Hemodynamic response of low dose bupivacaine with fentanyl spinal anesthesia in elderly patients

To determine whether a reduced dose of bupivacaine in combination with fentanyl could give reliable block with greater hemodynamic stability in elderly patients. Quasi experimental study. Department of Anaesthesiology, Intensive Care and Pain Management Combined Military Hospital Rawalpindi. One year duration, from May 2006 to April 2007. ASA I-III elderly patients [n=60] undergoing surgery for fracture neck of femur, meeting the inclusion and exclusion criteria. Sixty elderly patients were randomized in two groups. The study group [group-A] received spinal anesthesia as a combination of hyperbaric bupivacaine 7.5 mg and fentanyl 15 µgm while the control group [group-B] received hyperbaric bupivacaine 15 mg. The hemodynamic stability of the patients and the quality of the blocks were compared. All patients had adequate duration of block. There was no significant difference in the change of heart rate between the two groups. Fall in blood pressure was more pronounced in the control group [group-B] patients requiring more ephedrine as compared with the study group [group-A] patients which remained more hemodynamically stable. A reduced dose of hyperbaric bupivacaine in combination with fentanyl provides reliable spinal anesthesia in elderly patients with few events of hypotension and little need for vasopressor support of blood pressure.

Comparative study of intubating conditions after Rocuronium and Suxamethonium [study of 50 cases]

To compare the Intubating Conditions and Changes in heart rate [HR] achieved after suxamethonium chloride and rocuronium bromide, during intubation, in patients between ages 11-50 years out of which 4 were in paediatric age group [11-12 years] and 46 in adult group [19-50 years]. This study was conducted at the Armed Forces Hospital Sharourah kingdom of Saudi Arabia during six months period starting from 01/02/09. Fifty patients aged between 11-50 years, 4 including in paediatric age group [11-12 years] and 46 in adult age group [19-50 years], requiring general anesthesia for various surgical procedures, were randomly divided into two groups, i.e. Group A in which Rocuronium bromide, 0.9 mg kg-1 was given for intubation [[n=25] [23 adults, 2 children]] Group B in which Suxamethonium chloride 1.5 mg kg -1 was used for intubation [[n=25] [23 adults, 2 children]] Intubating conditions were observed at 60 seconds after intravenous bolus administration of suxamethonium or Rocuronium. HR was also observed immediately before induction [Pre-Op], at 60 seconds after bolus of Suxamethonium or Rocuronium [Immediately after relaxation], Immediately after intubation and then five minutes after intubation. Intubating conditions were rated as excellent in 96% [n=24 Twenty two adults two children] and good in 4% [n=1 Adult] of the patients who received Rocuronium and excellent in 100% of the patients who received Suxamethonium. There were no statistically significant changes observed in HR at all observation times between the two groups. It is concluded from this study that intubation can be performed under good to excellent conditions at 60 seconds after a bolus dose of Rocuronium of 0.9 mg kg-1. As far as affect on HR are concerned, our study indicate no significant difference between the two drugs. The result of this study indicates that to facilitate intubation using rapid sequence induction technique Rocuronium is a reasonably good alternative to Suxamethonium

Intensive care management after inadvertent intravascular injection of liquid paraffin

Medication errors in the hospitals are not uncommon even in the developed countries. A 30 years old lady was admitted with 32 weeks pregnancy with gastroenteritis followed by intrauterine death. In the high dependency unit of obstetric department, accidentally 50 milliliters of liquid paraffin was administered intravenously. With 12 days of vigorous treatment comprising mechanical ventilation with positive end-expiratory pressure, an emergency hysterotomy to avoid the complications of intrauterine death; 3 cycles of plasmapherisis; and ultimately broncho-alveolar lavage, her condition improved and she was discharged from hospital

Comparison of intra-articular pethidine and neostigmine for postoperative analgesia in patients undergoing knee arthroscopy

Traditionally local anesthetics such as bupivacaine along with systemic analgesics have been used for postoperative analgesia after knee arthroscopy but it has a short duration of action. Recently, neostigmine a cholinestrase inhibitor has shown analgesic actions when used intrathecally but this central delivery of neostigmine is associated with side effects. Same is the case with central actions of pethidine. Both drugs also have a peripheral analgesic effect. The purpose of this study was to compare the peripheral analgesic effects of intra-articular neostigmine and pethidine used separately in patients undergoing knee arthroscopy. Fifty American Society of Anesthesiologist [ASA] class I and II patients, scheduled for diagnostic knee arthroscopy were allocated randomly in two groups. A standard anaesthetic technique was used. No systemic analgesic was administered. At the end of arthroscopy group I received intra-articular neostigmine 500 mg diluted in 30 ml of normal saline and group II received 50 mg pethidine diluted in 30 ml of normal saline. Postoperative analgesia was assessed by Pakistan Coin Pain Scale at 1, 4, 8, 24 and 48 hours. If required, rescue analgesia was given as intravenous Inj. pethidine. Pakistan Coin Pain Scale Scores were lower throughout in the neostigmine group as compared with pethidine group [p < 0.05]. The requirement of rescue analgesia was also lower in neostigmine group as compared to pethidine group [p < 0.05]. Intra-articular administration of 500 mg of neostigmine in patients under going knee arthroscopy has superior analgesic effect as compared to 50 mg of intra-articular pethidine

Predicting difficult intubation - a comparison between Mallampati classification and Wilson risk-sum

To compare the Mallampati classification and Wilson risk-sum and adopt a predictive rule in our setup that has better results. An analytical study. The main Operation Theatre of Combined Military Hospital, Rawalpindi from 1st September to 31st December 2000. Three hundred and thirty-eight patients were evaluated pre-operatively for difficult intubation using both the tests. The sensitivities, specificities and positive predictive values [PPV] were determined in grading the laryngeal view in each case during direct laryngoscopy. Both tests identified only 3 out of 7 difficult intubations, giving a similar sensitivity of 0.42. Twice as many patients were predicted to be difficult by Maflampati classification than by Wilson risk-sum [specificity 84% and 93%]. The Wilson risk-sum had better positive predictive value [11%] as compared to 5% of Mallampati classification. The Wilson risk-sum had preferred for assessment of the airway because of its better specificity and positive predictive value while noting that both tests have poor sensitivities when used alone