Effect of hypotensive technique using sodium nltroprusslde on hemodynamlc, acid base balance and serum cortisol level in major orthopedic surgery

This study was carried out on 20 healthy adult patients who were undergone major orthopedic surgery. Patients were premedicated by atropine sulphate and pethidine hydrochloride. Anaesthesia was induced by thiopentone sodium. Cuffed endotracheal tube was inserted after succinyl choline injection. Anaesthesia was maintained by nitrous oxide, oxygen, pancuronium and controlled ventilation. After stabilization of anaesthesia sodium nitroprusside 0.01% in 5% dextrose was infused at a rate of 20-40 drops/min.to maintain systolic blood pressure around 80 mmHg. It was found that the heart rate increased significantly and mean arterial pressure decreased significantly during infusion. The serum cortisol level was significantly increased, Pa02 was significantly decreased with a significant increase in Pac02. There were no significant change in PH, standard bicarbonate and base excess. At the end of operation, all the studied parameters returned to their preoperative values without any complication or residual effects

Effects of labetalol and diltiazem on the intraocular pressure responses to tracheal intubation

The effects of labetalol and diltiazem on intraocular pressure [IOP] during laryngoscopy and endotracheal intubation were investigated in 30 patients, scheduled for elective extraocular ophthalmic operations. Anaesthesia was induced by thiopentone Na followed by succinylcholine to facilitate tracheal intubation, anaesthesia was maintained by oxygen, and Halothane 1-2% manual inflation of the lungs, then spontaneous respiration. Pretreatment with labetalol [0.2 mg/Kg] 4 minutes before intubation lead to attenuation of the mean heart rate [MHR], and mean arterial pressure [MAP] changes, although these changes were still significant [t=6.79, 8.84]. Pretreatment with diltiazem [0.3 mg/Kg] 2 minutes before intubation lead to attenuation of the MHR, and MAP. These changes were still significant [t=5.58, 7.41]. The attenuation of MHR, MAP were less in labetal group than in diltiazem group. Both drugs produced a significant reduction in IOP at intubation, 2.5 and 5 minutes after intubation in relation to the preoperative value. The decrease in IOP was less in labetalol group than in diltiazem group. In conclusion, single dose of IV labetalol and diltiazem before intubation is a practical and effective method of attenuating hypertension, tachycardia and ocular hypertension in response to tracheal intubation