadol in a dose of 1 mg.kg-1 iv was used for the intraoperative analgesia. All tonsillectomies were performed using electrodissection technique by the same surgeon. Patients with postoperative haemorrhage within the first 24 hours were excluded from the study. Patients who had two or more episodes of emesis [vomiting or retching] while in the hospital received 0.15 mg.kg-1 metoclopramide iv as a rescue treatment. If metoclopramide did nor control retching and or vomiting after 20 minutes, a second rescue antiemetic [ondansetron 0.15 mg.kg-1] was administered. Intravenous fentanyl 0.5 micro g. kg-1 increments was given for pain during early recovery. Children were offered liquids 45 minutes after the surgery. The quality of oral intake was judged. Parents were asked to call the otolaryngology service if the child experienced more than two episodes of vomiting, or had poor oral intake, postoperative haemorrhage or failed to void for more than 12 hours. There was insignificant difference between the two groups as regards age. weight, duration of anaesthesia, and duration of surgery. There was significant decrease in the total dose of fentanyl administered, in the incidence of vomiting, in the number of the patients who received rescue antiemetic therapy, and better quality of oral intake in betamethasone group starting to appear after two hours from the end of the operation and these changes were marked after discharge from the hospital. The frequency of phone calls to otolaryngology service after discharge from the hospital was significantly less in betamethasone group and the number of unscheduled admissions was significantly higher in the control group. it could be concluded that a single preoperative intramuscular injection of 7mg betamethasone in a mixed rapid and onset formulation was effective as analgesic and antiemetic with its effect marked after discharge from the hospital. Preoperative betamethasone administration also, improved postoperative oral intake, reduced the number of phone calls from parents, and prevented hospital returns for the management of PONV and poor oral intake during the first 24 hours after discharge. These beneficial effects of betamethasone were not evident during early recovery