Management of vasospasm in a neurosurgical center / Management of vasospasm in a neurosurgical center

Background: Cerebral vasospasm after subarachnoid hemorrhage remains a major source of morbidity and mortality. Various agents have come into vogue to deal with this complication but none has shown any absolute results. We conducted this study to asses the effectiveness of intracisternal lavage of papavarine both prophylactically and therapeutically in a simple cost effective way. Methods: This is a retrospective analysis of patients who were admitted at our institution between January 2002 and July 2003. Eighty five patients with anterior circulation aneurysmal bleed who underwent microsurgical clipping were divided into two groups. Group A: patients who received papavarine through a reservoir and Group B patients who did not receive papavarine. The location of aneurysm, timing of surgery , incidence and outcome of vasospasm were assessed in the patients in two comparable groups. Results: 13 por ciento of patients in Group A developed vasospasm whereas 38 por ciento of patients in Group B developed vasospasm. Symptoms of vasospasm reversed in all patients in Group A. There were 3 deaths in Group A but none where attributed to vasospasm. Four of seven deaths in Group B were attributed to consequence of vasospasm. Eleven patients who survived in Group B in spite of vasospasm had significant morbidity at the time of discharge. Conclusion: Intracisternal lavage with papavarine both prophylactically and theraputically can prevent and reverse vasospasm and this can be achieved by installing a simple reservoir. It is a cost effective and rapid bedside procedure for dealing with vasospasm

Propofol for pediatric radiotherapy.

OBJECTIVE: Pediatric radiotherapy is a day care procedure. In children, anaesthesia is necessary to prevent movement during the therapy. Traditionally intramuscular ketamine is used for these procedure because of its inherent safety in a child who used to be left alone in the cobalt room. METHODS: This study was designed to explore the efficacy of propofol and ketamine in pediatric radiotherapy in nineteen children. The inclusion criteria was a child fasting for six hours with no fever or URTI in the past week. A child coming to the radiotherapy (RT) unit without an intravenous cannula was given intramuscular ketamine 10 mg/kg and taken for the procedure. Before the child recovered from anaesthesia an intravenous cannula, 20-22G, Vasofix was inserted for subsequent sittings of RT. The child coming with an intravenous cannula was given propofol 2.5 mg/kg with xylocaine (0.1 mg/kg) without adrenaline. The parameters recorded were pulse rate, oxygen saturation and respiratory rate-baseline to every 30 seconds till five minutes. Onset time, recovery time, oral feeding time and any untoward effects like nausea, vomiting, nystagmus were also noted. RESULT: The drug was graded on a scale of 0-10 according to parental acceptability where 0 is the worst and 10 is the best acceptability. The mean (+/-SD) of all the measured parameters were calculated and compared between the two groups. CONCLUSION: Propofol was associated with faster onset, better recovery, early oral feeding time, no nausea and vomiting and better parental acceptability. There was no hypotension, bradycardia and oxygen saturation at 60 seconds, which was between 94-95%, was easily treatable with supplementation of oxygen by face mask.