Study of the effect of paracetamol in reducing postoperative morphine consumption by patient controlled analgesia after abdomenoplasty

Trials should not stop to found the proper pain killer that can effectively replace or reduce the use of narcotic analgesics to avoid their known side effects, most important is physical dependence. Paracetamol [perfalgan] is a promising parentral form of paracetamol. The aim of this work is to study the sparing effect of paracetamol on morphine consumed by the patients undergoing abdomenoplasty using patient controlled analgesia pump [PCA]. Eighty female patients were randomly arranged in two groups [40 each]. They were scheduled for surgical abdomenoplasty. The first group received paracetamol 1 5mg/kg intravenous infusion after induction and every 6 hours in the first post operative day. The second group received placebo. Both groups received the same anesthetic management and PCA settings postoperatively. The study variables were morphine consumption, pain at rest and activity [coughing], patient satisfaction throughout the first postoperative day and reporting of any adverse effects. From this study it is found that the use of paracetamol infusion on regular bases both intraoperativelly and 6 hours postoperatively reduced morphine requirements by more than 30%. From this work it is concluded that the use paracetamole infusion reduces the need for morphine in postoperative analgesia

Semi closed loop of spectral entropy and target controlled infusion versus dose based total intravenous anesthesia of propofol and remifentanil

As a step forward towards the installation of a totally computerized anesthesia, we tried to integrate target controlled infusion pump with its ability to determine effect site drug concentration and monitoring of state and response entropy in the patient as a feed back system for fine tuning of intravenous anesthesia, comparing this system with the regular dose based total intravenous. 40 patients included in this study, were randomly arranged in two groups [20 each] They were scheduled for elective ventral hernia surgery. The first group received dose based total intravenous anesthesia [TIVA], the second group received entropy modulated target controlled infusion [TCI]. We measured the amount of propofol and remifentanil used per kg of the patient weight per minute of anesthesia, time to extubation. the time needed from the end of anesthesia till a recovery score [Aldrete score] of 9 or 10. mean blood pressure and heart rate, postoperative pain score and the incidence of intraoperative awareness. It was found that there were no differences between the two groups in hemodynamic or pain data, also no significant difference in the rate of propofol used but there was significant reduction of remifentanil rate [23.11% reduction] in group TCI if compared with the other group. From this work it is concluded that the use of sophisticated TCI machine and sophisticated entropy monitor does not necessanly results in better outcome nor it is cost reasonable

study of lung recruitment in geriatric patients after prolonged general anesthesia using different concentrations of inspired oxygen 20 minutes during recovery

General anesthesia administered with an increased fraction of inspired oxygen [FIO[2]]. Elderly patients because of high incidence of ventilation perfusion [V/Q] mismatching, the use of high FIO[2] may lead to more liability of absorption atelectasis and postoperative hypoxemia and / or pneumonia. These are considered the major factors complicating prolonged general anesthesia in elderly patients in the postoperative period. In this study we tried to figure out the effect of using two different concentrations of inspired oxygen 20 minutes during recovery. The study was done on 30 geriatric patients above 60 years of age presented for non thoracic and non abdominal long surgeries. Patients arranged randomly and equally into three groups 10 patients each. Group 1, they received FIO[2] of 1. The second, Group 0.4, they received FIO[2] of 0.4 and the third, Group CPAP [continuous positive airway pressure.], they received FIO[2] of 0.4 and CPAP of about 15 cm H[2]O. All patients were subjected to arterial blood gases measurement during and after recovery, and plain chest X-ray postero-anterior and lateral views. We conclude from this study, that use of low FIO[2] combined with the use of CPAP mode during recovery associated with lower incidence of atelectasis and better blood gases levels than the use of high FIO[2]