Effect of injecting saline into epidural space before catheter insertion on frequency of intravascular placement

The objective of the study was to determine if injecting 10 ml saline before threading epidural catheter can decrease the accidental intravascular placement in epidural space. Interventional: experimental study. Department of Anaesthesia, Hameed Latif Hospital Lahore, affiliated with College of Physicians Surgeons Pakistan, from September 2008 to August 2009. One hundred healthy women requesting Epidural labour analgesia were prospectively randomized to receive either no epidural injection [dry group, n = 50] acting as a control or epidural 10 ml saline injection [saline group, n = 50] before epidural catheter placement. A nylon multiport catheter was then threaded 3 cm into the epidural space and the needle was removed. We diagnosed iv catheter placement if blood was freely aspirated, or if the mother became tachycardic after injection of epinephrine 15 microg. The groups were similar in age [P value=0.32]. We identified iv catheter placement in 2/50 saline group and 7/50 dry group patients [4% vs 14%, P value= 0.16]. Intravenous catheter placement was identified by initial blood aspiration [two saline, seven dry group patients]. No anesthetic complications occurred, including hypoxemia,patient complaint of difficulty swallowing, intrathecal catheter placement, respiratory arrest, or subsequent iv or intrathecal catheter migration. Our study results have shown that injecting 10 ml saline before threading epidural catheter has insignificant effect on decreasing the accidental intravascular placement in epidural space

Oral gabapentin reduces hemodynamic response to direct laryngoscopy and tracheal intubation

Laryngoscopy and tracheal intubation increase blood pressure [BP] and heart rate [HR]. We studied the effect of gabapentin 800 mg given orally one hour before surgery on hemodynamic responses to laryngoscopy and tracheal intubation. Sixty patients were randomly allocated to one of the two groups. Group I received 800 mg of gabapentin and Group II received placebo with sip of water one hour before the induction of anaesthesia. After standard induction technique, study variables, pulse and noninvasive BP [systolic, diastolic and mean] and HR were noted every minute for first five minutes then at 10 and 15 minutes. Relevant demographic data and study variables were recorded. Mean systolic BP with Gabapentin was lower compared to placebo but it was significant at 1min [136 +/- 22vs149 +/- 23], 2min [120 +/- 21vs136 +/- 24], 10min [107 +/- 12vs118 +/- 16] and 15 min [106 +/- 13vs116 +/- 13] after intubation [P<0.05]. Mean diastolic BP with gabapentin was significantly lower at 3min [69 +/- 15vs74 +/- 17] after intubation with P<0.05. Mean BP with gabapentin was significantly lower at 2min [91 +/- 18vs103 +/- 18], 10min [79 +/- 12vs88 +/- 13] and 15 min [79 +/- 14vs86 +/- 12] after intubation at P<0.05. Decrease in HR with gabapentin was significant at 10min [92 +/- 15vs101 +/- 18] and 15 min [87 +/- 14vs99 +/- 16] after intubation [p<0.05]. Oral gabapentin decreases the response to laryngoscopy and intubation on systolic BP at 2 min and 15 min; mean arterial pressure at 2, 10 and 15 min and HR at 10 and 15 min following laryngoscopy