Sevoflurane: an immunological safe anaesthetic agent?

In this work, evaluation of the effects of sevoflurane on some immune functions of surgical patients was tried. Assessment of the specific component of humoral immunity was carried out by estimation of serum immunoglobulins. The non-specific component of humoral immunity was assessed by estimation of the complement component C3c. Estimation of the total and differential leucocytic counts and the calculation of NBT-positive cells in "unstimulated NBT-reduction test" were used to assess the non-specific component of cell-mediated immunity. The study was conducted on 20 selected patients who underwent minor surgical procedures. Induction of anesthesia was carried out by using the single-breath inhalation technique with 8% sevoflurane, until successful insertion of cuffed oropharyngeal airway [COPA]. Anesthesia was maintained with 2% sevoflurane in a gas mixture of oxygen and N2O in a ratio of 1:1 via Bain circuit. The results showed that there was a decrease in levels of complement component C3c and phagocytic function under anesthesia and after surgical stimulation and postoperative. Serum Ig levels showed an increase under anesthesia and after surgery. While, there was a post- induction leucopenia. At the end of the operation and postoperatively there were significant leucocytosis, neutrophilia and lymphopenia

High dose rocuronium or cisatracurium is a reliable alternative to succinylcholine for rapid sequence intubation

Endotracheal intubation conditions after 60 seconds following intravenous administration of succinylcholine [1 mg/kg, n=20], rocuronium [1.2 mg/kg, n=20], cisatracurium [0.15 mg/kg, n=20], or cisatracurium [0.2 mg/kg, n=20] were evaluated and compared. No significant differences were found between the doses of the three drugs. Intubation conditions were characterized as excellent or good in 90% of patients received cisatracurium 0.15 mg/kg and in 95% of patients received succinylcholine 1 mg/kg, rocuronium 1.2 mg/kg or cisatracurium 0.2 mg/kg. High dose rocuronium 1.2 mg/kg, cisatracurium [0.15-0.2 mg/kg], provides satisfactory intubation conditions after 60 seconds and can be used safely instead of succinylcholine for rapid-sequence intubation when a long duration of neuromuscular blockade is acceptable. High dose rocuronium superior to high dose cisatracurium, if rapid onset is concerned, however cisatracurium has a shorter duration of action

Efficacy of melatonin versus clonidine as premedication on the propofol injection pain and salivary kallikrein response to tracheal intubation in adults

Ninety patients ASA I or II scheduled to undergo elective surgery had been included in this study. The patients were randomly allocated to receive one of three treatment prior to induction of anaesthesia with propofol. Melatonin group [=30] received 0.1 mg/kg[-1] melatonin, clonidine group [=30] received 5.5 microg/kg[-1] clonidine and control group [=30] received placebo. All premedicants were dissolved in 3 ml syringe and given sublingually 90/min before induction of anaesthesia. After pretreatment the incidence of propofol injection pain was 26.67% [8 of 30] in melatonin treated group. 30% [9 of 30] in the control group. Additionally, both melatonin and clonidine resulted in shifting a considerable number of patients from the category of sever pain towards a lower category of moderate and mild pain. In the current study [SK] levels showed a mirror image elevation resembling that course of elevation of norepinephrine after tracheal intubation. Our result revealed that both melatonin and clonidine were effective in reducing both norepinephrine and [SK] level at 9, 12, 15 and 30 minutes after intubtion compared to placebo. Clonidine reduced norepinephrine and [SK] to a significant level through whole the study compared to melatonin. We can concluded that melatonin could be used safely as a premedicant for reducing the incidence and severity of propofol injection pain and [SK] estimation reflects the sympathetic stimulation state after endotracheal intubtion in adults

Comparative efficacy and safety of p6 acupressure versus ondansetron in preventing nausea and vomitingafter laparoscopic cholecystectomy

We have evaluted the antiemetic effect of P6 acupressure compared with standard doses of commonly used prophylactic antiemetic [ondasetron 4mg i.v.] in the prevention of nausea and vomiting after laparoscopic cholecystectomy. We studied Sixty patients requireing general anaethesia for laparoscopic cholecystectomy in a randomized, placebo-controlled study. The anaesthetic technique and postoperative analgesia were standardized. Failure of treatment was defined as the occurrence of nausea and /or vomiting within the first 24h after anaesthesia. Data analysis showed that both P[6]acupressure and ondansetron [4mg i.v.] significantly reduced the incidence of nausea and vomiting from 48% to 16% and 19% respectively compared to placebo. Other variables were similar between groups. We conclude that P[6]acupressure is effective, safe procedure and considerably economic in preventing nausea and vomiting after laparoscopic cholecystectomy