Comparison between epidural anesthesia [bupivacaine and fentanyl] mixture and continuous intravenous morphine for pain control in the treatment of major abdominal vascular surgery at Queen Alia Hospital

To compare the use of continuous epidural analgesia [Bupivaccine and Fentanyl] mixture and continuous intravenous Morphine in regard to efficacy and side effects for the relief of postoperative pain in the treatment of abdominal vascular surgery [upper and lower abdominal surgery]. This study was conducted at Queen Alia Hospital between January 2003 and December 2005. Age range of the study participants was between 45-80 years, 85 were males and 21 were females. The patients signed a consent form for surgical and anesthesia intervention. A total of 106 patients who had coronary artery disease, diabetes mellitus, chronic obstructive pulmonary disease, chronic renal failure or more than one of these diseases [American Society of Anesthesiologists III and IV class] were divided into two treatment modalities. Group A [60 patients] received continuous epidural analgesia [Bupivacain and Fentanyl] mixture while group B [46 patients] received continuous intravenous morphine for the relief of postoperative pain in the treatment of major abdominal vascular surgery. Pain was assessed postoperatively using pain relief score. The different side effects reported included nausea and vomiting, motor block, respiratory depression and sedation. Simple descriptive statistics and the Chi-Square test were used to analyze the data. P value of < 0.05 was considered statically significant. Pain relief was better among patients in group A than those in group B [P<0 .001]. Similarly, there was a lower statistically significant difference regarding side effects among patients in group A. Patients who received continuous epidural Bupivacaine and Fentanyl experienced better pain relief and fewer complications than those in the Morphine group. Results indicate that the use of epidural anesthesia [Fentanyl and Bupivacaine] is a safe procedure and is more efficient than the continuous intravenous morphine for pain relief in the treatment of major abdominal vascular surgery

Obstetrical admissions to the intensive care unit after anesthesia survey at King Hussein Medical Center

To determine the Intensive Care Unit admission rate in two years among obstetric patients at King Hussein Medical Center, and to ascertain anesthetic complications requiring post anesthesia respiratory support. During the period between January 1[st] 1997 to December 31[st] 1998, a total of 26 obstetric patients were admitted to the Intensive Care Unit from operation room, as they required mechanical ventilation. The medical records of the patients were reviewed and analyzed regarding complications of anesthesia. During the study period, there were 44055 deliveries, with a total of 4229 cesarean sections were performed; 458 spinal [regional anesthesia] and 3771 general anesthesia. Twenty-six out of 4229 were admitted to the Intensive Care Unit due to one or more of the following complication[s], hypertension, hemorrhage, infection, heart disease. None of the patients who had spinal anesthesia had any problem the majority of patients requiring Intensive Care Unit admissions had hypertensive disease of pregnancy and hemorrhage. At King Hussein Medical Center the incidence of Intensive Care Unit admission among obstetric patients following anesthesia is [0.61%] and if the need for post anesthesia respiratory support is used as an indicator, then spinal anesthesia was safer than general anesthesia

Hemodynamic response to tracheal intubation: a comparison between young, middle- aged and elderly orthopedic patients

Objective: To examine and compare the hemodynamic changes associated with laryngoscopy and tracheal intubation in the different age groups who underwent orthopedic surgical procedure

Methods: A total of 90 patients fulfilling the criteria of the American. Society of Anaesthesiology [ASA] class 1 and 2 who were admitted to the Royal Jordanian Rehabilitation Center between July 2001 to September 2002 and underwent orthopedic surgery [Back surgery, Total hip and knee replacement, knee arthroscopy] were divided equally into three groups of 30; young [18-25years], Middle aged [40-50 years] and elderly [65-80 years]. The hemodynamic response after tracheal intubation [systolic, diastolic blood pressure, mean blood pressure and heart rate were observed as a percentage change compared to the baseline]

Results: The greatest percentage change in the systolic arterial pressure after tracheal tube insertion was seen in the elderly group [15%]. The increase in systolic arterial pressure was significantly less in the young group compared with the two older groups at one, two, three and four minutes post-intubation. The greatest percentage increase in diastolic blood pressure compared to the baseline was seen in the middle- aged group [24%]. The elderly and young patients showed a significant difference in the diastolic blood pressure response only at one minute post-intubation. However the heart rate response was greatest in the middle-aged patients [40%] and least in the elderly [16%]

Conclusion: Elderly patients had the greatest systolic arterial blood pressure response but the least chronotropic response following tracheal intubation, whereas middle-aged patients had the greatest heart rate and diastolic arterial pressure response. This has clinical implications for choosing drugs for prevention of this response. Further studies are needed to discuss other hemodynamic variable