Medial canthus single injection a comparative study between articaine and prilocaine

To compare the efficacy of 4% articaine with 4% prilocaine for peribulbar anesthesia in ocular surgery using single medial canthus injection technique. One hundred patients scheduled for elective ocular surgery were randomly selected to receive 8ml of articaine 4% with 1:200,000 adrenaline [ultracaine D-S], or to receive 8ml of prilocaine 4% with 1:200,000 adrenaline [citanest fort]. Hyaluronidase 20IU/ml was added to both solutions. The end results were evaluated. Articaine had a more rapid onset of action as regards extra-ocular muscle paralysis, similar potency and less incidence of restoring to supplementary anesthesia. In comparison to prilocaine in single medial canthus peribulbar anesthesia. 4% articane is a good competitor to 4% prilocaine in peribulbar anesthesia

Comparison of caudal bupivacaine plus ketamine and caudal bupivacine plus I.V. ketamine for post operative analgesia in children

The aim of this study was to compare the effect of single dose caudal bupivacaine, caudal bupivacaine plus ketamine and caudal bupivacaine plus I. V. ketamine in children for post operative pain management. Following ethics committee approval and informed parental consent 96 ASA I or II children between 1 and 10 years of age scheduled for elective inguinal hernia repair with general anaesthesia were recruited. After induction of anaesthesia and placement of a laryngeal mark air way [LMA], the patients were randomly divided into three groups to receive either caudal bupivacaine alone 0.25% 1ml.kg[-1] or caudal Bupivacaine 0.25% 1ml. kg[-1] plus ketamine 0.5mg/kg[-1] or caudal bupivacaine 0.25% ml.kg[-1] plus I.V Ketamine 0.5mg. Kg[-1]. Pain was evaluated by children's hospital of Eastern Ontario pain scale and sedation with a five point sedation test. No difference was found regarding age, weight, and duration of operation between the groups [p>0.05]. Duration of analgesia was longer in caudal ketamine group [1380.2+208.8min] than the other two groups. Pain scale was similar between groups in the first 2h-postoperative but lower in caudal ketamine group [4.6 +/- 1.1] than I.V ketamine group or bupivacaine group at 3h. The number of patients requiring supplementary doses of analgesia was significantly lower in caudal ketamine group 3 children compared with the IV ketamine group or bupivacaine group. Bupivacaine [0.25%] plus ketamine 0.5mg.Kg[-1] given caudally prolong postoperative analgesia and significantly reduce the need for subsequent post operative analgesia compared with caudal bupivacaine alone or I.V ketamine plus caudal bupivacaine

Tactile TOF count as a predictive factor for the efficacy of neostigmine reversal of rocuronium-Induced blockade during propofol or sevoflurane anesthesia

This study was done to determine whether train-of-four [TOF] count is a good predictor to the efficacy of neostigmine administration for reversal of rocuronium-induced blockade during propofol or sevoflurane anaesthesia, and to follow subsequent recovery until the TOF reached 0.9. One-hundred-twenty patients, divided into eight equal groups, were randomly allocated to maintenance of anaesthesia with propofol or sevoflurane. The tactile response of the adductor pollicis to TOF stimulation was evaluated on one arm, and the mecha-nomyographic response was recorded on the other Neuromuscular block was induced with rocuronium 0.6 mg.kg[-1] and maintained with rocuronium to 15% of the control first twitch in TOF, neostigmine 0.07mg.Kg[-1] was administered on reappearance of the first [Group I], second [Group II], third [Group III], or fourth [Group IV] tactile TOF-response in each anaesthesia. The times from administration of neostigmine until the ratio recovered to 0.7, 0.8 and 0.9 were recorded. The times [[median [range]] to TOF ratio - 0.9 were 8.2 [4.5-17.3], 7.8 [3.6-11.9], 5.6 [1.8-9.1], and 4.4 [1.1-7.6] min in Groups I-IV during propofol anaesthesia, respectively, and 24.6 [8.1-66.3], 22.8 [7.6-51.1], 15.4 [7.1-39.7], and 9.1 [4.9-22.3] minutes in corresponding groups during sevoflurane anaesthesia, respectively, [p<0.05]. We recommend more than 2 TOF responses with propofol anaesthesia and 4 TOF responses with sevoflurane anaesthesia for adequate reversal within 10 and 15 minutes, respectively. The more tactile TOF responses present at the time of reversal achieved greater adequate recovery

Postoperative emesis in pediatric strabismus correction

Postoperative emesis after strabismus surgery continues to be a problem, despite the use of anti emetic. The purpose of this study was to identify an anesthetic technique associated with the lowest incidence of vomiting after pediatric surgery. A prospective, randomized, double-blind study was conducted to evaluate the effect of intravenous, sufentanil, morphine,or peribulbar block with propofol infusion on emesis in 105 pediatric patients undergoing strabismus correction. Anesthesia was maintained with air, oxygen and propofol infusion diclofcnac sodium 1mg/kg intramuscular was administered to all patients after induction patients was given either a peribulbar block, intravenous sufentanil 0.25 micro g/kg or intravenous morphine 0.1 mg/kg for perioperative analgesia. The emesis score was observed for the first 24 hours postoperatively. The incidence of emesis was significantly lower [1 of 35:2.9%] in the peribulbar group compared with morphine group [9 of 35:25.6%] [P<0.1]. The sufentanil group had a higher incidence of vomiting [4 of 35:11.4%] than did the peribulbar group. Among three techniques, peribulbar block with propofol - based anesthesia is the technique with the lowest incidence of postoperative emesis. Sufentanil-propofol is equally acceptable alternative however morphine- propofol is associated with high incidence of postoperative emesis