Rocuronium versus cisatracurium: onset of action, intubating conditions, efficacy, and safety

Neuromuscuiar blockers [NMB] are very important adjuvant to general anesthesia. Rocuronium bromide [ammosteroidal NMB] and cisatracunum besylate [benzyl isoquinolme NMB] are recently introduced non-depolarizing muscle relaxants In a prospective randomized study we had compared both drug at a dose 2x [ED95] as regard the onset of action, intubating conditions, clinical duration, hemodynamic changes, and adverse effects 40 female patients ASA l and ll. 20-50 year old underwent elective gynecological ambulatory surgery under general anesthesia [GA] were randomly assigned into 2 equal groups. ROC group, where 0.6mg/kg rocuronium was given and CIS group, where 0 1mg/kg cisatracurium was given. Neuromuscuiar monitoring was done by stimulating uinar nerve and recording the action potential of the first dorsal interosseous muscle using Date x Relaxogram. Standardized GA was given to all patients as follows, fentanyl 1.5mcg/kg. propofol 2mg/kg. 2x [ED95]/kg of the examined NMB. intubation was tried by the same anesthetist who was blind to the given NMB after 60 sec of injection, intubation was done if the intubating condition was acceptable [excellent or good], and it was re-attempted every 30 sec if it was poor or inadequate Anesthesia was maintained by 60% N2O in 02 and isoflurane to a total MAC 1.5. controlled ventilation was adjusted to normocarpia. Mean arterial blood pressure [MAP], heart rate, and intubating conditions were recorded interpretation of relaxogram for the onset of action, clinical duration, recovery index was done Clinically acceptable intubating conditions were achieved after 60 sec more frequently after rocuronium [80%] than after ctsatracurium[O%]. Rocuronium had a significant shorter onset time than cisatracunum [70.6 +/- 18.2 versus 160.4 +/- 14.3sec], Rocuronium had a significant shorter duration of action than cisatracurium [30.3 +/- 5.2 versus 45.7 +/- 7/5min], and the spontaneous recovery index was significantly shorter with rocuronium than cisatracurium [9.2 +/- 1.8 versus 13.6 +/- 2.4min]. There were no evidences of any significant clinical cardiovascular changes in both groups. There were no clinical signs of histamine release in both groups, but there was burning pain at the site of rocuronium injection in more than 50% of patients Conclusion: Rocuronium has a rapid onset of action with good intubating conditions, cisatracurium has an intermediate duration of action, both are potent and safe with excellent cardiovascular stability and without apparent histamine release

Lumbar paravertebral subcutaneois infiltration analgesua for treatment of renal colicky pain

Many methods were described for treatment of renal colicky pain ranging between analgesic and antispasmodic drugs, regional blocks and acupuncture. In the present study 40 patients with acute renal colic were consenting and divided into 2 groups [20 each]. Where, Group 1 received lumbar subcutaneous field block using the inferior angle of the scapula and the iliac crest as landmarks for T7 and L4 spinal levels, respectively, the T10 and L2 spinous processes were identified. After sterile preparation of the skin, a subcutaneous wheel of 2% xylocaine [6 ml] was created 4 cm to midline, extending between T10 and L2 using a spinal needle 25 G, right or left according to the site of renal colic. Group 2 received 6 ml of saline [0.9% Na Cl] instead of xylocaine at the same previous site of injection. Another doses of local anesthetic or saline were given if pain returned and only above pain score 5 [5 cases were done as pilot study showed that effective pain relief occurred only with pain score above 5], intravenous fluids were given to facilitate the passage of concernments. Antispasmodics, non-opiod analgesics were given as described by the urologist with pain score below 5. There were significant analgesia and decrease in visual analogue score, mean blood pressure and heart rate in both groups after infiltration. When comparing the two groups, there were statistically significant prolonged analgesia in group 2 when compared to group 1 [p< 0.001] with no tolerance to repeated subcutaneous injection in patients with recurrent pain. There were no reported complications. The presented technique for treatment of renal colic is simple, easy, rapid, and decreases the complications of large doses of narcotics and non steroidal anti-inflammatory drugs. The mechanism of action not related to local anesthetic effect but more towards central modulation by segmental inhibition of nociceptive signals at spinal cord level

New method for confirmation of endotracheal tube placement: a prelimnary study

We presented a new and simple test which is useful in confirmation of oral endotracheal tube [ET] positioning in a preliminary study. This test is observe the movement of ET and its direction during side to side movement of the larynx and comparing the results with end tidal carbon dioxide measurement with the tube in the trachea and in [he esophagus. Our results proved that this test is simple, reliable, with 99% sensitivity when the test was applied with ET in the trachea and 100% sensitivity when the test was applied with the ET in the esophagus and it needs no extra devices. More over it is not time consuming. The direction of movement of the ET tube to the other side of laryngeal movement when the tube is in the proper position in the trachea could be explained by third law of newton and its applications