Assessement of patient-controlled analgesia using remifentanil as an effective and safe alternative to patient-controlled epiduralúanalgesia for labour

This study compared the administration of intravenous infusion of remifentanil using patient-controlled analgesia [PCA] device for analgesia in normal labour with that of 0.1% bupivacaine plus sufentanil 0.5 microg/ml via patient-controlled epidural analgesia [PCEA]. One hundred healthy pregnant women at term with a single fetus with a vertex fetal presentation were divided in two equal groups to receive either 0.25 microg to 1 microg/kg as bolus dose of remifentanil PCA in a stepwise manner with or without a background infusion [0.025-0.05 microg/kg] or 0.1% bupivacaine and 0.5 microg/ml sufentanil using PCEA. Pain Score on visual analog score [VAS]. Modified bromage scale [0-3]. Level of sensory block, drug use, supplemental boluses and side effects were recorded. Mode of delivery, duration of first and second stages of labour, umblical cord pH, Apger scores of the newborn and a measure of maternal satisfaction were recorded after delivery. VAS pain score during the progress of labour was significantly less in bupivacaine group PCEA [16.9 +/- 13.4mm] compared with the lowest pain scores in remifentanil group recorded at L[1]B[1] bolus 0.25 microg/kg [30.2 +/- 23 mm] and at L[1]B[2] bolus 0.5 microg/kg [24.4 +/- 18 mm] respectively, P<0.01, Maternal satisfaction with the relief of contraction pain was greater in bupivacaine group [90.8 +/- 10.8] than in remifentail group L[1]B[1] 70.20 +/- 20 mm, L[1]B[2] 50.2 +/- 12.8] P<0.0001, as with the relief of delivery pain [bupivacaine group 88.7 +/- 14.1 mm, L[1]B[1] 78.3 +/- 2.3 mm, L[1]B[2] 80.1 +/- 25.2 mm] P < 0.0001. On visual scale: 0 = not satisfied, 100 = fully satisfied. Motor and sensory block were assessed with the progress of labour in bupivacaine group. No differences were seen between the two groups for mode of delivery, maternal blood pressure, fetal heart rate, apger score 0, 5, 10 min and umblical pH. Patients in remifentanil group requested more supplemental boluses to achieve labour analgesia than those in bupivacaine group, adding background infusion at level two or three bolus doses not reduce pain scores but serves only to increase respiratory depression, sedation and opioid side effects [vomiting, nausea and itching]. Delivered as patient-controlled epidural analgesia 0.1% bupivacaine plus 0.5 microg/ml sufentanil are more potent than PCA remifentanil. Remifentanil PCA system [bolus doses 0.25-0.5 microg/kg without a background infusion] may safely provide worthwhile, although incomplete analgesia for labour

Low concentration sevoflurane anaesthesia supplemented with remifentanil: effect on recovery and cognitive function, also sevoflurane and hepatic integrity in elderly patients

The aim of this study was to assess hepatic function in elderly patients anaesthetized with sevoflurane - Nitrous oxide and to compare recovery and psychomotor performance after maintenance of anaesthesia with sevoflurane - nitrous oxide supplemented with remifentanil 80 patients. 70 to 90 yr old, were allocated randomaly to four groups, twenty patients each were allocated to maintenance of anaesthesia with sevoflurane only in concentration necessary to mentain adequate anaesthesia [Group I] with 1.5, 1.0, 0.5 MAC [end tidal] of sevoflurane supplemented with remifentanil. Measurement if cytosolic liver enzyme alpha glutathione S-transferase [alpha GST], the formation of the lidocaine metabolite monoethylglycinexylidide [MEGX] and gastric mucosal tonometery-derived variable as sensitive markers of hepatic function and splachnic perfusion. No significant changes in standard liver enzyme markers were seen throughout the study. Tonometric measurements showed a significant decrease from baseline in regional Pco[2]' regional to arterial difference in Pco[2] and intermucosal PH at 90 min after skin incision, alpha GST concentration increased significantly in group I. A return to base line values in tonometric values and alpha GST levels was seen 24 h postoperatively. MEGX formation did not charge significantly after surgery. The median dosage of ramifentanil required in the last three groups was 0.21, 0.25 and 0.34 mg/kg/min, respectively [P<0.05]. The median times to eye opening were 10.3, 12.7, 11.0 and 6.5 min in the four groups [P<0.05 between the 0.5 MAC and other groups] and for orientation 12.1, 14.9, 12.3 and 8.3 respectively [P<0.05 between 0.5 and 1.5 MAC groups]. There was no significant difference in the mini-mental state assessment scores on the actual discharge times from the recovery ward among the groups. Significantly greater numbers of patients could perform the critical thicker fusion test at 15 min in the group receving the lowest concentration of sevoflurane and the highest doses of remifentanil [p<0.05]. Patients in this group also showed the highest incidence of chest wall rigidity [P<0.003]. We conclude that, liver function in elderly patients is well preserved during sevoflurane anaesthesia, increased serum levels of alpha GST and changes of gastric tonometry-derived variables imply a reduction in splanchnic perfusion, leading to temporary impairment of hepatocyte oxygenation. Also the use of remifentanil with lower concentration of sevoflurane facilitate early recovery, it does not influence discharge time from recovery ward and may be associated with side effects as chest wall rigidity

Interaction of a new neuromuscular blocker pipecuronium bromide with some intravenous anaesthetic agents

This study has been carried out to evaluate interaction of pipecuronium bromide a new neuromuscular blockade with some intravenous anesthetic drugs. The clinical trials were studied on 40 adult patients scheduled for elective surgical procedures. They were randomly divided into 4 groups, each consists of 10 patients. Group I patients were given thiopentone sodium 5-8 mg/kg, group II patients were given ketamine hydrochloride 1-2 mg/kg, group III were given diazepam 0.01-0.02 mg/kg, and group IV were given pethidine 1 mg/kg. The study has demonstrated that, the neuromuscular blocking effect of pipecuronium bromide was significantly potentiated by diazepam, ketamine hydrochloride, pethidine hydrochloride, and was not significantly potentiated by thiopentone sodium

Patients response to laryngeal mask airway [LAM] after induction of anesthesia with propofol [Diprivan] or thiopentone

The response to the laryngeal mask airway [LMA] following either propofol 2.5 mg/kg-1 or thiopentone 5 mg/kg-1 was studied in 2 groups. The aim of this study was to evaluate which of these two induction agents provided the better conditions for insertion of LMA. The study showed that using these doses, propofol is superior to thiopentone as an induction agent for insertion of the laryngeal mask airway