Evaluation the effect of dexmedetomidine or tramadol when added to lidocaine for intravenous regional anaesthesia

Dexmedetomidine is approximately 8 time more selective toward the alpha 2-adrenoceptors than clonidine. It decreases anaesthetic requirements by up to 90% and induces/analgesia in patients. Tramadol, a centrally acting analgesic, might have local anaesthetic properties as do some opioid drugs. We designed this study to evaluate the adjuvant effect of dexmedetomidine or tramadol when added to local anaesthetc in IV regional anaesthesia. Forty five patients undergoing hand or forearm surgery were randomly assigned to 3 groups to receive IVRA. Each group 15 patients, lidocaine 0.5% group [group L], a mixture of 0.5% lidocaine and 0.25% tramadol [group TL] or mixture of 0.5% lidocaine and 0.5 ug/kg dexmedetomidine. We investigated onset and duration of sensory and motor blocks, the quality of the anaesthesia, intraoperative - postoperative heamodynamic, pain and sedation. We found that the addition of dexmedetomidine or tramadol modify the action of local anaesthetic, providing a shorter onset time of sensory block and less tourniquet pain in IVRA but dexmedetomidine more better because faster and less incidence of side effect

Advantages of addition of intrathecal morphine compared with addition of small dose intrathecal sufentanil in cesarean section

Spinal anaesthesia is widely used for cesarean delivery. Its quality can be improved by intrathecal [IT] addition of opioids to local anaesthetics. For obstetric analgesia, however spinal morphine alone was relatively ineffective and plagued with side effect. Spinal anaesthesia with bupivacaine combined with sufentanil has been widely used for cesarean delivery. However, the main site of action [spinal VS central] of IT sufentanil is controversial. The aim of this study was to test the responsiveness of IT sufentanil and its relative efficacy and incidence of side effect compared with intrathecal morphine after cesarean deliveries. The study done on 90 healthy ASA I or II physical status. Patients were randomly allocated to three groups. Each group of 30 patients. They received either hyperbaric bupivacaine alone [group 1] or with morphine 0.2 mg [group 2] or sufentanil 2.5 ug [group 3]. We found that the addition of IT small dose of opioid produced a significant longer duration, better quality and excellent post operative analgesia. Sufentanil was found to be more better than morphine because of less adverse effect

Is the airtraq laryngoscope superior to macintosh laryngoscope using armord endotracheal tube in head and neck surgery?

The control of the airway is a fundamental aim for the anaesthiologast during routine anaesthesia. The incidence of difficult tracheal intubation has been estimated at 3-18%. This incidence may be more in head and neck Surgery. Our study conducted on 30 patients divided randomly in two groups each of 15 patients. Fifteen patients intubated by Macintosh laryngoscope and 15 by Airtraq laryngoscope. We found that success rate in Airtraq laryngoscope was 100% in comparisons to Macintosh laryngoscope which was 81.8%. We found also the intubation time was reduced significantly with use the Airtraq laryngoscope. The intubation was done in the first attempts in all patients in Airtaq group without need to optimizing maneuvers in comparison to Macintosh laryngoscope which need optimizing maneuvers and also use intubating aids like Bougie. Nearly no complication in Airtraq group like oral mucosal laceration, oxygen alteration and heamodynamic changes. We found that the Airtraq laryngoscope provides superior intubating condition without need intubating aids and less or no complications

Laryngeal mask airway proseal and standard laryngeal mask airway in paralyzed anesthetized adult patients undergoing pressure-controlled ventillation: a randomized study

This study compared the laryngeal mask airway ProSeal [PLMA] and the standard laryngeal mask airway [LMA]. Ninety patients were randomly allocated for airway management with the PLMA or LMA. Patients were anesthetized with neuromuscular blocking drugs [controlled ventilation]. The patients were undergoing non-intra-abdominal surgeries [general, urologic, plastic orthopedic and gynecologic operations]. First-time insertion success rates were higher for LMA, 41/45 versus 36/45 for PLMA. Six patients required two attempts and three patients required three attempts in PLMA group in comparison to the two patients required two attempts and one patient required three attempts in LMA group. Oropharyngeal leak pressure was higher for the PLMA group [28 +/- 5 cm H2O] versus [18 +/- 4 cm H2O] for LMA. Gastric insufflations occurred in three patients in LMA group, also three patients developed hypoxia in the same group. Blood staining after removal occurred in three patients in PLMA group

Low concentration sevoflurane anaesthesia supplemented with remifentanil: effect on recovery and cognitive function, also sevoflurane and hepatic integrity in elderly patients

The aim of this study was to assess hepatic function in elderly patients anaesthetized with sevoflurane - Nitrous oxide and to compare recovery and psychomotor performance after maintenance of anaesthesia with sevoflurane - nitrous oxide supplemented with remifentanil 80 patients. 70 to 90 yr old, were allocated randomaly to four groups, twenty patients each were allocated to maintenance of anaesthesia with sevoflurane only in concentration necessary to mentain adequate anaesthesia [Group I] with 1.5, 1.0, 0.5 MAC [end tidal] of sevoflurane supplemented with remifentanil. Measurement if cytosolic liver enzyme alpha glutathione S-transferase [alpha GST], the formation of the lidocaine metabolite monoethylglycinexylidide [MEGX] and gastric mucosal tonometery-derived variable as sensitive markers of hepatic function and splachnic perfusion. No significant changes in standard liver enzyme markers were seen throughout the study. Tonometric measurements showed a significant decrease from baseline in regional Pco[2]' regional to arterial difference in Pco[2] and intermucosal PH at 90 min after skin incision, alpha GST concentration increased significantly in group I. A return to base line values in tonometric values and alpha GST levels was seen 24 h postoperatively. MEGX formation did not charge significantly after surgery. The median dosage of ramifentanil required in the last three groups was 0.21, 0.25 and 0.34 mg/kg/min, respectively [P<0.05]. The median times to eye opening were 10.3, 12.7, 11.0 and 6.5 min in the four groups [P<0.05 between the 0.5 MAC and other groups] and for orientation 12.1, 14.9, 12.3 and 8.3 respectively [P<0.05 between 0.5 and 1.5 MAC groups]. There was no significant difference in the mini-mental state assessment scores on the actual discharge times from the recovery ward among the groups. Significantly greater numbers of patients could perform the critical thicker fusion test at 15 min in the group receving the lowest concentration of sevoflurane and the highest doses of remifentanil [p<0.05]. Patients in this group also showed the highest incidence of chest wall rigidity [P<0.003]. We conclude that, liver function in elderly patients is well preserved during sevoflurane anaesthesia, increased serum levels of alpha GST and changes of gastric tonometry-derived variables imply a reduction in splanchnic perfusion, leading to temporary impairment of hepatocyte oxygenation. Also the use of remifentanil with lower concentration of sevoflurane facilitate early recovery, it does not influence discharge time from recovery ward and may be associated with side effects as chest wall rigidity