Post-extubation laryngeal spasm in children is no longer a nightmare

Postextabation laryngeal spasm in children is no longer a nightmare. Laryngospasm in children after extubation is ever happening. Sometimes it is severe and alarming and not easily amenable for treatment and may pose great morbidity. Opioids given prior to noxious stimuli, ameliorates or prevent physiologic responses. This study was conducted to assess safety and efficacy of pethidine on post extubation laryngospasm. Forty children ASA 1 and 11 aged 3-12 years undergoing minor and moderate surgery were included in this study. Approval of ethics committee and parental consent were taken. Standard anesthetic regiemen of fentanyl 1-2Mg/Kg[-1] followed by propofol 2-3mg/Kg[-1] and atracurium 0.5mg/Kg[-1] were used. Maintenence with sevoflurane [end tidal 1.5 MAC]. Patients were ventilated to ETCO2 32mmHg. All patients; were monitored for SaO2, NIBP, EGG and ETCO2. Children were divided into 2 groups; Pethidine group which received pethidine 0.5 mg/ Kg[-1], 10 minutes towards end of surgery. Control group received 5 ml NSS. Children were extubated in recovery position. Any adverse airway events; cough, stridor, breathholding, apnea, desaturation and laryngospasm were recorded. Emergency profile and awakening time were recorded and all results tabulated. Control group showed incidence of cough [25%], stridor [10%] laryngeal spasm [20%] and desaturation [15%] vs only one case of mild cough in pethidine group. Emergence was excellent in 95% in pethidine vs 75% in control Awakening times were groups [5.3, 9.5vs 5.2, 10.2min] in P and C groups. Pethidine prior to extubation almost prevents laryngospasm without undue prolongation of awakening time with overall excellent uneventeful recovery

comparison of bupivacaine 0.25% with ropivacaine 0.2% and 0.375% for caudal anaesthesia in children

Thirty- nine boys aged 3-7 yrs. ASA I. undergoing inguinal hernia repair were randomly allocated in this double-blind study. After induction of general anaesthesia, patients were given caudal injection [1 ml/kg] of bupivacaine 0.25% [B 0.25 group], ropivacaine 0.2% [R 0.2 group], or ropivacaine 0.375% [R 0.375 group]. The clinical effectiveness, the degree of motor block and any adverse effects were determined. Data were available for 36 children. The groups were comparable for demographic data and duration of surgery. The onset time of block was similar for B 0.25 and R 0.2 groups, but it was shorter for R 0.375 group [7.2 +/- 1.2 min, P<0.05]. A significantly longer [P <0.05] duration of analgesia was observed in the R 0.375 group [366 +/- 72 min], whereas the B 0.25 group [246 +/- 64 min] and the R 0.2 group [[268 +/- 81 min] were comparable. There was no difference [p >0.05] in the number of patients who did not require postoperalive analgesia in all groups. The degree of motor block was significantly lower [P <0.05] in the R 0.2 group than in the two other groups at 1.2 and 3 hours postoperatively. The mean time to first voiding was longer [P<0.05] in R 0.375 group compared to the two other groups. The mean time to first ambulation was significantly shorter [P< 0.05; in R 0.2 group compared to the two other groups. No significant difference was detected in the incidence of vomiting between the three groups. These findings suggest that caudal administration of 1 ml/kg of 0.2% ropivacaine provide equivalent analgesia to 1 ml/kg of 0.25% bupivacaine with less degree and duration of motor block. On the other hand ropivacaine 0.375% provides longer duration and better quality of analgesia but more intense motor block

Cardiovascular stability after epinephrine propranolol lidocaine infiltration in septoplasty operation in patients under nitrous oxide/02 opioid relaxant technique

Epinephrine infiltration is a common practice in ENT operations to produce haemostasis its concomittant administration with inhalational anaesthetics carries the risk to develop cardiac arrhythmias. This study was conducted to assess the cardiovascular stability after epinephrine propranolol-lidocaine infiltration in patients undergoing septoplasty operation under nitrous oxide nalbuphine relaxant technique. Forty ASA I adult patients of either sex were randomly allocated into two groups each of 20. Both groups received nitrous oxide [66%] in oxygen supplemented with nalbuphine 0.2 mg kg using atracurium 0.5 mg kg as the nuscle relaxant during maintenance of anaesthesia. First group received lidocaine 100 mg i.v. prior to infiltration of the nasal septum while the second group received nothing. infiltration of the nasal septum was done 10 minutes after intubation using 4 -5 ml of a solution containing epinephrine 1,00.000. lidocaine 1% plus propranolol 0.1 mg/ml. Patients were monitored as regards heart rate. systolic and diastolic blood pressures. Results showed insignificant changes in heart rate and blood pressure. No ventricular arrhythmias were seen. Lidocaine group showed more cardiovascular stability, in conclusion, epinephrine propranolol and lidocaine infiltration is almost safe during nitrous oxide opioid anaesthesia and lidocaine administration prior to infiltration confers upon more cardiovasculary stability

Bupivacaine lidocaine epinephrine infiltration as local anaesthetic in middle ear surgery. arrhythmogenic and analgesic potential

Cooperation of patients undergoing middle ear surgery under local anaesthesia provides feed back stat guide, whereas integrity of facial nerve as well as hearing can be tested. Yet, infiltration of epinephrine to produce haemostasis, carries the danger to produce cardiac arrhythmia. This study was conducted to evaluate the arrhythmogenic and analgesic potential of bupivacaine - lidocaine - epinephrine infiltration as local anaesthetic in middle ear surgery. One hundred adult patients of either sex scheduled for middle ear surgery were included in this study. Local anaesthesia was achieved by injection of 5-10 ml of a mixture of bupivacaine, lidocaine epinephrine [1:50.000]. Patients were monitored as regard heart rate, systolic and diastolic blood pressures. Post operative analgesia was, also assessed. There were insignificant increase in heart rate and systolic blood pressure 5 minutes after infiltration which declined gradually near basal value. No arrhythmia was detected. Postoperative analgesia was excellent. In conclusion, bupivacaine - lidocaine epinephrine local infiltration provides excellent surgical anaesthesia, stable haemodynamics and eventual post operative course with high degree of analgesia