Prophylactic phenylephrine - ephedrine combination therapy for maternal hypotension during spinal anaesthesia: comparative study

The study was designed to evaluate the efficacy of three different regimens for prophylactic treatment of hypotension during spinal anaesthesia for elective cesarean section. Thirty-six parturients, 21-32 years old, ASA I or II and term singleton pregnancy were randomized to one of three groups receiving, preload 1.5 L Ringer's lactate solution [Fluid group] [F group], ephedrine I.V infusion 2 mg/min. [Ephedrine group] [E group], or I.V infusion 2 mg/min ephedrine plus 10 micro g/min. phenylephrine [Ephedrine + phenylephrine group [E + P group]. Maternal systolic blood pressure and heart rate were measured at frequent intervals. Hypotension defined as systolic blood pressure decrease >/= 20% from baseline blood pressure. We found that hypotension occurred less frequently in [E + P] group than in [F or E] groups 35% versus 73% and 77% respectively, supplemental ephedrine requirement and nausea scores [0 - 3] were less in the [E + P] group. Neonatal venous and arterial pH values were significantly higher in [E + P] group. Apgar scores were similarly good in the three groups. On conclusion, the incidence of hypotension during spinal anaesthesia for elective caesarean section delivery was significantly lower in phenylephrine ephedrine combination than in ephedrine infusion alone or crystalloid preload

Transdermal nitroglycerine patch as a coadjuvant analgesic to morphine or diclofenacy for postoperative pain management

The aim of this study was to determine whether the application -of transdermal nitroglycerine patch would prolong postoperative analgesia associated with morphine or diclofenac in patients undergoing abdominal, orthopedic and gynecological surgeries under general anaesthesia. The study was conducted on 60 ASA I and II patients of both sexes, aged 22-62 years old, divided into 5 groups. Nitroglycerine group [NG] received 5 mg nitroglycerine alone, morphine group [MG] received 10 mg morphine alone, diclofenac group [DG] received 75 mg diclofenac alone, nitroglycerine-morphine group [NMG] received 5 mg nitroglycerine and 10 mg morphine and finally nitroglycerine-diclofenac group [NDG] received 5 mg nitroglycerine and 75 mg diclofenac. In all groups we used a standard anaesthetic technique and the study medications were given immediately after end of surgery and anaesthesia. Postoperative assessment included pain scores [VAS] for 24 hours, time of first rescue analgesic medication and its pain score, total dose of additional analgesic used within 24 hours and lastly adverse reactions. Our results showed that although neither morphine, diclofenac nor nitroglycerine alone delayed the time to administration of first rescue analgesic medication, the association of 5 mg/day transdermal nitroglycerine and 10 mg, morphine or 75 mg diclofenac resulted in an average of 12 hours, or 8 hours respectively of postoperative analgesia compared with 6 hours for morphine group and 4.5 hours for diclofenc group. We concluded that transdermal nitroglycerine was effective coadjuvant analgesic to morphine or diclofenac for postoperative pain management but more investigations may be required

Role of anaesthesia on cytokine responses to major surgery: inhalational versus intravenous

The aim of this study was to investigate the effects of inhalational vs intravenous anaesthesia on cytokines and hormones production in response to major surgery. Twenty patients ASA I and II were randomly allocated to receive either halothane-N0[2] [Inhalation group] or propofol-fentanyl [I.V. group]. Blood samples for cytokines include interleukin-1 beta [IL-1 beta], interleukin-2 [IL-2], interleukin-6 [IL-6] and interferon-lamda [IFN-lamda] and for hormones, cortisol and prolactin concentrations were obtained at intervals; before induction, end of surgery and 24 hours postoperatively. No significant changes were observed in interleukins or hormones concentrations between the two groups before induction of anaesthesia IL-1 beta increased by the end of surgery with no difference between both groups. IL-2 decreased significantly in I.V. group by end of surgery as compared with inhalational group. lL-6 increased significantly in inhalational group and still high 24 h. postoperatively. IFN-lamda decreased significantly by end of surgery in both groups. Cortisol level increased significantly in inhalational group more than in I.V. group by the end of surgery and no significant difference 24 h. postoperatively. Prolactin concentration increased but no significant difference between the two groups throughout the study period. We concluded that I.V. anaesthesia with propofol-fentanyl minimise rise of IL-6 and suppresses release of IL-2 and plasma concentration of cortisol as compared with halothaneNO[2] anaesthesia which increase secretion of IL-2, IL-6 and cortisol concentrations

Arterial to end tidal carbon dioxide pressure gradient during laparoscopic surgery: is it affected by obesity?

In this study changes in arterial to end tidal carbon dioxide pressure difference [PaCO[2] P[E] Co[2]] were determined in 40 ASA I and II female patients of different body weights undergoing laparoscopic surgery. They were classified into 4 equal groups, 10 patients each, according to their body weights using Broca index for obesity. Samples for measurement of arterial Co[2] tension were obtained before, during, after insufflation and before extubation. Our results showed a non significant changes in PaCo[2]-P[ET] Co[2] gradient in patients with body weight up to 60% greater than ideal weight during all phases of measurements while a high significant differences were recorded in obese patients of>60% greater than ideal weight during and after insufflation. End tidal Co[2] value have been found to be reliable in obese patients up to 60% greater than ideal weight but unreliable in obese patients of >60% greater than ideal weight. We concluded that arterial CO[2] tension should be considered in those patients to avoid hypercarbia during laparoscopy

Propofol [diprivan] versus midazolam - flumazenil anaesthesia for direct laryngoscopy

The study.was carried out on 40 patients of both sexes aged from 15-55 years old and with body weight between 55-85 kg scheduled for direct laryngoscopic procedures. Patients were divided randomly into 2 groups, 20 patients each.In the first group, propofol 2 mg/kg was used for induction of anaesthesia and maintained by continuous infusion of 200 micro g/kg/min for 10 minutes, followed by 150 micro g/kg/min for the next 10 minutes and 100 micro g /kg/min Thereafter .In the second group, midazolam 0.3 mg /kg was used for induction and maintained by infusion of 1 micro g/kg/min if the procedure lasted more than 20 minutes. At the recovery placebo was used to reverse the effect of propofol and fIumazeniI was used to reverse the effect of midazolam. Perianaesthetic care was the same for both groups. In both groups we evaluated the operative condition [adequate, inadequate and poor] and the quality of recovery [recovery time, degree of sedation, cooperation and orientation to time and space]. We found that both propofol and midazolam offered an adequate operative anaesthetic condition needed for the procedure but the quality of recovery of propofol was better than that of midazolam even after fIumazenil administration reaching to a conclusion to leave the midazolam - fIumazenil technique to be used in the poor cardiovascular risk patients or in a situation where propofol is not available or contraindicated

Nitroglycerine transdermal patch, is it effective in blocking the pressor response to tracheal intubation and noxious stimulation in hypertensive patients?

Fourty hypertensive patients ASA II scheduled for elective surgical procedures requiring endotracheal intubation, were randomly allocated into two groups 20 patients each. Nitroglycerine transdermal patch was applied to the patients of the first group [Nitroglycerine group] and was not applied to the patients of the other group [control group]. The anaesthetic technique was standerised for patients of both groups.A significant rise in blood pressure occured after tracheal intubation and following skin incision in the control group, while no rise in blood pressure recorded in the other group in which patients pretreated with nitroglycerine transdermal patch. In both groups, either serum cortisol concentration and serum glucose level increased significantly after tracheal intubation and skin incision. We conclude that nitroglycerine transdermal patch is effective in blocking the pressor response to tracheal intubation and noxious stimulation in hypertensive patients but not effective in minimizing the rise of stress hormones released with these situations

Nitroglycerine transdermal patch, is it effective in blocking the pressor response to tracheal intubation and noxious stimulation in hypertensive patients?

Fourty hypertensive patients ASA II scheduled for elective surgical procedures requiring endotracheal intubation were randomly allocated into two groups 20 patients each. Nitroglycerine transdermal patch was applied to the patients of the first group [Nitroglycerine group] and was not applied to the patients of the other group [control group]. The anaesthetic technique was standerised for patients of both groups. A significant rise in blood pressure occured after tracheal intubation and following skin incision in the control group, while no rise in blood pressure recorded in the other group in which patients pretreated with nitroglycerine transdermal patch.In both groups, either serum cortisol concentration and serum glucose level increased significantly after tracheal intubation and skin incision. We conclude that nitroglycerine transdermal patch is effective in blocking the pressor response to tracheal intubation and noxious stimulation in hypertensive patients but not effective in minimizing the rise of stress hormones released with these situations