ABSTRACT
Theophylline toxicity results in substantial morbidity and mortality particularly due to its narrow therapeutic index. The development of new treatments for acute theophylline toxicity is a point of research interest. The aim of the present work was to assess the efficacy of L-carnitine (LC) and propranolol in the management of patients with acute theophylline toxicity. The study was conducted on 60 patients with acute theophylline toxicity admitted to the Poison Control Center or Intensive Care Unit at Alexandria Main University Hospital. The studied patients were equally classified into four groups (GPs, 15 patients each): the first group was the control group who received standard treatment protocol for theophylline toxicity. The other three GPs also received standard treatment protocol for theophylline toxicity in addition. The second group (LC group) received LC with a loading dose of 100 mg/kg IV over 30-60 min (maximum 6 g) and the maintenance dose was 50 mg/kg IV every 8 h. The third group (propranolol group) received propranolol, administered slowly intravenous 0.5-1 mg over 1 min; it may be repeated if necessary up to a total maximum dose of 0.1 mg/kg. The fourth group (propranolol and LC) received both IV propranolol and LC in the same doses as previous. Treatment with LC alone or in combination with propranolol resulted in a significant improvement of both clinical and laboratory findings. Although combined therapy yields the best results and outcome, LC can serve as an antidote for acute theophylline toxicity if there is any contraindication to propranolol administration.
ABSTRACT
BACKGROUND: Umbilical hernia repair, a common day-case surgery procedure in children, is associated with a significant postoperative pain. The most popular peripheral nerve blocks used in umbilical hernia repair are rectus sheath infiltration and caudal block. The rectus sheath block may offer improved pain relief following umbilical hernia repair with no undesired effects such as lower limb motor weakness or urinary retention seen with caudal block which might delay discharge from the hospital. Ultrasound guidance of peripheral nerve blocks has reduced the number of complications and improved the quality of blocks. The aim of this case series is to assess the post rectus sheath block pain relief in pediatric patients coming for umbilical surgery. METHODS: Twenty two (22) children (age range: 1.5-8 years) scheduled for umbilical hernia repair were included in the study. Following the induction of general anesthesia, the ultrasonographic anatomy of the umbilical region was studied with a 5-16 MHz 50 mm linear probe. An ultrasound-guided posterior rectus sheath block of both rectus abdominis muscles (RMs) was performed (total of 44 punctures). An in-plain technique using Stimuplex A insulated facet tip needle 22G 50mm. Surgical conditions, intraoperative hemodynamic parameters, and postoperative analgesia by means of the modified CHEOPS scale were evaluated. RESULTS: ultrasonograghic visualization of the posterior sheath was possible in all patients. The ultrasound guided rectus sheath blockade provided sufficient analgesia in all children with no need for additional analgesia except for one patient who postoperatively required morphine 0.1 mg/kg intravenously. There were no complications. CONCLUSIONS: Ultrasound guidance enables performances of an effective rectus sheath block for umbilical hernia. Use of the Stimuplex A insulated facet tip needle 22G 50mm provides easy, less traumatic skin and rectus muscle penetration and satisfactory needle visualiza.
ABSTRACT
BACKGROUND: Postoperative nausea and vomiting (PONV) is a common complication following general anesthesia. Different regimens have been described for the treatment of PONV with few that mention the prevention of it. Therefore, we conducted this study to compare the effect of preloading with either crystalloids or colloids on the incidence of PONV following laparoscopic cholecystectomy (LC), under general anesthesia. MATERIALS AND METHODS: This study was carried out on 80 patients who underwent LC. The patients were divided into four groups (each 20 patients), to receive preloading of intravenous fluid, as follows: Group 1 received, 10 ml/kg of low-MW tetrastarch in saline (Voluven), group 2 received, 10 ml/kg medium-MW pentastarch in saline (Pentaspan), group 3, received 10 ml/kg of high-MW heta-starch in saline (Hespan), and group 4, received 10 ml/kg Lactated Ringer's, and this was considered as the control group. All patients received the standard anesthetic technique. The incidence of PONV was recorded, two and 24 hours following surgery. The need for antiemetics and/or analgesics was recorded postoperatively. RESULTS: The highest incidence of PONV was in group 3 (75% of the patients) compared to the other three groups. Also the same trend was found with regard to the number of patients who needed antiemetic therapy. It was the highest incidence in group 3 (70%), followed by group 2 (60%), and then group 1(35%), and the least one was in the control group (25%). CONCLUSION: Intravascular volume deficits may be a factor in PONV and preloading with crystalloids showed a lower incidence of PONV.
