Single dose diclofenac reduces agitation after sevoflurane anesthesia in children

Emergence agitation is a common side effect of sevoflurane anesthesia in children. Diclofenac, because its analgesic properties, might be useful for the mangement of this adverse effect. We studied the effect of Diclofenac recovery characteristics in 50 children aged 6 mo. to 5 yr, scheduled to undergo inginal hernioraphy. All children were premedicated with oral midazolam 0.5 mg/kg After inhaled induction with sevoflurane, patients were randomly assigned to receive either saline [n=25] or rectal diclofenac 1mg/kg [n=25]. Maintenance of anesthesia was with 2% sevoflurane, 50% nitrous oxide and atracurium with mechanical ventilation. Intra-operative hemodynamic and oxygenation variables are recorded every 5 min. At the end of anesthesia TEO, recovery time, discharge time and incidence of agitation were detected. There were significant reduction in agitation score and incidence of agitation in diclofenac group without affection the recovery or the discharge time. We conclude that a dose of diclofenac of 1 mg/kg administered after induction of anesthesia reduces the post sevoflurane agitation in children, with no adverse effects

effect of intrathecal magnesium sulphate versus intra venous magnesium sulphate on spinal fentanyl analgesia

This double-blinded, comparative study was designed to compare between the analgesic efficacy and safety of adding magnesium sulphate [MgSO4] intrathecal [I.T] versus intravenous [IV] MgSO4 on spinal fentanyl analgesia [1micro g / kg]. sixty pediatric patients of 6-12 years undergoing surgeries on the lower half of the body eg :inguinal hernia, hypospadius, undescended testis under sevoflurane: nitrous oxide anaesthesia were included. No intra-operative narcotics were administered. Patients were allocated into 3 groups [20 patients each] G[fit] received IT fentanyl micro/kg, G[mgit] received IT fentanyl 1mg /kg plus IT MgSO4 1mg/kg, G[mgiv] received IT fentanyl 1 micro g /kg plus IVMgSO4 20mg/kg as a loading dose, followed by infusion at a rate of 10mg /kg /h. Pain was evaluated by visual analogue pain scale [VAPS]. Duration of post operative analgesia was defined as the interval between intrathecal analgesic mixture administration and the first patient's request for additional analgesia. there was a significant prolongation of the duration of analgesia in group G[mgit] and group G[mgit] compared with group G[fit]. Also there was a significant decrease in VAS in group G[mgit] compared with G[fit]. No differences were noted among groups as regards haemodynamic and Ramsay sedation score. The addition of MgSO4 either intratheeaily or intravenously proiongd the spinal opioid Analgesia in humans and it is safe even in high doses. So the MgSO4 could be of clinical importance for pain management

Cardiovascular effects of propofol- fentanyl versus ketamine- midazolam in pediatric patients with congenital heart disease

Purpose: The cardiovascular effects of different anesthetic regiments in children with normal hearts have been studied but data in children with cardiac diseases are limited . This study was designed to compare the effects of propofol - fentanyl [P/F] and ketamin - midazolam [K/M] on systemic and pulmonary hemodynamics-.myocardial contractility and recovery time in patients with congenital heart diseases

Methods: 30 patients aged from 1 month to 12 years with congenital heart diseases undergoing cardiac catheterization. They were randomly divided into 2 groups the 1st received P/F and 2nd received K/M .The cardiovascular., echocardiographic data and recovery time were recorded

Results: Propofol-fentanyl caused significant decrease in the heart rate[HR] and mean blood pressure[MAP] also it diminished cardiac index [CI] significantly. While the ketamine- midazolam significantly prolonged the recovery time [R.T]

Conclusion: The use of K-M for children with congenital heart diseases provided hemodynamic stability .But fentany1-propofol provided more rapid recovery

Moderate sedation with midazolam- ketamine versus propofolketamine for bone marrow biopsy

Small- dose ketamine in combination with sedative drugs has increasingly been used for sedation and analgesia during local anaesthesia in outpatient procedure. This study compared the efficacy of sedation and analgesia of ketamine midazolam versus ketamine propofol combinations in bone marrow biopsy. Sixty patients of either sex undergoing bone marrow biopsy procedure under local anesthesia participated in this study. They were randomly allocated into two groups of 30 patients each, all received ketamine 0.5 mg /kg with either midazolam 0.05 mg/kg [KM group] or propofol 2.5 mg/kg [KP group]. Supplementary dose of ketamine was administered to achieve adequate sedation level. Time to induce sedation, recovery oxygen time, saturation and adverse effects were recorded. The sedation levels were satisfactory in both groups except two patients in KM group and one in KP group. The most common side effects in KP group were pain on injection and hypoxia, where nausea and vomiting were the commonest side effects with KM group. Induction and recovery times were significantly shorter in KP group. Both combinations provided adequate sedation for bone marrow biopsy procedure but KP offer a quicker onset of sedation and a faster, smoother recovery

effect of epidural nalbuphine and morphine versus systemic nalbuphine with epidural morphine in patients submitted for major abdominal surgery

In this double blind randomized study we compared. The effects of epidural nalbuphine to intravenous [IV] nalbuphine on the epidural morphine in patients undergoing elective major abdominal surgery. G[M] [control group] received epidural mixture of bupivacaine 0.5% 1mg/kg and preservative free morphine 150 micro g/ml bupivacaine G[M-epiN] received epidural mixture of bupivacaine 0.5% 1mg/kg and preservative free morphine 150 micro g /ml bupivacaine and preservative and buffer free nalbuphine 30 micro g/mL bupivacaine G[MivN] received epidural mixture of bupivacaine 0.5% 1mg/kg and preservative free morphine 150 micro g/ml bupivacaine and preservative and buffer free nalbuphine 0.1mg/kg [IV] There was no significant changes in analgesia score or sedation score between 3 groups. Nalbuphine markedly adverse the side effects of morphine regarding haemodynamics. There was significant decrease in HR and MAP in the G[M-epiN] G[MivN] groups comparing with G[M]. Our data indicate that the addition of nalbuphine either intra venous or epidurally prevent the morphine induced side effects without reversing its analgesic effect