Comparison of induction and recovery charcteristics of sevoflurane and halothane in pediatric ansthesia

Forty children ASA I-II, aged 3-9 years scheduled for adenotonsillectomy were randomly divided into two equal groups [each group 20 patients] according to whether they induced and maintained with halothane and sevoflurane. The comparison was between the two groups as regards induction, recovery characteristics, hemodynamic changes as well as complications happened during induction and recovery. Anesthesia was induced using graded inhalation technique with either halothane up to 5% and sevoflurane up to 8%. Maintenance was achieved by 1.5-2% halothane and 1-4% sevoflurane. The times of induction and emergence were significantly shorter in sevoflurane as compared with halothane group. The better intubation conditions were observed in patients who received halothane anesthesia with no statistically significant difference. The hemodynamic changes were similar in both groups with improved cardiovascular profile in sevoflurane group. There was no significant difference between the two groups as regards airway complications during induction and recovery. The conclusion of the study is that sevoflurane could be used safely as an alternative to halothane in pediatric anesthesia

Effect of intrathecal midazolam or midazolam-fentanyl with bupivacaine for cesarean section

Sixty healthy pregnant women at term scheduled for elective cesarean section under spinal anesthesia were randomly assigned to three equal groups, each of 20 women. The first group received 10 mg bupivacaine [B group], the second group received 2 mg midazolam added to 10 mg bupivacaine [BM group], while the third group received 2 mg midazolam, 10 mug fentanyl added to 10 mg bupivacaine [group BMF]. Midazolam significantly improved the quality of intraoperative anesthesia and analgesia, as none of the patients in BM group experienced pain which required analgesic supplement compared with eight patients in B group. Further more improved analgesia was achieved with the midazolam-fentanyl combination. The study concluded that adding a small dose of intrathecal midazolam to bupivacaine improved the quality of anesthesia reduction of the postoperative pain and reduction of analgesic consumption for cesarean section delivery. Combining midazolam with fentanyl much further improved analgesia without increasing the side effects

Impact of two different doses regimen of remifentanil in cases of cesarean section on maternal and neonatal conditions

Forty healthy full term pregnant women scheduled for elective cesarean section were randomly allocated into 2 equal groups, 20 women each. Induction of anesthesia was done by remifentanil, thiopental and succinylcholine in a rapid sequence fashion. After induction, patients received one of two doses of continues infusion, either 0.1 mug/kg/min [group I] or 0.25 mug/kg/min [group II]. Anesthesia was maintained by isoflurane 0.5% in oxygen and atracurium for muscle relaxation. Maternal vital signs [heart rate, mean arterial blood pressure, oxygen saturation and any side effects] were recorded. Neonatal evaluation including Apgar score at one and five minutes and umbilical cord blood gas analysis were estimated after delivery. Remifentanil infusion was stopped at the last of skin closure and time response to verbal stimuli and extubation time were recorded. Maternal and neonatal outcome was satisfactory in both groups. As regards Apgar scores and umbilical cord blood gas analysis, there was no significant difference between the two groups. Neither parturient women nor their babies required naloxone. In spite of the fact that there was a significant difference in remifentanil dose between the two groups, the time response to verbal stimuli and tracheal extubation were similar. However, hypotension was reported in 45% of patients in group II and no one in group I. Remifentanil appears to be safe and effective for mother and baby when used as a part of an opioid-based general anesthesia for cesarean section

Epidural fentanyl, intravenous morphine, and oral rofecoxib, analgesia for control of post -laminectomy pain in case of lumbar canal stenosis

Fifty-four patients of lumber canal stenosis as proved clinically and radiologically treated by lumber laminectomy were randomly allocated to one of three groups, 18 cases each. The first group received epidural fentanyl infusion, the second group received intravenous morphine and the third group received oral rofecoxib in the early 48 hours postoperatively. Study of the analgesic effect for control post-laminectomy pain was done, which revealed a big difference in the analgesic effect of three used methods during the first 16 hours. The superior method was epidural fentanyl analgesia, and a satisfactory level of analgesia was obtained with the three methods by the end of first 16 hours and became stationary till the end of the 48 hours