A Comparative Study of Two Different Doses of Epidural Neostigmine Coadministered with Lignocaine for Post Operative Analgesia and Sedation

Background: Adjuvants have been used to prolong analgesic effects of epidural local anaesthetics. We studied two different doses of neostigmine. Patients & Methods: A randomized double blind study was conducted on ninety adult females scheduled for lower intra abdominal surgeries. The study was designed to compare two doses of epidural neostigmine co administered with lignocaine, with regard to its analgesic efficacy and its effect on sedation in postoperative period. Patients were divided into three groups of 30 each. Group I received lignocaine 1% (9ml) with normal saline (1ml), group II lignocaine1% (9ml) with neostigmine 100μg in saline (1ml) and group III received lignocaine 1% (9ml) with neostigmine 200μg in NS (1ml). Group I served as a control. In operating room, after putting epidural catheter, general anesthesia was administered with propofol (2mg kg-1), succinylcholine (2mg kg-1) and maintained with O2, N2O, relaxant technique. At the end of surgery, patients were reversed. Epidural analgesic medication was administered to after proper recovery from anesthesia. Intensity of pain relief on VAS, duration of analgesia, level of sensory block, motor blockade, sedation by sedation score and complications were assessed. Results: The addition of neostigmine resulted in significant longer duration of analgesia (dose independent) and sedation (dose dependent). Sensory and motor blockade were identical in all three groups. There was no incidence of respiratory depression, pruritus, bradycardia or hypotension in any group. Two patients in control group and one, receiving neostigmine (200μg), developed nausea/vomiting. Conclusion: Co administration of epidural neostigmine and lignocaine appears to be a useful technique for postoperative analgesia as it increases the duration of analgesia and provides desirable sedation at the same time

Effect of midazolam premedication on the dose of propofol for laryngeal mask airway insertion in children

Background: The present study was conducted on 120 pediatric patients of ASA Grade I and II of either sex aged 3-12 years scheduled for pediatric surgeries under general anaesthesia. Patients & Methods: All patients were randomly divided into Group A and Group B. Group A was further divided into 3 subgroups of unpremedicated patients who received 3, 4 and 5 mg kg -1 propofol only designated as A1, A2 and A3 respectively. Group B was further divided into subgroups of premedicated patients with midazolam (0.05 mg kg -1 ) intravenous and received 3, 4 and 5 mg kg -1 propofol designated as B1, B2 and B3 respectively. Results: Results showed that increasing dose of propofol decreases the adverse events like inadequate jaw relaxation, limb movements, coughing, gagging and laryngospasm. Midazolam when added to propofol further reduces the incidence of adverse events and provides more favorable environment for insertion of LMA. At higher doses of propofol (5 mg kg -1 ), hypotension is a major problem due to its cardiovascular depressant action. Therefore, 4 mg kg -1 propofol along with midazolam is the optimum dose because there is more hemodynamic stability and we get better conditions for LMA insertion. Conclusion: Midazolam is an effective premedication in children which is synergistic with propofol and reduces its effective dose, required for LMA insertion

INTER-HOSPITAL TRANSFER OF TRAUMA PATIENTS IN A DEVELOPING COUNTRY: A PROSPECTIVE DESCRIPTIVE STUDY

Introduction: During interhospital transfer patients are at risk due to possibility of serious complications. There are no guidelines governing the transfer of injured patients in India. It is important to identify the extent of the problem in the transfer process of the injured transferred to the trauma centre.Methods: On arrival in the Emergency Department patients were assessed for clinical status and the Glasgow Coma Score (GCS). The transfer vehicle was evaluated and the accompanying transfer personnel was interviewed to record details of the transfer process, training of the transfer personnel, adequacy of the transfer vehicle and its outfitted monitoring equipment. Data communicated to the trauma centre from the referring hospitals were also collected from the transfer records. The transferred group was compared to the non-transferred group.Results: Of the 592 patients admitted, 572 consented to the study. 327 were referred patients and 245 were directly admitted patients. Patients referred from peripheral hospitals had significantly lower GCS, higher ISS, higher admission gap and longer duration of hospital stay. The date and time of injury was documented in none of the referred patients, referral time in 44 (13.71%) cases, pulse rate in 110(34.38%) patients, blood pressure in 112 (34.25%) cases. The request for transfer was made in only 3 (0.93%) cases. Twelve cases (3.66%) were accompanied by a paramedic or a nurse. Intravenous access and infusions in progress were present in 192/327 (58.71%) transferred patients. Urethral catheters were present in 49 (15.17%) patients. Only 9/327 (2.79%) transferred patients had hard cervical immobilization. Hypotension at admission defined as a systolic BP < 120mm of Hg was present in 106 referred admitted cases. Conclusion: This study suggests that the injured patients are not being transferred in a manner that is consistent with evidence based guidelines which are known to minimize the known hazards of transfer process and consequently improve outcome. Despite the efforts being made, the condition as of now is unacceptable and needs a rational referral policy contributed to and agreed by all service providers which must be strongly enforced without delay