Intrathecal fentanyl as adjunct to hyperbaric bupivacaine in spinal anesthesia for caesarean section.

OBJECTIVE: To compare the effect of adding fentanyl to intrathecal bupivacaine on the onset, duration and quality of spinal anesthesia and its effect of mother and neonate. DESIGN: Single blind randomized controlled clinical trial. PLACE AND DURATION OF STUDY: Department of Anesthesiology, Surgical Intensive Care Unit and Pain Management, Dow University of Health Sciences and Civil Hospital, Karachi, from January 2003 to June 2004. PATIENTS AND METHODS: Sixty young adult females, ASA physical status I and II, with singleton pregnancy undergoing elective or emergency cesarean section under spinal anesthesia were randomly allocated to receive spinal anesthesia either by using 0.75% hyperbaric bupivacaine 1.5 ml with 0.25 ml normal saline or 0.75% hyperbaric bupivacaine 1.5 ml with 0.25 ml fentanyl (12.5 microg). Blood pressure, heart rate, respiratory rate, oxygen saturation, sensory level, motor block, pain score and side effects were observed every 2 minutes for first 20 minutes, then at-5 minute interval throughout the surgery, thereafter at 30 minutes interval until the patient complained of pain. RESULTS: Comparing the bupivacaine group, time to achieve highest sensory level was significantly shorter in fentanyl group (*p < 0.05), while the duration of complete analgesia (time from injection to first report of pain) lasted significantly more longer in fentanyl group (184+/-20 minutes) than bupivacaine group (126+/-10 minutes). Duration of effective analgesia was also significantly more prolonged in fentanyl group (p < 0.05). There was no significant difference in the incidence of side effects between the two groups. CONCLUSION: Addition of fentanyl to intrathecal bupivacaine results in faster onset with improved peri-operative anesthesia without increasing the side effects.

Organophosphorus insecticide poisoning: management in surgical intensive care unit.

OBJECTIVE: To evaluate the outcome of patients with organophosphorus poisoning. DESIGN: Descriptive (non-interventional) study. PLACE AND DURATION OF STUDY: Surgical Intensive Care Unit, Civil Hospital Karachi, from January 1996 to December 2002. PATIENTS AND METHODS: Medical records of all the patients with organophosphorus poisoning, admitted during the study period, were reviewed. Their clinical features, complications, management and survival were noted. RESULTS: Out of 52 patients, admitted to surgical intensive care unit during the study period, 92.31% survived and were discharged to medical wards. Major cause of mortality (7.69 %) was acute respiratory distress syndrome. CONCLUSION: The common cause of mortality in organophosphorus poisoning is aspiration pneumonia leading to acute respiratory distress syndrome that is preventable by securing the airway early in emergency room.

Comparison of 25-gauge, Quincke and Whitacre needles for postdural puncture headache in obstetric patients.

OBJECTIVE: To compare the frequency of postdural puncture headache (PDPH) and failure rate of spinal anesthesia using 25-gauge Quincke and 25-gauge Whitacre needles in obstetric patients. DESIGN: Single blinded, interventional experimental study. PLACE AND DURATION OF STUDY: This study was conducted at the Department of Anesthesiology, Pain Management and Surgical Intensive Care Unit, Dow University of Health Sciences and Civil Hospital, Karachi from November 1, 2003-April 15, 2004. PATIENTS AND METHODS: One hundred females, aged 18-35 years, ASA physical status I and II, with singleton pregnancy undergoing elective or emergency cesarean section under spinal anesthesia were randomly allocated to receive spinal anesthesia either by using 25-gauge Quincke or 25-gauge Whitacre needles. Patients were followed for 3 days postoperatively. Headache, its relation with posture, onset, duration, severity and response to the treatment were recorded. RESULTS: Compared with the Whitacre group, frequency of postdural puncture headache was significantly higher in Quincke group (*p=0.015), while the overall occurrence of non-postdural puncture headache (NPDPH) did not differ significantly between two groups (p=0.736). Most of PDPH developed on 2nd postoperative day, were mild in nature and resolved within 48 hours of their onset. There was no significant difference in the failure rate of spinal anesthesia in both groups (p=0.149). CONCLUSION: It is suggested that use of 25-gauge Whitacre needle reduces the frequency of PDPH without increasing the failure rate of spinal anesthesia in obstetric patients.

Comparison of caudal bupivacaine and bupivacaine-midazolam for peri and postoperative analgesia in children.

OBJECTIVE: To compare the duration and side effects of postoperative analgesia of caudal bupivacaine and bupivacaine-midazolam mixture. DESIGN: Single blinded, interventional experimental study. PLACE AND DURATION OF STUDY: The Department of Anesthesiology and Surgical Intensive Care Unit, Dow Medical College and Civil Hospital, Karachi from May to November, 2002. SUBJECTS AND METHODS: Sixty children, aged 1-8 years, ASA physical status I and II, undergoing inguinal and urogenital surgery were randomly allocated to receive either 0.25% bupivacaine 0.75 ml/kg (group A) or 0.25% bupivacaine 0.75 ml/kg along with 0.1% midazolam 50mg/kg (group B) by caudal route immediately after induction of general anesthesia. Anesthesia was maintained till the end of surgery. Cardiorespiratory data, sedation and pain score were recorded for 24 hours following recovery from anesthesia. Analgesia was supplemented (diclofenac suppository) whenever the pain score was > or = 4. Duration of analgesia was recorded. RESULTS: The duration of analgesia was 21.41 +/- 2.7 hours in bupivacaine midazolam group and 9.97 +/- 2.25 hours in bupivacaine group, which showed a significant difference (p < 0.001). There was no significant difference in heart rate, respiratory rate, blood pressure and the incidence of side effects in both groups (p = 0.716). The sedation score were significantly higher in bupivacaine-midazolam group during first hour postoperatively (*p = 0.003). CONCLUSION: Addition of midazolam to caudal bupivacaine provides longer duration of postoperative analgesia without having significant side effects but with higher sedation score for 1 hour postoperatively.

Anesthetic management of cardiac patient for cataract surgery.

We are reporting the successful anesthetic management of a 6 years old child, who had cyanotic congenital heart disease and underwent an operation for cataract extraction. Ketamine was used for the induction and maintenance of anesthesia. Ventilation was assisted manually by using laryngeal masks.