Isoflurane neuroprotection is dependent on post-ischemic hypothermia in rats subjected to severe global forebrain ischemia

The present study tested whether isoflurane neuroprotection is dependant on post-ischemic cooling. Two categories of rats were generated; each category was subdivided into four anesthetic conditions, Isoflurane, MK801[dizoclipine, N-methyl-D-aspartate antagonist], Isoflurane plus Mk801 and fentanyl nitrous oxide. Rats were exposed to severe global forebrain ischemia for ten minutes. In the first Category the post-ischemic temperature was not regulated, while in the second category the postischemic temperature was servo regulated for 24 hours through a chronically implanted radiotelemetered thermistor. In the first category marked neuroprotection was observed with Isoflurane, Mk801 and their combination relative to fentanyl N2O. In the second category however this protection has completely dissipated. The results of the current study are suggestive of thermal dependence of isoflurane neuroprotection

comparison of sufentanil with or without bupivacaine, ropivacaine for continous postoperative thoracic epidural analgesia after major upper abdominal surgery

Postoperative pain is a potent trigger for the stress response, activates the autonomic system, and is thought to be an indirect cause of adverse effects on various organ system. Postoperative epidural analgesia can significantly decrease the incidence of pulmonary morbidity and is often considered the most effective technique for providing pain relief after abdominal surgery. The present study was carried on 60 patients ASA I-III were classified into 3 equal groups according to the epidurally infused solution, Group S received 10ml/h of sufentanil 5 micro g, Group BS received 10 ml/h of sufentanil 0.5?g/ml with 0.25% bupivacaine and Group RS received 10 ml/h of sufentanil 0.5 micro g/ml with 0.2% ropivacaine for postoperative analgesia after upper abdominal surgery through thoracic epidural catheter to compare and assess the quality of analgesia, the safety and the side-effects after the use of a continuous, thoracic epidural infusion for postoperative analgesia in patients who had undergone major upper abdominal surgery. The results showed that highly significant decrease in visual analogue scale [VAS] in all groups over a time with high pain scores in group S than in BS and RS groups. There were insignificant changes between groups as regarding homodynamic and side effects except for a decrease in mean arterial pressure of over time in-group BS and high incidence of motor block in-group BS than the other two groups. This study showed that a continuous, thoracic epidural infusion of sufentanil 5 micro g/h provided adequate and safe pain relief after major upper abdominal surgery. The quality of analgesia was further improved when a mixture of bupivacaine or ropivacaine with sufentanil was adminstered. The combination of 0.2% ropivacaine plus sufentanil 5 micro g/h appeared preferable because of the low incidence of motor block and hypotension when compared with 0.25% bupivacaine plus sufentanil 5 micro g/h

Acomparison of the cuffed oropharyngeal airway [COPA] with the laryngeal mask airway [LMA] during manually controlled positive pressure ventilation for short surgical procedures

To examine cuffed oropharyngeal airway [COPA] during manually positive ventilation and to compare its reliability and efficacy with laryngeal mask airway [LMA] as regard to placement success rate, airway interventional requirements, airway stability in different head/neck positions, haemodynamic response and intra- and post-operative adverse events/symptoms. Sixty Patients were randomly assigned to be manually ventilated with COPA [n=30] or a LMA [n=30]. Our results showed that LMA group had more frequent success rate than COPA and shorter time to achieve an effective airway. As regard frequency and type of airway interventions it was significantly higher in COPA group. For haemodynamic changes after insertion of the device there was no significant difference between the two groups. The incidence of intraoperative adverse events was similar. As regard to post-operative adverse events incidence of sore throat was higher in LMA group while incidence of jaw and neck pain was greater in COPA group and blood was detected more often on the LMA group on removal. Conclusions: Although the COPA and LMA are equivalent devices in terms of physiologic alterations and overall clinical problems associated with their use. The use of LMA is associated with higher first time insertions rate and fewer manipulations suggesting that it is easier to use. The COPA is associated with less blood on the device and fewer sore throat, suggesting it may cause less pharyngeal trauma. Ultimately, both devices are similar in establishing a safe and effective airway for manually ventilated patients for short surgical procedures, but the COPA is more cheaper than LMA