Hemodynamic effects of inhaled nitroglycerin in patients with pulmonary hypertension undergoing mitral valve replacement surgery

There has been a renewed interest in nitric oxide donor drugs such as nitroglycerin, delivered by the inhalational route for treatment of pulmonary arterial hypertension [PHT], since the presence of [PHT] affects the prognosis of the patients. Aim of this study was to investigate the postoperative hemodynamic effects of nitroglycerin inhalation on patients with [PHT] undergoing mitral valve replacement surgery. Twenty-two patients who diagnosed as having pulmonary hypertension [mean pulmonary artery pressures >25 mmHg] and underwent mitral valve replacement surgery were included in the study. Basal systemic and pulmonary hemodynamics were recorded in postoperative period at [T0] before inhalation of nitroglycerin. Then 2.5 microg/kg/min nitroglycerin liquid nebulized by 2 l/min gas flow of 40% oxygen and air mixture were given to the patients. Thereafter, the same parameters were measured at the first [T1], second [T2], and fourth [T3] hours after the beginning of nitroglycerin inhalation and one hour after the end of treatment [T4]. With respect to heart rate, mean arterial pressure, systemic vascular resistance, cardiac index, mixed venous oxygen saturation and arterial carbon dioxide tension, there were no statistically significant differences at T0, T1, T2, T3, or T4. On the other hand, the mean pulmonary artery pressure, pulmonary vascular resistance and intrapulmonary shunt fraction decreased significantly, whenever the PaO2/FiO2 ratio increased significantly at T1, T2 and T3 when compared to that of T0 and T4. The results of the present study suggest that nitroglycerin inhalation causes a significant decrease in both mean pulmonary artery pressure and pulmonary vascular resistance in patients with pulmonary hypertension undergoing mitral valve replacement surgery without decreasing mean arterial pressure and systemic vascular resistance thus can be used as a therapeutic modality during postoperative course

Effect of rocuronium compared with succinylcholine on intraocular pressure and intubating conditions during rapid sequence induction of anesthesia

Rapid sequence intubation is developed to secure the airway rapidly and safely. Succinylcholine provides excellent intubating conditions and thus remains the muscle relaxant of choice in emergency situation. The aim of this study was to compare the effects of rocuronium and succuinylcholine on intraocular pressure [IOP] during rapid sequence induction of anesthesia using propofol and fintanyl. In addition assessment of intubating conditions after administration of both succinylcholine and rocuronium. In a randomized, double-blind study we studied 40 adult patients, randomly allocated to one of two groups. Anesthesia was induced with fentanyl 2 microg/kg and propofol 2 mg/kg. This was followed by succinylcholine 1.5 mg/kg [group S; n=20] or rocuronium 0.6 mg/kg [group R; n=20]. Laryngoscopy and tracheal intubation were performed 60 seconds later. IOP, mean arterial blood pressure [MAP] and heart rate [HR] were measured before induction, immediately before intubation and every minute after intubation for 5 minutes. Tonopen tonometer was used to measure IOP and the mean of three consequative readings obtained in the right eye at each measurement time was recorded. Simple scoring system was used to evaluate intubating conditions. In the succinylcholine group, IOP was significantly greater than that in rocuronium group mean 23.7 +/- [SEM 1.6] vs mean 14.2 +/- [SEM 0.9] mm Hg; p<0.001. Intubating conditions were similar in both groups. Rocuronium 0.6 mg/kg when used with propofol and fentanyl during rapid sequence induction of anesthesia does not cause a rise in IOP. Thus, it may be a suitable alternative to succinylcholine, especially in cases of penetrating eye injury

Preemptive epidural analgesia for post thoracotomy pain

Pain treatment before surgery can minimized pain after surgery, may reduce anaesthestic need during the procedure, and could minimized the risk of chronic pain conditions developing in long term [1]. The aim of this study was to determine if preemptive epidural analgesia performed before thoracotomy incision and during the operation reduces post operative pain. In this randomized, double -blinded placebo controlled study, Patients in the treatment group received 8 ml of 0.25% bupivacaine and 2mL of fentanyl [50micro g /ml] via the epidural route prior to skin incision, followed by an infusion of bupivacaine 0.1% and fentanyl 10 micro g/mL at 6ml/hr. while the control group received saline in the epidural. At the time of chest closure patients of both groups received 8 ml of 0.25% bupivacaine and 2 mL of fentanyl 50 micro g/ml via the epidural route. The patients in the treatment group had lower maximum pain scores in the first six hours postoperatively. In addition they required less isoflurane intraoperatively. No significant differences were noted after the first six hours. Preemptive thoracic epidural analgesia appeared to reduce severity of post -thoracotomy pain but did not extend beyond six hours postoperatively

Ropivacaine 0.2% pharm following caudal block in children

Ropivacaine is a long -acting amide local anasetheic that is available as a pure S-enantiomer.Several clinical studies have shown that ropivacaine is a suitable drug for epidural anaesthesia [1]. There has little published on the use of caudally administered ropivacaine in children. The aim of this study was to evaluate the pharmacokinetics of ropivacaine after caudal block in children, comparing infants [children aged between I and 5 years]. Thirty male children as a grade 1 and scheduled for subumblical surgery were enrolled in this prospective study after informed parent consent. The children were grouped according to age [15 [infant] aged less than 1 year and 15 [toddlers] aged 1-5 years. After induction of general anaesthesia .caudal epidural injection using ropivacaine 0.2% 1 ml/kg was performed .Plasma concentrations of ropivacaine in the first 2 hours after injection were determined by reversed -phase high-pressure liquid chromatography. Caudal blockade with ropivacaine 2mg/ml resulted in mean [ +/- SD] peak plasma concentrations of 0.69 micro g/ml [ +/- 0.29] in infants and 0.46 micro g/ml [ +/- 0.23] in toddlers [p<0.01].Maximum plasma concentrations occurred after a median range period of 60 [15-90] minutes and 53 [30-120] in infants and toddlers respectively. No clinical signs of local anaesthetic toxicity were observed. The results of the present study suggest that, caudal blockade using ropivacaine 0.2% 1mI/kg, from a pharmacokinetic point of view, can be considered a safe technique in children i.e.in infants as well as in toddlers