Dexamethasone plus Ondansetron for prevention of postoperative nausea and vomiting in patients undergoing Laparoscopic Cholecystectomy: a comparison with Dexamethasone alone

To compare the efficacy of combination of dexamethasone plus ondansetron with dexamethasone alone for postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. Double blinded randomized controlled clinical trial. Department of Anaesthesiology, Surgical Intensive Care Unit and Pain Management, Dow University of Health Sciences and Civil Hospital, Karachi, from March 2007 to September 2007. One hundred patients, both male and female, age 20 to 50 years, ASA Physical status I and II, scheduled for elective laparoscopic cholecystectomy under general anaesthesia were randomly allocated to two groups. Group A received dexamethasone [2 ml] plus ondansetron 4 mg [2 ml] prepared in two different syringes, and group B received dexamethasone 8 mg [2 ml] and normal saline [2 ml], prepared in two separate syringes just before induction of anaesthesia. Anaesthesia was standardized. For the first 24 hours after anaesthesia, the presence or absence of nausea and vomiting [by simply yes or no] was assessed by anaesthetist blinded to randomization. The rescue antiemetic [metoclopromide 10 mg] i.v., was given, if patient remained nauseous for more than 15 minutes, or experience retching or vomiting during study period. In comparison to dexamethasone group, the frequency of nausea and vomiting was clinically and statistically lower in dexamethasone - ondansetron group [p=0.035]. Use of rescue antiemetic was significantly higher in dexamethasone group [p=0.022]. Two patients in group A and one patient in group B experienced peri-anal itching at time of giving dexamethasone, none of our patients experienced headache, flushing or other side effects. Combination of dexamethasone plus ondansetron is more effective in preventing postoperative nausea and vomiting than dexamethasone alone when used for prophylaxis of PONV before the induction of anaesthesia in patients undergoing laparoscopic cholecystectomy

Comparison of 25-gauge quincke and whitacre needles for postdural puncture headache in obstetric patients

To compare the frequency of postdural puncture headache [PDPH] and failure rate of spinal anesthesia using 25-gauge Quincke and 25-gauge Whitacre needles in obstetric patients. Single blinded, interventional experimental study. This study was conducted at the Department of Anesthesiology, Pain Management and Surgical Intensive Care Unit, Dow University of Health Sciences and Civil Hospital, Karachi from November 1, 2003 - April 15, 2004. One hundred females, aged 18-35 years, ASA physical status I and II, with singleton pregnancy undergoing elective or emergency cesarean section under spinal anesthesia were randomly allocated to receive spinal anesthesia either by using 25-gauge Quincke or 25-gauge Whitacre needles. Patients were followed for 3 days postoperatively. Headache, its relation with posture, onset, duration, severity and response to the treatment were recorded. Compared with the Whitacre group, frequency of postdural puncture headache was significantly higher in Quincke group [p=0.015], while the overall occurrence of non-postdural puncture headache [NPDPH] did not differ significantly between two groups [p=0.736]. Most of PDPH developed on 2nd postoperative day, were mild in nature and resolved within 48 hours of their onset. There was no significant difference in the failure rate of spinal anesthesia in both groups [p=0.149]. It is suggested that use of 25-gauge Whitacre needle reduces the frequency of PDPH without increasing the failure rate of spinal anesthesia in obstetric patients

Comparison of caudal bupivacaine and bupivacaine-midazolam for peri and postoperative analgesia in children

To compare the duration and side effects of postoperative analgesia of caudal bupivacaine and bupivacaine-midazolam mixture. Design: Single blinded, interventional experimental study. Place and Duration of Study: The Department of Anesthesiology and Surgical Intensive Care Unit, Dow Medical College and Civil Hospital, Karachi from May to November, 2002. Subjects and Sixty children, aged 1-8 years, ASA physical status I and II, undergoing inguinal and urogenital surgery were randomly allocated to receive either 0.25% bupivacaine 0.75 ml/kg [group A] or 0.25% bupivacaine 0.75 ml/kg along with 0.1% midazolam 50mg/kg [group B] by caudal route immediately after induction of general anesthesia. Anesthesia was maintained till the end of surgery. Cardiorespiratory data, sedation and pain score were recorded for 24 hours following recovery from anesthesia. Analgesia was supplemented [diclofenac suppository] whenever the pain score was > or = 4. Duration of analgesia was recorded. The duration of analgesia was 21.41 + 2.7 hours in bupivacaine midazolam group and 9.97 + 2.25 hours in bupivacaine group, which showed a significant difference [p < 0.001]. There was no significant difference in heart rate, respiratory rate, blood pressure and the incidence of side effects in both groups [p = 0.716]. The sedation score were significantly higher in bupivacaine-midazolam group during first hour postoperatively [*p = 0.003]. Addition of midazolam to caudal bupivacaine provides longer duration of postoperative analgesia without having significant side effects but with higher sedation score for 1 hour postoperatively