Comparison between the effect of nefopam, ondansteron or meperidine in preventing post anesthetic shivering

This study was carried on 80 adult patients undergoing elective surgery of more than 60min duration to compare the efficacy of nefopam, ondansetron or meperidine in preventing post-anesthetic shivering. All patients were allocated blindly into 4 groups according to drugs given. 0.15 mg/kg nefopam hydrochloride, 4 mg ondansetron, 0.4 mg/kg meperidine and10 ml saline were given intravenous before endotracheal extubation in G I, II, HI and IV respectively The results of the study showed that; core esophageal temperature [COT] and finger tip temperature [FTT] decreased significantly in all groups during intra- and postoperative times compared to preoperative values. Both readings did not significantly change at postoperative times when four groups compared to each other. Post anesthetic shivering was assessed by Wrench scale [0-4]. The highest incidence of shivering was manifested ingroup IV versus groups I, II and III up to 4 h postoperative. The least incidence of shivering was manifested in group III versus groups I, II and IV at 5 and 15 min postoperative. Arterial oxygen content and venous oxygen content decreased significantly in group IV compared to groups I, II and III at all times of measurements postoperative. Meanwhile both readings increased significantly in group III compared to groups I, II and IV at Sand 15 minutes postoperative and they were still the highest values in group III compared to groups I and IV at 60 minutes postoperative. Oxygen extraction ratio [O2 ER] and blood lactate level [BLL] increased significantly in group IV compared to groups I, II and III at 5, 15 and 60 minutes postoperative and O2 ER decreased significantly in group III compared to groups I, II and IV at 15 and 60 minutes postoperative. Post operative pain score was assessed using VAS. The highest incidence of pain was manifested in groups II and IV versus groups I and III and the least incidence of pain was manifested in group Ill versus groups II and IV up to 6 hours post operative. At 24 hours postoperative the highest incidence of pain was manifested in group IV versus groups I, II and III. In conclusion nefopam, ondansetron and meperidine reduced the incidence of PAS with varying degrees. Meperidine was more effective in controlling PAS, and maintaining tissue oxygenation than nefopam, and ondansetron. This study recommended, the prophylactic use of meperidine at the end of surgery to decrease incidence of PAS, further studies to evaluate the minimal effective dose of nefopam and ondansetron in preventing PAS and to evaluate the combination of pharmacological and nonpharmacological methods for prevention of PAS

Protein C and soluble thrombomodulin in relation to tumor necrosis factor-alpha in critically ill septic patients and their correlation with sofa score

The objective of this study was to investigate the influence of sepsis on protein C [PC] activity and soluble thrombomodulin [s-TM] in relation to tumor necrosis factor-alpha [TNF-alpha]. Also, to orrelate these parameters with the SOFA score and serum lactate concentration as predictors of morbidity and mortality in septic patients. Thirty two adult patients [17 with sepsis and 15 with severe sepsis] in the intensive care unit [ICU], as well as 10 healthy age- and sex- matched controls were accrued to the study. The results showed that the baseline values of PC activity were significantly lower in both groups of septic patients compared to the controls, whereas, the serum levels of s-TM, TNF-alpha and lactate were significantly higher in the former compared to the latter. Moreover, survivors in both patient groups had higher PC activity and lower serum levels of s-TM, TNF-alpha and lactate compared to non survivors, both on day [1] and day [3] of ICU admission with variable statistical significance reflecting the heterogeneity of sepsis and the well-known individual patient variation. In addition, day [3] samples showed significant increase in PC activity and reduction in serum levels of s-TM, TNF-alpha, lactate and SOFA scores in survivors and the reverse in non survivors compared to baseline levels. Also, baseline PC activity was correlated negatively with SOFA score but not with serum TNF-alpha in both groups of septic patients. It was also negatively correlated with serum TM and lactate in sepsis but not in severe sepsis

Effect of intra-operative inadvertent hypothermia on tissue oxygenation

Hypothermia is defined as a core body temperature less than 36°C. accidental hypothermia is a frequent event during the perioperative period. Anaesthesia depresses the threshold for responses to hypothermia and therefore, in the cold operating room environment, net heat loss with consequent decline in central body temperature. The present study investigated the relationship between perioperative decrease in core-body temperature and ambient temperature of operating room [OR] and post-anesthetic-care Unit [PACU] and the effect of intra-operative inadvertent hypothermia on tissue oxygenation. The present study included 40 adolescent patients [ASA I,II] scheduled for major surgery under general anaesthesia for more than 90 minutes. Patients were divided into two groups, 20 each. Group I: Operation performed in acclimatized [about 22-24 °C] and humidity controlled theater. [Relative humidity of 70%]. Group II: Operation performed in non-acclimatized room with no mean to control humidity. The anaesthesia technique was the same in the two groups. Measurements: Stimultaneous sampling from the radial artery and right atrium to measure the arterial and venous blood gases [pH, PaO[2], PaCO[2]] arterial oxygen content [CaO[2]] mixed venous oxygen content CVO[2]. Oxygen extraction [O[2]ER], core body temperature and hemodynamic data also measured. There was significant decrease in core body temperature during peri-operative period in GII than in GI [acclimatized theater] that associated with significant hemodynamic changes and significant decrease in O[2]ER. The decrease in arterial O[2] content [CA O[2]] during peri-operative period is the main factor for decreasing O[2]ER in GII whereas at 30 and 60 minute in post-operative period there was significant increase in O[2]ER in GII than GI due to shivering and increased body metabolism to maintain core body temperature. The present study revealed that non-acclimatized, and non-humidity controlled theatre has a deleterious effect on tissue oxygenation and it is highly recommended to perform all surgery in a standard acclimatized atmosphere

Nifedipine versus fentanyl to prevent the pressor response to tracheal intubation

Thirty six patients, ASA I or II, undergoing surgery that required tracheal intubation, were allocated randomly into three groups of twelve. Before induction of anesthesia, they received either saline, nifedipine sublingual 10 mg or fentanyl 1.5 micro g. kg [-1] i. v. Heart rate, systolic blood pressure, diastolic blood pressure and mesn blood pressure [MAP] were recorded automatically every minute for 5 minutes before induction of anesthesia, and for 5 minutes after intubation. Nifedipine was better than fentanyl in blocking the pressor response to intunbation. The fentanyl dose was too small to abolish this response completely. The increase in HR and blood pressure were most evident in the control group, followed by fentanyl, at least increase was seen with nifedipine

Haemodynamic and ventilatory responses to mechanical ventilation in patients with status asthmaticus

The hemodynamic and ventilatory response to mechanical ventilation were studied in ten patients with status asthmaticus, their mean age was 30.4 +/- 6.8 years. On admission, before starting mechanical ventilation, these patients were tachycardic, hypertensive with low CVP, hypoxic and hypocarbic, Qs/Qt 31.93 + 15.53%, CI 3.01 + 0.38 L/min./m 2. Mean pulmonary artery pressure and pulmonary vascular resistance were elevated. Mean VT was 247.4 +/- 58.13 ml and mean f was 28.6 +/- 5.32. Continuous m and atory ventilation was applied to all the patients for a mean of 3.1 days. Mechanical ventilation ameliorated the ventilatory condition as was evident by a significant in PaO2, and decrease in PaCO2, which reflect an amelioration on the hemodynamic parameters [MABP, heart rate, CVP, MPAP, PCWP, CI, PVRI and LVSWI]. These parameters showed continuous amelioration until they reached normal value after relief of bronchial spasm, i.e. before start of weaning. In conclusion, the hemodynamic and ventilatory condition improved shortly after starting artificial ventilation, the better the prognosis will be

Management of patients with severe status asthmaticus admitted to ICU

26 patients [10 males and 16 females] with severe status asthmaticus admitted to the general ICU in the Main Alexandria University Hospital during three years [1980-1982] were included in the present study. All the patients were presented with acute respiratory failure. Their mean age was 35.15 +/- 14.38 years. Their mean duration of stay in the unit was 5.73 +/- 2.51 days. Inhalation therapy was tried with eight patients because their ventilatory condition did not necessitate mechanical ventilation. This line of treatment succeeded with six patients [75%] and failed with two [25%]. Mechanical ventilation was applied to twenty patients [eighteen from the start and the two who failed to respond to inhalation therapy]. The mean duration of mechanical ventilation was 4.05 +/- 4.32 days. All the patients received all kinds of respiratory care including control of secretions, bronchodilators and physiotherapy. This good respiratory care has led to the good prognosis obtained, for this type of patients during the last years. Twenty-two patients were cured [84.62%] and four died [15.38%]

Management of children with acute respiratory failure due to polyneuritis in the intensive care unit

Polyneuritis is an entity of several diseases, as acute toxic polyneuritis, infective neuronitis and Guillain Barre' syndrome. The severe form of the disease can involve the respiratory muscles leading to respiratory failure which is the cause of death. The incidence, pathology, pathogenesis signs and symptoms and management of cases suffering from respiratory affection of polyneuritis in general and Guillain Barre' syndrome in particular was discussed

versatile fixed performance oxygen therapy device

For the clinical practice of anesthesia lower concentration of oxygen is achieved by solution with air. Pre-mixing of air and oxygen is essential for accurate control of the inspised air by miming metered flows of compressed air and oxygen using an oxygen-driven injector. The air-oxygen mixing unit of the "Brompton-Manley ventilator" is a well known device in Egypt. Humodification is allowed by assing a thermostatically controlled humidifier to the circuit