Pharmacological intervention to reduce intra-operative hypothermia in geriatric patients during ophthalmic surgery

To reduce the effect of hypothermia during general anaesthesia using either midazolam or nitroglycerin premedication. Hypothermia has many disadvantages during general anaesthesia e.g decrease in oxygen consumption, decreased drug metabolism, arrhythmia, post-operative shivering or even cardiac arrest. So, we used midazolam and nitroglycerin in a trial to reduce likehood of occurance of intraoperative hypothermia. 60 geriatric patients were scheduled for intraocular surgery were randomly assigned into three groups. Each group has 20 patients n=20; midazolam group received 0.04mg-kg - midazolam i.m. 30 minutes before induction; nitroglycerin group received 10 mg nitroglycerin patch one hour before induction. Control group had no premedication. Results showed that midazolam and nitroglycerin have a beneficial effect to reduce intraoperative hypothermia. Nitroglycerin increased fingertip blood flow more than midazolam. Midazolam had a satisfactory role in body heat redistribution more than nitroglycerin. Midazolam is a suitable drug for premedication to reduce intra-operative. Hypothermia through its effect on heat redistribution. It is superior to nitroglycerin

New concepts in treatment of post-dural puncture headache: Tetracosactide vs. tetrazepam

We investigated the effect of tetracosactide hexa-acetate vs tetrazepam as therapeutic agent for treatment of post-dural puncture headache [PDPH]. Thirty patients with PDPH were randomly allocated to receive either tetracosactide 1 mg IM [group A, n=15] or oral tetrazepam 1.2 mg/kg [group B, n=15]. Severity of headache [VAS scale], neck rigidity, nausea and vomiting were recorded before treatment and at intervals after treatment. The need for supplementary management as hydration, analgesics or epidural blood patch was also recorded. Our results suggest that tetrazepam has a superior effect compared to tetracosactide in controlling PDPH. It also alleviates neck rigidity and vomiting in a statistically significant way. The drug is also cheap, easy to use and has minimal side effects