Résumé
Opioids such as morphine and fentanyl have been used in neuraxial anesthesia to prolong the analgesic effects since long, but these have frequently been associated with few adverse effects e.g. nausea, vomiting, pruritus and rarely respiratory depression. Tramadol has also been used in epidural as well as spinal anesthesia, and respiratory depression has not been reported with its intrathecal use. We present a case in which 20 mg of intrathecal tramadol produced signs of opioid overdose including respiratory depression. The side effects were reversed with naloxone confirming our suspicion that these were caused by tramadol. We recommend adequate monitoring and vigilance for tramadol as is used for other intrathecal opioids
Sujets)
Adulte , Humains , Mâle , Rachianesthésie/méthodes , Injections rachidiennes , Rachianesthésie/effets indésirables , Mauvais usage des médicaments prescrits , Analgésiques morphiniques , Antagonistes narcotiques/usage thérapeutique , Insuffisance respiratoireRésumé
Background and Objective: Craniotomy bone flaps should be replaced for both cosmetic and protective purposes. Different methods are available commercially. The aim of this study was to assess outcome of bone flap fixation using mini titanium plates and screws
Methods: Between March 2011 and March 2014, 71 patients underwent cranial bone flap fixation with mini titanium plates and screws after craniotomy and excision of supratentorial lesions at Combined Military Hospital, Peshawar. There were 42 males and 30 females with a mean age of 40.07. All patients had supratentorial lesions. Intracranial lesion size ranged from 3 cm by 2 cm to 7 cm by 5 cm. The changes of local incision and general condition were observed
Results: Subcutaneous effusion occurred in two patients. One patient developed a mild postoperative wound infection. CT scan showed good repositioning of the flap and edge to edge apposition at two weeks after operation. All the patients were followed up for 12 months post operatively. Skull had good appearance without any discharge and, local deformity or effusion. Repeat CT/MRl showed no subsidence or displacement of cranial flap or artifacts
Conclusion: Mini titanium plate and screw fixation of cranial flaps is a simple, cost effective and safe option for repositioning and immediate stability as compared to traditional sutures