Nalan Celebi

Ketamine gargle for attenuating postoperative sore throat

BACKGROUND Tracheal intubation is a foremost cause of trauma to the airway mucosa, resulting in postoperative sore throat (POST) with reported incidences of 21-65%. We compared the effectiveness of ketamine gargles with placebo in preventing POST after endotracheal intubation. METHODS Forty-six, ASA I-II, patients undergoing elective surgery for septorhinoplasty under general anaesthesia were enrolled in this prospective, randomized, placebo-controlled, single-blind study. Patients were randomly allocated into two groups of 23 subjects each: Group C, saline 30 ml; Group K, ketamine 40 mg in saline 30 ml. Patients were asked to gargle this mixture for 30 s, 5 min before induction of anaesthesia. POST was graded at 0, 2, 4, and 24 h after operation on a four-point scale (0-3). RESULTS POST occurred more frequently in Group C, when compared with Group K, at 0, 2, and 24 h and significantly more patients suffered severe POST in Group C at 4 and 24 h compared with Group K (P<0.05). CONCLUSIONS Ketamine gargle significantly reduced the incidence and severity of POST.

The efficacy of intravenous or peritonsillar infiltration of ketamine for postoperative pain relief in children following adenotonsillectomy.

Background : A few previous studies have suggested the efficacy of i.v. ketamine for postoperative pain relief in children after adenotonsillectomy, but none has investigated the efficacy of peritonsillar infiltration of ketamine in these children.

Minimum effective dose of dexamethasone after tonsillectomy

Background : The minimum effective dose of dexamethasone in conjunction with 50 μg·kg−1 ondansetron was evaluated in the treatment for vomiting after elective tonsillectomy or adenotonsillectomy.

The evaluation of propofol dosage for anesthesia induction in children with cerebral palsy with bispectral index (BIS) monitoring

Background:  We designed a randomized prospective study to investigate whether developmentally delayed children with cerebral palsy (CP) need a lower dosage of propofol for induction than normal children using bispectral index (BIS) monitoring criteria.

topical ketamine and morphine for post-tonsillectomy pain

Background and objectives: Tonsillectomy is frequently associated with postoperative pain of considerable duration, which is usually accompanied by the substantial consumption of both opioid and non‐opioid analgesics. Despite the use of different surgical and anaesthetic techniques in the search for safe and effective post‐tonsillectomy pain relief, this problem remains a clinical dilemma. The aim of the current study was to evaluate the potential effects of topically administered ketamine and morphine by an oral rinse into the tonsillar fossae. Methods: In all, 60 children, 15 for each group, aged between 3 and 12 yr scheduled for tonsillectomy were randomly assigned to one of four groups. Study drugs were administered to both tonsillar fossae for 5 min. Group K received 0.4 mL (20 mg) ketamine in 10 mL artificial saliva, Group KM received 0.4 mL (20 mg) ketamine + 5 mL (20 mg) 4‰ morphine aqueous solution in 5 mL artificial saliva, Group M received 5 mL (20 mg) 4‰ morphine aqueous solution in 5 mL artificial saliva, Group C received only 10 mL artificial saliva. Postoperative pain, nausea, vomiting, sedation and bleeding were evaluated. Results: Pain scores were higher in the control group at arrival in the recovery ward (P < 0.05). Morphine and ketamine groups had longer effective analgesia time than the morphine + ketamine and control groups. The 24‐h analgesic consumption was significantly higher in the control group. Conclusion: Topical ketamine and morphine seems to be a safe and easy analgesic approach for decreasing adenotonsillectomy pain.

Comparison of dexmedetomidine-propofol vs. fentanyl-propofol for laryngeal mask insertion.

Background and objectives There have been many studies to find the optimum anaesthetics to provide excellent conditions for laryngeal mask insertion. We compared the effects of dexmedetomidine administered before propofol, on laryngeal mask insertion with fentanyl combined with propofol. Methods In all, 52 patients, ASA I–II, scheduled to have minor urological procedures were randomized into two groups. Group F received 1 &mgr;g kg−1 fentanyl (in 10 mL normal saline) and Group D received 1 &mgr;g kg−1 dexmedetomidine (in 10 mL normal saline). We used 1.5 mg kg−1 propofol for induction and 50% N2O and 1.5% sevoflurane in oxygen for maintenance. We observed jaw mobility (1: fully relaxed; 2: mild resistance; 3: tight but opens; 4: closed), coughing or movement (1: none; 2: one or two coughs; 3: three or more coughs; 4: bucking/movement) and other events such as spontaneous ventilation, breath holding, expiratory stridor and lacrimation. In each category, scores <2 were acceptable for laryngeal mask insertion. Results More patients developed apnoea and their apnoea times were longer in Group F than Group D (P < 0.001). Respiratory rates increased in Group D (P < 0.001). Adverse events during laryngeal mask insertion were similar. The reductions in systolic and mean blood pressures were greater in Group F (systolic: P < 0.05, mean: P < 0.01). Emergence times were shorter in Group F than in Group D (P < 0.001). Conclusion Dexmedetomidine, when used before propofol induction provides successful laryngeal mask insertion comparable to fentanyl, while preserving respiratory functions more than fentanyl.

Perioperative anxiety and postoperative behavioural disturbances in children : comparison between induction techniques

Background and objective: This study was designed to determine if subhypnotic propofol reduces postoperative behavioural disturbances in children undergoing sevoflurane induction compared with intravenous propofol induction for elective adenoidectomy and tonsillectomy. Methods: Following Ethics Committee approval and parental informed consent, ASA I–II, 120 children (2–10 yr) were recruited. Parents were not allowed to accompany their child. Unpremedicated children were randomly allocated to groups receiving inhalation induction with sevoflurane, 2–2.5 mg kg−1 intravenous propofol induction or inhalation induction with sevoflurane followed by subhypnotic dose of propofol (1 mg kg−1). Anaesthesia was maintained with 2–4% sevoflurane, O2 and N2O. Anxiety on arrival to operating theatre, at anaesthesia induction and 30 min after emergence was assessed. Parents completed a state–trait anxiety inventory test preoperatively and a post hospitalization behaviour questionnaire a week later to assess childrens postoperative behavioural disturbances. Kruskal–Wallis test, Wilcoxon signed rank sum test, Bonferronis test, Paired t‐test, t‐test, Pearson and Spearmans rank correlation test, χ2‐test were used for statistical analysis. Results: The anxiety level at induction was high in all groups (P < 0.05). There was no difference between groups in respect to anxiety at other measurement times. A relation between preoperative anxiety level and postoperative behavioural disturbances was determined (P < 0.05). Some behavioural disturbances as nightmare/night fear and desire of sleeping with parents were rarely seen in intravenous propofol induction group (P < 0.05). Conclusion: Addition of subhypnotic dose of propofol to sevoflurane induction did not reduce the incidence of postoperative behavioural disturbances.

Mercury intoxication and neuropathic pain

produce systemic side effects in susceptible patients (4). To limit this, many centers use atropine ointment rather than drops for children. The large molecules of the ointment are not easily removed by the lacrimal drainage system by blinking thus producing lower systemic concentrations of atropine compared with the solution (5) . Moreover, atropine in ointment form is retained in the conjunctival sac for a longer time thereby allowing effective cycloplegia with minimal side effects (6). Lastly, in our institute, the use of atropine ointment for cycloplegia is generally reserved for young children (<5 years) who either have accommodative esotropia or are refractory to other cycloplegic agents. Accurate measurement of hyperopia is necessary to correct accommodative esotropia. This requires maximum cycloplegia which is most reliably achieved with the 3 day routine of atropinization (7). Till the availability of a safer and more potent cycloplegic agent, ocular atropine will continue to be used and our intention was to make the anesthesiologist aware of the possible adverse effects of ocular atropine. Vimi Rewari Anjan Trikha Department of Anaesthesiology and Intensive care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029 (email: vimirewari@gmail.com)

Anesthetic management of a patient with Brugada syndrome

1 Steinherz PG. Transient and severe hyperlipidemia in patients with acute lymphoblastic leukaemia treated with prednisone and asparaginase. Cancer 1994; 74: 3234–3239. 2 Tozuka M, Yamauchi K, Hjidaka H et al. Characterization of hypertriglycerideamia induced by L-asparaginase therapy for acute lymphoblastic leukaemia and malignant lymphoma. Ann Clin Lab Sci 1997; 27: 351–357. 3 Kroll MH, Elin RJ. Interference with clinical laboratory analyses. Clin Chem 1994; 40: 1996–2005. 4 Preckel B, Bolten J. Pharmacology of modern volatile anaesthetics. Best Pract Res Clin Anaesthesiol 2005; 19: 331–348. 5 Wasan KM. Modifications in plasma lipoprotein concentration and lipid composition regulate the biological activity of hydrophobic drugs. J Pharmacol Toxicol Methods 1996; 36: 1–11.

Bolus ketamine does not decrease hyperalgesia after remifentanil infusion

Abstract Background and aim: Several animal and human studies have proposed that acute tolerance to opioids might be manipulated by NMDA receptor antagonists. This study was designed to test the opioid-induced hyperalgesia produced by remifentanil, and to evaluate the effect of ketamine under these conditions. Methods: Forty-seven ASA 1-2 patients undergoing lumbar disc operation were randomly assigned into 3 anaesthetic regimens. The patients were not premedicated. After standard anaesthesia induction with propofol and vecuronium, group R and group K patients received a remifentanil infusion of 0.1 μg kg−1 min−1. Group K also received 0.5 mg kg−1 ketamine bolus before remifentanil infusion. Group S was the control group and equal volume of saline instead of remifentanil was infused throughout the operation. Groups R and S also received a bolus of the same volume of saline instead of ketamine by an anaesthesiologist blinded to the study. After the surgery under desflurane anaesthesia, patient-controlled a...