Intra-articular analgesia with ketamine and tramadol; the effect of the type of surgery

Arthroscopies are most commonly performed on day case basis, but postoperative pain remains a problem as more complicated procedures are performed. This study was earned out on 60 adult ASA l-ll patients undergoing arthroscopic procedures. Patients were assigned into 2 equal groups; group I underwent low inflammatory surgeries, whereas group II had high inflammatory surgeries. Both groups were further subdivided randomly into 3 equal subgroups. Subgroup K received 0.5 mg kg[-1] ketamine intra-articularty, subgroup T received 100 mg tramadol intra-articularly and subgroup S received placebo. The following parameters were recorded; vital signs, first time to ask for analgesia, total rescue i.v pethidine given and VAS scores hourly for the 1[st] 6 hours, then 3-houhy till the end of the first postoperative day Group I showed significantly delayed onset of pain [p=.009]. lower pethidine consumption [p=.O36] and lower VAS scores at 1, 4, 5, 6, 9, 12, 15, 18, 21, and 24 hours On the other hand, on comparing K. T and S subgroups, both K and T subgroups showed a significant delay in asking for analgesic [p=.001], significantly lower pethidine consumption [p=.001] and significantly lower VAS scores at 1, 2, 3, 6, 12, 15. and 24 hours as compared to S subgroups. On comparing K and T subgroups, there was no significant difference among them except in the first 2 hours where K subgroups had significantly lower VAS in the first hour [p=.O18]. while T- subgroups showed significantly lower VAS in the second hour [p=.004]. Both ketamine and tramadol proved to be useful and safe analgesic agents when applied intra-articularly particularly in the low inflammatory procedures

Does preloading with hydroxyethyl starch 130/0.4 prevents post spinal hypotension in elective caesarsan deliveries

The aim of the study was to compare the efficacy of the normal saline preloading versus 6% hydroxyethyl starch 130/0.4 [voluven] in preventing post spinal hypotension in women undergoing elective caesarian section. 20 patients ASA I or II undergoing elective caesarian section were included in the study. Previous caesarian section patients were excluded from the study. Patients were fasting for 8 hours as regards the solid and semisolid food and 6 hours for the fluids. Patients were divided into 2 groups the first group received one liter 6% hydroxyethyl starch 130/0.4 [voluven] within 60 minutes before the spinal intrathecal anaesthesia. The second group received two liters normal saline solution within 60 minutes before the spinal anaesthesia. Measurements included systolic and diastolic blood pressure every 3 minutes during the first 15 minutes and then every 5 minutes till the end of surgery. Incidence of hypotension and the total dose of ephedrine sulfate given to each patient were recorded. Facial outcome was judged using Apgar scoring after one and 5 minutes and umbilical artery pH immediately after delivery. The results of the present study showed significant difference between the 2 groups in the systolic blood pressure at the times of 12, 15 and 20 minutes after induction of spinal anaesthesia, blood pressure was significantly higher in the hydroxyethyl starch group. As regards the diastolic blood pressure there was a significant difference between the 2 groups at the time of 12, 15, 20, 25, 30,35 and 40 minutes after induction of spinal anaesthesia. Blood pressure was significantly higher in the hydroxyethyl starch group. Regarding the dose of the ephedrine used in the 2 groups there was a significant difference between the 2 groups only 3 patients in the first group received ephedrine sulfate when the blood pressure decrease to less than 80% of the baselines. While in the second group more patients received ephedrine sulfate in response to the attacks of the hypotension. There was no significant difference between the 2 groups in the Apgar scoring at one and 5 minutes after delivery. Also the umbilical artery pH was within normal in the 2 groups with no significant difference. The study recommends the use of one liter hydroxyethylstarch [130/0.4] as a volume preload before spinal anaesthesia as this will lead to lesser incidence of hypotension and lesser need for vasopressor therapy

Perioperative evaluation of the measurement of the arterio-jugular venous oxygen difference and the use of the free radical scavenger tirilazad mesylate in the management of the severely head injured patients

The aim of this study was to highlight the anesthetist role in dealing with the severely head injured patients, the assessment of the arteriojugular venous oxygen difference as an important parameter in the management of head injured patient and evaluation the role of the tirilazad mesylate in improving the outcome. This study was carried out on 80 adult patients with severe head injury. They were divided into 2 equal groups according to arterio-jugular venous difference in oxygen content [AVDO2]. Then each group was further subdivided into 2 subgroups A and B, subgroups I A and IIA receiving tirilazad mesylate while subgroups IB and IIB received placebo. The incidence of unfavorable outcomes in patients with wide AVDO2 [group I] was significantly higher than in those with normal or narrow AVDO2 [group II]. Unfavorable outcome occurred in 92.6% of the patients who had one or more episodes of hypertension compared with only 41.5% in those who did not. The outcome in patients who suffered a single or multiple episode of raised [ICP] above 20 mmHg was grave compared with those without intracranial hypertension. The present study showed no significant difference between the 4 subgroups as regard cerebral perfusion pressure [CPP]. The study showed that the patients who had hyperglycaemia above 150-mg/ dl had unfavorable outcome compared with those with normoglycaemia. In the present study tirilazed mesylate failed to demonstarte any neuroprotective efficacy in those who received this drug. Retrograde jugular cannulation is a simple technique that should be mastered and implemented by anesthesiologists for jugular oxygenation monitoring to detect the presence or absence of ischemia and hyperemia and consequently can modify his anesthetic plan according to the prevailing condition

role of hydroxamic acids in biochemical processes

Hydroxamic acids, a group of naturally occurring and synthetic weak organic acids of general formula RC[=O]N[R']OH, are widespread in the tissues of plants, in metabolites of bacteria and fungi, including complex compounds. Hydroxamic acids and their derivatives fulfill a variety of important roles in biology and medicine; here we provide a comprehensive brief review of the most basic medicinal chemistry and pharmacology of hydroxamate molecules