Is preemptive analgesic effect of ketamine dose dependent? Effect of increasing dose on post septorhinoplasty pain

To find out the effect of increasing the dose of preemptive ketamine on ketoprofen requirement in first 24 hours after surgery. 120 patients, scheduled for elective septorhinoplasty were randomly divided in to four groups. At the time of induction of general anesthesia one test drug was given. Group 1 received placebo, group 2, 3 and 4 received I.V ketamine, 0.5 mg kg[-1], 1.0 mg kg[-1] and 1.5 mg kg[-1] respectively. The total postoperative consumption of ketoprofen and pethidine as rescue analgesia in 24 hours was recorded. The incidence of common side effects was recorded. There was no difference in ketoprofen requirement between group 1 and 2[P=0.108].Patients in group 1 and 2 required more ketoprofen than patients in group 3 and 4 [P=0.00]. Group 4 patients required significantly less ketoprofen compared to group 3 patients [P=0.01]. Time to first request analgesia was longer in the groups 2, 3 and 4 compared to group 1 [P=0.00]. Time to discharge from PACU was found to be longer in patients where ketamine was used [P=0.018]. No patient in any group required pethidine as rescue analgesia. There was no significant difference in the common side effects among the groups. Ketamine in the doses of 0.5 mg kg[-1] failed to produce reduction in ketoprofen requirement. However, the dose of 1.0 mg kg[-1] and 1.5 mg kg[-1] resulted in reduction in post operative ketoprofen requirement and prolonged the time to first request analgesia without any increase in side effects

Effect of two different doses of fentanyl on intubating conditions with sevoflurane inhalation without neuromuscular blocking agents in adults

To compare the effect of two different doses of fentanyl on intubating conditions, after inhalational induction with sevoflurane in adults, without using neuromuscular blocking agents. In this prospective, randomized, double blind study, fifty six adult patients with ASA status I-II, without any airway problem and scheduled to undergo elective surgical procedures under general anesthesia requiring endotracheal intubation were selected. Patients with allergy to any of the drugs used, body mass index > 30 kg/m2 and anticipated difficult airway were excluded from the study. Patients were premedicated with midazolam 0.1mg/kg and ranitidine 150 mg PO two hours prior to surgery and received 0.2 mg of glycopyrrolate intravenously just before the start of inhalational induction. The patients were randomly divided into two groups. Group-I patients received fentanyl 2 micro g/kg and those in Group-Il received 3 micro g/kg intravenously one minute after the start of inhalational induction with 8% sevoflurane in 50% nitrous oxide and oxygen. After 4 minutes of start of inhalational induction, conditions for tracheal intubation were assessed based upon a set of criteria. Tracheal intubation was successful in all patients. Mean time to loss of consciousness was 47 sec in Group-I and 46 sec in Group-Il. Optimal intubating conditions were higher in the Group-II [89% vs. 54% P <0.01].The incidence of post-intubation coughing was lower in the Group-II as compared to Group-I [11% vs.39%] with P <0.02. We conclude that both doses of fentanyl along with inhalational induction with sevoflurane nitrous oxide mixture provided adequate conditions for tracheal intubation without using neuromuscular blocking agents. However, increasing the dose to fentanyl to 3 micro g/kg further improved the intubating conditions. Tracheal intubation using sevoflurane and fentanyl may be an alternative to traditional tracheal intubation with neuromuscular blocking agents

Comparative study of tramadol and propacetamol for postoperative pain management in patients undergoing nasal surgeries

To compare the analgesic and side effects of propacetamol and tramadol after nasal surgeries. King Abdul Aziz University Hospital, Riyadh [KSA]. From January 2006 to February 2007. A total number of 40 surgical patients were prospectively randomized into two equal groups of 20 and were entered into single blinded clinical trial. Anaethesta. protocol was similar for all patients. Pain intensity was measured based on a 4-point verbal rating scale [VRS]. VRS was obtained before analgesic administration [T0] and at 0.5, 1.5, 3, 4.5, 6, 12, 18 and 24 hours, Patients received either tramadol 100 mg I/V or propacetamol 2 gm I/V at T0 and then 50 mg tramadol or 1.5 gm propacetamol at 6, 12, 18 and 24 hours if pain was present. The results of this study showed that propacetamol is less effective as analgesic in severe pain requiring more supplementary morphine as compared to tramadol. On the other hand tramadol is associated with higher incidence of nausea and or vomiting than with parcetamol. It was concluded from the study that propacetamol is less effective as analgesic in severe pain receiving more supplementary morphine as compared to tramadol