efficacy and optimum time of administration of ranitidine [Zantac] HCl on the gastric PH and volume in adult patients undergoing elective surgery

We examined the effect of single oral dose of ranitidine HCl [Zantac] 300 mg, administered 12 or 2 hours before elective surgery, on intragastric pH and volume. One hundred and twenty five adult inpatients of either sex, aged 20-40 years, ASA physical status I and II scheduled for elective surgery with general anesthesia, were randomly enrolled into three groups: Group A [control group] 41 inpatients, group B [oral Ranitidine administered 12 hrs preoperatively] 43 inpatients and group C [oral Ranitidine administered 2 hrs preoperatively] 42 inpatients. There was no statistically significant difference between the three Groups regarding age, sex, ASA physical status, weight, height, and body mass index [BMI]. There was a statistically significant difference between group A vs group B and group A vs group C regarding pH [p <0.0001]. The difference between group B and group C was not significant regarding pH [p > 0.05]. The gastric secretion volume increased in group A more than in group B and C where there were a highly significant difference [p <0.0001] while the difference between group B and C was not significant [p > 0.05]. The proportion of the patients considered [at risk] of significant lung injury should aspiration occur as there was a significant there was a statistically difference between group A vs B [P<0.001], group A vs C [P < 0.05] and no significant difference between group B vs C [p> 0.05]. In conclusion: Oral Ranitidine HCl [Zantac] 300 mg administered twelve or two hours before elective surgery improves condition of gastric secretion at the time of induction of anesthesia, thus reducing the potential risk of pneumonitis, if the aspiration of gastric contents occur following the induction of anesthesia. Our results suggested that the twelve hours dose of ranitidine HCl [Zantac] decreased gastric acidity, secretion volume and numbers of patients at risk of aspiration better than two hours dose but without statistically significant difference

I.V. paracetamol [perfalgan] infusion for postoperative analgesia after laparoscopic cholecystectomy

The adequacy of postoperative laparoscopic cholecystectomy pain control is one of the most important factors in determining when a patient can be safely discharged from the outpatient facility. The purpose of this study was to compare the quality of analgesia and side effects of intravenous paracetamol [perfalgan] 1 g versus intravenous meperidine 100 mg for postoperative analgesia after ambulatory laparoscopic cholecystectomy. The study comprised eighty patients, ASA physical status I or II, age 20-60 years, undergoing elective cholecystectomy under general anesthesia at Benha University Hospital. Before the end of the operation and after removal of the gall bladder, patients were randomly allocated to one of two equal groups, [Group 1] patients received 1g/100ml I.V. paracetamol [Perfalgan] in 15 minutes and [Group 2] patients received 100 mg meperidine [pethidine] I.V. in 15 minutes. Most of the patients [72.5%] in paracetamol group had a VAS Score more than five at six hour after the operation. But in meperidine group [Group 2] the pain intensity increases after 15 minutes and made a peak level in the second hour after the operation. Patients with a VAS score more than five a rescue analgesic was given to the patient. The time to the first request for supplemental analgesia after injection of the study drugs was approximately three times longer in the paracetamol compared with meperidine. Total analgesic consumption 24 hours postoperatively was higher in meperidine group. 16 [40%] of patients in meperidine group [Group 2] were taken three doses of rescue analgesic but 12 [30%] of patients in paracetamol group [Group 1] take three doses of rescue analgesics. 10 [25%] patients in meperidine and 6 [15%] in paracetamol group had nausea. No respiratory depression, vertigo, ataxia, itching, somnolance and headache was observed. Our results indicate that iv paracetamol 1g has better analgesic potency and less side effects than 100 mg meperidine for postoperative analgesia after ambulatory laparoscopic cholecystectomy

Intravenous sedation prior to peribulbar anesthesia for cataract surgery in elderly patients

Cataract surgery, a common operation in the elderly, is frequently performed under regional anesthesia. Dexmedetomidine, a sedativeanalgesic, is devoid of respiratory depressant effects. This study was to compare the effects of dexmedetomidine sedation with those of midazolam sedation in patients undergoing cataract surgery under peribulbar anesthesia and to assess if iv sedation [using dexmedetomidine or midazolam] prior to peribulbar anesthesia minimizes the pain or discomfort, when compared with placebo [saline]. 60 patients were undergoing elective cataract surgeries under local anesthesia randomized into three equal groups to receive one of the following: dexmedetomidine Group D, midazolam Group M and saline Group S. Sedation was titrated to a Ramsay sedation score of 3. Mean arterial pressure [MAP], heart rate [HR], readiness for recovery room discharge [time to Aldrete score of 10], and patients' and surgeons' satisfaction [on a scale of 1-7] were determined. The three groups were similar in age, sex, ASA physical status and mean axial length of the globe. 10 minutes post block the MAP decreased in Group D compared to Group M and S where there was a highly significant difference [P < 0.01] [between Group D and M] and a Very highly significant difference [P < 0.0001] [between Group S and D]. The heart rate also decreased in Group D compared to Group M and S where there was a significant difference [P < 0.01] [between Group D and M] and a Very highly significant difference [P < 0.0001] [between Group S and D]. As regard SpO2 there was no significant difference between the Groups throughout the operation. There were no differences in HR between treatment groups in the recovery period; however, MAP was significantly lower throughout the period of recovery in the dexmedetomidine group. There was no difference between treatment groups in the time to achieve an Aldrete score of 10 and the time to eligibility for PACU discharge. In conclusion, this study demonstrates that iv dexmedetomidine or midazolam appears to be a suitable agent for sedation in patients undergoing cataract surgery, reduced the perception of pain associated with the performance of peribulbar anesthesia and attenuated haemodynamic responses. In the recovery room, dexmedetomidine was associated with an analgesia-sparing effect, slightly increased sedation, but no compromise of respiratory function or psychomotor responses

Local anesthesia with sedation for ambulatory anorectal surgery

Anorectal surgery is extremely painful and it is a challenge to the anesthetist and surgeon. Most patients are anxious about pain during and after the surgery. We tried in this study to solve this problem especially for patients who may have some problems with general anesthesia or contraindications to regional anesthesia. In this study our aim was to compare between the local anesthesia [which is not a common technique in our hospital], spinal anesthesia and general anesthesia for anorectal operations. We selected 87 patients for the study. The patients were allowed to choose between the three methods of anesthesia and then categorized according to their choice. 31 patients choose the local anesthesia and were categorized as [LA] group. 28 patients choose spinal anesthesia and were categorized as [SA] group. The third group was the general anesthesia [GA] group including 28 patients. Patient's satisfaction and intraoperative and postoperative VAS also reported. The operative time ranged from 23 to 55 [23 +/- 18] min in LA group and [25 +/- 12] in SA group, but in the GA group the operation time ranged from 20 to 40 min [20 +/- 10]. There was no difference between LA group, SA group and GA group regarding the personal data [age, weight, and ASA I /II/III]. The percent of female patients in the third group was more than that in the other two groups. The intraoperative pain scale in the in the LA and SA groups during the operation didn't exceed 3 form the start of operation till the end except only one patient in group LA who is shifted to general anesthesia as she was noncooperative and she asked for GA. Intraoperative pain scale more than 5 [3 and 2 patients] in the LA and SA groups during anal dilatation and early manipulations and intensity of pain decreased by time to pain scale less than 3. Five minutes after the end of operation, all patients received declofenaic sodium 75 mg IM. Twenty six patients in the GA start to complain of pain so pethidine 0.3mg /kg IV bolus dose followed by 0.7 mg / kg pethidine IM to control pain. In spite of this six patients of the GA group started to complain of pain again after 90 min of the last dose of pethidine, VAS for these patients was more than 5. 87% of patients in the LA group didn't need any analgesic in PACU for 120 min. Three patients [11%] in SA group developed urinary retention. No patient in LA or GA group developed urinary retention. No surgical complication reported in the three groups. Local anesthesia is more effective and more beneficial to the patients planned to have simple anorectal operations than general anesthesia. Local anesthesia is nearly as effective as the spinal anesthesia. It has the advantages of preemptive analgesia, early patient movements, and early return to the work, and fewer complications than GA

Ketofol [ketamine/propofol]for pediatric orthopedic emergencies

Emergency management of pediatric fractures and dislocations re-quires effective analgesia, yet children's pain is often undertreated. Wecompared the safety and efficacy of intravenous ketamine / propofolcombination ["ketofol"] in the same syringe versus ketamine / midazolam[K/M] for procedural sedation and analgesia in the emergency depart-ment. Sixty patients between 5 and 12 years of age, [ASA] class I or IIwere randomly allocated into two equal groups Ketofol group and K/Mgroup. The presence or absence of adverse events was documented, aswere procedural success, induction time, recovery time and total se-dation time. Physiologic data were recorded with established hospitalprocedural sedation and analgesia guidelines. The induction, recoverytimes were shorter in Ketofol group than in [K/M] group, respectively[P< .05] while total sedation time was very highly significant[P<0.001]. As regard to deep sedation, complete amnesia and Success-ful reduction there was no significance difference between ketofol and[K/M] groups. Vomiting occurred in two patients during procedure in [K/M] group [very high significant difference P<0.0001] while during recoveryit occurred in two patients in Ketofol group and four patients in [K/M]group [no significance difference]. We conclude that during emergencyorthopedic fractures, intravenous ketofol [ketamine / propofol] and thecombination of ketamine and midazolam provides safe, effective seda-tion for procedures in children. Both regimens are effective in facilitatingfracture reduction and both produce amnesia in nearly all children,but average time required for recovery is longer for ketamine / midazo-lam than for ketofol

Proper depth of theendotracheal tubes in adults

The aim of this study was to assess the success rate of proper positionof ETT by external topographic measurements or by Chula formula usingfiberoptic bronchoscope [FOB] as compared with the 21/23 cm method.One hundred and twenty patients scheduled for elective surgery withgeneral anesthesia, were randomly enrolled into three equal groups:Group A, as a control, the ETT was positioned and secured with the 21cm marking for women and the marking 23 cm for men at the right mouthcorner. Group B, with the topographic method, the ETT insertion depth [incm] was determined by adding the distance measured from the rightmouth corner to right mandibular angle to the distance measured fromthe right mandibular angle to a point situated on the center of a line run-ning transversally through the middle of the sternal manubrium. Group C,the length of oral ETT was calculated by Chula formula [4 + body height/10] and marked on the side of the ETT. Results: The length of ETT at thelevel of right upper canine was shorter in group B and C than the lengthof endotracheal tubes in group A [P<0.0001] a very high significant differ-ence. The distance from the tip of ETT to the carina was shorter in groupA than the other groups where there was [P<0.0001] a very high signifi-cant difference, also the distance was shorter in group C than group B[P<0.05] significant difference. The distance from the upper border of thecuff of ETT to the vocal cords was longer in group A than the other groups[P<0.0001] a very high significant difference. There was no significancedifference between the groups as regard the tracheal length. Reposition ofETT after an initial insertion was seven cases [17.5%] in group A and twocases in group C because the distance from the tip of ETT to his or her ca-rina was less than 2 cm and no reposition in groupB [P<0.001] a highsignificant difference. The results of this study suggested that the topographic and Chula formula method are accurate in estimation of the prop-er position for orotracheal intubation than 21/23 cm method. Topographicmethod may be especially useful in women who have shorter tip to carinadistances and can solve the problem individual anatomical variation

Remifentanil with propofol or thiopental for tracheal intubation without muscle relaxants

This study designed to evaluate the use remifentanil followed by propofol or thiopental without muscle relaxants for endotracheal intubation compared to thiopental followed by succinylcholine as a control group for obtaining clinically acceptable intubation conditions and hemodynamic changes. We studied 90 healthy children [ASA I-II], aged three to nine years presenting for elective ENT-surgery. The children were enrolled into three equal groups: Group A received remifentanil 3 micro g/kg followed by 2.5 mg/kg propofol. Group B received remifentanil 3micro/kg followed by 5 mg/kg thiopental, and Group C as a control group received 5mg thiopental followed by succinylcholine 1.5 mg/kg. The tracheal intubating conditions were considered excellent in 30[100%] of children in Group C, 27[90%] in Groups A and 24 [80%] in Group B. Mask ventilation done easily in all children and complete jaw relaxation in 93.3% of children in Group A, 86.6% in Group B and 100% in Group C [significant difference between Group B and C P<0.05]. All children intubated easily, and slight cord movement in 10% of children in Group A and in 20% in Group B [significant difference between Group A and C P<0.05 and a highly significant difference between Group B and C P<0.001]. 6.66% of children in Group A and 20% in Group B developed slight coughing at intubation [a highly significant difference between Group B and C P<0.001]. As regard the MAP changes after induction and intubation In Group C there was significant difference [P<0.05] between Group C and B and a very highly significant difference [P<0.0001] between group A and C. The heart rate decreased 14% and 2% in the remifentanil groups A and B respectively [P<0.05] arid remained lower than baseline throughout the study. The heart rate increased in group C after induction and intubation and there was significant difference [P<0.05] between Group C and B while the difference in heart rate was very highly significant difference [P<0.0001] between group A and C. In summary, the administration of 2.5 mg/kg propofol or 5mg/kg thiopental and 3.0 microg/kg remifentanil provided clinically acceptable conditions for tracheal intubation and stable hemodynamic in children pretreated with atropine. With this combination of drugs, the return of spontaneous ventilation was as rapid as after thiopental/ succinylcholine with acceptable hemodynamic changes. This technique may be advantageous in children with normal airway anatomy undergoing elective brief surgical procedures or in cases in which neuromuscular block is contraindicated