Continuous spinal anesthesia versus single small dose bupivacaine–fentanyl spinal anesthesia in high risk elderly patients: A randomized controlled trial

Background: Greater numbers of patients are presenting for surgery with aging-related, pre-existing conditions that place them at greater risk of an adverse outcome. Hemodynamic instability due to high sympathetic block largely limits the use of conventional dose spinal anesthesia in high risk elderly patients. In this study we aim to compare the hemodynamic stability and the incidence of hypotension in continuous spinal anesthesia (CSA) versus single low dose spinal anesthesia (SD) in elderly high risk patients. Methods: This prospective randomized blinded study was carried on 34 ASA III & IV elderly patients aged >75 years undergoing orthopedic lower limb surgery. The patients were randomly assigned to one of the study groups. Group CSA received intermittent dosing of local anesthetic solution via an intrathecal catheter using 0.5 ml of 0.5% isobaric bupivacaine increments and 0.5 ml of fentanyl (25 μg) while group SD single dose of 1.5 ml of 0.5% isobaric bupivacaine and 0.5 ml of fentanyl (25 μg). The study groups were compared regarding hemodynamic stability, incidence of hypotension and total ephedrine consumption. Results: Incidence of severe hypotension was significant. 52.9% of patients in SD group experienced an episode of severe hypotension versus none of them in CSA group (p 0.033∗). Total dose of fluids infused was significantly more in the SD group. The use of ephedrine was significantly more in SD group. Conclusion: CSA provided fewer episodes of hypotension and no severe hypotension versus SD 7.5 mg bupivacaine. CSA offers the added advantage of the ability to titrate dose of local anesthetic as needed while maintaining hemodynamic stability

Ketofol versus sevoflurane for maintenance of aesthesia in paediatric cardiac catheterization: A prospec

Background: Pediatric cardiac anesthesia involves anaesthetizing very small children with complex congenital heart disease. Sevoflurane provides the advantage of rapid induction of anesthesia with short recovery time. Ketofol is a neologism coined to refer to the combination of ketamine and propofol mixed together in one syringe. Ketamine and propofol have opposing influences on blood pressure, heart rate, and SVR. Aim of the work: To compare the effectiveness and side effects of ketofol versus sevoflurane for maintenance of aesthesia in pediatric cardiac catheterization. Methods: This double blinded randomized study was carried on 90 pediatric patients ASA II and III undergoing cardiac catheterization. Induction was accomplished with titration of 3–5% sevoflurane. Patients were randomly assigned to one of the two study groups. Group K received ketofol mixture (propofol, 4 mg/mL, and ketamine, 2 mg/mL) infusion rate propofol 25–50 mic/kg/min and ketamine 12.5–25 mic/kg/min for maintenance. Group S received sevoflurane 0.5–1 MAC. Changes in recovery time, hemodynamic variables and the incidence of adverse effects were measured. Results: Diastolic blood pressure showed significant difference between the study groups at induction p (0.001), 5 min after induction p(0.04), on recovery 0.037, 5 min postoperatively p(0.016), and 10 min postoperatively. The need for vasopressor and MAP decrease >20% compared with baseline did not show significant difference p(0.832). Recovery time was shorter in group S p(.000). The incidence of nausea and vomiting was significantly more in group S p(.000). Emergence agitation was observed in group S in 12(26.6) patients. Watcha scale was significantly lower in group K at 10 min postoperatively p(.001). Conclusions: Both propofol–ketamine and sevoflurane provided effective sedation and analgesia during pediatric cardiac catheterization. But propofol–ketamine combination was superior to sevoflurane because the incidence of agitation, nausea and vomiting in patients given sevoflurane was significantly higher than in ketofol group