Safety of tramadol as a pre-induction agent

To study the safety profile of intravenous use of tramadol immediately before induction of general anesthesia. Prospective, observational study. January 2005 to October 2007. Combined Military Hospital Multan, Military Hospital Rawalpindi and Railway Hospital Rawalpindi. 600 patients of ASA-I to ASA-III, aged 10.-50 years, undergoing elective surgery were selected for the study under convenient sampling. Children less than 10 years were excluded. Morbidly obese and patients with history of syncope, convulsive syncope, panic attacks and other convulsive events were excluded. Ladies undergoing caesarian section were also excluded from the study. The patients were injected 1.5mg/kg body weight, but not exceeding 100mg of tramadol [100mg of the drug diluted to 10 ml] intravenously, slowly over a period of two minutes as a part of pre-induction regimen. Patients were monitored for any untoward signs and symptoms for 10 min and all observations were recorded. The main complications / side-effects observed were nausea / vomiting, sweating, heart sinking and seizures in that order. Out of 600 patients, 47 [7.83%] patients complained of nausea alone and 9 [1.5%] patients had a bout of vomiting, 23 [3.88%] patients were observed to have sweating, 31 [5.17%] female patients complained of heart sinking and 2 [0.33%] patients had had seizure activity. We conclude that although the use of IV tramadol as a pre-induction agent is associated a low risk of side effects, but due to its potential to cause seizure activity, it is best avoided in the environments where adequate resuscitative measures are not available

Neonatal outcome: a comparison between epidural and general anesthesia for cesarean sections

The choice of anesthetic technique for cesarean sections, a common problem faced by anesthetists remains controversial. To compare the effects of epidural anesthesia with general anesthesia. To evaluate which mode is better especially keeping in mind the Apgar score of the newborn. Which was taken as the index of immediate neonatal outcome. A prospective cohort study. Combined Military Hospital Peshawar. Six months. A total of hundred patients aged between 26-35 years were selected who were under going elective cesarean section. The gestational ages of the newborn were between 36 and 40 wks. The patients were divided into two groups of fifty each receiving the two modes of anesthesia. A random sampling of the patients was done. Apgar scores of the newborn babies were taken at 01 and 05 minute intervals. Computer based SPSS 8.0 was used to analyze the results and it was found that none of the babies was severely depressed, [Apgar score less than 4 at 01-minute interval in both the groups]. 2% of the cases were moderately depressed, [Apgar score 4-6 at 01-minute interval in the epidural group as compared to 10% of the cases born under general anesthesia]. In the epidural group 4% of the cases had 01 minute Apgar score of less than 8 compared to 36% in the general anesthesia group. As regards the 05 minute Apgar score 6% of the patients had Apgar score less than 10 in the epidural group compared to 11% in the general anesthesia group. This showed that epidural anesthesia has an advantage over general anesthesia especially as regards 01 minute Apgar score as well as being safe for the mother. So this mode of anesthesia should be preferred