Midazolam deep sedation versus metoclopramide to prevent nausea and vomiting during small dose bupivacaine spinal anesthesia for cesarean section

Nausea and vomiting during regional anesthesia for Cesarean section are very common and unpleasant events. They cause significant distress to the patient and also interfere with the surgical procedure. They have multiple etiologies, which include psychological [anxiety] factor, arterial hypotension, and hypo perfusion of the central nervous system. The trials for prevention and treatment of IONV still not definite. In the present study we evaluate the efficacy of hypnotic doses of midazolam in comparison with metoclopramide to prevent nausea and vomiting during spinal anesthesia for elective Cesarean section. One hundred [100] pregnant females were divided to two groups. Group [A] receives [midazolam, n=50], Group [B] receives [metoclopramide, n= 50], the two groups received spinal anesthesia with 8 mg of bupivacaine to avoid sever hypotension and decrease incidence of nausea and vomiting. Nausea and vomiting occurred in 5% of the total cases. IONV was absent in 97% in the midazolam group, 96% in metoclopramida group [p <0.001] for both group, no significant difference between two groups. The results showed a significant lower incidence of IONV in the deep sedation with midazolam and metoclopramide, without significant difference between two groups. The results confirmed and explained that, IONV during spinal anesthesia for Cesarean Section can be caused by psychological [anxiety] factors

Brachial plexus block [axillary block] for emergency orthopedic pediatric surgery versus deep sedation

Our study was to compare procedural distress during manipulation of forearm fractures in children receiving either axillary [brachial plexus] block regional anesthesia [ABRA] [32 children] or deep sedation with ketamine and midazolam [30 children]. This was a prospective randomized unmasked controlled comparative trial conducted in hospital emergency department. The 2 groups were similar in age [older than 4 years], fracture types, initial pain scores, narcotic analgesia received, and midazolam doses before fracture manipulation. The primary outcome measure was procedural distress during manipulation as measured with the Children's Hospital of Eastern Ontario Pain Scale [CHEOPS]. The mean CHEOPS score was 6.4 +/- 2.8 in the group with axillary block and 7.5 +/- 1.6 in those receiving deep sedation; the difference between the CHEOPS scores in the 2 groups was not statistically significant [P = 0.126, 95% CI: 2.5, 0.3]. Axillary block was used successfully in 26[90%] of the 32 children. No patient in either group experienced any adverse events

Effects of some recent intramuscular analgesics on labour pain and maternal and fetal blood gases and pH

This study attempted to determine the analgesic properties of pentazocine hydrochloride, nalbuphine hydrochloride, butarphanol tartarate and tramadol hydrochloride given during labor and their potential effects on maternal and fetal blood gases and pH. Tramadol and butarphanol analgesics were superior to either nalbuphine or pentazocine in relieving labor pain. The studied analgesics caused maternal respiratory acidosis and fetal metabolic acidosis and these acidetic changes were marked with pentazocine, moderate with nalbuphine and minimal with butarphanol and tramadol analgesia