Comparison of intravenous Lornoxicam and fentanyl combined with midazolam on analgesia during extracorporeal shock wave lithotripsy

Various sedative and analgesic medications have been used for shockwave lithotripsy [SWL]. This study compare the analgesic and side effects of intravenous lornoxicam with that of intravenous fentanyl, in combination with midazolam in ESWL. One hundred patients were randomly divided into two groups; group A [n = 50] received 16 mg lornoxicam i.v. 30 min before ESWL and group B [n = 50] received 2 microg/kg fentanyl i.v. 3 min before ESWL. All patients received 2 mg midazolam i.v. 3 min before ESWL for intraoperative sedation. Pain intensity was evaluated on a visual analog scale [VAS]. A supplemental analgesia with intravenous fentanyl 25 micro g was given when complained of pain, changed position, or grimaced in response to the shockwaves. The level of sedation was determined using the Observer's Assessment of Alertness/Sedation [OAS/S]. Oxygen supplement through a face mask was given when the SpO[2] fell below 94%. Side effects [nausea, vomiting, dizziness] and the time of discharge from post-anesthesia room [PAR] were recorded. There were no differences between two groups in the demographic data, number of shock waves, duration of ESWL procedure, and fentanyl supplement. The incidence of oxygen supplement was lower in lornoxicam group [5/50] compared with that of fentanyl group [20/50], P < 0.01. The frequency of dizziness was lower in lornoxicam group [3/50] than that in fentanyl group [15/50], P < 0.01. Five patients in fentanyl group complained of nausea, but two did in lornoxicam group. The discharge time from PAR was significantly shorter in lornoxicam group [24.4 +/- 3.23 min] than that in fentanyl group [37.14 +/- 5.82 min], P < 0.01. Intravenous lornoxicam plus midazolam could provide an adequate analgesia as good as fentanyl plus midazolam but with a lower incidence of desaturation, nausea/vomiting and dizziness and could be discharged from PAR earlier. Therefore, we suggest that a single-dose intravenous lornoxicam combined with midazolam is a safe and effective regimen for pain relief in ESWL

Ondansetron/dexamethasone combination for reducing nausea and vomiting during and after spinal anesthesia for cesarean section

A prospective r and omized, double blind study was performed to assess the efficacy of ondansetron plus dexamethasone or ondansetron alone in preventing nausea and vomiting in parturient undergoing cesarean section [C-section] under spinal anesthesia. 150 patients were divided into three groups received saline i.v. [Groupl, n=50], ondansetron 4mg i.v. [GroupII, n=50] or ondansetron 4mg plus dexamethasone 8mg i.v. [Group III, n=50] immediately after clamping of the fetal umbilical cord. A complete response, defined as no emetic symptoms and no need for another rescue antiemetic medication in the intraoperative, postdelivery period was 40%, 80% and 94% in group I, II and III respectively with P[1] value <0.0001 between both group II and III and group I and P[2] value <0.008 between group II and III, the corresponding rates during the first 24h after surgery was 70%, 90% and 98% in group I, II and III respectively with P[1]<0.0001 and P[2] <0.04. No clinically serious adverse events were observed in any of the groups. In conclusion ondansetron plus dexamethasone were more effective than on dansetron alone in preventing nausea and vomiting in parturient undergoing C-section under spinal anesthesia

Tracheal intubation without the use of muscle relaxants: propofol with varying doses of remifentanil

The intubating conditions were assessed in three groups of 60 patients ASA I or II after induction of anesthesia with remifentanil 2, 3 or 4 ug kg-1 [groupl, II or III respectively] and. propofol 2.5 mg kg[-1] Intubation conditions were assessed as satisfactory or unsatisfactory on the basis of jaw relaxation, position of the vocal cords and patient response to intubation coughing or movement of the limbs. Overall conditions at intubation were regarded as satisfactory in 40%, 70% and 95% of patients in groupl, II and III respectively. All three groups had a decrease in heart rate and arterial pressure after induction but there was no difference between groups. The decrease in heart rate and arterial pressure were not regarded as clinically significant. Intubating conditions were best after induction with remifentanil 4ug kg and propofol 2.5 mg kg[-1]. This provided satisfactory intubating conditions in 95% of patients, and prevented cardiovascular response

Low dose succinylcholine facilitates laryngeal mask airway insertion during propofol anesthesia

In this clinical trail, the use of small dose of succinylcholine [Sch] to facilitate the insertion of a laryngeal mask airway was investigated. Sixty patients were recruited randomly in a double blind manner to receive 0.9% sodium chloride or Sch. 0.1 mg/kg. Intravenously following intravenous induction with propofol 2.5 mg/kg. Small dose Sch. improved the correct positioning of the laryngeal mask during the first attempt [93 vs. 65% p < 0.02], decreased the incidence of swallowing [p < 0.001], gagging [p < 0.001] and head or limb movement [p < 0.05]. Laryngeal mask insertion was graded as easy in 93% of patients who have small dose Sch. compared with 65% in the placebo group [p < 0.05]. The duration of apnea between the two groups was not significantly different. The total dose of propofol needed to insert the laryngeal mask was lower in Sch. group [2.5 vs 3.3 mg/kg. p < 0.05] and was associated with less hypotension [p < 0.01]. Fasciculation and mild myalgia [33%] were common despite the small dose of Sch. used. In conclusion, small dose Sch. facilitates laryngeal mask insertion