Sixty ASA physical status I and II children aged 3 - 6 years were included in this study. After inhalation induction with sevoflurane, patients were randomly assigned to receive either Saline (group 1, n=20), fentanyl 1 mic /kg IV (group II, n=20) or dexmedetomidine 0.3mic/kg IV (group III, n=20)10 minutes before discontinuation of anesthetics. There was no significant difference (p>0.05) between the three groups regarding age, weight, duration of anesthesia, duration of surgery, time to eye opening, modified Aldrete recovery scores and post operative complication. The time of first postoperative analgesic dose was significantly shorter in group I compared with other two groups. The incidence of agitation was significantly higher in group I compared with other two groups, the incidence of agitation was 40% in Group I, 15% in Group II and 20% in Group III. In conclusion, the dose of fentanyl 1 mic/kg iv or dexmedetomidine 0.3mic/kg iv that is administered 10 minutes before the termination of anesthesia reduces the postoperative agitation in children with no adverse effects.

Background and Objectives: The efficacy of bilateral thoracic paravertebral block (TPVB ) was compared to intraperitoneal ( IP ) bupivacaine in reducing postoperative pain following laparoscopic cholecystectomy (LC ) using a prospective randomized study design. Methods: We studied forty two patients scheduled for laparoscopic cholecystectomy. All of them received the same technique of general anaesthesia. Patients were randomly allocated into 3 equal groups, 14 patients each; Group PV received bilateral thoracic paravertebral block at T5-6 level with 25 mL of bupivacaine 0.25 % with epinephrine 1 : 200.000 on each side, Group IP received 50 mL of bupivacaine 0.25 % with epinephrine 1: 200.000 sprayed into the peritoneal cavity immediately after the pneumoperitoneum, and Group GA, received general anaesthesia only. Postoperative pain was assessed used visual analogue scale (VAS) and analgesic requirements and complications were recorded. Results: There was significant decrease in VAS, HR, MAP, and morphine consumption in groups PV & IP when compared to group GA, also there were significant prolongation in time to rescue analgesia and reduction in hospital stay in group PV and IP compared to group GA. In comparison between the 2 active groups, paravertebral block was significantly superior to intraperitoneal bupivacaine in all parameters. Conclusion: Both TPVB and IP bupivacaine are effective in reducing pain after LC. TPVB is superior to IP bupivacaine in controlling postoperative course of LC.

Objectives: To explore the effect of saliva on pH and volume of gastric aspirate by using two different techniques of blind gastric aspiration of gastric contents. Materials and Methods: This prospective and randomized clinical trial was conducted in the Department of Anaesthesia at King Khalid University Hospital, Al-Riyadh, Saudi Arabia from August to December, 2006 on 140 adult inpatients of either sex, aged 15-70 years and American Society of Anesthesiologists physical status I-II. An orogastric tube was passed by conventional method in Group A and through an endotracheal tube placed in esophagus in Group B. Gastric contents were aspirated with a large bore, multi-orifices gastric tube after tracheal intubation and analyzed for the presence of bile salts, pH and volume. Results: Thirty nine (28.57 %) samples were contaminated with duodenal contents and one with blood. Six patients have no gastric contents in Group A due to failed orogastric intubation and none in Group B (p 0.0280). Saliva, by conventional method of orogastric intubation, significantly affected both the pH (A-2 versus B-2: p <0.0001) and volume (A-2 versus B-2: p 0.0045) of gastric contents. Duodenogastric refluxate significantly affected both the pH (A-1 versus A-2: p0.0236), B-1 versus B-2: p 0.0019) and volume (A-1 versus A-2: p .0343), B-1 versus B-2: p 0.0005) of gastric contents. Conclusion: Saliva significantly affected both the pH and volume of gastric contents when sampled by conventional method of orogastric intubation. Duodenogastric refluxate significantly affected both the pH and volume of gastric contents.

Gastro-bronchial fistula (GBF) represents an extremely rare complication after surgical procedures. Anesthetic management of such case is challenging. We are presenting a case of GBF following gastric bypass surgery for treating morbid obesity. A 25-year-old female patient was admitted in the thoracic surgical floor with cough of gastric contents following Roux-in-Y surgery. Barium meal revealed gastro-bronchial fistulous tract. She underwent left thoracotomy under general anesthesia and the fistula was closed. Rapid sequence induction of anesthesia and proper isolation of the sound lung are important to minimize incidence of pulmonary aspiration and soiling of the non-operated lung at induction of anesthesia. All precautions of managing one lung ventilation during surgery are to be undertaken. In conclusion, anesthesia for repair of GBF is challenging. To the best of our knowledge this is the first report in literature describing the anesthetic management of surgical correction of GBF.