Tracheal intubation using propofol and adjuvants without muscle relaxants

We have assessed tracheal intubating conditions in 80 ASA I or II patients after induction of anaesthesia with propofol 2.5 mg/kg and midazolam 5 mg or remifentanil 2 micro g/kg with or without iv lignocaine 1 mg/kg. No neuromuscular blocking agents were administered. Patients were allocated randomly to four groups: group I midazolam 5 mg - propofol, group II lignocaine 1 mg/kg - midazolam 5 mg - propofol, group III remifentanil 2 micro g/kg - propofol, group IV lignocaine 1 mg/kg - remifentanil 2 micro g/kg -propofol. In all groups baseline MAP and HR [awake], after induction, immediately after tracheal intubation and 3, 5 min after tracheal intubation values were recorded. Intubating conditions were assessed as excellent, good or poor on basis of scoring system dependent on ease of laryngoscopy, vocal cord position and coughing on insertion of tracheal tube. Intubating conditions were good to excellent in 70%, 90%, 80% and 100% of patients in groups I - IV, respectively. Intubating conditions were better and there was less coughing in lignocaine groups. The mean time to resumption of ventilation after induction was less than 4 min in groups I and II and less than 5 min in groups III and IV. The MAP decreased significantly P < 0.05 after induction of anaesthesia in all groups and remained lower than baseline values in groups III and IV at all times. The HR decreased significantly P < 0.05 after induction of anaesthesia in groups III and IV and ramined lower than baseline values throughout the investigation

Tramadol-bupivacaine versus ketamine-bupivacaine to improve epidural anaesthesia

The study included 45 patients undergoing lower ureteric surgery. The patients were allocated randomly to three equal groups to receive epidural injection of 0.5% bupivacaine [18 ml] with tramadol 100 mg, 0.5% bupivacaine [18 ml] with ketamine 40 mg in 2 ml saline or 0.5% bupivacaine [18 ml] plus 2 ml saline. Onset, duration and quality of anaesthesia, haemodynamic variables, postoperative analgesic requirements and side effects were recorded. The tramadol group recorded the most rapid onset, the most prolonged duration and the highest quality of anaesthesia. It also, provided significantly more prolonged postoperative analgesia when compared with the ketamine and the bupivacaine groups. The ketamine group provided better quality, more rapid onset and longer duration of anaesthesia compared with the bupivacaine group with more prolonged postoperative analgesia.But, it was also associated with some adverse effects as hallucinations which limits its epidural application. The results suggest that the addition of tramadol to epidural bupivacaine can significantly improve the quality of anaesthesia with significant prolongation of the postoperative analgesia without serious side effects