Naloxone versus nalbuphine for treatment of intrathecal morphine-induced side effects

This study included 200 adult male and female patients undergoing lower abdominal and anorectal surgeries under spinal anesthesia. All patients received [3 ml bupivacaine 0.5% + 1 mg morphine] intrathecally. Patients were observed for 24 hours postoperatively. One hundred patients requested treatment for moderate to severe symptoms [pruritus, nausea and/or vomiting]. According to the drug used to treat intrathecal morphine-induced side effects, patients were divided randomly into two equal [each of 50] groups: Group I, received nalbuphine in a dose of 2 mg for a maximum of 6 doses [12 mg] and group II, received naloxone in a dose of 0.08 mg for a maximum of 6 doses [0.48 mg]. The remaining 100 patients developed no or mild symptoms requiring no treatment. Those patients constituted group III. Intrathecal morphine in a dose of 1 mg produced moderate to severe side effects [pruritus, nausea and/or vomiting and urinary retention] in a 50% of patients. No incidence of respiratory depression was observed at this dose. Both naloxone and nalbuphine were effective and safe in treating the side effects of intrathecal morphine. However, there was an evidence that nalbuphine may be superior than naloxone as regards the possibility to reverse intrathecal morphine-induced analgesia

Effect of the level of injection of spinal anesthesia on sensory anaesthetic level

A prospective, randomized study was performed in Assiut University Hospital to investigate the influence of the level of injection on sensory anaesthesia in patients undergoing lower limbs and perineum surgeries when 3 mL of plain 0.5 percent bupivacaine was injected intrathecally at three different levels [L2-3, L3-4 and L4-5] in three groups of 20 patients each. The patients were kept sitting for 2 minutes after injection. No significant difference in maximal level of sensory anaesthesia was found. In all patients, anaesthesia was sufficient for surgery. These preliminary results indicate that if a higher level of injection is more suitable for anatomic reasons, it can safely be used without the risk of a much higher level of sensory blockade

Suxamethonium myalgia in relation to fasciculations, serum electrolytes and CPK changes

The relation between fasciculations, serum electrolytes and CPK changes and myalgia has been studied in 120 patients divided into four groups [n = 40 in each]. The first group [control] received normal saline, the second, third and fourth groups received atracurium in a dose of 0.04 mg/kg, 0.05 mg/kg and 0.06 mg/kg respectively. Saline or atracurium was given 3 min. before suxamethonium. There was no correlation between the intensity and incidence of visible muscle fasciculations and post-suxamethonium muscle pains. Not all patients with severe type of fasciculations complained of severe type of pain and not all patients who showed no fasciculations, did not complain of pain post operatively. All patients who complained of myalgia in the control group showed a significant [P < 0.001] rise in serum K+. Patients who were symptom free showed the least rise in serum K+. Also the greater the intensity of myalgia, the greater was the rise in serum K+ values. No relation between serum Na+ values and incidence and intensity of myalgia. The changes in serum Ca++ level was found to be related to the presence of myalgia. Patients complaining of myalgia showed a highly significant [P < 0.001] decrease in serum Ca[++] values. Also severe type of myalgia was associated with more decrease in serum Ca[++] in all groups of patients. The serum CPK was found to be the most markedly affected with the presence or absence of myalgia. The rise in CPK values was also found to be related to the severity of post suxamethonium myalgia. In conclusion, positive relation was found between the severity of pain and the degree of rise in serum K+ and CPK values and the degree of hypocalcaemia. On the other hand no relation could be detected between myalgia and serum Na[+] changes and fasciculations

Comparative study between propofol and methohexital during induction and first hour of recovery

Anesthesia and recovery during the first hour after propofol and methohexital anesthesia for dilatation and curettage [D and C], lasting about 12 min. were compared, the latter in a double-blind manner by means of psychomotor tests [coin counting and continuous auditory reaction time]. Muscle movements and hiccups were seen significantly more frequently during methohexital inductions. No differences were seen regarding pain at the site of injection or apnea between the groups. At 15 min after the last dose of anesthetic, recovery after methohexital was ahead of that after propofol, but after one hour, psychomotor performance was better in the propofol group. Side-effects during recovery were few, and incidence did not differ significantly. Although the difference in reaction time test was significant, it was hardly large enough to be of any clinical importance. Both drugs are useful for brief day-case-anesthesia, but smoother induction gives propofol on edge over methohexital

Lidocaine given intravenously decreases the incidence of laryngospasm and cough in connection with extubation after a brief surgery of the larynx and vocal cords

Forty two otherwise healthy patients undergoing short surgical procedures of the larynx and vocal cords were investigated In an open study to examine the effect of intravenous lidocaine in preventing laryngospasm and coughing upon extubation. Induction of anesthesia was carried out with thiopentone and suxamethonium followed by orotracheal Intubation and anesthesia was maintained, by O[2] and N[2] O[50% each] halothane for all the patients. They were randomly divided into two groups, group 1 included 21 patients who received lidocaine 2 mg/kg prior to intubation while group 2 [21 patients] received nothing before intubation and served as control. One patient [4.8%] in lidocaine group developed laryngospasm. In the control group, 5 patients [23.8%] developed laryngospasm which was relieved just after i.v. administration of lidocaine 2 mg. kg. The incidence of coughing [more than 5 sec.] in the recovery period was [19.2%] in lidocaine group compared to [81.3%] in control group. It can be concluded from this study that lidocaine 2 mg/kg decreases the incidence of extubation laryngospasm as well as coughing in the recovery period following short surgical procedures of the larynx and vocal cords after general anesthesja