Patients undergoing relatively minor surgery under spinal or epidural anesthesia alone occasionally request sedation or sleep during surgery and certain sedatives such as midazolam or propofol are administered intravenously. The study evaluated the applicability and safety of using nasal BI-PAP and low-dose propofol sedation as an adjunct to spinal anesthesia during herniorrhaphy. Twenty-five adult patients undergoing repair of inguinal hernia under spinal anesthesia received propofol infusion for sedation with the assist of noninvasive positive-pressure ventilation (NPPV). Circulatory and respi-ratory parameters, such as percutaneous oxygen saturation, transcutaneous carbon dioxide tension, respiratory rate, tidal volume, blood pressure, and heart rate, were maintained within accepted ranges during anesthesia. There were no adverse effects. These findings suggest that the application of NPPV in patients receiving propofol infusion for sedation is clinically practicable during anesthesia.

A long acting local anesthetic; ropivacaine and a synthetic opioid ; tramadol were used to improve pain relief and decrease postoperative systemic analgesic requirement after total thyroidectomy in patients with thyroid cancer. The study also assesses the effect of local infiltration with ropivacaine and tramadol on plasma catecholamine levels. Methods: Ninety six patients underwent thyroid surgery were randomly assigned to 3 groups. Before skin closure, tissues were infiltrated 10 ml of ropivacaine 0.75% plus 5 ml saline in Group R, with 1.5 mg/kg of tramadol in 15 ml saline in Group T, and with 15 ml containing 10 mL ropivacaine 0.75% plus tramadol 1.5mg/kg in Group RT. Plasma epinephrine and nor-epinephrine were recorded at preoperative (0), 1, 5, 15, 30min, 1, 2 and 4 h postoperative. Pain scores at min, 0.1/2, 1,2,4,6, 12, 18, and 24 hr post-operatively; time to first analgesic, number and % of patients requiring rescue analgesia, number of rescue analgesia and total dose of analgesic were recorded. Results; The pain scores in group RT were significantly lower in the first 24 hours than in groups R and T. Time to first analgesic (hrs) in group RT was significantly more than in either group R or group T. The percentage of patients in group RT requiring rescue analgesia was significantly less than the percentage of patients in other groups. Also, the numbers of rescue analgesia requests and the cumulative 24 h analgesic consumption were significantly smaller in group RT than other groups. The plasma epinephrine and nor-epinephrine increased significantly in three groups at 5 and 15 min when compared with the baseline then returned to near baseline value at 30 min 1,2 and 4 hrs. There was significant decrease in plasma concentration of epinephrine and nor-epinephrine in group RT than R or T groups. The aim of this study is to evaluate wound infiltration with ropivacaine, tramadol or their combination on plasma catecholamine levels and post-operative pain following thyroid surgery.

Introduction: Possible approaches for postoperative analgesia after pediatric inguinoscrotal surgery are caudal block by bupivacaine/ketamine (BK) and bupivacaine/magnesium sulfate (BM). Aim: The purpose of the following study is to compare the analgesic efficacy and safety of ketamine and magnesium sulfate in combination with bupivacaine for caudal blockade in pediatric patients after inguinoscrotal operations. Materials and Methods: Patients randomly received one of the two solutions for caudal epidural injection after induction of general anesthesia. Group-BK: Were given a mixture of 0.25% bupivacaine and 0.5 mg/kg of ketamine. Group-BM: Were given a mixture of 0.25% bupivacaine and 50 mg magnesium sulfate. Postoperatively, a blinded post-anesthesia care unit nurse assessed the quality of analgesia with a visual pain analog scale (VPAS). Significant pain is defined as one that has a VAPS of ≥3. Results: Forty American Society of Anesthesiologists I-II children (20 in each group) completed the study. The two groups were comparable regards age, sex, body mass index, anesthesia and surgery durations, recovery time and sevoflurane concentration. The mean duration of caudal analgesia ± standard deviation was 462 ± 17.2 min versus 398.05 ± 12.9 min for BK and BM groups, receptively (P 0.001). Supplemental rectal paracetamol within 12 h postoperatively were 15% for BK group versus 25% for BM (P = 0.05). Four patients in BK group only experienced postoperative nausea and vomiting (P = 0.053). Conclusion: Caudal administration of BK is efficient and safe for pediatric inguinoscrotal operations with longer postoperative analgesia than BM sulfate.

To evaluate the efficacy and safety of ultrasound technology for infraclavicular brachial plexus block in chronic renal failure patients undergoing arterio-venous shunt operations. Material and methods Our study included 40 patients with fulfilled clinical criteria of chronic renal failure. All patients (32 RT and 8 LT sided) were subjected to infraclavicular block using ultrasound visualization with 7.5–10 MHz linear probe. The anesthetic mixture consisted of 20 ml lidocain hydrocarbonate 2% and 20 ml of plain bupivacaine 0.5%. Sensory block, motor block and supplementation rate were evaluated for the musculocutaneous, median, radial and ulnar nerves. Results Surgical anesthesia was achieved without supplementation in 38 patients (95%) and 2 patients needed supplementation with infiltration anesthesia (5%). No patient in the study needed general anesthesia. Duration of surgery, administration, onset and complete blocks in minutes were (165 ± 11.7, 11 ± 4.5, 4.5 ± 1.5 and 8.5 ± 3.4), respectively. No vascular injury was reported in this study. Conclusion We concluded that real-time ultrasound imaging during infraclavicular brachial plexus blocks can facilitate nerve localization, needle placement and provide high success rate. Also it improves safety for ICBPB.