No abstract

Background:Opioid analgesics used for analgesia are associated with sedation, respiratory depression and post-operative nausea and vomiting. Non-steroidal anti-inflammatory drugs such as diclofenac are a safe and effective alternative with opioid-sparing effect.Objective:To evaluate the effectiveness of pre-operative rectal diclofenac suppository (1 mg/kg) in cleft palate repair for post-operative analgesia and reduction in post-operative opioid requirements.Study Design:A randomized clinical trial.Methods:After obtaining approval from the institutional ethical committee, 60 children were allocated by a computer-generated randomisation into two groups of 30 each; group D (Diclofenac group) and group C (Conventional group). Children in group D and group C were similar in all aspects except for the fact that group D children received 1 mg/kg diclofenac suppository after induction. Pain was evaluated using modification of the objective pain scale by Hannallah and colleagues for 6 h post-operatively by an anaesthesiology resident or nursing staff who was blinded to the group. If the pain score was more than 3, rescue analgesic I.V. fentanyl 0.5 μgm/kg was administered. The pain scores at different intervals, number of doses and quantity of rescue analgesic required were noted.Results:We observed that pre-operative rectal diclofenac provided effective analgesia in the immediate post-operative period, as evidenced by reduced pain scores and reduced opioid requirement (P=0.00002). There was no evidence of any increased perioperative bleeding in the diclofenac group.Conclusion:Pre-operative rectal diclofenac reduces opioid consumption and provides good post-operative analgesia.

IntrOductIOnLaryngoscopy and tracheal intubation can cause tachycardia, hypertension, dysarrhythmias, perioperative myocardial ischaemia, acute heart failure, and cerebrovascular accidents in susceptible individuals [1] .These responses are due to intense sympathetic discharge caused by stimulation of upper respiratory tract, evidenced by rise in catecholamine's. Various drugs and techniques like, topical and IV Lignocaine, deepening level of anaesthesia, adrenergic blockers, vasodilators like, alpha blockers, and opioids have been used [1]. Fentanyl, a synthetic opioid which attenuates the cardiovascular response by its action on opioid receptors, effects on cardiovascular system, preventing the increase in plasma concentrations of catecholamines and decreasing the central sympathetic vasoregulatory outflow. We conducted a randomized double blind controlled study to determine the effective dose of fentanyl to attenuate the cardiovascular effects of laryngoscopy and tracheal intubation. MAterIAls And MethOdsWe conducted a randomized double blind controlled study on 50 ASA physical status I and II patients, aged between 20-60 years, scheduled for elective surgery requiring general anaesthesia. Institutional ethical committee approval and informed consent was obtained. Patients with history of hypertension, angina, coronary artery disease, recent myocardial infarction, congestive cardiac failure, heart blocks, cardiac pace maker, chronic obstructive pulmonary disease, pregnant and nursing women, anticipated difficult airway and patients on treatment with anti-hypertensive and anti arrhythmic drugs were excluded from study. All the patients were randomly allocated in a double blind fashion and using a sealed envelope technique to one of the two groups, fentanyl 3µg/ kg (group A), fentanyl 5µg/kg (group B) each containing 25 patients. All the patients were premedicated with Inj.glycopyrrolate 0.2 mg intramuscularly and midazolam 0.05mg/kg IM, 30 min prior to

Waardenburg syndrome (WS) is a rare autosomally inherited and genetically heterogeneous disorder of neural crest cell development. Literature regarding the anesthetic management of these cases is limited. We present 2 cases of Shah–Waardenburg syndrome and discuss them in the context of review of previously published cases.