Sumatriptan and gabapentin for treatment of postdural puncture headache

Postdural puncture headache [PDPH] is one of frequent adverse complication of dural puncture. Although, it is a self limiting and non-fatal condition, its postural nature prevents the patient from performing routine activity and may make them anxious and depressed. In this study we evaluate a combination of sumatriptan and gabapentin for treatment of PDPH and compare it with sumatriptan or gabapentin as sole medication. ASA I and II 45 patients age between 20 and 40 years and non-parturient, who's developed PDPH after spinal or epidural neuraxial block was included in the study. Patients were randomized to receive either gabapentin 300 mg orally every 8 hours for one week group I, in group II patient was received sumatriptan 50 mg orally once daily for 3 successive days. In group III, patients received sumatriptan 50 mg orally every day for 3 days and gabapentin 300 mg every 8 hours for 7 days. PDPH was evaluated by using Visual Analog Scale [VAS], measured 20 min after patients assumed upright postures either sitting or standing. It was recorded before start the treatment as baseline and at 12, 24, 36, 48, 72 and 96 hours after. Satisfaction of patients with treatment was asked, after 4 days. Complications such as somnolence, dizziness, seizures, chest pain, nausea, vomiting and dry mouth were recorded. VAS was significantly low and patient satisfaction was high in group III when compared with the other two groups. Number of patients reported somnolence and dizziness were significantly high in group III compared to group I or II. Combination of sumatriptan and gabapentin could be beneficial for treatment of patients with PDPH, more than sumatriptan or gabapentin alone, as it relief the headache and decrease usage of epidural blood patch which is invasive and not safe procedure

Increased intraocular pressure: a sequala of prone positioning of anesthetized patients during spine surgery

The study was designed to evaluate the effects of changing patient's position on intraocular pressure [IOP] during spine surgery, and to study the effect of Preoperative diuretic injection. The study comprised 45 ASA grade I and II, patients assigned to undergo spine surgery under general anesthesia. Patients were divided into three equal groups: group I and II assigned to undergo surgery in prone position, but group I received intravenous mannitol 0.5gr. / kg, 1/2 an hour before induction of anesthesia, and group III assigned to undergo surgery in lateral position. [IOP[B]] was measured before premedication. [IOP[1]] after induction in the supine position. [IOP[2]] 1/2 hr. after position change. [IOP[3]] at the end of surgery before position change. [IOP[4]] before emergence from anesthesia, but after return to supine position. At each estimation of IOP, mean arterial pressure [MAP] and heart rate [HR] were recorded. The length of time in prone position was measured. Transposition from supine resulted in significant [P<0.05] hemodynamic changes in prone position and non-significant [P>0.05] in lateral position. IOP[2] was significantly [P<0.05] higher compared both to IOP[B] and IOP[1], but, transfer to lateral position, despite resulting in increased IOP compared to their IOP[B] and IOP[1], induced a significantly [P<0.05] decrease of IOP compared to groups I and II. IOP still progressively increased in group II with a significant [P<0.05] difference compared to the other two groups, maintenance of lateral position resulted in progressively decreased IOP. Return to supine position resulted in decreased IOP in the three groups, but more pronounced in groups I and There was a positive significant correlation between the duration in prone position and IOP during such period both in group I [r=0.537, P=0.039] and in group II [r=0.719, P=0.003]. No cases of visual affection during postoperative period were detected. We could identify a relation between patient's position during spine surgery and IOP changes whether attributed to direct extraocular pressure or to induced hemodynamic imbalance, and could afford a possible prophylactic measure to attenuate the rise of lop by change the patient position to the lateral position or use of mannitol prior to induction of anesthesia

Low-pressure pneumoperitoneum improves the outcome of laparoscopic cholecystectomy

Laparoscopic cholecystectomy [LC] is an advantageous procedure that widely replaced the traditional open cholecystectomy. However, highpressure pneumoperitoneum was accused for precipitating some intraoperative hemodynamic effects and postoperative shoulder-tip pain [STP]. The objectives of this study were to determine the influence of lowpressure pneumoperitoneum on the frequency and intensity of shouldertip pain and body hemodynamics in patients undergoing laparoscopic cholecystectomy. The study comprised 70 chronic calcular cholecystitis patients [25 men and 45 women]. Thirty-three patients [Group I] were assigned to undergo LC under high-pressure [13-15 mmHg] and 37 patients under low-pressure [7-9 mmHg] [Group II]. Intraoperative monitoring included measurement of heart rate [HR], systolic, diastolic blood pressure, and mean arterial blood pressure [MAP] was calculated. The frequency of postoperative STP was determined and its intensity was determined using visual analogue scale charts [VAS]. There was a significant [P<0.05] increase in MAP in both groups at 5 mm. after insufflation and after tilting the patient to reversed Trendelenberg position [RTP], but there was a significant decrease of MAP in Group II as compared to Group I [X[2]= 7.716, P<0.05]. There was a significant reduction of both frequency [13.5% vs. 33.3%] and intensity of STP in low-pressure group compared to high-pressure group. This difference was especially significant 6, 12, 24 hours postoperatively. Moreover there was a positive significant correlation between the insufflated pressure and the frequency [r=0.691. P<0.05] and intensity [r=0.612, P<0.05] of STP. There was a significant reduction of the amount consumed analgesic [declphenac potassium 75 mg/cc, amp.] in low-pressure group compared to high-pressure group. We can conclude that reduction of the pressure of the pneumoperitoneum to 7-9 mmHg results in a significant reduction of both the frequency and intensity of shoulder-tip pain and allows more stable hemodynamics of the patients through the duration of laparoscopic cholecystectomy. On the basis of these results, the widespread use of low-pressure pneumoperitoneum throughout most of a laparoscopic cholecystectomy procedure is recommended

One-lung ventilation under general anesthesia: is it appropriate for thoracic surgery?

The study comprised 30 [ASA grades II and III] patients aged 47-72 years, randomly allocated into three equal groups [n=10] according to type of anesthesia administered and number of lungs ventilated: Group I anesthetized using continuous intravenous general anesthesia [GA] with two-lung ventilation [TLV], group II received GA with one-lung ventilation [OLV] and group III received thoracic epidural anesthesia [TEA] combined with GA with OLV. Arterial and venous blood gases, heart rate HR], and mean arterial pressure [MAP] were measured during TLV, 15 [OLV+15] and 30 min after beginning OLV [OLV+30]. Duration of surgery, the number of blood bags used for transfusion, and postoperative analgesia requirements were recorded. Hemodynamic parameters showed nonsignificant changes between patients administered GA, whereas there was significant [P<0.05] decrease in MAP and HR in TEA group and 7 patients required administration of 10 mg of IV ephedrine in group III. OLV resulted in significant [P<0.05] reduction of PaO2, SaO2, CaO2 and Cc02 in groups II and III at OLV+15 compared to group I, and in group III compared to group II. At OLV+30, there was significant [P<0.05] reduction of all measured pamameters in groups II and III compared to group I. and in group III compared versus group II. All patients showed an increased Qs/ Qt% 15 and 30 min after OLV, however, the increase was significant [P<0.05] in groups II and III compared both to group I and to their percentages measured during TLV. Despite the non-significant difference between groups II and III, at OLV+15, there was a significant [P<0.05] increase of Qs/Qt% in group III, at OLV+30 compared to group II. Hemoglobin [Hb] concentrations showed a significant [P<0.05] decrease at OLV+30 in all patients compared to their starting levels. Group II showed the least decrease of Hb concentration. OLV had significantly [P<0.05] reduced the duration of surgery in group II compared to group I and non-significantly compared to group III. Furthermore, OLV had significantly [P<0.05] reduced the need of blood transfusion in both group II and III compared to group I. All patients included in groups I and II required postoperative analgesia, while only 4 patients in group III required additional analgesia. There were no complications encountered with TEA technique. We can conclude that OLV under TEA combined with general anesthesia is not appropriate for thoracic surgical procedures while OLV under continuous general intravenous anesthesia is appropriate for safe thoracic surgical procedures