Pre-emptive analgesic effect of low dose N-methyl-D-aspartate receptor antagonists: ketamine and magnesium in conjunction with spinal anesthesia

The role of NMDA receptor antagonists in mitigating acute and chronic pain is well documented. Both ketamine and magnesium are among the best known and available NMDA antagonists. In this trial, we tested the hypothesis that intravenous administration of small doses of ketamine or magnesium prior to spinal anesthesia may positively affect the characteristics of spinal block and improve the quality of postoperative pain relief. 45 patients were enrolled in this study, randomly assigned to 3 equal groups, group K received iv ketamine, group M received iv magnesium sulphate, and group S received saline placebo 5 minutes prior to induction of spinal anesthesia using hyperbaric bupivacaine. The following parameters were recorded: mean arterial blood pressure, onset and duration of sensory and motor blockade, time till first analgesic request, total amount of analgesics administered to patients in the first 24 hours postoperatively, and visual analogue scale [VAS] scores for pain. Onset of both sensory and motor blocks was significantly delayed in group M compared with both K and S groups. Duration of both sensory and motor blocks was significantly longer in K and M groups compared with group S [K>M>S]. Again, time to first analgesic was significantly delayed in K and M groups compared to S group and this applies also to the total dose of opioids given which was significantly lower in K and M groups compared with S group. Finally, VAS scores were significantly lower in K and M groups in the first 3 hours postoperatively, an effect that continued with K group for the first 8 hours. Both ketamine and magnesium potentiated bupivacaine spinal anesthesia, prolonged the period of effective postoperative analgesia, reduced opioid consumption, and decreased pain scores especially in the early postoperative period

comparative blind study for assessment of Intubating conditions using propofol and remifentanil with and without muscle relaxant

Remifentanil is a powerful and ultra-short acting opiate, with a rapid onset of action. It is hydrolyzed by non-specific blood and tissue esterases and it has a half life of approximately 3 min compared with 58.5 min for alfentanil after 4 hours infusion Thus, remifentanil can be administered without fear of accumulation over time. Intubation without neuromuscular blocking agents has been used in a number of different studies. Based on the pharmacokinetic profile of remifentanil, it was hypothesized that it may be very useful in facilitating tracheal intubation. The aim of our study is to determine the quality of intubation using remifentanil 3 micro g/kg and propofol 2 mg/kg compared with the standard use of muscle relaxants. We studied 100 healthy adult patients [ASA physical status I, II], undergoing elective surgery requiring tracheal intubation. They are arranged in two equal groups: one group with muscle relaxation given for intubation, while the other group no relaxant was given. Anesthesia was induced with 3 micro g.kg[-1] of remifentanil over 3 min. followed by propofol 2mg.kg[-1] as a bolus over 30 seconds for both groups. Laryngoscopy was performed after assisted ventilation with 50% N2O and 6-8% desflurane in O2 till a bispectral index value [BIS] of < 40% was reached. The trachea was intubated with an appropriate-sized cuffed tube. The study parameters were: MAP, HR, and SpO2 which were measured before induction, then every minute until the tube is fixed. A blinded operator scored the ease of intubation using a special scoring system. Adverse events such as laryngospasm, bronchospasm, chest wall rigidity, coughing or post-operative sore throat were recorded if occurred. Intubation conditions were clinically acceptable in both groups with no statistical difference. From this study we conclude that the use of propofol and remifentanil in the given doses provided excellent intubation condition without the need for muscular relaxation

Biochemical view on the effect of hepatitis delta virus infection on expression of hepatitis B virus in blood donors

One thousand voluntary blood donors attending the Blood Bank of Medical Research Institute, Alexandria University were enrolled in the present study. Sera from blood samples were separetd for screening of HBsAg using ELISA technique. Screening of 200 1-IBsAg negative blood samples for past exposure to HBV infection was also performed through the detection of anti-HBc using specific ELISA kit. Determination of ALT and AST revealed a significant increase among HBsAg positive group while, Malondialdehyde [MDA] detection revealed the absence of the causative relationship between MDA and liver injury. On the other hand, no anti-HDV could be found among the HBsAg-ve/anti-HBc+ve group of blood donors [46 cases]. PCR analysis for HBV-DNA was performed in the chosen 24 serum samples. None of them was positive for HBV-DNA regardless their positively or negativity to the different serologic markers studied

Sedation for mechanically ventilated postoperative patients in the intensive care unit: comparative study between propofol and dexmedetomidine

Alpha 2 agonist dexmedetomidine is a new sedative and analgesic drug, which has been recently approved by FDA for use in ICU sedation. Dexmedetomidine is pharmacologically much more selective on alpha 2 receptors than clonidine. In the present study dexmedetomidine was compared to propofol as infusion for sedating 20 patients [10 patients in each group] admitted to ICU for postoperative short-term mechanical ventiiatory support [8-10 hrs] after major surgical procedures. Additional analgesics were supplied using nalbuphine iv bolus doses. Depth of sedation was measured continuously by using bispectral index neurosonic 1400 monitor. Hemodynamic and ventilator variables were recorded hourly Depth of sedation was equivalent in both groups by bispectral index scale 56 [44-67] for propofol group versus 49 [42-57] for dexmedetomidine group with non-significant difference [P= 0.41] between both groups. Although dexmedetomidine group showed more alertness and cooperation during ventiiator support and more rapid and easy extubation [extubation time 33 minutes in propofol group versus 32 minutes in dexmedetomidine group] [p= 0.7], but these changes were statistically non-significant Also propofol group required almost three times analgesic doses than for dexmedetomidine group [240 mg versus 80 mg]. No significant difference was found in mean arterial blood pressure or central venous pressure between both groups However heart rate showed significant reduction in dexmedetomidine group than in propofol group [p= 0.026]. No adverse events were recorded when related to the sedative infusions used in this study. It could be concluded that dexmedetomidine is a safe and an effective sedative agent in ICU postoperative patients as it provides safe profile and reduces analgesic requirements

Intra-articular analgesia with ketamine and tramadol; the effect of the type of surgery

Arthroscopies are most commonly performed on day case basis, but postoperative pain remains a problem as more complicated procedures are performed. This study was earned out on 60 adult ASA l-ll patients undergoing arthroscopic procedures. Patients were assigned into 2 equal groups; group I underwent low inflammatory surgeries, whereas group II had high inflammatory surgeries. Both groups were further subdivided randomly into 3 equal subgroups. Subgroup K received 0.5 mg kg[-1] ketamine intra-articularty, subgroup T received 100 mg tramadol intra-articularly and subgroup S received placebo. The following parameters were recorded; vital signs, first time to ask for analgesia, total rescue i.v pethidine given and VAS scores hourly for the 1[st] 6 hours, then 3-houhy till the end of the first postoperative day Group I showed significantly delayed onset of pain [p=.009]. lower pethidine consumption [p=.O36] and lower VAS scores at 1, 4, 5, 6, 9, 12, 15, 18, 21, and 24 hours On the other hand, on comparing K. T and S subgroups, both K and T subgroups showed a significant delay in asking for analgesic [p=.001], significantly lower pethidine consumption [p=.001] and significantly lower VAS scores at 1, 2, 3, 6, 12, 15. and 24 hours as compared to S subgroups. On comparing K and T subgroups, there was no significant difference among them except in the first 2 hours where K subgroups had significantly lower VAS in the first hour [p=.O18]. while T- subgroups showed significantly lower VAS in the second hour [p=.004]. Both ketamine and tramadol proved to be useful and safe analgesic agents when applied intra-articularly particularly in the low inflammatory procedures

Assessment of metabolic and acid-base changes during trans-urethral resection of prostate

TURP patients are usually critically ill and suffer from multiple diseases. The use of irrigation fluid has its own risks. This study was carried out to detect if any acid base disorders develop in these patients. Thirty patients received general anesthesia with controlled ventilation to maintain normocarbia. Arterial blood gases, electrolytes and lactate were determined preoperatively, 30 minutes after the start of the procedure and after finishing the operation. The present study revealed mild acidosis that can be explained on the basis of the Stewart concept as a decreased strong ion difference acidosis. This may pay our attention to acid base monitoring in TURP patients when there is too much absorption of the irrigation fluid and in prolonged cases

Treatment of human demodex folliculorum by camphor oil and metronidazole

A total of 15 females suffering from Erythematotelangiectatic rosacea and 12 females free from other dermatological lesions was selected. Demodex folliculorum infestation density in both patients and controls was evaluated by noninvasive skin surface biopsies. Five facial sites were selected. The daily topical application of 1/3 diluted camphor oil with glycerol and 500 mg metronidazole orally were given for 15 days. The results were very successful with no clinical side effects

Pulmonary function changes after interscalene brachial plexus anaesthesia; comparison between 0.75% ropivacaine and 0.5% bupivacaine

This study was carried out on 20 adult patients, scheduled for shoulder and arm surgery. After monitoring of the patients for heart rate, non invasive blood pressure and pulse oximetery. They were allocated randomely to receive 20 ml of either 0.75% ropivacaine [group I] or 0,5% bupivacaine [group II] for interscalene bradial plexus [ISBP] block. The patients demographic data were similar in both groups, the onset of sensory block and motor block were significantly prolonged in group I in comparison to group II [12.08 +/- 0.69 min and 15.05 +/- .0.69 min in group I vs 10.10 +/- 0.70 min and 12.25 +/- 0.72 min respectively] P< 0.0001. A significant reduction in pulmonary function occurred in both groups after 5 minutes till 30 minutes of the block. Forced vital capacity [FVC] decreased by 9% after 5 min to 40% after 30 minutes in group I and by 13% to 39% in group II. forced expiratory volume after one seconds [FEVl] decreased by 12% to 18% in group I and from 13.5% to 18.5% in group II. The peak expiratory flow rate [PEFR] decreased from 11% to 26.3% in group I, and from 11% to 32% after 30 minutes. No significant difference between both groups as regard FVC. FEVI, and PEFR at any time of measurement. We concluded that both 0. 75% ropivacaine and 0.5% bupivacame can be used for interscalene brachial plexus block,, but owing to the less cardiac toxicity of ropivacaine. it is recommended to be widly used