Supplementation of general anaesthesia with tramadol or fentanyl in parturients undergoing elective Caesarean section

Purpose

Tramadol has been recommended for analgesia in parturients undergoing vaginal delivery. The present report investigated the effect of tramadol versus fentanyl on umbilical vein (UV) blood gases and Apgar scores of neonates delivered via elective Caesarean section under general anaesthesia.

Methods

Forty ASA I or II parturients undergoing elective Caesarean section were included in a randomized double-blinded study. The patients were divided into a tramadol (n = 20) and fentanyl groups (n =.20). During preoxygenation, one group received 100 mg tramadoliv, while the second received 100 μg fentanyl. Anaesthesia was induced in both groups by 3 mg·kg^?1 thiopentone and 1.5 mg·kg^?1 succinylcholine was given to facilitate tracheal intubation. Anaesthesia was maintained during the induction-delivery period with nitrous oxide 50% in oxygen.

Results

The umbilical vein PO₂ was higher in the fentanyl (34 ± 5 mmHg) than in the tramadol group (24 ± 6 mmHg) (P < 0.01), while the UV PCO₂ was higher in the tramadol group (50 ± 5vs 45 ± 4 mmHg) (P 0.01). The Apgar scores at one and five minutes were not different between the two groups. Post operatively, two patients in the tramadol group recalled the crying of their newborn at delivery.

Conclusion

Tramadol is associated with a high incidence of intraoperative maternal recall and can result in lower umbilical vein PO₂ and higher PCO₂ than in the fentanyl group.     

Laser tattoo removal: Fundamental principles and practical approach

Tattoos have long become a part of human civilization. However, as the number of people who get tattoos increases, so is the number of people who wish to have their tattoos removed. Compared to other methods, laser‐based devices are associated with the best efficacy and least side effects in tattoo removal. Lack of understanding of the fundamental principles of laser and managing its parameters may result in suboptimal result and increased risk of side effects. Recognizing and mastering multiple factors including skin types, nature and color of tattoos, and proper selection of laser parameters such as wavelength, fluence, and pulse, are central in achieving an optimal tattoo removal outcome. This review provides a comprehensive overview on the fundamental principle of laser and practical approaches in tattoo removal.     

Does HIV infection contribute to increased beta-amyloid synthesis and plaque formation leading to neurodegeneration and Alzheimer’s disease?

Journal of NeuroVirology - HIV infection in the combination antiretroviral therapy (cART) era has become a chronic disease with a life expectancy almost identical to those free from this infection....     

Enormous Right Atrial Hemangioma in an Asymptomatic Patient: A Case Report and Literature Review

We report the case of an enormous right atrial hemangioma in an asymptomatic 42-year-old woman. The diagnosis was made by echocardiogram after the patient was found to have an abnormal EKG during a routine medical exam. The hemangioma is the largest described in English literature. The tumor was surgically resected and the patient did well postoperatively. In this case report, we discuss the discovery of the tumor and treatment of our patient. A brief discussion of cardiac hemangiomas follows.     

Unusual case of difficult double-lumen endotracheal tube removal

A reusable Robertshaw red rubber double-lumen endotracheal tube (DLT) was placed to facilitate lung isolation for thoracoscopy in a 49-year-old atopic patient. In spite of its smooth insertion, it was then not possible to remove the DLT. Direct laryngoscopy showed severe laryngeal edema. After 48 hours of medical treatment with steroids, the trachea was extubated. The laryngeal edema could have been the result of physical and chemical irritation by the reusable rubber DLT itself, or from the substances formed during repeated cleaning and sterilization of the DLT. Atopic patients who are prone to developing latex allergy are also more liable to develop severe reactions to chemical, mechanical, and physical irritation from reusable red rubber DLTs or from the chemical solution used for its cleaning and sterilization.