Comparison of acid reducing property of tramadol and ranitidine given before cesarean section under general anesthesia

Intramuscular tramadol has been shown to reduce gastric acid secretion. We aimed to investigate its role in reducing the gastric acid contents and compared it with ranitidine in patients undergoing elective cesarean sections under general anesthesia. Sixty ASA-II parturients undergoing elective cesarean section were included in a randomixed double-blind study. The patients were randomly allocated to receive either tramadol 100 mg [n=30] or ranitidine 50 mg IM [n=30] 1 hour before general anesthesia. Gastric contents were collected using blind gastric aspiration after induction and at the end of the procedure. The patients receiving tiamadol had a lower, mean gastric fluid pll after induction and before recovery as compared to patients treated with ranitidine [3.5 +/- 1.7 vs. 5.8 +/- 1.5], and the difference was significant [P value=0.001]. A significantly higher proportion of newborns had a lower APGAR at 1 min in tramadol group as compared to ranitidine group [P value= 0.026] Nalbuphine consumption in first 12 hours after operation was reduced in the tramadol group. There was no significant difference in the incidence and severity of nausea, vomiting or any other side effect between the two groups. In comparison with ranitidine, the administration of tramadol in patients undergoing elective cesarean sections under GA resulted in significantly greater volume and acidity of the gastric contents, lower neonatal APGAR at 1 minute, reduced post operative opioid consumption and no change in the frequency of PONY

Scabies; safety of permethrin and ivermectin

Scabies is a common health problem worldwide. Most treatment modalities available are topical. Among them 5% Permethrin is the most effective scabicide with few side effects. Limiting factors are its high cost, cumbersome application and emerging resistance. Ivermectin is the only oral scabicide available. It is effective, inexpensive and easy to use drug with no known drug interactions and limited side effects. To compare the safety of topical Permethrin and oral Ivermectin in treatment of scabies. Quasiexperimental study. Setting: Department of dermatology Jinnah Hospital, Lahore. Subjects: 120 patients were enrolled and were randomly divided in 2 groups of 60 each.-12-02-07 to 31-01-08. Non funded study [As ivermectin was not available in Pakistan during the study period, it was imported from India as tablet Ivecop 12 mg]. Topical Permethrin and oral Ivermectin were used in groups A and B respectively. Patients were examined and certain investigations were carried out before dug administration, and at day 7 and day 14 to evaluate the safety of both drugs on the basis of appearing of side effects and change in baseline investigations. In both groups, equal number of patients experienced side effects [n=15]. In group A, side effects observed were burning [n=8], contact dermatitis [n=4] and stinging [n=3]. In group B, we observed muscular pain [n=5], nausea [n=5], headache [n=2] and others [n=3]. Significant rise of hepatic enzymes was noticed in only 1 patient of group B which improved on next follow up. We found no statistically significant difference regarding safety of use between permethrin and ivermectin

Effect of injecting saline into epidural space before catheter insertion on frequency of intravascular placement

The objective of the study was to determine if injecting 10 ml saline before threading epidural catheter can decrease the accidental intravascular placement in epidural space. Interventional: experimental study. Department of Anaesthesia, Hameed Latif Hospital Lahore, affiliated with College of Physicians Surgeons Pakistan, from September 2008 to August 2009. One hundred healthy women requesting Epidural labour analgesia were prospectively randomized to receive either no epidural injection [dry group, n = 50] acting as a control or epidural 10 ml saline injection [saline group, n = 50] before epidural catheter placement. A nylon multiport catheter was then threaded 3 cm into the epidural space and the needle was removed. We diagnosed iv catheter placement if blood was freely aspirated, or if the mother became tachycardic after injection of epinephrine 15 microg. The groups were similar in age [P value=0.32]. We identified iv catheter placement in 2/50 saline group and 7/50 dry group patients [4% vs 14%, P value= 0.16]. Intravenous catheter placement was identified by initial blood aspiration [two saline, seven dry group patients]. No anesthetic complications occurred, including hypoxemia,patient complaint of difficulty swallowing, intrathecal catheter placement, respiratory arrest, or subsequent iv or intrathecal catheter migration. Our study results have shown that injecting 10 ml saline before threading epidural catheter has insignificant effect on decreasing the accidental intravascular placement in epidural space