Prophylactic antiemetic effects of midazolam, dexamethasone, and its combination after middle ear surgery

To evaluate and compare the efficacy of the combination of midazolam and dexamethasone, with midazolam and dexamethasone alone, for the prevention of postoperative nausea and vomiting [PONV] in female patients undergoing middle ear surgery. A prospective, randomized, double-blind, placebo-controlled study in 80 female patients [mean age 32.6 years], undergoing middle ear surgery with general anesthesia at Ohud Hospital, Madina, Kingdom of Saudi Arabia from May 2007 to May 2008. Patients were classified into 4 groups. They received intravenous normal saline [S group], midazolam 0.075 mg/kg [M group], or dexamethasone 10 mg [D group], or a combination of midazolam and dexamethasone [MD group], before the induction of anesthesia. Postoperatively for 24 hours observation and assessment of nausea, vomiting, rescue anti-emetics, and side effects of the study drugs such as headache and drowsiness were carried out. There was a significant difference between the 4 groups. The MD group was the least to develop PONV compared to other groups [p<0.01]. Regarding nausea, there was a non-significant difference between the 4 groups, although the MD group developed the least symptoms among the 4 groups, there were no significant differences in pain intensity and side effects such as, headache, dizziness, and drowsiness between the 4 groups. The combination of midazolam 0.075 mg/kg and dexamethasone 10 mg intravenously is better than either drug alone in reducing the incidence of PONV in female patients after middle ear surgery

new analgesia protocol for cataract surgery

Our objective was to describe the safety and efficacy of a new analgesia protocol that enables the surgeon to maintain control over an alert patient experiencing seemingly painless ambulatory cataract surgery, while eliminating the risks and side effects associated with general, local, and intracameral anesthesia. This study was carried out on two thousands cataract surgery cases. This technique produces profound ocular analgesia, avoiding any undesired sedative effects, using very low-dose, titrated, intravenous alfentanil. Complete control of the uncooperative patient, including lid squeezing and ocular and genera! body movements, is obtained whenever necessary using very low-dose, titrated, intravenous propofol. Success was defined as surgery completed in a controlled manner without the need to convert to general, local, or intracameral anesthesia and the patent's experience being perceived as pain free. One thousand nine hundred ninety-five [99.75%] of the cases were successful without ever deviating from the protocol. This analgesia protocol offers advantages for cataract surgery. It virtually eliminates the morbidity of cataract surgery associated with other anesthesia techniques while providing excellent and reliable control with minimal side effects. It allows for an immediate postoperative recovery with instantaneous vision restoration. These patients are generally awake, alert, and retain their protective reflexes

Evaluation of the dose - response potency of intrathecally administered clonidine by itself during first stage of labor with respect to analgesia and maternal and fetal side effects

Intrathecal clonidine produces dose-dependent postoperative analgesia and enhances labor analgesia from intrathecal sufentanil. We evaluated the dose-response potency of intrathecally administered clonidine by itself during first stage of labor with respect to analgesia and maternal and fetal side effects. Forty-five parturients requesting labor analgesia were studied. In a combined spinal-epidural technique, patients with <5 cm cervical dilatation were assigned to receive one of the following intrathecal solutions: either 75 micro g clonidine [n = 15]; 150 micro g clonidine [n = 15]; and 250 micro g clonidine [n = 15]. Visual analog scores for pain, blood pressure, heart rate, ephedrine requirements, sensory levels, incidence of nausea, pruritus and sedation, fetal heart rate tracings continuously, and maternal and cord blood concentrations of clonidine were recorded. Duration of analgesia was defined as time from intrathecal clonidine administration until request for additional analgesia. We found that clonidine produced a reduction in VAPS with all three doses. The duration of analgesia was significantly longer in patients receiving 250 micro g [median, 150; range, 85-220 min] and 150 micro g [median, 120; range; 65-190 min] than 75 micro g [median 50; range, 30 - 160 min], and VAPS was lower in the 250 micro g than in the 75 micro g group. As regards the sensory levels, no patient in any group had sensory changes above T[3]. In the 250 micro g group, hypotension required significantly more often treatment with ephedrine than in the other groups. Also, bradycardia and sedation were more in 250 micro g group than the other two groups. No adverse events or fetal heart rate abnormalities occurred. Clonidine levels were undetectable in maternal and cord serums. In conclusion, the current study showed that 75 micro g to 250 micro g intrathecal clonidine produces dose-dependent analgesia during first stage of labor. Although duration and quality of analgesia were more pronounced with 150 and 250 micro g than with 75 micro g, the high incidence of hypotension, bradycardia and sedation requires caution with the use of 250 micro g for labor analgesia

Safety and efficacy of intracameral injections of preservative - free lidocaine as an adjuvent to topical anesthesia to reduce intraocular sensation versus peribulbar anesthesia

This study was done to evaluate the efficacy and safety of intracameral lidocaine in cataract surgery compared to peribulbar anesthesia. This study was carried out on rabbits [n = 20] and patients [n = 160]. Our primary concern was the potential for corneal toxicity from the intracameral lidocaine. The preliminary study with rabbits showed no significant difference in corneal endothelial toxicity between the 20 rabbit eyes injected with 1% preservative-free lidocaine and the 20 eyes injected with BSS [p = 0.42]. As regards the human studies, a total of 160 cataract patients [160 eyes] participated. Eyes were classified to two groups: one group [n = 80] received 0.2 ml intracameral 1% unpreserved lidocaine combined with topical anesthesia [bupivacaine]; the other group [n = 80] received a peribulbar block with a sharp 26-gauge needle using a solution of lidocaine 2% [3 ml], bupivacaine 0.5% [2 ml], and hyaluronidase [wydase] 150 U before phacoemulsification with sclerocorneal tunnel incision .Duration of surgery was measured; implicit time and amplitudes of the b-waves of the photopic electroretinogram [ERG] potentials [single-flash ERG and the 30-Hz flicker ERG] were recorded; frequencies of intraoperative problems, complications, intraoperative, and postoperative pain were evaluated. Surgeon assessments of operative conditions and patient cooperation were recorded. The attending anesthesiologist recorded any increase in pulse or increase in blood pressure. After lidocaine anesthesia combined with topical anesthesia, similar complications were found, longer operation time [p < 0.001], and significantly better visual acuity immediately after surgery [p < 0.001]. The ERG amplitudes were not significantly reduced after 0.2 ml intracameral lidocaine half an hour after surgery [p > 0.05]. The surgeon assessment showed more patient cooperation in the peribulbar group [p = 0.012]. No patient in either group was rated as poorly cooperative. Intracameral lidocaine 1% combined with topical anesthesia can be recommended as an alternative procedure to peribulbar anesthesia in cataract surgery especially in the following situations: in patients with high myopia, fear of syringes, or prolonged coagulation

Hepatorenal integrity following a long anesthetic exposure: a comparative study between low - flow and high - flow sevoflurane anesthesia

This study assessed the effects of low-flow sevoflurane anesthesia on renal function using BUN, serum creatinine, creatinine clearance and urinary excretion of kidney-specific enzymes, and it compared these values with those obtained in high-flow sevoflurane anesthesia. We also studied the effects of low-flow sevoflurane anesthesia and high flow on the hepatic functions. Forty male patients undergoing oculoplasty or rhinoplasty were studied. Patients were randomized to receive sevoflurane anesthesia with fresh gas flow of 1 L/min [low-flow sevoflurane group; n= 20] or 6-8 L/min [high-flow sevoflurane group; n= 20]. In both groups the carrier gas was oxygen/nitrous oxide. Soda lime was used is the low-flow sevoflurane anesthesia group, The compound A concentration was measured by gas chromatography. Blood samples were obtained before and on days 1, 2 and 3 after anesthesia to measure hepatic functions, serum electrolytes, BUN and serum creatinine. Twenty-four-hour urine samples were collected before anesthesia and for each 24-h period from 0 to 72 h after anesthesia to measure creatinine, NAG and AAP. The maximum compound A concentration was 24,7 +/- 10.1 ppm [mean +/- 80], and the average duration of exposure to this concentration was 4.55 +/- 1.88 h in the low-flow sevoflurane group, Post-anesthesia BUN and serum creatinine concentrations decreased, creatinine clearance increased, and urinary NAG and AAP excretion increased in both groups compared with preanesthesia values, but there were no significant differences between the two groups for any renal function parameter at any time after anesthesia. Total and direct bilirubin increased in the first day postanesthesia in both groups of sevoflurane anesthesia and no significant changes among the two groups, AST increased in the 2nd and 3rd postanesthesia days than the peranesthesia value but there were no significant changes among both groups of sevoflurane anesthesia. LDH increased in the three postanesthesia days than the preanesthesia values but no significant differences among both groups of sevoflurane anesthesia. We concluded that, the only difference between the low-flow and high flow sevoflurane groups was compound A formation, and postanesthesia laboratory data showed no significant effects of compound A formation during sevoflurane anesthesia on renal and hepatic functions

Intraperitoneal lidocaine for pain ralief during and after tubal sterilization

We conducted a randomized, blinded, placebo-controlled study to evaluate the effectiveness of intraperitoneal lidocaine, IM meperidine, or both drugs together for pain relief [intraoperative and postoperative] in postpartum tubal ligation. Sixty postpartum patients scheduled to have tubal ligation were randomly divided into four groups to receive IM isotonic sodium chloride solution [2 mL] and intraperitoneal instillation of 40 mL of isotonic sodium chloride solution [Group I]; IM meperidine [100 mg in 2 mL] and intraperitoneal instillation of 40 mL of isotonic sodium chloride solution [Group II]; IM injection of isotonic sodium chloride solution and intraperitoneal instillation of 1% lidocaine in 40 mL [Group III] and both imeperidine and intraperitoneal lidocaine instillation [Group IV]. The rninilaparotomy was performed after local infiltration with 20 ml of lidocaine. A numerical rating score was used to rate pain on a 0 - 10 scale during and after the surgical procedures. During the surgical procedures, the mean pain scores were 1.8 in group III and 0.7 in group IV. These pain scores were significantly lower than those in groups I and II, which were 6.4 and 6.0, respectively [p < 0.001]. Postoperative mean pain scores at 24 h rest were 2.1 in group III and 0.8 in group IV. These pain scores were significantly lower than those in groups I and II, which were 6.5 and 6.4, respectively [p < 0.001]. Postoperative mean pain scores at 24 h movement were 2.9 in group III and 1.6 in group IV. These pain scores were significantly lower than those in groups I and II, which were 7.5 and 7.3 respectively [p < 0.001]. The plasma lidocaine concentrations reached a maximum in groups III and IV 30 min after instillation begun. The highest mean plasma lidocaine level was 2.6 ug/ml [range 1.2 - 3.6]. In conclusions pain relief was inadequate in patients undergoing post-partum tubal ligation under local anesthesia, even after the administration of IM meperidine. Intraperitoneal lidocaine, however, effectively, decreased intraoperative and postoperative pain in these patients