[Intravenous sedation in dental surgery, midazolam versus diazepam]

A study on intravenous sedation in dental surgery was conducted comparing diazepam with midazolam. One hundred and twenty patients, aged between 12 and 50 years, ASA grade I or II divided randomly into two groups. A total of 80 patients received diazepam 0.03 mg/kg with fentanyl 0.7 microg/kg [Group-A], and 40 patients received midazolam 0.03 mg/kg with fentanyl 0.7 microg/kg [group-B]. In both groups, the dental surgeon gave 1.5-3 ml xylocaine 0.5% with adrenaline 1:200.000 to perform the nerve block to the upper or lower jaw as needed. No premedication was given. Perioperative cardiovascular effects, anterograde amnesia, respiration, oxygen saturation, patient satisfaction and adverse venous sequelae were investigated. Blood pressure was reduced in both groups; the reduction was less than 30 mmHg, the difference was not significant. In diazepam group [A], 30% were able to remember the events, 25% suffered painful injection, 10% suffered redness and swelling at site of injection. In midazolam group [B], 10% were able to remember the events, no patient suffered redness and swelling at site of injection or painful injection, the difference was statistically significant for these adverse effects. Both drugs gave safe and acceptable sedation. Midazolam was superior to diazepam, had better amnesic effects, more patient satisfaction with no incidence of venous sequelae

[ value of intraopepvative use of topical bupivacaine combined with rectal diclofenac on post tonsillectomy pain and oral intake in children]

To evaluate the efficacy of intraoperative topical bupivacaine combined with rectal diclofenac in reducing postoperative pain and facilitating early oral intake. Between 1 January 2005 and 1 January 2008 one hundred fifty patients aged 5-13 years underwent elective tonsillectomy with adenoidectomy in Prince Rashed Ben Al-Hassan hospital and Prince Zaid Ben Al-Hussein hospital, Jordan. Patients were randomized into two groups; group [1]: 75 patients received 0.5% bupivacaine 2 mg/kg soaked swabs [2x2] inch tightly packed in their tonsillar fossa for five minutes after complete and good hemostasis. Group [2]; 75 patients had soaked swab with normal saline for five minutes also. Three patients excluded for failure to complete the postoperative data and another two patients for postoperative bleeding from the adenoid site. Data from 145 patients were analyzed as five patients were excluded. When comparing the two groups for postoperative pain, less pain was noted in the bupivacaine group, the difference was statistically significant for the first 8 hours and also after 24 hours among treatment group who did not complain of pain postoperatively. The mean time difference of first drink and eat between the two groups was statistically significant. No major complications such as airway obstruction, dehydration or local anesthetic toxicity developed. We concluded that topical bupivacaine combined with rectal diclofenac is safe and easy to administer. Topical bupivacaine use combined with diclofenac reduces postoperative pain and facilitate early oral intake in children

Local anesthesia with propofol infusion versus spinal anesthesia for groin hernia repair

Compare local anesthesia with propofol sedation, and spinal anesthesia for groin hernia repair, with respect to recovery times, preoperative complications and patient satisfaction. Setting and design: This is a prospective study conducted in prince Hashim military hospital, Zarqa. Eighty Four patients randomly divided into two groups. LA group [n=42] received 0.5 mg/kg propofol injected slowly prior to the injection of 60 ml 0.5% xylocaine with adrenaline [1:200.000], followed by propofol infusion 0.04 mg/kg/min. SA group [n=42] received 2ml 0.5% heavy bupivacaine into the subarachnoid space. Perioperative complications visual analogue pain scale score for three days, patient satisfaction and hospital stay were recorded and assessed. Patients in spinal anesthesia group spent more time in operating theatre and recovery room. 22 patients [52.4%] with local anesthesia left the hospital on the same day of surgery, compared to only 14 patients [33.3%] in spinal anesthesia group. The mean patients satisfaction score was 2.47 in the local anesthesia group and 2.19 in spinal anesthesia group: the difference is not statistically significant. Postoperative complications occurred in four patients in spinal anesthesia group [2 urinary retention and 2 spinal headache].Inguinal local infiltration anesthesia with propofol sedation for repair of groin hernia resulted in shorter hospital stay, more postoperative patient's satisfaction and no complications compared with spinal anesthesia

Evaluation of peribulbar anesthesia for senile cataract surgery at Prince Rashid Hospital

To evaluate peribulbar local anesthesia for senile cataract surgery at Prince Rahsed Hospital.Materials and This was a prospective study of patients undergoing senile cataract surgery with peribulbar anesthesia between April, 2001 and April,2002 at Prince Rashed Hospital. One hundred and ninety senile cataract patients who were admitted for cataract surgery were evaluated for local anesthesia. One hundred and seventy two [88 males and 84 females] were found suitable for local anesthesia and were entered into the study. The remaining eighteen patients had surgery under general anesthesia and were excluded from the study.A change to general anesthesia was done in one case. Ninety% of cases had no complication. Complications such as scleral perforation or retrobulbar hemorrhage did not occur.Our study confirms the safety and applicability of cataract surgery performed with peribulbar anesthesia in our setting. Furthermore it solved the problem of those medically compromised patients whose operations were repeatedly delayed due to their unfitness for general anesthesia