Comparative analgesic efficacy of different doses of dexamethasone during infraumbilical surgery: A Randomized controlled trial.

BACKGROUND: Postoperative pain is a common complaint and despite the availability of various drugs, is still not managed well. Analgesic effects of glucocorticoids are still to be substantially established. Hence, we designed randomized, double-blind, placebo-controlled trial to compare the effect of two different doses of dexamethasone on postoperative pain in patients undergoing infra-umbilical surgeries under spinal anesthesia. METHODS: Ninety American Society of Anesthesiologists Grade I and II patients were randomized to receive injection dexamethasone 8 mg (Group DI), dexamethasone 16 mg (Group DII) or placebo (Group C) prior to performance of intrathecal block. Outcome studied was postoperative pain on the rest and motion and nausea and vomiting. RESULT: There was no difference in Visual Analog Scale (VAS) scores during rest in all the three groups. However, VAS scores on motion showed a significant decrease in Group DII at 24 and 36 h when compared to Group C (95% confidence interval [CI] of mean at 24 h for Group C = 5.6093-7.1049 and Group DII = 4.8709-5.9567, P = 0.04; 95% CI of mean at 36 h for Group C = 4.5868-5.8418 and Group DII = 3.5388-4.7378, P = 0.01). There was no significant difference in the incidence of postoperative nausea and vomiting or additional analgesic requirements. CONCLUSION: Dexamethasone 16 mg reduces postoperative pain on motion at 24 and 36 h. It has no effect on postoperative pain at rest or on nausea and vomiting.

A randomised controlled study comparing the effects of laryngeal mask airway and endotracheal tube on early postoperative pulmonary functions.

INTRODUCTION: Classic laryngeal mask airway (LMA) has long been used for airway management. General anaesthesia has been associated with a significant decrease in pulmonary functions during the postoperative period. The decrease in pulmonary functions has been found to be greater with the use of a tracheal tube (TT). In this study, we compared the effects on pulmonary functions during the early postoperative period when the airway was managed using an LMA versus a TT. METHODS: A total of 20 patients in each group received either LMA or TT for airway management. Postoperative pulmonary functions were recorded at 30 and 60 minutes after removal of the airway device in patients undergoing peripheral limb surgeries. Forced vital capacity (FVC) , forced expiratory volume during the first second (FEV1), vital capacity, FEV1/FVC, peak expiratory flow rate and percentage saturation of oxygenated haemoglobin were compared. Postoperative coughing and hoarseness were also recorded. RESULTS: Pulmonary functions were significantly decreased in both groups at 30 and 60 minutes postoperatively. The decrease in the TT group was significantly greater than that in the LMA group at both 30 and 60 minutes. The FEV1/ FVC was not significantly changed, indicating a restrictive pattern. Patients in the TT group had a significantly higher incidence of coughing at both 30 and 60 minutes. CONCLUSION: The use of LMA instead of TT for airway management during peripheral limb surgeries causes less depression of pulmonary functions during the early postoperative period. The incidence of coughing is also significantly lower.

Peripartum cardiomyopathy: a short review.

Peripartum cardiomyopathy is an unusual form of dilated cardiomyopathy, which manifests as acute heart failure in the last trimester of pregnancy or early postpartum period. Its aetiology is currently unknown. The presenting signs and symptoms are those of congestive heart failure and more specifically those of left ventricular failure. Its importance lies in the fact that it has a high mortality rate and strikes the patient in the prime of life. Peripartum cardiomyopathy has far reaching implications for the anaesthesiologist. The reason for this is that many of the signs and symptoms of normal pregnancy are indistinguishable from mild cardiac failure so that the condition may remain undiagnosed and can present suddenly at the time of induction of anaesthesia or in the peri-operative period. The goals of anaesthetic management include avoidance of drug induced myocardial depression and prevention of increases in ventricular preload and afterload. Vigilant monitoring is essential throughout the surgery and in the postoperative period and the need for invasive monitoring should be assessed according to the clinical condition of the patient. It is important to recognise the association of cardiac failure and pregnancy as a separate syndrome so that peripartum cardiomyopathy can also be kept as a differential diagnosis for cardiac failure occurring in the peripartum period and a high index of suspicion should be maintained for the timely detection and management of this condition.