Comparison between epidural anesthesia [bupivacaine and fentanyl] mixture and continuous intravenous morphine for pain control in the treatment of major abdominal vascular surgery at Queen Alia Hospital

To compare the use of continuous epidural analgesia [Bupivaccine and Fentanyl] mixture and continuous intravenous Morphine in regard to efficacy and side effects for the relief of postoperative pain in the treatment of abdominal vascular surgery [upper and lower abdominal surgery]. This study was conducted at Queen Alia Hospital between January 2003 and December 2005. Age range of the study participants was between 45-80 years, 85 were males and 21 were females. The patients signed a consent form for surgical and anesthesia intervention. A total of 106 patients who had coronary artery disease, diabetes mellitus, chronic obstructive pulmonary disease, chronic renal failure or more than one of these diseases [American Society of Anesthesiologists III and IV class] were divided into two treatment modalities. Group A [60 patients] received continuous epidural analgesia [Bupivacain and Fentanyl] mixture while group B [46 patients] received continuous intravenous morphine for the relief of postoperative pain in the treatment of major abdominal vascular surgery. Pain was assessed postoperatively using pain relief score. The different side effects reported included nausea and vomiting, motor block, respiratory depression and sedation. Simple descriptive statistics and the Chi-Square test were used to analyze the data. P value of < 0.05 was considered statically significant. Pain relief was better among patients in group A than those in group B [P<0 .001]. Similarly, there was a lower statistically significant difference regarding side effects among patients in group A. Patients who received continuous epidural Bupivacaine and Fentanyl experienced better pain relief and fewer complications than those in the Morphine group. Results indicate that the use of epidural anesthesia [Fentanyl and Bupivacaine] is a safe procedure and is more efficient than the continuous intravenous morphine for pain relief in the treatment of major abdominal vascular surgery

Effect of passive smoking on children undergoing elective tonsillectomy

to evaluate the effect of passive smoking on the frequency and severity of airway complications during general anaesthesia [GA] and in the postanaesthesia care unit [PACU]. sixty healthy children, who underwent general endotracheal anaesthesia for elective tonsillectomy, aged between three and ten years was included in the study. They were monitored for adverse respiratory events and desaturation during induction, intra-operatively and in the recovery room. Thirty patients were exposed to passive smoking with a potential daily exposure varying from 20-50 cigarettes per day. All patients were not premedicated and had a standard induction agents and maintenance, which consists of fentanyl 1mcg/kg, sodium thiopentone 5mg/kg and atracrium 0.5mg/kg with a mixture of N20/02, [60/40] per cent there was no difference in the frequency of respiratory events between passive smokers and those not exposed to cigarette smoke at induction or intraoperatively. However, in the recovery room, desaturation and coughing were significantly more common in passive smokers [p<0.05]. Twelve patients in passive smoking group had coughing, while only 2 patients in the non-exposed group had coughing [p<0.05] passive smoking increases the incidence of the postoperative hypoxaemia [using pulse Oxymeter] and coughing. We always advice our adult patients to stop smoking three weeks prior to general anaesthesia .We should also advice parents to stop cigarette smoking for the same period of time prior to their child's operation