Dexamethasone-low dose ketamine combination versus droperidol low dose ketamine. A comparative study for their effect on postoperative nausea and vomiting and swallowing evoked pain after paediatric adenotonsillectomy

40 children aged [6 - 12] years ASA 1 and II scheduled for Adenotonsillectomy were randomly allocated to receive either ketamine [0.1 mg/ kg] IM 15 minutes before induction of anesthesia and dexamethasone [150 micro g/ kg] before the end of surgery [group I] or ketamine [0.1 mg/ kg] IM 15 minutes before induction plus droperidol 15 micro g/ kg before the end of surgery [group II]. General anesthesia was standardized for both groups where all children were given rectal diclofenac [2 mg/ kg] 20 minutes before end of surgery. Thiopental 5 mg/ kg was used as an induction agent and suxamethonium [1 mg/ kg] was used to facilitate tracheal intubation. Anesthesia was maintained with halothane 1-2% concentration supplemented with oxygen -nitrous oxide [40-60%] After the end of surgery, all children were transferred to post anesthesia care unit where a trained nurse blinded to the study observed [and after that in the ward] observed all episodes of nausea and vomiting during the first 24 hours. Also pain scores were assessed 1/2 hour, 1,2 and 3 hours after extubation and remaining of the first postoperative day. Time for first call analgesia, first oral intake and first adequate oral intake were observed during the first postoperative day. All episodes of postoperative nausea and vomiting were significantly lower in group I; pain scores were significantly lower in group I at all times compared to group II. Time for first call of analgesia was significantly longer in group 1 and time of oral intake and adequate oral intake were significantly shorter in group I compared to group II. We concluded that ketamine [0.1 mg/ kg] + dexamethasone [150 micro g/ kg] combination gave significant better results than [ketamine [0.1 mg] + droperidol combination as regards PONOV and pain relief during the first postoperative day in children undergoing elective adenotonsillectomy done on ambulatory basis

Effects of different intravenous anaesthestics on free radicals in polytraumatized patients

Oxygen free radicals are highly reactive and potentially destructive. In the normal cells there are always a small number of free radicals produced, but cell enzymes easily deal with them. The aim of this study is to detect the effects of trauma and thereafter different intravenous anaesthesia on free radical production in individuals with multiple injuries. This study was performed on 40 individuals. They were divided into 2 groups; trauma group [n = 20] and non trauma control group [n =20]. Both groups were matched as regard age, sex and body weight. Each group was classified according to the type of intravenous anaesthesia used into ketamine- fentanyl group [n =10] and propofol- fentanyl group [n=10]. Estimation of plasma malondialdhyde [MDA] and blood superoxide dismutase [SOD] and glutathione per-oxidase [GPX] levels was done. The results of this study revealed significant increase in MDA levels and significant decrease in SOD and GPX level in trauma group in comparison with control one. On the other hand, propofol and ketamine induced decrease MDA levels during the three stages of study in both groups in comparison to their corresponding basal values. Also, propofol and ketamine induced significant increase in GPX levels after induction in traumatic and control groups when compared with their basal values. However, propofol produced significant increase in SOD levels after induction in traumatic and control groups when compared with their basal values. From this study, we conclude that propofol and ketamine decrease free radicals generation while propofol increased the antioxidant scavengers than ketamine. So, propofol could be more beneficial than ketamine for anaesthesia of polytraumatized individuals, which have oxidant and antioxidant imbalances

Haemodynamic profile of isoflurane versus total intravenous anaesthsia in patients submitted for closed mitral commissurotomy

This study was conducted on 16 patients submitted to closed mitral commissurotomy surgery. They were randomly classified into two groups eight patients each. The first group recieved thiopentone-for induction and isoflourane-vecronium for maintenance The second group received kjtamine-midazolam for induction and then followed by continuous infusion according to a pharmacokinetics based multistepped decreasing regimen. Arterial cannulation and pulmonary artrey catheter were fixed to measure the haemodynamic variables at 5 time points before and during surgery. Data are collected and analysed statistically to compare both groups and record changes during the course of surgery inside each group. The results showed non significant changes between the two groups regarding the haemodynamic parameters recorded, but the systemic vascular resistance [SVR] was significantly increased in the isoflourane group at post-commissurotomy time point. In conclusion, TIVA with ketamine-midazolam can provide a pattern of haemodynamic stability during mitral valve stenosis surgery comparable to that of isoflurane. Concomitant ad-minsteration of midazolam to ketamine according to the regemin used in this study almost neutralized the cardiovascular effects of ketamine