Combined spinal epidural anesthesia in patients with dilated cardiomyopathy undergoing vascular surgery in the lower half of the body

Dilated cardiomyopathy [DCM] is characterized by ventricular dilatation and impaired systolic cardiac Junction. Anesthetic management, of patients with cardiomyopathy with reduced systolic Junction, is challenging and may be associated with high mortality. The purpose of this study was to evaluate the hemodynamic effects of combined spinal epidural anesthesia [CSEA] in patients with dilated cardiomyopathy, underwent vascular surgery in the lower half of the body, in addition to assess the safety of this anesthetic technique in the early postoperative period. After approval by local research ethics committee of the Faculty of Medicine, and informed written consent obtained from all patients, 24 patients having dilated cardiomyopathy, subjected to vascular surgery in the lower half of the body under CSEA. The effects of CSEA on hemodynamics; IBP, HR and CVP [measured at base line and then every 10 min], in addition to cardiac complications during the hospital stay period were studied. patients had significant decrease in MAP in all readings after the base line one with maximal decrease at 70 min [-14.7%], while HR increased significantly in all readings after the base line one except the last reading with maximal increase at 50 min [13.1%]. CVP showed insignificant changes in all readings except at 90 and 100 min which showed significant increase [p< 0.05]. Four patients developed ECG changes in the postoperative period, while no significant changes in EF. combined spinal epidural anesthesia [CSEA] may be an alternative to general anesthesia in patients with dilated cardiomyopathy undergoing vascular surgery in the lower half of the body, as our patients had a largely im eventful postoperative recovery with good pain control

Comparative study between tramadol and pethidine when added to lidocaine for intravenous regional anesthesia

Both pethidine and tramadol have a local anesthetic effect and thus can be used for intravenous regional anesthesia [IVRA], is to compare the local anesthetic and analgesic action of lidocaine alone, tramadol added to Lidocaine and pethidine added to lidocaine in IVRA for surgeries on the upper limb. A prospective nonrandoinized case series study included 60 patients ASA physical status I and II scheduled for forearm surgery using IVRA. The patients were classified into three groups:- Lidocaine group [L]:- Included 20 patients, as a control group, and they received lidocaine hydrochloride 200 mg [0.5%] diluted in 40 ml normal saline, Pethidine group [P]:- Included 20 patients who received Pethidine hydrochloride 100 mg [0.25%] added to lidocaine hydrochloride 200 mg [0.5%] diluted in 40 ml normal saline and Tramadol group [T]:- Included 20 patients who received tramadol hydrochloride 100 mg [0.25%] added to lidocaine, hydrochloride 200 mg [0.5%] diluted in 40 ml normal saline. The patients were assessed for onset and recovery of sensory and motor block, visual analogue scale [VAS]] for tourniquet and forearm pain, presence or absence of postoperative pain and time to first analgesic requirement. The onset of pinprick and touch loss was significantly shorter in pethidine and tramadol groups in comparison to lidocaine group [p <0.001], while their recovery was longer [p<0, 001 and p<0.05 respectively]. The onset of pinprick and touch loss in pethidine group was significantly shorter in comparison to tramadol group [p <0.05]. The pinprick recovery in pethidine group was significantly shorter than in tramadol group [p <0.05]. The onset of motor block in tramadol and pethidine groups was significantly shorter in comparison to lidocaine group [p <0.01, p <0.05 respectively]. There was no significant difference in the onset of motor block between tramadol and pethidine groups. The motor recovery in all three groups was comparable and the difference was [statistically non significant. For tourniquet pain VAS was significantly less at 10 min. and 20 min in the pethidine group in comparison to the lidocaine group [p<0.01 and p<0.05 respectively]. For foreann pain, VAS was significantly less in tramadol and pethidine at 10 minutes in comparison to lidocaine group [p <0.01, p < 0 001 respectively]. At 20 min there was no pain in all groups postoperative analgesic requirements The mean time to the first analgesic requirement in pethidine and tramadol groups was greater than in lidocaine group [P < 0 001]. The mean time to the first analgesic requirements in tramadol group was greater than in pethidine group [P <0.05]. Recorded side effects the incidence of tachycardia was more significant in pethidine group [40%] in comparison to the other groups. Our results suggest that, both tramadol and pethidine have a local anaesthetic effect on the peripheral nerves. Both of them enhance the speed of onset of sensory and motor block, induce better anesthesia and analgesia for tourniquet and forearm pain, improve postoperative analgesia and reduce postoperative analgesic requirements after tourniquet deflation when added to lidocaine. But tramadol is considered to be safer than pethidine