Comparison between the induction of anesthesia using sevoflurane-nitrous oxide, propofol or combination of propofol and sevoflurane-nitrous oxide using laryngeal mask airway [LMA] in hypertensive patients

In a double-blinded trial, 90 patients with stable hypertension were enrolled in this study. Each group consisted of 30 patients. The induction in group S was by sevoflurane 4% + 50% oxygen +50% nitrous oxide by inhalation using the tidal volume technique. The induction in group P was by propofol 2mg/kg IV, and in group PS [combination group] was by propofol 1mg/kg followed by inhalation of 4% sevoflurane.The present study compared hemodynamic changes, laryngeal mask airway [LMA] insertion time and any complications occurred in the induction period between the three groups. LMA insertion time was significantly longer in the sevoflurane group than in the other two groups. Mean arterial blood pressure [MAP] was significantly lower within each group after induction in comparison to before induction. In all the groups, LMA was successfully inserted in all patients. According to patients induction was pleasant in 90% of patients in the propofol group and was 88% in the combination group and 40% in the sevoflurane group. This study concluded that in the combination group there is the advantage of patient satisfaction and rapid induction with no apnea which occurred with propofol and had the advantage of hemodynamic stability encountered with sevoflurane

Prevention of sevoflurane induced agitation in children using caudal or IV clonidine

The aim of this work was to study the effects of clonidine on the incidence and severity of agitation in preschool children after sevoflurane anesthesia and to determine if caudal clonidine has an advantage over i.v. route. This placebo controlled double blind study included 75 children aged 2-7 years admitted to Menoufyia University Hospital for repair of congenital hernia or hydrocele. Sevoflurane was used for induction and maintenance of anesthesia. Caudal epidural block was performed in all the children using 0.175% bupivacaine 1 ml/Kg. Children were randomized into five groups; Group I: clonidine 1 micro g/Kg was added to caudal bupivacaine while normal saline was given i.v. as a placebo. Group II: received caudal bupivacaine while clonidine 1 micro g/Kg was given i.v. Group III: clonidine 2 micro g/Kg was added to caudal bupivacaine while normal saline was given i.v. Group IV: received caudal bupivacaine while clonidine 2 micro g/Kg was given i.v. Group V: received caudal bupivacaine and normal saline was given i.v. A 3-point agitation score was used to determine the incidence and severity of agitation. Midazolam bolus injection was used to treat severe agitation. Incidence of agitation was significantly less in patients who received clonidine 2 micro g/Kg [0% in Group III and 6.7% in Group IV] compared to control group [73.3%]. The difference was not significant when clonidine 1 micro g/Kg [Group I and II] was used. The difference was not significant when caudal and i.v. clonidine groups were compared [Group I vs. Group II and Group III vs. Group IV]. Midazolam bolus to stop agitation was not needed at all in Group III or Group IV. No bradycardia, hypotension or hypoxemia was noted. We concluded that clonidine 2 micro g/kg body weight, caudally or i.v., significantly decreases the incidence and severity of agitation in children after sevoflurane anesthesia without added side effects