Intravenous clonidine reduces the frequency and severity of shivering and pain after urological surgeries

This study aimed to evaluate the therapeutic yield of ketamine and clonidine in patients assigned for various urological surgeries. The study comprised 90 patients; 54 males and 36 females with mean age of 43.5 +/- 8.3 years. Patients were randomly allocated into 3 equal groups to receive saline [Control group]; ketamine 0.5 mg/kg or clonidine 3 microg/kg injected intravenously 20 min before the end of surgery. Anesthetic management of all patients was standardized and recovery times were measured from completion of wound dressing to eligibility for discharge from the recovery room; defined as a modified Aldrete score of >/= 9. Post-anesthetic shivering [PAS] was graded on admission to the post-anesthetic recovery room [T0], and 10 min [T10], 20 min [T20] and 30 min [T30] thereafter using a four-point scale. Pain was assessed using a 0-10cm visual analogue scale [VAS] hourly for 6 hours and then 3-hourly for the first 24-hrs after surgery, VAS scores were expressed collectively as 3-hours VAS score. Meperidine, 20 mg IV injection was given for PAS >/= 2 and/or VAS >/= 4. Any possible side-effects of the study drugs were recorded. Patients received clonidine consumed longer time till had Aldrete score of >/= 9 that had significant compared to saline and non-significant compared to ketamine group with a non-significantly longer time with ketamine compared to saline. No PAS was recorded in 40 patients [44.4%] with a total frequency of PAS of 55.6%. Clonidine significantly reduced the frequency and score of PAS with a significant reduction of the need for and the numbers of requests of PAS rescue treatment in comparison to saline and ketamine with a significant difference in favor of ketamine. Clonidine significantly reduced VAS scores and spared the need for rescue analgesia compared to both placebo and ketamine with a significant difference in favor of ketamine. It could be concluded that clonidine administration prior to end of surgery provided superior postoperative outcome compared to ketamine and manifested as reduced frequency and severity of both PAS and pain with significant reduction of the need for rescue treatment

Comparative evaluation of alfentanil with propofol or sevoflurane for endotracheal intubation in pediatric without muscle relaxant

Intubation without muscle relaxant may be needed especially in pedi-atric short procedure. Although suxamethonium produces rapid profound neuromuscular block, it have many potential problems. Non-depolarizing neuromuscular blocking agents are an alternative but, slower in onset and have a longer duration of action. Propofol and sevoflurane may provide adequate conditions for intubation without neuromuscular blocking agents in pediatric. We studied 60 ASA I or II children undergoing elective surgery. Patients allocated randomly to one of two groups. Group P [GP] received lignocaine 1mg kg[-1] followed by alfentanil 15micro kg[-1] 2 min before propofol 2.5 mg kg[-1] was given. In group S [GS] patients received lignocaine Img kg[-1] followed by alfentanil 15 microg kg[-1] and induction of anesthesia was done by sevoflurane start by 3% concentration, which increase gradually until end tidal concentration was 3%, Laryngoscopy and intubation was performed, in GP 1 min after propofol and in GS 3min after stabilization of end tidal sevoflurane to 3%. Intubation conditions were assessed and recorded. Duration of induction and intubation were estimated. Complications during induction, intubation, and after extubation were recorded. Patients with acceptable intubation conditions in GP were more by one than GS group, but these results were statistically not significant and unacceptable condition was equal in both groups, impossible intubation conditions happened only in one patient in GS. Induction time was significantly prolonged in GS, but intubation time did not show significant difference between both groups. Adverse effects, hypertension was occurred in one patient in GS. Hypotension and bradycardia were happened in one patient in GP. Only one patient, in GS, expressed laryngospasm and hypoxia which need suxamethonium to facilitate intubation. After extubation. laryngospasm and vomiting occurred in 1 and 2 patients in GS respectively and no patient in GP suffer from vomiting or laryngospasm. We concluded that, Induction with intravenous propofol or inhalational sevoflurane, in addition to intravenous alfentanil and lignocaine equally facilitate endotracheal intubation without muscle relaxant in pediatric patients. Induction time was significantly prolonged with sevoflurane bat intubation time, show; no significant difference