Horner's syndrome after lumbar epidural analgesia during labor

Horner's syndrome is rarely reported after epidural analgesia during labor. The use of Top-Up local anesthetic for controlling labor pain in the first stage of labor, or to dense the block in caesarean deliveries can result in this complication. We reported a cases of Horner's syndrome during epidural analgesia in labor in spite of not giving any Top-Up dose. The case was clinically evident and was successfully managed by stopping the epidural infusion, and reassuring the parturient as well as the family; until the disappearance of the signs and symptoms. The infusion was then restarted, delivery was uneventful and no consequent neurological or psychological problems were noticed after a one-month follow-up

Effects of sevoflurane on postoperative liver functions in morbidly obese as compared to the non-obese patients

To assess the effect of sevoflurane anesthesia on hepatic function in morbidly obese versus non-obese patients undergoing abdominal surgeries. We prospectively evaluated the levels of the serum concentration of liver enzymes aspartate aminotransferase [AST], alanine aminotransferase [ALT], lactate dehydrogenase [LDH], gamma glutamyl transferase [GGT], alkaline phosphatase [ALP], and total bilirubin [TBil], in 42 morbidly obese and 40 non obese patients who were scheduled for elective abdominal surgery under sevoflurane anesthesia at the Jordan University Hospital, Amman, Jordan. Measurement of liver enzymes was done in the recovery room, and on the first, 3 and 7 days after sevoflurane anesthesia, and the results were compared between the morbidly obese and non obese patients. ALT, AST, GGT and LDH increased significantly in the morbidly obese than they did in non obese patients. In morbidly obese patients TBil increased gradually peaking 7 days after anesthesia, LDH increased in the recovery room, AST and ALT increased in the recovery room and first day, while GGT increased 7th day after anesthesia. In non obese patients, AST, LDH increased in the recovery. ALP did not change in both groups. Sevoflurane induces elevation of the serum liver enzymes in morbidly obese patients with variable onsets

Intravenous dexmedetomidine prolongs bupivacaine spinal analgesia

The prolongation of spinal anesthesia by using clonidine through the oral, intravenous and spinal route has been known. The new ?2 agonist, dexmedetomidine has been proved to prolong the spinal anesthesia through the intrathecal route. We hypothesized that dexmedetomidine when administered intravenously following spinal block, also prolongs spinal analgesia. 48 patients were randomly allocated into two equal groups following receiving spinal isobaric bupivacaine 12.5 mg. Patients in group D received intravenously a loading dose of 1 microg/kg dexmedetomidine over 10 min and a maintenance dose of 0.5 microg/kg/hr. Patients in group C [the control group] received normal saline. The regression times to reach S1 sensory level and Bromage 0 motor scale, hemodynamic changes and the level of sedation were recorded. The duration of sensory block was longer in intravenous dexmedetomidine group compared with control group [261.5 +/- 34.8 min versus 165.2 +/- 31.5 min, P < 0.05]. The duration of motor block was longer in dexmedetomidine group than control group [199 +/- 42.8 min versus 138.4 +/- 31.3 min, P < 0.05]. Intravenous dexmedetomidine administration prolonged the sensory and motor blocks of bupivacaine spinal analgesia with good sedation effect and hemodynamic stability

Venous air embolism associated morbidity and mortality in patients undergoing neurosurgical procedures in the sitting position

To identify the morbidity and the mortality related to Venous Air Embolism [VAE] during posterior fossa surgery in the sitting position. This study was conducted at Jordan University Hospital, Amman, Jordan. Records of 73 patients undergoing posterior fossa surgery in the sitting position from 1990 to 2005 were retrospectively reviewed to determine the incidence of VAE, the nature of perioperative morbidity and mortality and their relation to VAE. The incidence of VAE was 13.5%. Intraoperative hypotension secondary to VAE was [9.6%]. Intraoperative hypotension was 19% during the positioning of patients and 29% during the procedures. Patients who received blood transfusion were 10 [19.2%] children and 5 [9.6%] adults. Average blood transfusion in children was 200 mls and 360 mls in adults. Postoperatively, six [11.5%] patients were electively intubated and ventilated. Postoperative evacuation of posterior fossa haematoma was performed in seven [13.5%] patients. Six [11.5%] patients died within one month after surgery. There was no intraoperative or postoperative morbidity or mortality related to VAE. Our results indicate the absence of morbidity and mortality related to VAE. With early detection and prompt treatment of VAE, the sitting position is safe for neurosurgical procedures

Ondansetron in the prevention of postoperative nausea and vomiting in gynaecological surgery

In a double blind randomized study, we compared the prophylactic antiemetic effect of Ondansetron, a 5 HT3 receptor antagonist with that of placebo on postoperative nausea and vomiting in 92 patients undergoing general anaesthesia for gynaecological surgery. The patients received either 4 mg bolus ondansetron or placebo I.V immediately after induction of general anaesthesia. Postoperative nausea and vomiting were assessed for 24 hrs. The incidence of vomiting was 10.86% in the ondansetron group and 34.78% in the placebo group [p < 0.05]. There was no significant difference in the incidence of nausea between the two groups