Assessment of midazolam, fentanyl, or neostigmine as an adjuvant to bupivacaine spinal anaesthesia

The aim of this study is to evaluate the postoperative analgesic and side effects of intrathecal midazolam, fentanyl, and neostigmine on bupivacaine spinal blockade. A total of 60 patients undergoing lower limb surgery were randomized to one of four groups. All patients received 10mg hyperbaric bupivacaine plus 2ml of the test drug intrathecally [1T]. The control group [B] received saline as the test drug. The midazolam group [BM] received 2mg midazolam, the fentanyl group [BF] received 20ug fentanyl, and the neostigmine group [BN] received 25ug neostigmine. Extent and duration of sensory and motor blockade were evaluated. Adequacy of analgesia and incidence of adverse effects were also recorded. The groups were demographically similar. The time required for first rescue postoperative analgesic was shorten in the control group compared to the other groups [p<0.001]. The frequency of postoperative analgesic intake was significantly more in control group [p<0.001]. Preoperative sedation was noted to be significantly higher in midazolam group. More patients in fentanyl group reported pruritus, whereas more patients in neostigmine group experienced nausea and vomiting than did the other groups. The mixtures of midazolam-bupivacane, fentanyl-bupivacaine, or neostigmine-bupivacaine intrathecally lengthened postoperative analgesic duration and reduce analgesic consumption postoperative, however making choice between the three drugs, side effects related to each one must he considered and careful monitoring is mandatory

Spinal anaesthesia versus combined sciatic femoral nerve block for knee arthroscopy

This study was designed to evaluate the duration required to perform anaesthesia, achieve surgical block and fulfill standardized discharge criteria for knee surgery with spinal anaesthesia versus combined sciatic femoral nerve block. fifty patients ASA 1-11 scheduled for knee hrartoscopy were randomized to receive either spinal anaesthesia with 4 mg of 0.5% hyperbaric bupivacaine [spinal group], or combined sciatic -femoral nerve block with 0.75% ropivacaine and a multiple injection technique [12 ml for femoral nerve block and 18 ml for sciatic nerve block]. Time lasting from skin disinfection to the end of local anaesthetic injection [performance time] and then to achieve surgical anaesthesia [readiness for surgery], time required for block resolution, as well as time for discharge were recorded. Occurrence of adverse events was also recorded. Performance time was longer with sciatic femoral block than spinal block while no differences were observed in the time required to achieve anaesthesia [mean time for sensory block was 6.2 +/- 1.5 min and 8.8 +/- 1.7 min in the spinal and sciatic femoral block respectively and that for motor block was 9.7 +/- 3.6 min and 10.5 +/- 3.5 min]. No differences in haemodynamic parameter or in the visual analogue scale. Patients in the spinal group showed faster resolution of nerve block however no significant differences were observed in the discharge time. Sciatic femoral nerve block with multiple injection technique using ropivacaine 0.75% provided adequate anaesthesia for knee arthroscopy as spinal anaesthesia with no differences in home discharge and less side effects

Can fluid preloading attenuate spinal induced hypotension in the elderly?

Physiologic is aimost associated with progressive loss of reserve in organ function. The objective of this study was to evaluate fluid preloading either by colloid, crystalloid or both on the incidence and frequency of spinal anesthesia induced hypotension in elderly patient. 60 patients scheduled for lower limb orthopedic surgery under spinal anaesthesia were randomly allocated to receive preload with either 6% hydroxyethyl starch 500 ml [Colloid group], 1000 ml lactated Ringer's [Crystalloid group], 500 mI lactated Ringer's plus 250 ml 6% hydroxyethylstarch [Combined group] or received no prehydration [No preload group]. ABP decreased significantly in the four groups after induction of spinal anaesthesia and it was significantly higher in the colloid goup than the other groups. The mean of ephedrine and incidence of hypotension was significantly lower in colloid group 3 of 15 [20%], compared with crystalloid 9 of 15 [60%], combined group 7 of 15 [46%] and no preload group 11 of 15 [73%]. intravascular administration in the four groups resulted in significant increase of CVP then decrease after spinal block. The use of colloid as a pre-emptive infusion is demonstrably effective to attenuate spinal anaesthesia induced hypotension in elderly patient as compared with crystalloid or no fluid preload. However, the incidence of hypotension was only reduced but not completely eliminated

Maternal and neonatal outcome after cesarean section: a comparative study between spinal anaesthesia and inhalational anaeshesia

This prospective comparative study was undertaken to determine the effect of the type of anesthesia for elective cesarean section on neonatal and maternal outcome. Forty-five ASA I-II women presenting for elective cesarean section were randomly assigned to receive either sevoflurane or isoflurane in a 50% N2O and O2 for maintenance of anesthesia or spinal anesthesia using 2.5 ml hyperbaric bupivacaine. Intraoperative hemodynamic variables and perioperative adverse events were recorded. Neonates were assessed by Apgar scores, neurological adaptive capacity scores [NACS], early neonatal neurobehavioral scale [ENNS], umbilical cord blood gas analysis and cortisol level. Maternal recovery times and time of analgesic request were recorded. From the results obtained, it was concluded that spinal anesthesia is as effective as general anesthesia with favorable maternal and fetal outcome and sufficient postoperative analgesia. Both inhalational agents were otherwise similar, but faster emergence and rapid recovery characteristic after maintenance of anesthesia with sevoflurane was observed. So, sevoflurane appears to be more satisfactory for cesarean section than isoflurane

Prospective randomized study of acute normovolaemic haemodilution versus induced hypotension on haemostatic markers and transfusion requirements in major orthopaedic surgery

Thirty patients scheduled for orthopedic surgery of the hip, femur or pelvis for sepsis or malignant tumors, all under general anesthesia, were randomly allocated to one of two groups: Acute normovolemic hemodilution group [ANH group] and hypotensive group [H group]. ANH was started after induction of general anesthesia. In H group, hypotension was induced and maintained using esmolol. Hemoglobin [Hb] and hematocrit [Hct] measures as well as coagulation variables were measured during perioperative period. Total blood loss of each patient was evaluated. The results revealed that homologous transfusion requirements were noted. In ANH group, Hb and Hct values were significantly decreased intra and postoperatively compared to H group. ANH caused significant decrease of platelet count and prolongation of activated partial thromboplastin time [aPTT] intra and postoperatively compared to H group. Significant more volume was infused in ANH group than H group. Patients in H group had significant lower blood loss and needed significant less allogenic blood transfusion

Propacetamol vs meperidine for analgesia during extracorporeal shock wave lithotripsy: a randomized double-blind study

As extracorporeal shock wave lithotripsy [ESWL] is carried out on an outpatient basis, it is crucial to choose an adequate analgesic with less adverse effects aiming to rapid post-ESWL discharge of patients. Propacetamol is a non opioid analgesic that seems to be suited to these goals because of its pharmacokinetics and pharmaco-dynamic characteristics. The safety and effectiveness of propacetamol use during ESWL in comparison to meperidine were evaluated in this study. Eighty patients with renal stones scheduled for ESWL procedure were randomly assigned to receive i.v. injection of either 2 gm propacetamol or 100 mg meperidine during ESWL without preoperative medications, according to a double-blinded protocol. Cardiorespiratory variables [respiratory rate, heart rate, mean arterial BP, peripheral O[2] saturation] were recorded before and every 5 min during ESWL and 15 min after the end of ESWL. During and after ESWL, patient arousal was assessed and nausea or vomiting were recorded. During ESWL an evaluation of effectiveness of pain management was done using 4 points scale: [0] No pain, [1] mild pain, [2] moderate pain, [3] severe pain. After ESWL the effectiveness of pain management was evaluated using 10-points visual analogue pain scale [VAS]. Gradual reduction of the mean blood pressure [MBP] was observed with meperidine use which became significant at 25 and 30 min after start of ESWL [p=0.003], while with propacetamol MBP was more stable. Also significant reduction of SpO[2] was observed with meperidine 10 min after the start of ESWL and even 15 min after the end of ESWL [p < 0.05], while it was insignificant with propacetamol. Respiratory upsets [short period of apnea with SpO[2] less than 90%], drowsiness, nausea and vomiting were observed with meperidine but not with propacetamol. Pain control during ESWL was not significantly different in both groups. The median value of pain scale was 0 [range 0 to 3] for group M and I [range 0 to 3] for group P [p = 0.25]. The mean value of VAS was [2.3 +/- 3.5] [range 0 to 10] for group M and [3.6 +/- 3.1] [range 0 to 8] for group P [p = 0.23]. Propacetamol is as effective as opioid-based analgesics yet it is safer and resulted in rapid discharge of patients following ESWL

Hemodynamic and oxygenation variables during radical cystectomy

The effect of anesthetics on hemodynamic variables [HV] has been clarified, but ambiguity existed concerning their effect on oxygenation variables [OV]. Radical cystectomy provided a clinical setting for studying the effect of anesthetics on perioperative HV and OV. Patients subjectd to radical cystectomy [n = 33] were assigned through balanced randomization to receive one of four anesthetic modalities, namely, group I: inhalation anesthesia using N[2] O:O[2],halothane, d-tubocurarine [n 11]; group II: inhalation anesthesia sing N[2] O:O[2], halothane, d-tubocurarine, and supplemented with epidural analgesia [EA] [n = 11]; group III: total intravenous anesthesia [TIVA] using ketamine 10-30 micro g. kg[-1]. min [-1], propofol 2 mg. kg[-1]. h [-1], d-tubocurarine, and supplemented with continuous EA [n = 6]: and group IV:TIVA using ketamine 20-50 micro g. kg[-1]. min [-1], midazolam in increments of 1.5 to 5 mg, and supplemented with intermittent EA [n = 5]. Monitoring entailed continuous ECG, pulse oximetry, invasive arterial pressure, and pulmonary artery catheter for HV [HR, MAP, PAP, PAOP, CO, SVR, and PVR] and OV [PaO[2], SaO[2], PvO[2], SvO[2], a-vDO[2], O[2]ext, Q[s]/Q[t], DO[2], and VO[2]]. The heart rate was lower in TIVA while other HV did not show striking differences. Group I showed higher arterial oxygen tension than group II and IV. Mixed venous oxygen tension and saturation were higher in group I over group IV. Other OV did not show remarkable differences. In conclusion, HV and OV in 4 anesthetic modalities did not elicit striking differences