Supraglottic versus subglottic analgesia for attenuation of sympathetic response to laryngoscopy and intubation

Sixty patients of ASA physical status 1 or II aged 20-40 years scheduled for elective surgery under G.A. were classified into 3 groups: group I [n=20] where no local aneasthetics were injected or sprayed. group II [n=20] in which a bilateral superior laryngeal block SLN block was done 5 minutes before intubation and group III [n=20] in which a transtracheal injection of 5 ml of 1% xylocaine through the cricothyroid membrane 5 minutes before intubation. In the 3 groups blood pressure and pulse rate was measured before induction after induction before intubation. 1, 3, 5 and 10 minutes after intubation .In group I the mean arterial pressure showed significant increase [96. 75 +/- 11.09] after intubation from its basal value [87.45 + 12.1]. Also the mean pulse rate showed significant increase after 3 min [11 0.2 +/- l0.49].In group II the rise in mean arterial b.p was insignificant after intubation [82.9+8.230 to 98.80+ 10.51]. Also the increase in pulse rate after intubation was insignificant: [95.75 +/- 20.3 to 98.8 +/- 10.5] In group III the mean arterial pressure showed 11 significant reduction after intubation from induction values 72.30 + 6.57 from 91.20 + 8.21. Also the pulse rate didn't change much 1 min. after intubation, although it showed a significant reduction after words: from [97.6 + 14.76 to 69.3 +/- 094] 10 minutes after intubation. In conclusion: the transtracheal injection of xylocaine produced a pronounced attenuation of intubation response and is superior to SLN block in that respect

Epidural fentanyl and 0.5 bupivacaine for elective cesarean section. Effects on shivering, maternal and neonatal outcome / bupivacaine for elective caesarean section. Effects on shivering, maternal and neonatal outcome.

The aims of this study were to investigate whether 100 microgram fentanyl administered prophylactically by the epidural route would influence the incidence of shivering in parturients who underwent elective caesarean section under epidural analgesia and whether it would affect the maternal and neonatal outcome. Forty mothers of ASA physical status I or II presenting for elective Caesarean section were divided into two equal groups according to type of solution injected in the epidural space. Patients of Group A received 100 microgram fentanyl in addition to 0.5 percent bupivacaine while patients of group B received 0.5 percent bupivacaine alone. Shivering occurred in 20 percent of patients of group A and in 70 percent of patients of group B. There was 72 percent reduction in the incidence of shivering in mothers receiving epidural 100 microgram fentanyl with no further adverse actions on maternal and neonatal outcome. None of the neonates required resuscitation and there was no immediate or delayed respiratory depression in mothers. Only two mothers who received fentanyl required analgesic supplementation during surgery compared with ten mothers who did not receive epidural fentanyl. Another finding in our study was the markedly prolonged post-operative analgesia in patients of group A compared with group B. So, it can be concluded that the addition of 100 microgram fentanyl in the epidural space prophylactically in elective Caesarean section reduced significantly the incidence and severity of shivering and significantly improved operative comfort and duration of post-operative analgesia with no deleterious effects on neonatal and maternal outcome