Novel management of methylene blue extravasation: a case report and review of literature

Methylene blue is a highly irritant drug and has been used intraoperatively. Its accidental extravasation can lead to tissue necrosis. In this report, a unique management is described, and the patient recovered without any morbidity

Comparison of the effect of pre-operative single oral dose of Tramadol and Famotidine on gastric secretions pH and volume in patients scheduled for laparoscopic cholecystectomy

To evaluate and compare the effects of pre-operative single oral dose of tramadol and famotidine on gastric secretions pH and volume in patients electively scheduled for laparoscopic cholecystectomy. Randomized control trial. Department of Anaesthesia, King Saud University Riyadh, Saudi Arabia, from August 2011 to June 2013. Ninety adult, ASA-I and II patients scheduled for laparoscopic cholecystectomy were included in the study. Patients were randomly assigned to receive pre-operatively either placebo [Group-C, n=30], oral tramadol 100 mg [Group-T, n=30] or famotidine 40 mg [Group-F, n=30]. After induction of general anaesthesia, gastric fluid was aspirated through orogastric tube. The gastric secretions volume and pH was measured using pH meter. There was no statistically difference between groups in age, weight and gender. The gastric secretions mean pH was 2.06 +/- 0.22,2.04 +/- 0.20, 5.79 +/- 0.77 and volume was 0.59 +/- 0.17, 0.59 +/- 0.14 and 0.28 +/- 0.16 ml/kg in Group-C, Group-T and Group-F respectively. There was a significant statistical difference in the mean pH values between Group-C vs. Group-F [p < 0.001] and Group-Tvs. Group-F [p < 0.001]. Statistically significant difference was also found in the mean gastric secretions volume between Group - C vs. Group-F [p < 0.001] and Group-Tvs. Group-F [p < 0.001]. There was no significant difference in the mean gastric fluid pH values [p=0.99] and mean gastric secretions volume [p=0.99] between Group-Tand Group-C. As compared to famotidine, pre-operative single oral dose of tramadol was unable to elevate the desired level of gastric fluid pH [> 2.5] and decrease in gastric secretions volume [< 0.4ml/kg]

Effect of bispectral index [BIS] monitoring on postoperative recovery and sevoflurane consumption among morbidly obese patients undergoing laparoscopic gastric banding

Early and uneventful postoperative recovery of morbidly obese patients remains a challenge for anesthesiologists. It could be valuable to titrate the administration of inhaled anesthetic, such as sevoflurane, in morbid obese patients, in order to shorten emergence using bispectral index [BIS] monitoring. It would be a great advantage if BIS permitted a more rapid recovery and less consumption in morbidly obese patients with a high cost inhaled agent. The aim of the study is to show whether the titration of sevoflurane based on the BIS monitoring would allow shortening of recovery time in morbidly obese patients and to evaluate whether BIS monitoring would contribute to reduce the amount of sevofLurane administered while providing an adequate anesthesia. Thirty morbidly obese ASA I and II patients undergoing laparoscopic gastric banding [LAGB] procedures were studied. In the first group [15 patients], patients were anesthetized without the use of BIS [non BIS or control group], and sevoflurane being administered according to standard clinical practice [control group]. In the second group [15 patients], sevoflurane was titrated to maintain a BIS value between 40 and 60 during surgery, and then 60-70 during 15 min prior to the end of surgery [BIS group]. Recovery times were recorded. Time to extubation was also noted, as well as the time to achieve a modified Aldrete score of 9 were evaluated subsequently at 10-min intervals until 3 h after surgery by nurses who had no knowledge of the study. Sevoflurane consumption was calculated using the vaporizer weighing method. Awakening and extubation times were significantly shorter in the BIS group [P <0.05]. In the BIS [vs. non BIS] group, there were no significant differences observed in the time to obtain an Aldrete score of 9. The sevoflurane consumption and cost in the BIS group were lower than in the non BIS group [P <0.05]. Bispectral index monitoring during anesthesia for morbidly obese patients provides statistically significant reduction in recovery times. It also has the added advantage in decreasing sevoflurane consumption