Comparative experimental and clinical study between sevoflurane and isoflurane renal effects

Sevoflurane is a promising new nonflammable halogenated inhalational agent which produces anaesthesia of excellent quality. This study was performed to investigate experimental and clinical renal effects of sevoflurane versus isoflurane. The expermental part of study included 60 rats divided into 3 equal groups. Group I [control] was exposed to oxgen 4L/min for hours, group II [isoflurane] was exposed to 1.2% isoflueane for 2 hours, group III [sevoflurane] was exposed to 2% sevoflurane for 2 hours. Each group was further subdivided equally into two subgroups. Subgroup [A] in which animals were sacrified 24 hours after exposure, subgroup [B] in which animals were sacrified 7 days from the exposure. Animala blood samples were collected for blood urea nitrogen [BUN] and serum creatinine [Cr.] measurements, then the kidney was removed for histological and histochemical [succinic dehydrogenase enzyme activity] studies. The clinical part of this study was carried out on 40 ASAI and II of adult patients and were divided equally into two groups. Group I received 1.2 isoflurane for 2 hours and group II received sevoflurane 2% for 2 hours. Haemodynamics were assessed by measuring heart rate [HR] and mean arterial blood pressure [MBP], renal function tests [BUN and serum Cr.] was done preinduction, 2, 4,24 hours and 7 days postoperatively. Experimental study results founded that both isoflurane and sevoflurane had no effect on renal enzymes level all-through the study period. Histological examination of the kidney revealed mild congestion of central vein in sevoflurane group in contrast to isoflurane group which had severe congestion of central vein and cellular infiltration. On the other hand succinic dehydrogenase enzyme granules decreased slightly in sevoflurane but showed moderate activity in isoflurane group. The present clinical study showed that sevoflurane group had significantly lower [HR] than isoflurane group intra operatively. Also MBP was significantly lower in sevoflurane group from 5 minutes till 30 minutes intra operatively. No changes were recorded in renal enzymes all through the study period. Analysis of the data obtained from the experimental and clinical studies in this work demonstrated that sevoflurane had no harmful effect on the kidney with cardiovascular stability

Comparative study of spinal, epidural and combined spinal epidural anaesthesia in orthopaedic surgery

This study was carried out to compare spinal, epidural and combined spinal epidural [CSE] techniques of anesthesia on 60 ASA I and II patients of both sexes [35 females and 25 males] scheduled for major orthopedic surgery. They were divided into three groups [each of 20 patients, aged 20-67 years old]: Group I [spinal group] in which 2.5-3 ml heavy bupivacaine 0.5% was injected through a 25 G spinal needle, group II [epidural group] in which 3 ml of 0.5% bupivacaine was injected as a test dose, after that 12-15 ml of 0.5 bupivacaine was received, and group III [group CSE] in which a 25 G spinal needle is inserted through the epidural needle about 1.5 cm further to reach the subarachnoid space. After injection 1.5 ml of 0.5% hyperbaric bupivacaine in the subarachnoid space, the spinal needle was withdrawn then 10-12 ml of 0.5% plain bupivacaine was injected in epidural space. This study compared the onset time of sensory analgesia, the degree of muscle relaxation, changes in respiratory rate [RR], hemodynamic changes [HR, MAP, COP, CI], blood glucose levels as well as the postoperative events produced by spinal, epidural and CSE block. In conclusion, the CSE technique was superior alternative in selected patients for spinal and epidural analgesia. CSE reduced and eliminated some of the disadvantages of both techniques, while preserving advantages of both

Comparative study of propofol versus sevoflurane for facilitation of LMA insertion

This study compared the stages of induction, condition of LMA [Laryngeal Mask Airway], insertion, haemodynamic effects and emergence from anaesthesia of sevoflurane with those of propofol in forty unpremedicated ASA I or II patients aged between 20-52 years old, scheduled for minor elective surgery for which the use of the Laryngeal Mask Airway [LMA] was considered appropriate. Patients were divided equally into two groups of twenty patients each to receive one of the following induction technique: group I [propofol group] received propofol 3 mg / kg mixed with 2 ml 1% lignocaine and group II [sevoflurane group] received 7- 8% sevoflurane gas induction in 50% nitrous oxide in oxygen. After induction of anaesthesia and loss of the eyelash reflex, introduction of the LMA was attempted by an experienced anaesthestist. Jaw opening, ease of LMA insertion, coughing, gagging, airway obstruction and patient movement were graded by anaesthetist inserting the LMA. From this study we found that the time to loss of eyelash reflex was shorter in propofol group 46 +/- 11s vs 58 +/- 16s in sevoflurane group [p > 0.05], time taken for LMA insertion was 86 +/- 22s and 126 +/- 56s in propofol and sevoflurane groups respectively [p < 0.01], sevoflurane has a slightly slower induction time with reduced incidence of apnea. The condition for laryngeal mask insertion was assessed as excellent, satisfactory or poor on the basis of total score in each group. The result was Poor in 3 [15%] patients in propofol group in comparison with 1 [5%] patient in sevoflurane group, satisfactory conditions were observed in 7 [35%] patients in propofol group vs 6 patients [30%] in sevoflurane group and excellent in 10 [50%] patients in propofol group in comparison with 13 [65%] patients in sevoflurane group [p >0.05]. Haemodynamically, sevoflurane produced a minimal decrease in the heart rate and systolic blood pressure. Postoperatively, sevoflurane has a slower emergence from anaesthesia as compared to propofol, but no differences were noted in discharge times. From these results we concluded that 7-8% sevoflurane with 50% nitrous oxide in oxygen may be a useful alternative to propofol for safe induction, laryngeal mask insertion and recovery

Current concept of nutritional support after gastrointestinal surgery

In patients who have had major surgery or trauma, early enteral feeding is safer and more effective than parenteral or nasogastric feeding but is frequently associated with diarrhea. Limited recordings have shown that the patterning of duodenal interdigestive motor activity is frequently abnormal after surgery or in patients who are critically ill. The aim of the present study was to evaluate and compare the effects of postoperative administration of sufficient amounts of protein and calories, provided in the three different methods namely, total parenteral nutrition, total enteral nutrition, and a new method consisting of the combined use of peripheral parenteral nutrition and enteral nutrition. In the combined method, half the calculated total nutritional requirements was provided via the peripheral venous route, and the remaining amount via the enteral route. The three nutritionally supported groups of patients were compared with patients who received the usually administered conventional fluid therapy, where insufficient amounts of calories and no protein were provided

Comparative study between the efficacy of the antiviral [acyclovir] and the epidural local anaesthetic in the prevention of postherpetic neuralgia

Postherpetic neuralgia is the most common and feared complication of herpes zoster. The objective of the present study is to evaluate the relief of acute pain and possible preventive effects on postherpetic neuralgia through the use of IV anitviral acyctovir versus combined usage of epidural blockade kind acyclovir in the acute stage or herpes zoster. Ninety patients were randomly allocated to one of three equal groups [n=30 each]. Group [A]: treated with intravenous acyclovir [5mg/kg/three times /day] for 7 days. Group [B] treated with intravenous acycIovir [5 mg/kg/three times /day] and an epidural btockade for 7 days. Control group [C]: received oral nonsteroidal anti-inflammatory in the form of diclofenae sodium. The changes in intensity of pain in all groups were assessed for 12 months. The mean +/- SD number of days required for relief of pain by 50% and 90%. which was done by using the visual analogue scale of 100 [worst pain] to zero [no pain], was highly significantly lesser [P<0.01] in group B than in groups A and C. The duration of late residual pain was significantly shorter in group B [5.9 +/- 4.8 days] than in group A [11.9 +/- 7.5 days] [P<0.01]. The total duration of pain was also significantly shorter [P<0.01] in group B [51.5 +/- 8.8 days] than in groups A [67.5 +/- 8.8 days] and group C [164.5 +/- 8.8 days]. It was concluded that epidural blockade combined with antiviral agent is a very effective treatment modality for the pain of acute herpes zoster and its use is recommended for the prevention of postherpetic neuralgia, in view of shortening of total duration of pain, especially the late residual pain