Epidural ketamine for postoperative analgesia in the elderly

We assessed the epidural use of ketamine in elderly patients undergoing major abdominal surgery. Patients older than 65 years were randomly allocated to receive preemptive epidural bupivacaine 0.125% [20 ml] combined with either epidural ketamine 40 mg [ketamine group], or epidural morphine 2 mg [morphine group]. Postoperatively, boluses of 0.125% bupivacaine [5 ml] supplemented with ketamine [2 mg/ml] or morphine [0.1 mg/ml] were given until a pain score of two was established. Analgesia at rest was assessed by a verbal rating score [0 = no pain, 1 = mild pain. 2 moderate pain, 3 = severe pain] at 1h, 2h, 6h, 12h and 24h after surgery. The patient's degree of sedation was assessed using the Ramsay sedation score and episodes of nausea and vomiting [PONV] were recorded. Patients in the morphine group were more sedated but had significantly lower pain scores and requested less rescue analgesic than patients receiving epidural ketamine [P <0.05]. In the morphine group three patients were treated for PONV while none of the patients in the ketamine group showed PONV. Epidural ketamine, when compared to epidural morphine, appears to be associated with less sedation and a smaller risk of PONV, but necessitates more frequent or continuous administration to achieve comparable analgesia

Ilioinguinal iliohypogastric nerve blocks for post-operative pain relief in pediatric patient submitted for groin surgery

Evaluation of effectiveness, postoperative analgesia hemodynamic effects, recovery profiles and degree of satisfaction of both parents and surgeons to ilioinguinal and iliohypogastric nerve blocks performed with local anaesthtics. bupivacaine alone and with fentanyl. Sixty patients undergoing groin surgery using sevoflurane nitrous oxide anaesthesia were included. Patients were randomly allocated into 3 equal groups [n =15]. Group p received normal saline at the dose of 0.3- 0.4 ml/kg for local nerve block [placebo group]. Group B received 0.25% bupivacaine at the dose of 0.3- 0.4 ml/kg as a local anaesthetic for the nerve block. Group BF received 0.25% bupivacaing at the dose of 0.3-0.4ml/kg and fentanyl at the dose of 1 micro g kg as local anaesthetic for the nerve block. Pain was evaluated by the CHEOPS pain score, [Modified Children's Hospital Eastern Ontario Pain. Score].Recovery criteria were assessed by Modified Aldrete Recovery Score. There was significant prolongation in duration of analgesia in group BF [348 +/- 15 min] and group B [327 +/- 18 min] than placebo group the total number of fentanyl doses significantly decreased in group [BF] 6 doses than group [B] 18 doses and placebo [38] doses the modified CHEOPS scor showed significant decrease in group BF, and group B than placebo group. No significant changes in hemody namics between all groups. It could be concluded that the addition of fentanyl to bupivacaine for the nerve block improves the postoperative analgesia and decreases requirement for post-operatives analgesics

Intermittent epidural analgesia and continuous ketamine infusion without tracheal intubation for patients with chest problem submitted for radical cystectomy

Intermittent epidural analgesia covered with continuous ketamine infusion through a computerized syringe pump at a rate of 20-50 ug/kg/minute without tracheal intubation was studied in 15 patients with chronic chest problem submitted for radical cystectomy at MUNC. The study included haemodynamic parameters and oxygen saturation and the outcome of these cases. The results of this study indicated that this combination could be a suitable anaesthetic regimen for patients with chest problem submitted for radical cystectomy

Indirect versus direct blood pressure monitoring in major surgery under different anaesthetic techniques

Hewlett packard six channels monitor is recently introduced at MUNC. It can assess both invasive and non-invasive blood pressure beside other monitoring facilities including cardiac output and ECG. The reliability of this monitor for non-invasive blood pressure measurments in major surgery as during the operation of radical cyctectomy with Kock's pouch was assessed. The results indicated that this monitor could be used to assess non-invasively the blood pressure during this type of surgery provided that massive blood loss with impaired peripheral blood flow is not allowed to happen during anaesthesia and surgery

Anesthesia for cases diagnosed as query pheochromocytoma. A retrospective study

The files of patients diagnosed as query pheochromocytoma and submitted for adrenalectomy at MUNC were reviewed to assess the anaesthetic managment used from the year [1987-1990]. The results of this study indicated that 3 cases were diagnosed as query pheochromocytoma and submitted for adrenalectomy under anaesthesia during the study period. The anaesthetic regimens used did not vary widely from those reported in the litratures. All cases survived, but they were lacking proper preoperative preparation and good pharmacological protection due to relying upon a normal single test to assess catecholamine release

Mean arterial blood pressure and heart rate changes during supine and lateral positions under different anesthetic techniques

The effect of supine and lateral positions and different anaesthetic techniques on mean arterial blood pressure and pulse rate were studied for 40 patients submitted at MUNC for kidney operations, between the age of 20-40 years. The results of this study indicated that: the non-depolarizing muscle relaxant d-tubocurarine caused a significant hypotension in the supine position. In the mean time halothane administration was associated with marked hypotension in the supine position that was exaggerated in the lateral position. No significant effect on the pulse rate was displayed whether in the supine or the lateral position

Anesthesia for children below the age of fifteen years submitted for renal allotransplant

The files of children below the age of 15 years diagnosed as endstage renal failure and submitted for renal allotransplant at Mansoura Urology and Nephrology Center were reviewed from the year 1984 till 1990, to evaluate the anaesthetic technique adopted and possible effects on the grafted kidney. Data inspected included preoperative medications anaesthetic drugs and techniques, intraoperative monitored haemodynamic variables, hydration and the outcome of the grafted kidney till the end of the 1st post-operative week. From the results of this study it was found that there was no adoption for a specific anaesthetic or hydrating regimens. Patients who received epidural [marciane/morphine] beside general anaesthesia cover, henifited from its prolonged post-operative analgesic effects especially during the first post-operative 24 hours and a less number of cases needed blood replacement. No significant effects on the grafted kidney were detected that might be attributed to anaesthesia

effect of pre-operative acute hemodilution on the dose requirements of d-tubo-curarine in patients submitted for radical cystectomy

The effect of acute normovolaemic haemodilution [AHD] on the dose requirements of d-tubocurarine was studied in patients submitted for radical cystectomy. They were randomly classified into two groups. Group I [n=10] were given homologous blood [control group], and group II [n=20] were subjected to AHD before induction of anaesthesia. The dose of d-tubocurarine decreased significantly in group II despite the longer duration of action when compared to group I. There was no significant correlation between the dose of d-tubocurarine [mg. kg.[-1] hr.[-1]] required and haemoglobin conc., globulins and albumin in both groups whether before or after anaesthesia and surgery

Acute haemodilution and autologous blood transfusion in patients submitted for radical cystectomy

Acute haemodilution [AHD] was studied in 40 patients submitted for radical cystectomy. They were randomly allocated into 3 groups; a control group [n=10] and a preinduction AHD group [n=20] and a postinduction AHD group [n=10]. They were anaesthetized by the same anaesthetic technique [epidural followed by general]. The study included haemodynamic, haematological, biochemical, hepatic function, coagulation and hormonal assessment before and after AHD, at the end of surgery, 3 days and 7 days after operation. From the results, it was concluded that acute haemodilution within certain precautions] could be applied safely and without complications in cases of radical cystectomy. It decreased significantly the needs for homologous blood transfusion and consequently its hazards