Comparison of small dose ketoprofen and ketorolac added to lidocaine during intravenous regional anaesthesia for post operative analgesia

Non-steroidal anti-inflammatory drugs have a predominantly peripheral site of action by blocking the local synthesis of prostagl and ins. The aim of this study was to compare and evaluate whether the additional of small dose ketoprofen and ketorolac to lidocaine during intravenous regional anaesthesia [IVRA] would improve the quality of postoperative analgesia. Sixty patients undergoing upper limb IVRA for minor sugery were randomly assigned to three double-blind groups, group A [placebo], group B where 15 mg ketoprofen was mixed with lidocaine 0.5% for IVRA administered i.v. after toumiquet inflation and group C where 5 mg ketorolac was added to the local anesthetic for IVRA. Mean dose of fentanyl consumption intra operatively was significalltly lower [P < 0.05] in groups B and C when compared with group A durationl of post operative analgesic was significantly longer [P 0<005] in group B [14 +/- 11] and group C [15 +/- 10] when compared with group A [1.4 +/- 0 7], but not significant [P < 0.50] between group B and C. Analgesic requirements remained significantly lower in groups B and C when compared with group A but not significant between groups B and C Pain scores were significantly lower in groups B and C when compared with group A, but was not significant between groups B and C We concuoded that 15 mg ketoprofen and 5 mg ketorolac added to lidocaine 0.5% during IVRA improves the quality of intraoperative and postoperative analgesia and ketoprofen was as efficacious as ketorolac

Sevoflurane compared with halothane for tracheal intubation in children

Forty healthy children were studies, aged 1-5 yr. undergoing elective surgery, in a double-blind randomized study. Intubating time and intubating conditions were recorded and assessed when the pupils had become small and central [clinical endpoint] after inhalation Induction with either 4% halothane or 7.5% sevofiurane [as an equipotent concentrations for these age group of 3 MACEl] and 60% nitrous oxide in oxygen The quality of tracheal intubation was graded according to ease of laryngoscopy. position of the vocal cards, coughing, jaw relaxation and movement of limbs Intubating time was significantly more rapidly In the sevoflurane [P<0.05] [236.3 vs 286.6 S]. There was no significant difference between the groups regarding ideal intubating conditions, mean total intubation score. No significant difference regarding side effects [coughing, breath holding or laryngospasm] hemodynmic data, or oxyhaemoglobin saturation between the groups. In all children the trachea was intubated successfully at the first attempt. This study suggested that sevoflurane at 7.5% concentration, achieve a shorter time for intubation compared with halothane 4%[as an equipotent to 3MACEI of these age group] with equal satisfactory intubating conditions and minimal side effects

Prevention of spinal anaesthesia-induced hypotension in elderly: methoxamine or ephedrine

Two vasopressors were compared to reduce incidence of hypotension during spinal anaesthesia in elderly patients, methoxamine 10mg i.m. or ephedrine 10mg i.v. plus 20mg I.m, in terms of haemodynamic stability and requirement for additional vasopressors. Forty patients [aged 60-75yr] undergoing surgery of the lower body were allocated randomly into group M [n=20] and group E [n=20] the vasopressors were injected 10 min before induction of spinal anaesthesia. Rescue ephedrine 3-6 mg was given if systolic blood pressure [SAP] or mean arterial blood pressure [MAP] reduced more than 25% of the base line value. Patient and spinal characteristics were similar in the two groups. SAP and MAP increased initially form baseline until induction of spinal anaesthesia and then decreased for 25 min in both groups [not significant between groups]. Heart rate [HR] decreased from the baseline in group M [p<0.05] and was lower than in group E at all time form 4-70 min [p<0.01]. The incidence of hypotension of SAP and MAP was not significant between groups [SAP 25% vs 30% and MAP 20% vs 25%]. Requirements for rescue ephedrine [20% vs 25%] dose of rescue ephedrine given [4.8 vs 5.1mg] and time to onset of hypotension [9.8 vs 11.6 min] were similar in groups M and E. respectively. We conclude that methoxamine 10mg i.m. given 10 min before induction of spinal anaesthesia in normovolaemic elderly insignificantly reduce Incidence of subsequent SAP and MAP hypotension. requirements for rescue vasopressor therapy but has significant reduction of HR compared with ephedrine 10 mg i.v. plus 20mg i.m

Cardiovascular effects of mivacurium Experimental and clinical evaluation

Mivacurium, in a dose of 0.2 mg / kg body weight, produced a transient decrease in blood pressure [BP] and a transient increase in heart rate [HR] in anaesthetized cats. Mivacurium antagonized the hypotensive effect of acetylcholine [Ach] on PB and also antagonized the negative inotropic and chronotropic effects of Ach on isolated rabbit's heart. Meanwhile, mivacurium potentiated the hypertensive effect of adrenaline on BP and also the positive inotropic and chronotropic effects of adrenaline on isolated rabbit's heart. A clinical study was performed on forty adult surgical patients who received 0.2 mg / kg body weight mivacurium as a loading fast dose, then neuromuscular blockade was maintained either by a bolus dose of 0.06 mg / kg body weight in 20 patients, or by continuous infusion of 4 - 8 micro g / kg /min in another group of 20 patients whenever T1 returned. There was a brief transient decrease in the mean arterial pressure [MAP] and an increase in HR lasting for 1-3 minutes, but there was no significant change in MAP or HR after the second bolus dose or continuous infusion. The hemodynamic changes with mivacurium suggested histamine release. To conclude, mivacurium can be considered a safe drug in absence of clinically significant alterations in HR and MAP from baseline