Managing IOP in open eye injury repair: evaluation of a suggested technique

Background: No single technique is ideal for anesthetizing an open eye injury repair operation. In this study, succinylcholine is [again] challenged versus a combination of relaxants that may offer the ideal solution

Patients and Methods: Two groups of adult patients [25 each] were given either succinylcholine 1.5 mg/kg, or a combination of mivacurium 0.15 mg/kg and rocuronium 0.45 mg /kg as a part of anesthesia before repair of open eye injury. A rapid onset and a short duration of action of that combination without increase in IOP is challenged. To the best of our knowledge, no one has used this combination for managing. IOP in anesthesia for open eye injury repair

Results: showed that the mentioned combination could produce a comparable onset and intubating conditions without much increase in IOP after intubation. A rapid recovery rate [short recovery index] despite of a longer than expected duration of action, reflected easy reversibility

Conclusion: though a short duration of that combination was not achieved [as claimed in previous studies], yet a fast onset, excellent intubating conditions without increase in IOP and easy reversibility [meaning a controlled duration of action], nominated that combination as a suitable alternative for succinylcholine before intubation in open eye injury repair procedures without much increase in IOP or duration of action

Intrathecal clonidine as a sole analgesic agent during the first stage of labor:maternal and fetal effects a dose response study

Intrathecal clonidine mimics the activation of the descending noradrenergic pathways and produces analgesia by a specific action on post-synaptic alpha 2 adrenoceptors thus inhibiting dorsal horn neurone firing [1]. It produces dose dependent postoperative analgesia and enhances labor analgesia with intrathecal narcotics. The authors evaluated the dose-response potency of intrathecal clonidine alone during first stage of labor with the respect to analgesia and maternal and fetal side effects. Forty-five parturients were included in this prospective, randomized, double-blind study. Parturients with less than 6-cm cervical dilatation received 30, 60, or 180 micro g intrathecal clonidine. The authors recorded visual analog pain score [VAS], maternal blood pressure and heart rate, ephedrine requirements, and sedation at regular intervals and fetal heart rate tracings continuously. Duration of analgesia was defined as time from intrathecal clonidine administration until request for additional analgesia. clonidine produces a reducion in VAS with all three doses. The duration of analgesia was significantly longer in patients receiving 180 micro g [median, 135; range, 60-200 min] and 60 micro g [median, 120.6; range, 60-l80 min] than 30 micro g [median, 58.4; range, 22-150 min], and VAS was lower in the 180-micro g group than in the 30-micro g group. In the 180-micro g group, hypotension required significantly more often treatment with ephedrifle than in the other groups. No adverse events or fetal heart rate abnormalities occurred. Thirty to 180 micro g intrathecal clonidine produces dose-dependent analgesia during first stage of labor. Although duration and quality of analgesia were more pronounced with 60 and 180 micro g than with 30 micro g, high incidence of hypotension requires caution with the use of 180 micro g for labor analgesia

Tropisetron versus acupuncture in prevention of postoperative vomiting in children undergoing outpatient strabismus correction

This study compared the antiemetic effect of tropisetron with that of acupuncture and placebo. Ninety children who underwent squint surgery were randomly allocated into one of three equal groups to receive 0.1 mug/kg tropisetron, acupuncture or placebo. The incidence of emetic episodes was recorded. A significant difference was found in the number of patients who vomited and the total number of emetic episodes when comparing the two treatments groups with placebo group. It was concluded that traditional Chinese acupuncture is a valid non- pharmacological alternative antiemetic treatment that can be recommended as a prophylactic technique in children undergoing squint surgery

Intrathecal ropivacaine and clonidine for ambulatory knee arthroscopy

The aim of this study was to compare intrathecal ropivacaine at different doses with that after the addition of clonidine. A prospective double blinded, computer randomized study was conducted on 150 patients, classified as American Society or Anesthesiology physical status 1 and scheduled for knee arthroscopy. The patients were randomly assigned to receive 4 ml of the following double blinded isobaric solution: 8 mg of ropivacaine [group 1, n = 30], 12 mg of ropivacaine [group 2, n = 30], 8 mg of ropivacaine plus 15 mug clonidine [group 3, n = 30], 8 mg ropivacaine plus 45 mug clonidine [group 4, n = 30] and 8 mg ropivacaine plus 75 mug clonidine [group 5, n = 30]. The level and duration of sensory anesthesia were recorded along with the intensity and duration of motor block. The patients were interviewed to identify the transient neurologic symptoms. The study concluded that ropivacaine 12 mg alone produces an adequate quality of anesthesia, but sensory and motor blockade are prolonged. So, a small dose of intrathecal clonidine [15 mug] plus 8 mg intrathecal ropivacaine produces an adequate and short-lasting anesthesia for knee arthroscopy