Bispectral index for evaluation of recovery after sevoflurane anesthesia

Bispectral index [BIS] is a method of monitoring depth of hypnosis during anesthesia. Guided anesthetic administration using BIS target range may be associated with a reduction in volatile anesthetic and faster recovery. We evaluated recovery profile after sevoflurane anesthesia with and without BIS monitoring. 60 ASA I and II patients, aged 20-60 years, were enrolled in this study. Patients were divided randomly into two groups [n= 30]. In group A [GA] concentration of sevoflurane was adjusted according to clinical data. In group B [GB] concentration of sevoflurane was adjusted to keep BIS reading in range of 50 +/- 5. The following emergency times were evaluated: spontaneous eye opening, responding to verbal command and orientation time. Also, duration of patients stay in post anesthesia care unit [PACU] was determined and all patients were questioned about recall 24 hours after operation. End tidal sevoflurane concentration was significantly high in GA, during maintenance until stop of inhalational agents, compared to GB. Early recovery times are shorter in GB compared to GA, but not significant. When we compared duration of patients stay in PACU to be eligible for transfer to ward, it was significantly shorter in GB. No patient can recall any events during operation. Compared with standard anesthesia monitoring practice, adjunctive use of BIS monitoring can improve titration of sevoflurane during general anesthesia, leading to improved recovery profile and shorten the duration of stay in PACU. But, consideration of hemodynamic parameters is very important to avoid unaccepted change in HR and MBP, especially in cardiac patients

Succinylcholine versus rocuronium for emergency rapid sequence induction during remifentanil, propofol anaesthesia

This study aimed to evaluate and compare the intubating conditions of standard doses of rocuronium 0.6 mg kg-1 and succinylcholine 1.0 mg kg -1 during a strict rapid-sequence induction [RSI] regimen including propofol and remifentanil. The study included 80 male and female patients [ASA I - III] older than 17 yr scheduled for emergency abdominal surgery and with increased risk of pulmonary aspiration of gastric content. Patients were randomized to a rapid-sequence induction with succinylcholine 1.0 mg kg [-1] or rocuronium 0.6 mg kg [-1] after induction with remifentanil 1micro g kg [-1] and propofol 2-3 mg kg [-1] Patients with a predicted difficult air-way were excluded. A senior anaesthesiologist blinded for the randomization performed the intubation 60 seconds after injection of the neuromuscular blocker. Intubation conditions were evaluated according to an established guideline. Clinically acceptable intubation conditions were present in 95.6% and 93.3% of patients in the succinylcholine group [n = 40] and the rocuronium group [n = 40] respectively [p = 0.58]. during RSI with remifentanil and propofol, both recuronium 0.6 mg kg [-1] and succinylcholine 1.0 mg kg [-1] provide clinically acceptable intubation conditions in 60 seconds in patients scheduled for emergency surgery. Under the conditions of this RSI regimen rocuronium my be a substitute for succinylcholine

Impact of naloxone and droperidol on postoperative epidural morphine analgesia

This study was designed to evaluate the impact of epidural naloxone [N] or droperidol [D] on the outcome of epidural morphine analgesia. The study comprised 60 females assigned to undergo abdominal hysterectomy randomly allocated into three equal groups [n=20], each received medication mixture via infusors; Group M received 3 mg morphine in 100 ml bupivacaine 0.125% at rate of 2 ml/hr; group M+N and M+D received the same mixture, but with the addition of naloxone so as to provide an infusion rate of 0.167 micro g/kg/hr of naloxone in group M+N or droperidol in a dose of 1.25 mg/day continuous infusion in group M+D. Pain sensation was evaluated using 100-mm visual analogue scale, postoperative nausea and vomiting [PONV] was monitored on a four-point scale: 0: no, 1: mild not requiring an antiemetic, 2: moderate requiring an antiemetic and 3: severe nausea/vomiting, resistant to antiemetic. Pruritus was evaluated using a four-point scale: 0=no, 1= mild, 2 moderate and 3= severe itching. Somnolence was graded as follow: 1=clear mentality, 2= good response to verbal command but drowsy and 3= poor response to repeated verbal command. Respiratory depression was assessed as 1= no respiratory depression and 2= respiratory depression exists with a respiratory rate<8 breaths/min. All parameters were assessed at 2, 4, 8, 16, 32, and 48 hr PO. At 8-hrs PO, VAS scores were significantly lower in M+N [P1 =0.017] and M+D [P1 =0.034] groups compared to group M., with a non-significant [P2>0.05] reduction of VAS scores between combination groups but in favor of group M+N. Thereafter, VAS scores were significantly lower in groups M+N and M+D compared to group M with a significant reduction of VAS scores in group M+N compared to group M+D. Epidural naloxone [Group M+N] significantly reduced the frequency and severity of side effects in comparison to group M and significantly reduced the frequency and severity of somnolence and respiratory depression and non-significantly reduced the frequency and severity of PONV in comparison to group M+D. On the other hand, epidural droperidol [Group M+D] significantly reduced the frequency and severity of pruritus and respiratory depression but reduced the frequency of PONV and somnolence non-significantly in comparison to group M. Moreover, epidural droperidol significantly reduced the frequency and severity of pruritus compared to epidural naloxone. It could be concluded that epidural co-administration of morphine and naloxone or morphine and droperidol provided more effective postoperative analgesia with a significant reduction of morphine-induced side effects; however, droperidol appears to be a better alternative when pruritus is taken into consideration, while naloxone is a better alternative when somnolence is taken into consideration