Comparison of intrathecal ropivacaine and in combination with fentanyl, clonidine or midazolam for minor surgery

Sixty adult ASA I and II patients scheduled for lower abdominal surgery were studied. Patients were randomly assigned to receive intrathecal 15 mg ropivacaine GII [n=15] or ropivacaine plus 25 micro g fentanyl GI [n=15] or ropivacaine plus 75 micro g c/onidine GIII [n=15] or ropivacaine plus Img midazolam GIV [n=15].The addition of fentanyl to ropivacaine in GII did not significantly affect pulse rate, while the addition of clondine and midazolam in GIII and in GIV significantly decreased PR. The MABP decreased significantly intra-operatively in the four studied groups. The addition of clonidine decreased MABP significantly in GIII compared to GI The addition of fentamyl clonidine or midazolam to ropivacaine did not influence the onset of sensory block, but they increased sensory level significantly. The duration of analgesia was significantly prolonged in GII and in GIII Midazolam in GIV did not significantly prolong the duration of analgesia in our study. The onset of motor block was delayed significantly and the duration of the block was significantly shorter in GII compared to GI. Clonidine and midazolam in GIII and GIV increased the degree of motor block without increasing the duration. The analgesic consumption was significantly less in GII and in GIII while there was no significant change in GIV compared to GI. The incidence of complications was nil in GII and in GIII. In GI one case complained of shivering, however, one case had a post-operative headache in GIV

Atteenuation of cardiovascular response to emergence from anaesthesa and tracheal extubation by either topical lidocaine, intravenous lidocaine or verapamil

We have examined the effect of either topical lidocaine, intravenous lidocaine or intravenous verapamil on the haemodynamic response to emergence from anaesthesia and endotracheal extubation in 80 adult ASA I or II patients, undergoing a variety of elective surgical procedures. All patients received a standard general anaesthetic. At the end of surgery group A [control group n = 20], received a bolus dose of 10ml normal saline 2 minutes before extubation. Group B [topical lidocaine n = 20], had their larynx and vocal cords sprayed with 10% aerosolized lidocaine [40mg] after induction and 2 minutes before intubation plus 10ml normal saline, 2 minutes before extubation. Group C [IV lidocaine n = 20], received a bolus dose of 1 mg kg-1 lidocaine diluted up to 10mI in normal saline, 2 minutes before extubation. Group D [IV verapamil] received a bolus dose of 0.1mg kg-1 verapamil diluted up to 10ml in normal saline, 2 minutes before extubation. Arterial pressure, heart rate, ECG, peripheral oxygen saturation and end tidal CO2 were recorded at pre induction, end of surgery, 2 minutes before extubation and at 1 and 5 minutes after extubation. The quality of extubation was evaluated using an extubation score. It was found that topical lidocaine, IV lidocaine and verapamil have attenuated the increase in both heart rate and arterial blood pressure following extubation compared with pre induction values and significantly attenuated the cardiovascular response as compared to the control group [p<0.001]. Tracheal scoring however showed that topical lidocaine had the lowest favourable sore [p<0.001] followed by IV lidocaine [p<0.05], while IV verapamil showed no significant change when compared to the control group

Hypoxia during endoscopic retrograde cholangiopancreatography. a place for oxygen therapy

Patients who undergo flexible endoscopy suffer from periods of low oxygen saturation which may present a risk for the development of complications. The aim of this study was to evaluate the effect of oxygen therapy on lowering the number of patients who suffer from periods of low oxygen saturation during ERCP through a randomized controlled clinical trial. A pilot study was first done to determine the number of patients who suffer from hypoxia during ERCP. Accordingly 100 consecutive patients were randomized to either receive supplemental oxygen therapy [3 litres / min] through nasal prongs or to receive no therapy. The oxygen saturation and the pulse rate of each patient was measured before, at start and during ERCP by means of a pulse oximeter attached to the right index finger. Oxygen therapy significantly reduced the number of patients suffering from hypoxia [Fisher's exact test: p<0.05]. Severe levels of hypoxia increased significantly in the group of patients not receiving oxygen therapy in comparison to pre-ERCP state [Fisher's exact test: p<0.05]. The average oxygen saturation level was significantly higher during ERCP in the group of patients receiving oxygen therapy [Mann-Whitney U test: p<0.05]. Patients are at risk of developing hypoxia during ERCP. Supplemental oxygen therapy reduces this risk and should be routinely supplied to all patients during ERCP

Effect of some anaesthetic agents and surgery on blood glucose, triglycerides, growth hormone, adrenocorticotrophic hormone and liver functions in humans

The present study was carried out to compare the effects of the most widely used inhalational anaesthetics in the form of nitrous oxide and oxygen or halothane and oxygen and regional analgesia using intrathecal bupivacaine on carbohydrate and fat metabolism. The study included the determination of blood glucose triglycerides and the hormones that affect their metabolism mainly growth hormone [GH] and adrencortictrophic hormone [ACTH] as well as the liver functions under the stress of minor operations. Thirty patients ASA 1 and II, were randomly divided into three groups, 10 patients in each group according to the type of anaesthetic. Venous blood samples were taken before induction of anaesthesia, during operation two hours after the end of surgery and on the third postoperative day. A significant increase in blood glucose was detected in the three groups and it remained significantly high in the nitrous oxide and halothane groups during the postoperative period. Plasma Gil increased significantly in the three groups and remained high in the immediate postoperative period and decreased to preoperative values on the third postoperative day. ACTH significantly increased in all three groups during operation and in the postoperative period However liver functions showed some changes but within normal levels. Therefore the rise of blood glucose, ACTH and GH indicates a stress response to anaesthesia and surgery especially in those receiving general anaesthesia hence it should be supplemented with analgesic agents as premedication, during induction of anaesthesia and during operation as well as in the postoperative period in order to obtund these stressful responses

Oxygen therapy in the late postoperative period, the evaluation of three different methods of administration

As postoperative hypoxaemia became a well-recognized and documented complication after general anaesthesia and surgery, therapeutic oxygen administration immediately after hypoxaemia recognition has been demonstrated to improve mean arterial oxygen saturation [Spo[2]], therefore this study evaluated three modes of oxygen delivery devices commonly used i.e., the Hudson face mask, the nasal cannula and the Venturi mask in the late postoperative period i.e., on the second postoperative day on 90 post-surgical patients who had abdominal operations. They were monitored with a pulse oximeter and those whose Spo[2] levels were