Iatrogenic water intoxication in healthy parturient causing convulsions and fractured mandible

We report a case of a mandibular dentoalveolar fracture caused by severe iatrogenic hyponatremia-induced grand mal seizure in a 31-year-old pregnant lady who underwent normal vaginal delivery. She had oxytocin augmentation of her labor, and the seizure happened in the immediate postpartum period. The seizure was thought to be because of severe hyponatremia and prompt management controlled the metabolic disorder. The fracture was reduced and fixed successfully, and she was discharged after 48 hours, healing was uneventful

Intravenous dexmedetomidine or propofol adjuvant to spinal anesthesia in total knee replacement surgery

The purpose of this study was to compare the effect of intravenous dexmedetomidine with the intravenous propofol adjuvant to spinal intrathecal anesthesia on the duration of spinal anesthesia and hemodynamic parameters during total knee replacement surgery. Seventy five patients were enrolled into this randomized study from the 1[st] of April 2008 till the 30[th] of August 2009 for total knee replacement surgery under spinal anesthesia. They were randomly assigned into three groups, group D, group P and group C. Following intrathecal injection with bupivacaine 12.5 mg in all patients in the three groups, patients in group D received intravenous loading dose of microg/kg/hr dexmedetomidine over 10 minutes and a maintenance dose of 0.2 to 0.5 p,g/kg/hr. Patients in group P received intravenous propofol 4 mg/Kg/hr over 10 min and a maintenance dose of 0.5-2 mg/Kg/hr. Patients in group C [control group] received nothing extra to the regular IV fluid. The regression times to reach SI sensory level and Bromage 0 motor scale, the hemodynamic parameters, the Bispectral Index level of Sedation [BIS], and arterial CO[2] level were recorded. The regression time to reach SI dermatome was 149.4 +/- 14.6 min in group C, 152.8 +/- 16.6 min in group P and 209.6 +/- 25.9 min in group D. The regression to Bromage 0 was!84.6 +/- 22.8 min in group C, 190.0 +/- 21.0 min in group P, and 255.8 +/- 36.7 min in group D. Statistical analysis of regression of sensory and motor block was significant among groups [C vs. D, P vs. D, P < 0.05]. The heart rate was significantly decreased in group D in comparison to groups C and P. Sedation levels were within accepted ranges in groups D and P and not affected in the control group. Minimal respiratory depression occurred in group P and D, clinically it was not significant. Supplementation of spinal anesthesia with intravenous dexmedetomidine or propofol produces good sedation levels without significant clinical hemodynamic changes. Adding dexmedetomidine produces significantly longer sensory and motor block than propofol

Thromboprophylaxis in neurosurgical patients at Jordan university hospital: a prospective comparative study

Venous Thromboembolism [VTE] is potentially a life threatening complication in patients undergoing major neurosurgical procedures. There has been a general reluctance over the years to use anticoagulant prophylaxis for patients with head injury or in patients who need intracranial surgery. Intermittent Pneumatic Compression [IPC] and elastic stocking are widely used as prophylaxis against venous thrombo-embolism in these patients. The aim of the study is to assess and compare the value of VTE prophylaxis using a control group with Low dose Unfractionated Heparin [LDUH] every eight hours alone with a study group using Intermittent Pneumatic compression [IPC] and elastic stocking along with Single dose Unfractionated Heparin [SDUH] at the time of anaesthesia in induction on patients undergoing brain and spinal surgery. A prospective case-control study was conducted at Jordan University Hospital, over 15 months during the period 2005-2006. A total of 223 patients were included. In the study group, 113 patients using single dose of unfractionated heparin at the time of anaesthesia induction along with Intermittent Pneumatic Compression [IPC] intraoperatively and compression Elastic Stocking [ES] post operatively were used until full ambulation. In the control group, there were 110 patients in whom unfractionated heparin at a dose of 5000 units every 8 hours was used until full ambulation or for 7 days. All patients underwent either brain surgery or spinal surgery. The characteristics of the two groups were fully comparable except for the duration of surgery which was statistically longer in the study group [P= <0.001]. Deep Vein Thrombosis [DVT] occurred in 3 patients in the study group, compared to 6 patients in the control group, of these 6 patients, 4 patients developed PE in addition to DVT and one of the four patients expired. The observed differences among these rates are statistically not significant [P=0.288]. When pooled together, patients who developed VTE in both groups were older than those who did not have VTE. This difference was statistically significant [P=0.07]. The combination of elastic stocking, intermittent pneumatic compression along with single dose unfractionated heparin at the time of anaesthesia induction is comparable in effectiveness of reducing the incidence of VTE as the low dose unfractionated heparin alone in patients undergoing neurosurgical procedures of the brain or spine, despite the trend towards better results of the combined method

impact of long-lasting preemptive epidural analgesia before total hip replacement on the hormonal stress response. a prospective, randomized, double-blind study

Recent studies suggest that preemptive analgesia may be effective in reducing postoperative pain. One physiologic explanation may be interference with the endogenous opioid response. We investigated whether long-lasting preoperative preemptive analgesia may have an effect on the hormonal stress response after total hip replacement. 42 patients scheduled for elective hip replacement for coxarthrosis were randomized to receive, on the day before the operation, either 5 ml*h[-1] ropivacaine 0.2% [study group, n=21] or 5 ml*h[-1] saline [control group, n=21]. Postoperative analgesia was achieved in both groups by patient-controlled epidural analgesia [PCEA] with ropivacaine 0.2%. The main outcome measure was the concentration of authentic beta-endorphin [1-31] in plasma up to 4 days after surgery. Additional parameters included concentrations of adrenocorticotrope hormone and cortisol. Both groups were comparable concerning preoperative parameters and pain scores. Epidural blocks were sufficient in all patients for operative analgesia. Preemptive analgesia was performed for 11-20 hours in both groups and led to significantly decreased pain scores before surgery. Preemptive analgesia with epidural ropivacaine did not lead to decreased concentrations of beta-endorphin [1-31] before the start of surgery or in the postoperative period. Furthermore, no differences could be detected in the time course of beta-endorphin and adrenocorticotrope hormone after surgery. However, cortisol concentrations differed significantly between groups before the operation, but showed a comparable rise after surgery. Differences in postoperative pain after preemptive analgesia do not seem to be due to an altered endogenous opioid response

Effect of dexmedetomidine added to spinal bupivacaine for urological procedures

To determine the effect of adding dexmedetomidine to bupivacaine for neuraxial anesthesia. Sixty-six patients were studied between April and May 2008 in the University of Jordan, Amman Jordan. They were randomly assigned into 3 groups, each receiving spinal bupivacaine 12.5mg combined with normal saline [group N] Dexmedetomidine 5ug [group D5], or dexmedetomidine 10ug [group D10]. The onset times to reach T10 sensory and Bromage 3 motor block, and the regression times to reach S1 sensory level and Bromage 0 motor scale, were recorded. The mean time of sensory block to reach the T10 dermatome was 4.7 +/- 2.0 minutes in D10 group, 6.3 +/- 2.7 minutes in D5, and 9.5 +/- 3.0 minutes in group N. The mean time to reach Bromage 3 scale was 10.4 +/- 3.4 minutes in group D10, 13.0 +/- 3.4 minutes in D5, and 18.0 +/- 3.3 minutes in group N. The regression time to reach S1 dermatome was 338.9 +/- 44.8 minutes in group D10, 277.1 +/- 23.2 minutes in D5, and 165.5 +/- 32.9 minutes in group N. The regression to Bromage 0 was 302.9 +/- 36.7 minutes in D10, 246.4 +/- 25.7 minutes in D5, and 140.1 +/- 32.3 minutes in group N. Onset and regression of sensory and motor block were highly significant [N vesus D5, N versus D10, and D5 versus D10, p<0.001]. Dexmedetomidine has a dose dependant effect on the onset and regression of sensory and motor block when used as an adjuvant to bupivacaine in spinal anesthesia

Bupivacaine with Meperidine versus Bupivacaine with Fentanyl for continuous epidural labor analgesia

To compare the efficacy of bupivacaine-meperidine and bupivacaine-fentanyl mixtures when continuously infused epidurally to relief the labor pain. We performed this prospective double-blinded study at Jordan University Hospital, Amman, Jordan between October 2005 and April 2006. Sixty-seven American Society of Anesthesia physical status I parturients were randomly divided into 2 groups, Group M [n=34] received a continuous infusion of 1 mg/ml of bupivacaine mixed with 1 mg/ml meperidine, and Group F [n=33] received a continuous infusion of 1 mg/ml bupivacaine mixed with 2 micrometer/ml fentanyl. Efficacy of analgesia, degree of motor block, hemodynamic variability, incidence of nausea and vomiting, pruritus, sedation, and the neonatal outcome were all compared between the 2 groups. A p value<0.05 was considered to be significant. Highly effective analgesia was achieved in both groups with a similar incidence of motor block, sedation, pruritus, and neonatal outcome. The only significant difference was in the incidence of nausea and vomiting. Group M had 8 parturients with nausea, compared with only 2 parturients in Group F [p=0.003]. Bupivacaine-meperidine in a continuous epidural infusion is as efficient as bupivacaine-fentanyl for pain relief during labor, but associated with a higher incidence of nausea and vomiting

Venous occlusion with lidocaine for preventing propofol induced pain. A prospective double-blind randomized study

Pain is a well-known complication of intravenous administration of propofol, and to find out the optimal method to decrease this pain, we studied 4 methods of delivering propofol. The study took place at Jordan University Hospital, Amman, Jordan between November 2004 and March 2005 on 200 patients. The patients were divided into 4 groups, group I [n=50], the control group, propofol 1% was given alone. Group II [n=50], patients received propofol 1% premixed with 40 mg of lidocaine. Group III [n=50], patients received propofol 1% 60 seconds after giving 40 mg of lidocaine. Group IV [n=50], patients had venous occlusion for 60 seconds with the use of lidocaine 1% [40 mg], followed by release of the occlusion and administration of the propofol. Pain was assessed during injection and categorized into: no pain, pain, and pain with behavioral changes. In group I [control], 35 patient complained of pain, compared to 26 in group II, 23 in group III, and 7 patients in group IV, with a significant reduction in the incidence and intensity of pain in group II, III, and IV compared with the control [p<0.005]. The best reduction of intensity and incidence was achieved in group VI, when compared with groups I, II and III [p<0.005], with no statistical difference between group II and III when compared with each other. Of the 4 methods studied, the optimal method to decrease the incidence and intensity of pain resulting from propofol injection is to inject lidocaine while applying venous occlusion for 60 seconds prior to administering propofol