ABSTRACT
We compared general anesthesia [GA] with spinal anesthesia [SA] foroutpatient knee arthroscopy. Fifty patients were randomized to receive either sevoflurane in a mixture of nitrous oxide [60%] in oxygen with laryngeal mask, or 30 mg of lidocaine 1% spinal anesthesia. All patients received premedication with intravenous [iv] lornoxicam 8 mg and at theend of the operation; patient's knee joint was injected with 1 ug/kg cloni-dine diluted in 20 ml of 0.25% bupivacaine. Postoperatively, iv fentanyl was given if visual pain scale [VAS] at rest exceed 4 and on discharge from the hospital, patients were instructed to take lornoxicam 8 mg tablet every 12 hour [h] as needed for pain. Perioperative vital signs, intraoperative time intervals, duration in the recovery and discharge times were re-corded. Postoperatively, we also evaluated pain and sedation scores, to-tal analgesic requirements, patient satisfaction, and incidence of complications [nausea, vomiting, pruritus, positional headache, backache,difficulty voiding, and dizziness]. We found that in the recovery, no patients in either group asked for analgesia. VAS pain scores were very low in both groups [2.6 +/-0.8 in GA group versus 2.4 +/-1.0 in SA group after60 min postoperatively]. There were no significant differences between both groups as regards total analgesic consumption during 72h postoperatively, and sedation scores. Patients in SA group had longer time of operating room [OR] entry until starting skin preparation [13 +/-4.5 versus 5.2+/-3.1 min] and also, from OR entry until skin incision [16 +/-5.2 versus 10.9 +/-4.7 min] in comparison with patients in GA group. However, the total duration inside OR was not different between both groups. Patients received SA had met the criteria for home readiness earlier than those received GA [68.3 +/-44 versus 95.2 +/-33 min respectively]. Patients in GA group suffered more nausea than in SA [24% vs 8% respectively]. The incidences of other side effects were comparable in both groups and there were no differences in patients' satisfaction scores between groups. We concluded that the two techniques with the multimodal analgesia given had provided comparable patient satisfaction and efficiencies both intra-operatively and postoperatively with low incidence of complications
ABSTRACT
In this study, we evaluated the efficacy and safety of an epidural single dose of fentanyl alone, or, in combination with clonidine, or, and neostigmine to provide selective and balanced analgesia during first stage of labor. Eighty healthy parturients were randomly allocated to receive, after a test dose, a single epidural injection of either 125 ug fentanyl, 50 ug fentanyl plus 75 ug clonidine, 50 ug fentanyl plus 500 ug neostigmine, or a combination of epidural 50 ug fentanyl plus 75 ug clonidine and 500 ug neostigmine was given in a total volume of 12 ml. Pain score, onset and duration of analgesia were determined. Maternal and fetal vital parameters as well as side effects were closely monitored. We found that a combination of epidural fentanyl 50 ug with 75 ug clonidine, or, 500 ug neostigmine, produced effective analgesia in 50% of parturients within 10 min and in 60% within 20 min with average duration of 105 and 121 min respectively. But whom received 125 ug fentanyl alone had delayed onset of analgesia "10% of parturients within 10 min and 50% within 20 min" with shorter duration of analgesia "average 87.6 min". However, combination of epidural 50 ug fentanyl with 75 ug clonidine and 500 ug neostigmine had resulted in rapid onset of analgesia "50% of parturients within 10 min and in 75% within 20 min" with average duration of analgesia 123.9 min. We also found that with any combination of the studied dugs, there was ropivacaine sparing effect and no motor block was observed. Maternal sedation in 25% of parturients received epidural 125 ug fentanyl. Maternal hypotension in 25% of parturients received fentanyl and clonidine. However, we observed that epidural neostigmine counteracts hypotension induced by epidural clonidine. Nausea and vomiting were not significantly higher between parturients received epidural neostigmine in comparison with whom did not. No adverse effects had been seen on the fetus and fetal vital parameters remained stable during labor in all of the studied groups
ABSTRACT
This study was designed to investigate the diagnostic and prognostic values of serum procalcitonin concentrations "PCT' in comparison with other bacterial infection markers e.g. C-reactive protein concentrations "CRP" and microbiological cultures of protected specimen brush "psb" in patients with respiratory failure due to acute exacerbations of chronic obstructive pulmonary disease "COPD". We deemed that PCT concentrations could be used as a guide to reduce antibiotic overuse in these patients. Fifty-nine patients with acute respiratory failure due to exacerbations of COPD on mechanical ventilation were divided into two groups. PCT group "30 patients" were given antibiotic only if PCT concentrations were above 0.5ug/L and standard group "29 patients" were given antibiotic according to the physician opinion regardless of PCT concentrations levels. PCT guided antibiotic use resulted in reduction of antibiotic use by 46% without worsening the outcome in comparison with the standard group. Also, PCT was a good tool in diagnosis of bacterial infection as reflected by a higher PCT concentrations in patients with positive bacterial cultures of psb of the lower respiratory tract. 29 of 59 patients [49%] had positive bacterial growth, of them 28 patients were had high PCT concentrations "more than 0.5 ug/L" and only one patient had PCT concentration less than 0.5 ug/L. Patients with high PCT concentrations were also had significant leucocytosis in comparison with patients with low PCT concentrations "white blood cell count [13.2 +/- 9.4 vs 8.2 +/- 6.71 x 109/L respectively". CRP was also higher in patients with high PCT concentrations in comparison with patients who had low PCT concentrations [99.4 +/- 96.5 vs 94.7 +/- 103.2mg/L respectively], but the difference was not statistically significant. Also, PCT concentrations declined earlier than CRP after proper treatment of bacterial infection. PCT levels reached physiological concentrations within 10 -15 days while CRP was still above normal range, which means that PCT was of better diagnostic and prognostic values in patients with acute exacerbations of COPD on mechanical ventilation