Rehana S. Kamal

Is there a role of a small dose of propofol in the treatment of laryngeal spasm

Summary Background: Propofol has been found to depress the laryngeal reflexes. We studied whether this property could be utilized to relieve laryngeal spasm.

Cerebral infarct following central venous cannulation

Inadvertent carotid artery puncture is a well‐known complication of internal jugular vein cannulation. A case of cerebral infarct subsequent to carotid artery puncture during internal jugular vein cannulation is reported.

Effect of general anaesthesia and surgery on neutrophil function

The effects of general anaesthesia and surgical trauma on neutrophil function were studied in 60 female ASA 1 and 2 patients undergoing anaesthesia for gynaecological surgery. Patients were divided into three groups depending on the degree of trauma and duration of surgery. Group 1 (n = 15) were patients for dilatation and curettage (minor surgical trauma) and were given 2% halothane. Group 2 (n = 30) had laparoscopic surgery (moderate surgical trauma) and received either 0.5% halothane or 1% enflurane. Group 3 (n= 15) were those having hysterectomy (major surgical trauma) and received 0.5% halothane for a longer duration. Venous samples were taken 30 min before anaesthesia (control value), 10 min after induction of anaesthesia, 10 min after the start of surgery, 30 min after the end of anaesthesia and 24 h later. Phagocytic index, nitroblue tetrazolium reduction test, total leucocyte count, and differential leucocyte counts were performed on each sample. Data were analysed by paired t‐test to compare findings in the same patient and by unpaired t‐test for differences between groups. Anaesthesia with halothane 0 5% to 2% caused a dose‐related depressant effect on leucocyte function which reversed. Enflurane 1% on the other hand caused significantly greater depression of leucocyte function compared with 0.5% halothane which persisted during the recovery period and recovered on the first postoperative day. Total leucocyte counts also showed a fivefold increase in the major surgery groups.

Effect of route of buprenorphine on recovery and postoperative analgesic requirement in paediatric patients.

Summary Background: We compared the effects of extradural with intravenous (i.v.) buprenorphine on postoperative pain and recovery characteristics.

Caudal analgesia with buprenorphine for postoperative pain relief in children

Caudal buprenorphine was investigated as a postoperative analgesic in a randomized double blind study in thirty children aged 5–12 years undergoing lower abdominal and lower limb surgery. Comparison was made between two groups of patients, one group receiving plain bupivacaine and the other a combination of plain bupivacaine with buprenorphine. Postoperative analgesia was assessed using a linear analogue scale, and by the response to direct questioning of children using an illustration of sequence of faces. Any untoward side effects and the need for additional analgesics were recorded. The degree and duration of analgesia was far superior in the buprenorphine group and there was a highly significant difference in the requirement of postoperative analgesia between the two groups. There were no major adverse side effects and no motor weakness in either groups, however the incidence of nausea and vomiting was higher in the buprenorphine group. It is concluded that a combination of bupivacaine with buprenorphine administered through the caudal epidural space is a safe and reliable means of providing postoperative pain relief in children for up to 24 h.

Effect of buprenorphine on the cardiovascular response to tracheal intubation

The effects of buprenorphine on the haemodynamic responses to tracheal intubation were studied in a placebo‐controlled double‐blind trial in 40 patients who had elective surgery. In one group saline was administered intravenously 8 minutes before induction, whereas the others received buprenorphine 2.5 μg/kg intravenously. Anaesthesia was induced in both groups with thiopentone 4 mg/kg followed by suxamethonium 1.5 mg/kg after 90 seconds. In the buprenorphine group, the maximum increase in systolic and diastolic arterial blood pressures, heart rate and rate pressure product were significantly lower compared to the control group. It is concluded that buprenorphine is partially effective in attenuating the cardiovascular response to laryngoscopy and intubation, but does not obliterate it.

Comparison of nalbuphine and buprenorphine in total intravenous anaesthesia

Nalbuphine (0.3 mgkg−1) and buprenorphine (2.5 μgkg−1) were compared as part of a total intravenous anaesthesia regimen using a propofol infusion in 60 patients undergoing laparoscopic cholecystectomy in a randomised double‐blind study. Changes in haemodynamic variables greater than 20% from the baseline were noted. No difference was observed in blood pressure but the heart rate was significantly lower in the buprenorphine group. Intra‐operative bradycardia (heart rate < 60 beatmin−1) occurred more often in the buprenorphine group. Recovery was fast and comparable with both drugs and no patient reported awareness. Quality of analgesia was similar in both groups. Both drugs provide suitable analgesic supplementation to total intravenous anaesthesia.

Total intravenous anaesthesia with propofol and buprenorphine

A combination of propofol infusion and two bolus doses of buprenorphine, 2.5 or 5.0 μg/kg were evaluated in a total intravenous anaesthesia technique in 36 patients of ASA grade 1 or 2 undergoing cholecystectomy. Additional boluses of propofol were given intravenously if needed. Systolic blood pressure after tracheal intubation increased significantly only in those who received the smaller dose of buprenorphine. Patients in both groups remained haemodynamically stable throughout surgery with minimal side effects. Recovery was fast even with prolonged infusions and without major side effects. No patient reported awareness on postoperative questioning.

The effect of increasing the dose of buprenorphine on the haemodynamic response associated with tracheal intubation

The effect of buprenorphine on the haemodynamic response to tracheal intubation was studied at two dose levels, 2.5 μg.kg‐1 and 5 μg.kg‐1, in a placebo‐controlled double‐blind trial in 75 patients undergoing laparoscopic cholecystectoniy. The study drugs were administered intravenously 8 min before induction of anaesthesia with thiopentone 5 mg.kg‐1 and vecuronium 0.1 mg/kg‐1. Buprenorphine 2.5 μg.kg‐1 caused 50% attenuation of the blood pressure response whereas 5 μg.kg‐1 caused 70% attenuation compared to the saline placebo. The maximum increase in heart rate was 14% of the control value after 2.5 μg.kg‐1 and 11% after 5 μg.kg‐1 of buprenorphine. A significant difference in heart rate was also observed between the two buprenorphine groups at 5 and 10 min after intubation. Blood pressure and heart rate both showed a significant fall from baseline values 10 min after intubation in both buprenorphine groups, with the changes being greater in the 5 μg.kg‐1 group. We recommend the use of 2.5 μg.kg‐1 buprenorphine for attenuation of the hypertensive response to intubation in major abdominal surgery.