Peribulbar anesthesia for intraocular surgery comparison between three anesthetic solutions; evaluating anesthetic efficacy and ocular movements

Forty five adult patients, ASA I - III, scheduled for cataract using single medial canthus peribulbar anesthesia were randomly allocated into 3 group, group I received the standard local anesthesia mixture with no hyaluronidase, group II received standard local anesthetic mixture with hyaluronidase 15 IU/ ml and vecronium bromide 1 mg and group III received standard local anesthetic mixture containing hyaluronidase 150 IU/ ml. Patients were assessed for ocular and eyelid movement using Brahma scoring at 1,5 and 10 minutes after injection, on completion of surgery and before the discharge from day surgery unit. If after 5 minutes there was still full movement in any direction or total score of 6 or greater, supplementary anesthesia was applied via inferiolateral route with, 3-5 ml of the test solution. If after 10 minutes, the block was still inadequate, a further infenolateral injection was performed. The need for supplementary anesthesia and total volume of local anesthetic mixture were recorded. There were no statistical differences between the 3 groups as regards the demographic data. The median ocular movement scoring was significantly reduced at 5 minutes in group II and III compared to group I [P <0.05]. No statistical difference in median ocular movement score at 1, 10 minutes and at the end of surgery was found between the groups. Median eyelid movement scoring was reduced significantly at 1 and 5 minutes in group II and III compared to group I [P <0.05]. No statislical difference between the 3 groups found as regards the ocular movement scoring before the discharge from day surgery unit. The number of the patients who received supplementary anesthesia were significantly, reduced in group II and III [5 and 3] compared to group I [8 patients]. The total volume of local anesthetic mixture was significantly lower in group II and III compared to group I [P < 0.05]. There was no difference between the 3 groups as regards the visual acuity at the start of surgery or before discharge. We concluded from the study that the addition of neuromuscular blocking agent vecronium bromide 1 mg to standard local anesthetic mixture with hyaluronidase 15 IU/ ml as recommended by British National Formulary improved global akinesia and operative condition with no side effects and without too much increase in the concentration of hyaluronidase in adult patients undergoing cataract surgery using single medial canthus peribulbar anesthesia

Dexamethasone-low dose ketamine combination versus droperidol low dose ketamine. A comparative study for their effect on postoperative nausea and vomiting and swallowing evoked pain after paediatric adenotonsillectomy

40 children aged [6 - 12] years ASA 1 and II scheduled for Adenotonsillectomy were randomly allocated to receive either ketamine [0.1 mg/ kg] IM 15 minutes before induction of anesthesia and dexamethasone [150 micro g/ kg] before the end of surgery [group I] or ketamine [0.1 mg/ kg] IM 15 minutes before induction plus droperidol 15 micro g/ kg before the end of surgery [group II]. General anesthesia was standardized for both groups where all children were given rectal diclofenac [2 mg/ kg] 20 minutes before end of surgery. Thiopental 5 mg/ kg was used as an induction agent and suxamethonium [1 mg/ kg] was used to facilitate tracheal intubation. Anesthesia was maintained with halothane 1-2% concentration supplemented with oxygen -nitrous oxide [40-60%] After the end of surgery, all children were transferred to post anesthesia care unit where a trained nurse blinded to the study observed [and after that in the ward] observed all episodes of nausea and vomiting during the first 24 hours. Also pain scores were assessed 1/2 hour, 1,2 and 3 hours after extubation and remaining of the first postoperative day. Time for first call analgesia, first oral intake and first adequate oral intake were observed during the first postoperative day. All episodes of postoperative nausea and vomiting were significantly lower in group I; pain scores were significantly lower in group I at all times compared to group II. Time for first call of analgesia was significantly longer in group 1 and time of oral intake and adequate oral intake were significantly shorter in group I compared to group II. We concluded that ketamine [0.1 mg/ kg] + dexamethasone [150 micro g/ kg] combination gave significant better results than [ketamine [0.1 mg] + droperidol combination as regards PONOV and pain relief during the first postoperative day in children undergoing elective adenotonsillectomy done on ambulatory basis

dose-response study of peribulbar anaesthesia using mixture of local anaesthetic and vecuronium in the eldery: evaluating oxygen saturation and akinesia of the globe

The aim of this double blind randomized study was to evaluate the effect of adding 1mg vecuronium bromide to the standard local anaesthetic solution compared to a dose of 0.5 mg vecuronium bromide added to the same local anaesthetic mixture used for peribulbor anaesthesia evaluating the akinesia of the globe and oxygen saturation in eldery people undergoing elective cataract surgery. 60 patients were included In the study, all received a mixture of 5m 12% lignocain with 1:200000 adrenaline. 5ml 0.5% bupivecaine and 150 international units hyaluronidase with either 1mg vecuronium [group I, n = 30] or 0.5 mg vecuronium group [n = 30]. Eye movement assessed at both 5 and 10 minutes were significantly reduced in group I compared to group II [p < 0.05]. There were no significant difference between the 2 groups with regards to the oxygen saturation measured throughout the procedure and the next postoperative 2 hours. We concluded that adding 1mg vecuronuim to local anaestbetic mixture was superior to 0.5 mg vecuroriuim as reginds the akinesia of the globe and without any harmful side effects on the respiratory function represented by the oxygen saturation