Steroids are effective in the management of MAS and route of administration does not have a bearing on the efficacy.
In a randomized, double blind, placebo controlled study; the acceptability, efficacy and safety of injectable midazolam as oral premedicant in children was evaluated. One hundred children (ASA 1,2) aged 6 months to 6 years, undergoing elective neurosurgical operations, like meningomyelocele, meningo-encephalocele, ventriculo peritoneal and other shunts and craniotomies for tumour decompression etc., were included in the study. The patients were randomly assigned to one of four groups (A, B, C, D) receiving respectively saline or 0.50, 0.75 and 1.0 mg/kg midazolam in honey, 45 min before separation from parents. All received identical general anesthesia (GA). Age, sex, weight, heart rate, blood pressure, respiratory rate, saturation (SaO2), reaction to parent's separation, sedation score and duration of anesthesia, recovery conditions and side effects were noted. We found no difference in age, sex, weight, patient acceptability vomiting after ingestion and duration of anesthesia between groups. Even though many children resisted the placement of premedicant in the mouth, only three children spat it out and none vomited after swallowing. The reaction to separation from parents was better after midazolam premedication. However, on reaching the operating room, 24% children (placebo-60%) were found anxious after 0.50 mg/kg, but 12% were deeply sedated after a dose of 1.0 mg/kg. Recovery was similar in groups A, B and C except that more (48%) patients were anxious in group A. Recovery, however was delayed in 16% patients of group D. Though, fewer complications were reported during recovery after midazolam than placebo premedication, they were minimal in the 0.75 mg/kg group. We concluded that giving injectable midazolam orally as premedication in pediatric age group scheduled for neurosurgical operations is acceptable, effective and safe in 0.75 mg/kg dose. While 0.50 mg/kg is less effective, 1.0 mg/kg does not offer any additional benefit over 0.75 mg/kg but does delay recovery and may compromise safety.
Background: Many drug combinations and techniques have been used to give more effective and safer analgesia, especially in caesarean deliveries. Aims and Objectives: To evaluate the analgesic efficacy and side effects of buprenorphine or clonidine with bupivacaine in the caesarean deliveries. Methods: A prospective, randomized and tripleblinded study was carried out in 100 patients. The patients were divided into 3 groups, Bupivacaine (0.125%) at 3 hour intervals and buprenorphine (0.075 mg) at 12-hour intervals, Bupivacaine (0.125%) and clonidine (37.5 micrograms) at three-hour intervals and Bupivacaine (0.125%) alone at three-hour intervals. The onset and the duration of analgesia was noted along with side effects like nausea and vomiting, shivering, pruritus, respiratory depression (respiratory rate less than 12 / minute), and sedation and hypotension were recorded up to 24 hours after administration of drug. The obtained data was analyzed using the Statistical Package for Social Science (version 10.0 for Windows, SPSS). Analysis of variance / Chi square test was used to compare the variables between groups. A P value of < 0.05 was considered significant. Results: The mean duration of analgesia was significantly longer in group one patients receiving buprenorphine plus bupivacaine in comparison to group two patients receiving bupivacaine plus clonidine and it was the least in group three patients receiving bupivacaine alone. Conclusion: Epidural buprenorphine with bupivacaine produced a significantly rapid onset, better quality and longer duration of analgesia than bupivacaine combined with clonidine or bupivacaine alone with minimum side effects in lower segment caesarean section patients.
Background: Pregabalin is used for postoperative pain management. Aims and Objectives: To evaluate efficacy of pregabalin in relieving acute postoperative pain. Materials and Methods: 650 studies were assessed, out of which 50 studies with 4012 patients (2212 received pregabalin and 1800 served as control) were included in the final analysis. 45 studies investigated acute pain, and 5 chronic pain. Results: Perioperative pregabalin after surgery reduced pain scores, hospital stay, opiod side effects. Conclusion: pregabalin has a significant role in relieving acute postoperative pain.
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