Prophylactic intravenous ondansteron and nalbuphine for reduction of subarachnoid fentanyl-induced pruritus in patients undergoing elective cesarean delivery

Addition of fentanyl to spinal anaesthesia with bupivacaine improves the quality and success of anaesthesia. However, it has a frequent incidence of pruritus and a substantial incidence of nausea and vomiting. tn this placebo controlled study, we compared the prophylactic efficacy of ondansetron and nalbuphine for the prevention of intrathecal fentanyl-induced pruri tus after cesarean delivery. Ninety elective parturients were assigned to one of the groups: Group 0 [Ondansetron 8mg IV n=30], Group N [Nalbuphine 4mg IV n=30] and Group S [Saline 0.9% IV n=30] as placebo. The study drugs were administered immediately after the umbilical cord was clamped. The occurrence of pruritus, nausea, pain and adverse reactions from ondansetron and nalbuphine was evaluated by pruritus score, 4-point rating score and visual analog scale respectively, at 15 minutes in the first hour after the injection of the study drugs. Afterward, evaluations were performed at 1, 2, 3 and 4 hours after the administration of study drugs. The overall incidence of pruritus, it was significantly more frequent in Group S [62%] compared with both Group 0 [43%] and Group N [42.5%]. The incidence of pruritus during the different study intervals showed significant increase in Group S compared with the other groups mainly at 45mm and 1 hour. The pruritus score was significantly different between Group 0 and Group S and between Group N and Group S [p<0.0S] respectively, it was mostly mild in Group 0 and Group N and mostly moderate in Group S. Treatment for pruritus was requested by patients in, 10%, 11% and 29% of patients in the Group 0, Group N and Group 5, respectively. There was no significant difference in the overall incidence and the severity of nausea andlor vomiting at different time study intervals for all groups. However, the number of patients requesting treatment for nausea and/or vomiting was significantly less in Group 0 and Group N when compared with Group S. No significant adverse reactions related to the study drugs reported during the different study intervals. Although IV ondansetron and nalbuphine significantly decreased the incidence of of fentanyl-induced pruritus more than placebo after cesarean delivery, further studies are recommended to show the other possible mecha nisms might be involved in the pathogenesis of fentanylinduced pruritus

Comparison between the streamlined liner of pharyngeal airway TM [slipa] and the laryngeal mask airway unique TM for spontaneous ventilation anaesthesia

The newly developed disposable streamlined of pharyngeal airway [SLIPATM] has recently been introduced into clinical practice. It has no inflatable cuff, because the shape of the SLIPATM closely resembles anatomy of the pharynx. The current study compared the SLIPATM and the LMA Unique TM with respect to insertion success rate, ease of insertion and insertion time, maximum air way sealing pressure, respiratory variables during spontaneous ventilation, haemodynamic response to the insertion of study devices, and postoperative adverse events related to these devices in 80 adult patients [ASA I-II] undergoing routine general surgery, orthopedic, urologic and gynecologic of short, moderate duration under general anaesthesia and through spontaneous ventilation. There was significant rise in MAP from the baseline value [73.8 +/- 12.0 mmHg] at all five minutes interval following insertion of the SLIPA with maximum rise [87.1 +/- 14.9 mmHg] seen at two minutes. There was significant rise in mean arterial blood pressure [MAP] from the baseline value [74.1 +/- 10.3 mmHg] at one and two minutes following insertion of the LMA Unique with maximum rise [81.1 +/- 11.2 mmHg] seen at one minute. MAP was significantly higher with SLIPA than with LMA Unique at two, three, four, and five minutes. There was no significant difference between the two groups with respect to oxygen saturation, inspired and expired tidal volume [TV ins, TV exp], and end-tidal carbon dioxide concentration throughout the surgical procedure. There was no statistical significant difference between the study groups with respect to the rate of successful insertion [96% and 98% in the SLIPATM and LMA Unique TM groups, respectively], and its scale. In the SLIPATM group, insertion was rated straight forward in 87%, slightly difficult in 10%, obviously difficult in 0%, and failure in 2% of patients. In the LMATM Unique group, insertion was rated straightforward in 89%, slightly difficult in 8%, obviously difficult in 2%, and failure in 0% of patients. Regarding to insertion time and peak airway sealing pressure there was no significant difference between the two SGA. With respect to adverse events related to the study air way devices, no regurgitation of gastric contents was observed in any patients, there was a significantly higher incidence of blood on the device with the SLIPA [11/40 versus 4/40 with LMA unique]. Also complaints of sore throat were noticed at significantly higher rate in the LMATM unique group than in SLIPATM group [19%, 3% respectively], 30 minutes after arrival in the post-anesthetic care unit. No cases of sore throat reported at the 24[th] hour postoperatively in both groups. Both the SLIPA and the LMA unique appear to be effective in establishing a clinically patent airway in patients who are spontaneously breathing under general anesthesia during operations of short or intermediate duration. They have similar insertion and functional characteristics. The SLIPA has significant haemodynamic effects on the study patients with frequent blood traces on the device in comparison with the LMA Unique. Fewer patients in the SLIPA group complained of a sore throat suggesting that the SLIPA might increase patients comfort after minor surgery

Effect of three different pretreatment techniques on clinical intubation conditions and haemodynamics in patients under rocuronium neuromuscular blockade

Onset of action of muscle relaxants is influenced by cardiac output and muscle blood flow. Both of ephedrine and priming rocuronium reduce the: onset time of rocuronium. Aim of our study to hypothesize that the effect of priming rocuronium dose combined with ephedrine on intubating condition and haemodynamic effect of anaesthetic agent is superior to either technique used separately. Ninety adult patients ASA class I and II allocated into one of the three groups - priming rocuronium 0.04mg/kg in combination with ephedrine 75 micro g/kg group I, priming rocuronium 0.04mg/kg with placebo group II and ephedrine 75 micro g /kg with placebo group III. The patients of three groups pretreated with the study drugs 3 minutes before the induction dose of rocuronium [0.5mg/kg] which follows a standardized propofol-fentanyl induction [2.5mg/ kg propofol- 3 micro g/kg fentanyl]. Assessment of clinical intubating conditions occurred within 30 seconds by using 3 point rating scale. Heart rate and mean arterial blood pressure were measured before induction [baseline], before intubation and 1, 3, 5 minutes after intubation. Patient characteristics, changes in heart rates and mean arterial blood pressure were comparable between the study groups. In group I intubation conditions were moderate significantly better than in both group II and group III [P<0.01]. However there was no significance difference between group II and group III [P>0.05]. No adverse effects which related to study drugs observed in all groups. The present study concludes that pretreatment with combination of priming rocuronium dose [0.04mg / kg] and ephedrine [75 micro g / kg] is significantly more effective on clinical intubating conditions and haemodynamic effect of induction agents than either technique used separately in patients under rocuronium neuromuscular blockade

Efficacy of Ketamine versus propofol in decreasing the incidence of emergence agitation in pediatric ENT day case surgeries under sevoflurane anesthesia

Emergence agitation or delirium may occur children after sevoflurane general anesthesia. Different drugs have been used to decrease its occurrence with variable efficacy. The aim of this study to compare the incidence and severity of emergence agitation in children who received a single dose of ketamine at the end of ENT day case surgeries versus children who received a single dose of propofol. Forty eight healthy children 3-7 years old allocated to ketamine group [n = 24], which received 0.25mg / kg ketamine at the end of the surgery, or propofol group [n = 24], which received 1mg/ kg propofol. Evaluation of recovery characteristics was done upon awakening and during the first thirty minutes using the pediatric anesthesia emergence delirium scale. The mean scores in the pediatric anesthesia emergence delirium scale were significantly lower in the ketamine group compared with the propofol group [8.71 +/- 4.09 vs.11.29 +/- 4.50 respectively]. Also the incidence of agitation was significantly lower in the ketamine group compared with the propofol group [12.5% versus 29.5% respectively]. There was no difference in time to meet eye opening [7 +/- 3.4 min versus 9 +/- 2.7mm] and recovery room discharge [32.67 +/- 2.014min versus 33.04 +/- 1.829 min] between the two groups. The present study concludes that the addition of ketamine 0.25 mg:/ kg at the end of the surgery can significantly decrease the incidence of emergence agitation more than propofol 1mg / kg, in children undergoing ENT day case surgeries under sevoflurane general anesthesia