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Neostigmine/atropine was effective in treating PDPH after only 2 doses. Neostigmine can pass the choroid plexus but not the blood-brain barrier. The central effects of both drugs influence both cerebrospinal fluid secretion and cerebral vascular tone, which are the primary pathophysiological changes in PDPH. The results are consistent with previous studies and clinical reports of neostigmine activity.

Patients with sleep apnea are prone to postoperative respiratory complications, requiring restriction of sedatives during perioperative care. We performed a prospective randomized study on 24 patients with obstructive sleep apnea (OSA) who underwent elective surgery under general anesthesia. The patients were equally divided into two groups: Group Dex: received dexmedetomidine loading dose 1 mcg/kg IV over 10 min followed by infusion of 0.2–0.7 mcg/kg/hr; Group KFL: received ketofol as an initial bolus dose 500 mcg/kg IV (ketamine/propofol 1 : 1) and maintenance dose of 5–10 mcg/kg/min. Sedation level (Ramsay sedation score), bispectral index (BIS), duration of mechanical ventilation, surgical intensive care unit (SICU) stay, and mean time to extubation were evaluated. Complications (hypotension, hypertension, bradycardia, postextubation apnea, respiratory depression, and desaturation) and number of patients requiring reintubation were recorded. There was a statistically significant difference between the two groups in BIS at the third hour only (Group DEX 63.00 ± 3.542 and Group KFL 66.42 ± 4.010, p value = 0.036). Duration of mechanical ventilation, SICU stay, and extubation time showed no statistically significant differences. No complications were recorded in both groups. Thus, dexmedetomidine was associated with lesser duration of mechanical ventilation and time to extubation than ketofol, but these differences were not statistically significant.

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Aim of the study: to compare between the efficacy of using forearm intravenous regional anesthesia (IVRA) and upper arm IVRA and investigate the effects of nitroglycerine (NTG) compared to fentanyl when added to lidocaine in IVRA in wrist and hand surgery. Patients and Methods: 100 patients divided into 4 equal groups. Patients had upper arm tourniquet and received lidocaine (3 mg/kg) mixed with fentanyl (1 μg/kg) in Group I and NTG (400 μg) in Group III. Patients had forearm tourniquet and received half dose of the aforementioned drugs in Group II and Group IV. Results: there was a rapid sensory and motor block onset and reduction in postoperative diclofenac requirement in group III and group IV compared to group I and group II. Conclusion: Both forearm and upper arm tourniquets showed comperable results. Nitroglycerin was associated with rapid onset of sensory and motor block, and reduction in postoperative diclofenac requirement.