The frequency of postdural puncture headache in different age groups.

OBJECTIVE: To compare the frequency of postdural puncture headache (PDPH) in younger and older age groups i.e. 30-50 years and 51-75 years in patients undergoing spinal anaesthesia. DESIGN: Cross-sectional comparative study. PLACE AND DURATION OF STUDY: Anesthesia Department of Hayatabad Medical Complex, Peshawar, from June to December 2002. PATIENTS AND METHODS: Two hundred patients, fulfilling the American Society of Anesthesiologist (ASA) I and II criteria, were included in the study and the results of PDPH in both age groups were compared and Chi-square test was applied. The level of significance was significant, if the p-value was less than 0.05. RESULTS: The occurrence of PDPH was more in young patients i.e. 30 patients (30%) in group A, as compared to 5 patients (5%) in group B (p<0.05) Female patients had higher frequency of PDPH in both groups. In group A, 20 female patients (40%) had PDPH as compared to 10 male patients (20%), while in group B, 4 female patients (8%) had PDPH as compared to 1 male patient (2%). CONCLUSION: The frequency of postdural puncture headache (PDPH) was less in older age group than younger age group and more frequent in females than males.

Dexamethasone as antiemetic during gynaecological laparoscopic surgery.

OBJECTIVE: To evaluate the efficacy of intravenous dexamethasone for preventing postoperative nausea and vomiting in women undergoing gynecological laparoscopic surgery. DESIGN: Double blind trial. PLACE AND DURATION OF STUDY: December 2001 to June 2002 at Hayatabad Medical Complex, Peshawar. PATIENTS AND METHODS: A 100 admitted female patients of ASA-1-II scheduled for diagnostic gynecological laparoscopic surgery were included in this study. Patients with severe systemic or endocrine disease who had predisposing factors for delayed gastric emptying, such as diabetes, chronic cholecystitis or neuromuscular disorders were excluded. In addition patients who suffered from postoperative nausea and vomiting (PONV) or had received an antiemetic agent or narcotic medications within last 24 hours were also excluded. Patients were divided into two equal groups, patients in one group were given dexamethasone while saline was injected to patients in the second group. Nausea and vomiting were assessed immediately after operation, at 1 hour interval for 4 hours in the recovery and from 4-10 hours in the Ward. Result was compared in two groups by chi-square test. RESULTS: During patient s stay in the Postanaesthesia Care Unit (4 hours postoperatively) 26% patients in the dexamethasone group in comparison with 54% of patients in the saline group reported PONV (P < 0.01). Sixteen percent of patients in the dexamethasone group, in comparison with 28% of patients in the saline group needed rescue antiemtic (P 0.05), postoperative nausea vomiting (P < 0.01). During the postoperative observation period of 10 hours, 42% of the patients in the dexamethasone group in comparison with 82% of patients in the saline group reported postoperative nausea and vomiting (P < 0.001). CONCLUSION: Dexamethasone significantly reduced the incidence of postoperative nausea and vomiting in women undergoing laparoscopic surgery. Furthermore, it is freely available, is less costly and has few side-effects. So, it should be more frequently used as prophylactic antiemetic in women undergoing gynaecological laparoscopic surgery.