Can ketamine potentiate the analgesic effect of epidural morphine, preincisional or postincisional administration?

A randomized controlled trial was conducted to determine the effect of adding epidural ketamine to epidural morphine comparing between giving ketamine at preincisional time and postincisional time on postoperative analgesia in patients undergoing gynecological operations. Eighty patients scheduled for gynecological operation under combined epidural-general anesthesia were randomly divided into 4 groups. Group 1 received epidural morphine 3 mg before skin incision. Group 2 received epidural morphine 3 mg after skin incision. Group 3 received epidural morphine 3 mg and ketamine 30 mg before skin incision. Group 4 received epidural morphine 3 mg and ketamine 30 mg after skin incision. Lidocaine 2 per cent with epinephrine 1:200,000 was used as the main anesthetic agent during the operation in all groups. Postoperative analgesics were pethidine 1 mg/kg intramuscularly or paracetamol 1,000 mg oral. The time to the first analgesic requirement and pain during 48 h were recorded. The amount of pethidine and paracetamol required and the time to the first dose of analgesic requirement were not significantly different among the groups. There were no differences in the incidences of pruritus, nausea, vomiting and nightmare. We concluded that adding ketamine to epidural morphine either by preincisional or postincisional administration did not potentiate the analgesic effect of epidural morphine.

Cuffed oropharyngeal airway in the patients undergoing short surgical procedures.

OBJECTIVE: This study was designed to study the efficacy of Cuffed oropharyngeal airway (COPA) in the patients undergoing short surgical procedures at Siriraj Hospital. MATERIALS AND METHOD: A prospective study of 65 patients, age 15-65 years, scheduled for elective short surgical procedures under general anesthesia were managed with COPA. Lip-mandibular angle distance was used to indicate the appropriate size of COPA. Demographic characteristics, airway assessments, COPA size, insertion time, airway manipulation, complications during COPA insertion, removal and 2 hour postoperative period were recorded. RESULTS: Success rate of COPA insertion were 93.8 per cent and 4.6 per cent at 1st attempt and 2nd attempt respectively. Insertion time was 53.27 +/- 20.07 seconds. There were 84.4 per cent of patients who needed airway manipulation during anesthesia. The incidence of complications were 12.3 per cent, 13.8 per cent and 15.4 per cent during insertion, removal and 2 hour postoperatively respectively. CONCLUSION: COPA is a new adjunctive airway device designed for direct connection with breathing system with a high success rate of insertion. COPA placement is an easy technique to learn but it usually requires a high incidence of airway manipulations such as head turn, jaw thrust, head tilt, and chin lift, so skill and confidence in its use requires instruction and practice. It would be unwise to use a COPA in an emergency without first having become proficient in its use for routine cases.

Can lidocaine reduce succinylcholine induced postoperative myalgia?

This study was undertaken to determine the effect of lidocaine pretreatment on reduction of succinylcholine-induced myalgia in patients undergoing general anesthesia for gynecological surgery. One hundred and thirty-five patients were assigned to one of three groups in a prospective, double blind, randomized manner. Group PS, the control group, received normal saline and succinylcholine 1.5 mg x kg(-1); Group LS, lidocaine 1.5 mg x kg(-1) and succinylcholine 1.5 mg x kg(-1); Group PR, normal saline and rocuronium 0.6 mg x kg(-1). Morphine 0.1 mg x kg(-1) iv was given for premedication and all patients were monitored with a noninvasive blood pressure monitor, ECG and pulse oximetry. Anesthesia was induced with 5 mg.kg(-1) thiopental iv. followed by succinylcholine (Group PS, LS) or rocuronium (Group PR) for tracheal intubation. Following administration of these agents, the presence, and degree of fasciculation were assessed visually on a four point scale by one investigator who was blinded to the drug administered. The blood pressure and heart rate of each patient were monitored on nine occasions. Twenty-four hours later, any myalgia experienced was assessed according to a structured questionaire and graded by a four point scale by one investigator blinded to the intraoperative management. The results indicate that muscle fasciculation was not found in Group PR while the patients in Group LS had a lower incidence of muscle fasciculation than those in Group PS (p < 0.001). At 24 h, the incidence of myalgia was higher in Group PS than in Group LS and PR (p < 0.05). A correlation was not found between the incidence of myalgia and the occurrence of muscle fasciculation. The changes in systolic and diastolic blood pressure and heart rate were not significant among the three groups. In conclusion, where succinylcholine is used, lidocaine is proven to be the useful pretreatment agent for the reduction of postoperative myalgia.