comparative study between intrathecal isobaric bupivacaine-morphine and ropivacaine-morphine for caesarean delivery

This study was designed to evaluate the effects of intrathecal isobaric bupivacaine 0.5% plus morphine and isobaric ropivacaine 0.5% plus morphine combinations in women undergoing Caesarean deliveries. Twenty parturients received ropivacaine 150mg and morphine 150 microg [RM group] and twenty parturients received bupivacaine 15mg and morphine 150 microg [BM group] for spinal anaesthesia. Sensory and motor block, haemodynainics, postoperative analgesia, fetal outcomes, and side-effects were evaluated. Intrathecal bupivacaine-morphine and ropivacaine-morphine provided effective sensory anaesthesia and motor block. Time to reach complete motor block was shorter and time to complete recovery from motor block was longer in the BM group than the RM group [P<0.05]. Time to first complaint of pain and the mean total consumption of tenoxicam were similar in both groups [P>0.05]. APGAR scores at 1 and 5 min were similar in the two groups, as were mean umbilical blood pH values [P>0.05]. Hypotension and pruritus were the most common side-effects in both groups during the operation. Intrathecal isobaric ropivacaine 0.5% 15 mg plus morphine 150 micro g provides sufficient anaesthesia for Caesarean delivery. The ropivacaine-morphine combination resulted in shorter motor block, similar sensory and postoperative analgesia

Inguinal hernia repair: comparative study between local spinal and general anesthesia

To compare three different anesthetic techniques for inguinal hernia repair [regional, spinal and general] anesthesia. Prospective study included 75 adult male patients scheduled for elective unilateral reducible primary inguinal hernia repair. Patients were between 18-80 years, ASA physical status I and II. Patients were divided into 3 groups: group I: 25 patients received general anesthesia. Group II: 25 patients received local anesthesia. Group III: 25 patients, received spinal anesthesia. The period from the beginning to the end of the operation was recorded as the duration of the operation. Mean B.P and heart rate, were also recorded. Satisfaction would be recorded as satisfactory or unsatisfactory. Complication: postoperative nausea, vomiting, retention of urine, headache and sore throat were recorded for each patient. There was no statistical significant difference as regard to age, body mass index [BMI], HR and BP [P value > 0.05]. The duration of the procedure was significantly longer in local anesthesia group in comparison to general anesthesia and spinal anesthesia group [P value < 0.01]. Hospital stay was less in group II than the other two groups. Patients were more satisfied in local anesthesia group than the other groups. The cost of the operation was significantly lower in local anesthesia group in comparison to the other two groups. Postoperative pain as measured by Visual analogue scale [VAS] was lower in local anesthesia group than the other groups. Also complications were lower in local anesthesia group in comparison with other groups. We concluded that a proper inguinal field block for inguinal hernia repair provides satisfactory intraoperative analgesia and great benefits for patients as regard faster recovery, less pain, faster mobilization and higher satisfaction

Effect of gynecological laparoscopy on intraocular pressure in patients anesthetized with propofol total intravenous anesthesia versus isoflurane inhaled anesthesia

To evaluate the effect of gynecological laparoscopy on intraocular pressure changes in patients anesthetized with propofol total intravenous anesthesia in comparison to isoflurane inhaled anesthesia. This is a prospective randomized clinical study was done in the departments of Obstetrics and Gynaecology, Sohag University Hospital. Thirty patients underwent an elective gynecological laparoscopy were recruited in this study after fulfilling the inclusion criteria. Patients were divided randomly into two groups; propofol group [n=15] and isoflurane group [n=15]. MAP, HR, peak and plateau airway pressures [Paw], ETco2 and IOP were recorded at the following time points. Tl: before the induction of anesthesia, T2: before pneumoperitoneum, T3: after pneumoperitoneum, T4: at 15°-20° head-down tilt, T5: After return to the horizontal position, T6: after the pneumoperitoneum had been evacuated and lastly T7: in the recovery room, 20 minute after tracheal extubation. Both groups were comparable as regard to their age, body mass index [BMI], duration of the procedure and the preoperative IOP. There were no significant differences in MAP or HR between both groups. After induction of anesthesia, IOP decreased significantly in propofol group [P<0.01] than isoflurane group [P<0.05]. In the isoflurane group, there was a significant increase in IOP after pneumoperitoneum [T3 versus T2, P< 0.05]. Also there was a significant increase in the IOP after head-down position [T4 versus T2, P< 0.01], which exceeded the preoperative IOP value [T4 versus Tl]. In the propofol group, IOP insignificantly increased after pneumoperitoneum and with head-down position. IOP in propofol group was at all times less than isoflurane group. In the recovery room, IOP returned to baseline in the Isoflurane group, but remained insignificantly lower in the propofol group. There was no significant correlation between MAP, HR, IOP values and plateau airway pressures in both groups. Laparoscopic gynecologic surgery with head down position increases IOP within the normal diurnal range. propofol TIVA has an IOP controlling effect during laparoscopy and may be preferred if control of IOP is a must before laparoscopy

Relation between Jugular bulb oxygen saturation [SjO2] and the Neurological outcome after head injury

To study the relation between SjO2 and the neurological outcome after head injury. Prospective randomized study. sixty adult patients ASA I and II with recent head injury [age 18-50 ys]. They were admitted to the Intensive Care Unit [ICU] for 48 hs. They were evaluated hemodynamically, neurologically [according to Glasgow Coma Scale-GCS], investigated for hemoglobin concentration, random blood sugar, serum urea and creatinine. Then they were monitored in the ICU for hemodynamics [non-invasive blood pressure-NIBP- systolic, diastolic and mean arterial blood pressure-MABP-], pulse oximetry, heart rate [HR], ECG, central venous pressure-CVP- through left internal jugular vein, and SjO2 through right internal jugular bulb catheter. According the base line reading of SjO2 the patients were classified into 3 groups; Group [1]: Low SjO2 < 55 mmHg, Group [2]: normal SjO2 55-75 mmHg, and Group [3]: high SjO2 >75 mmHg. In the ICU the patients were managed to minimize secondary brain insults for 48 hs. Samples for SjO2 monitoring were taken every 6 hs. After 48 hs the patients were re-evaluated neurologically according to Glasgow Outcome Scale [GOS] and classified into 2 groups; Group I: poor outcome [GOS 1-3, dead, vegetative or disable] and Group II: good outcome [GOS 4-5 are moderately disable or have good recovery]. 11 patients were excluded from the study because 3 patients died within the 48 hs and 8 patients reqiured mechanical ventilation. There was no significant statistical difference as regard height, weight, MABP, HR, pulse oximetry, CVP, mean hemoglobin concentration, serum urea and creatinine,. The difference in readings of SjO2 in the 3 groups was statistically significant in group[1] in all time of reading hours compared to group [2] and [3], Also when compared to the base line reading in the same group. The same with group [2]. As regard GOS; in group [1] was lower than other groups on admission to the ICU and all time of readings. Also, patients in Group [3] had poor outcome. This study confirm that an increased SjO2 occur significantly more in patients with poor outcome. Other methods of measurement of SjO2 are recommended as near infrared spectrography or trans-cranial doppler ultrasonography as these methods are less invasive and give continuous measurements of SjO2