This is a review of Ibn al Quff's account of surgical pain relief in his surgical book Al Omdah, in which he mentioned the word anesthetic (Al moukhadder) and the involvement of physician (al tabbaaee) to give mixture of drugs to prevent pain in a surgical condition to relieve the patient from pain or to make surgical management possible. Hich indicated one rare occasion to such description in Arabic medical texts. Methods of administration of these drugs were inhalation, ingestion and by rectal suppositories. The drugs used in anesthetic sponges include all the drugs that are recorded in the modern literature of anesthesia. They are as follows: opium, mandrake, Hyocymus albus, belladonna, Cannabis sativus, Cannabis indica, wild lettuce. The anesthetic sponge, mentioned in many references as an inhalation method, may be of symbolic value to surgery.

Context and Background: Dose sparing action of one adjuvant for another in regional anesthesia. Aims and Objectives: To evaluate and compare the clonidine-ropivacaine combination with fentanyl-ropivacaine in epidural anesthesia and also to find out whether addition of clonidine can reduce the dose of fentanyl in epidural anesthesia. Materials and Methods: 60 patients of ASA grade I and II between the ages of 21 and 55 years, who underwent lower abdominal surgeries, were included randomly into three clinically controlled study groups comprising 20 patients in each. They were administered epidural anesthesia with ropivacaine-clonidine (RC), ropivacaine-fentanyl (RF) or ropivacaine-fentanyl-clonidine (RCF). Per-op and post-op block characteristics as well as hemodynamic parameters were observed and recorded. Statistical data were compiled and analyzed using non-parametric tests and P<0.05 was considered as significant value. Results: The demographic profile of the patients in all the three groups was similar as were the various block characteristics. The reduction of clonidine and fentanyl in the RCF group did not make any significant difference (P>0.05) in the analgesic properties of drug combination and hemodynamic parameters as compared to RC and RF groups. However, there was significant reduction of incidence of side effects in the RCF group (P<0.05) and it resulted in increased patient comfort. Conclusions: The analgesic properties of the clonidine and fentanyl when used as adjuvant to ropivacaine in epidural anesthesia are almost comparable and both can be used in combination at lower dosages without impairing the pharmacodynamic profile of the drugs as well as with a significant reduction in side effects.

Aim: Intubating conditions after Suxamethonium, a time tested popular short acting depolarizing neuromuscular blocking agent, and Rocuronium, a recently introduced intermediate acting non depolarizing neuromuscular blocking agent, with Thiopentone as the sole induction agent, were compared in this study. Materials and Methods: The patients were divided into two groups, each consisting of 30 patients: group a patient's received Rocuronium bromide, 0.6 mg/kg and group B patients received Suxamethonium chloride 1.5 mg/kg. In both the groups, jaw relaxation and vocal cord relaxation were considered for atraumatic laryngoscopy at 60 seconds or, if needed, at 75 seconds and then at 90 seconds. Results: Intubation conditions were rated as excellent in 90% and good in 10% of the patients who received Rocuronium, and excellent in 100% of the patients who received Suxamethonium. Conclusion: It is concluded from this study that intubation can be performed under good to excellent conditions at 60-90 seconds after a bolus dose of Rocuronium of 0.6 mg/kg. The result of this study indicates that this new nondepolarizing neuromuscular blocking agent may be considered as a valuable alternative to Suxamethonium for rapid tracheal intubation, i.e., within 60 seconds, even after induction with Thiopentone as the sole anesthetic agent.

Context: Celphos poisoning is one the most common and lethal poisonings with no antidote available till now. Aims: To evaluate the effectiveness of new treatment regimens and interventions in reduction of mortality from the fatal effects of celphos poisoning. Settings and Design: A profile of 33 patients, who got admitted in Intensive Care Unit (ICU) of our institute with alleged intake of celphos pellets, was studied. Materials and Methods: In all the 33 patients with alleged celphos poisoning, extensive gastric lavage was done with a mixture of coconut oil and sodium bicarbonate solution. Strict monitoring, both invasive and non-invasive, was done and symptomatic/supportive treatment was carried out on a patient to patient basis. Statistical Analysis: At the end of the study, all the data were compiled systematically and statistical analysis was carried out using the non-parametric tests and value of P<0.05 was considered significant. Results: Majority of the patients out of the total 33 were young with mean age of 21.86±4.92 and had good educational level. Most of the patients presented clinically with cardiovascular signs and symptoms (58%), followed by respiratory distress (15%) and little higher incidence of multi-organ symptomatology (18%). The mean stay of the patients in ICU was 5.84±1.86 days and the survival rate was 42%. Conclusions: With the treatment regimen we have formulated, we were able to save 42% of our patients and recommend the use of this regimen by all the intensivists and physicians.

Background: The I-gel mask is a novel supraglottic airway device. The objective of this study is to compare the insertion conditions for I-gel, using thiopental in two dosage regimes and propofol. Materials and Methods: A prospective, randomized, double-blind design was used. Ninety patients included in the study were classified at induction into group I that received intravenous 2.5 mg.Kg-1 propofol, group II that received 6 mg.Kg-1 thiopental and group III that received 7 mg.Kg-1 thiopental. Mean arterial blood pressure (MABP) and heart rate (HR) were recorded immediately before, after insertion and 5 minutes later, as well as the baseline hemodynamic variables. Tolerance of I-gel insertion was assessed using a scoring system. Results: Insertion conditions for I-gel supraglottic airway device showed significantly higher incidence of jaw relaxation (P=0.0008, 0.02 in groups I and III, respectively). No significant difference was found in the incidence of breath holding, lacrimation and stridor between the groups (P>0.05). The incidence of coughing/movement was significantly less in groups I and III (P=0.012, 0.04, respectively). Insertion time was significantly less in groups I and III (P<0.0001). The changes in MABP and HR were significantly less in groups I and III (P<0.0001). Conclusion: The use of thiopental at a dose of 7 mg.Kg-1 as an induction agent produced comparable I-gel supraglottic airway device insertion conditions with 2.5 mg.Kg-1 propofol in comparison to thiopental at 6 mg.Kg.-1.

Background: Making efforts to decrease maternal mortality rate is a moral, economic and human rights related issue. This issue could not be handled without investigation of maternal mortality related factors. The role of anesthesia in maternal mortality in developing countries is obscure. The aim of the study is to estimate the prevalence, causes and risk factors of maternal mortality related to anesthesia. Patients and Methods: An observational retrospective study was carried out in our university hospital from January 2004 till December 2008. Results: The study revealed that maternal mean age of death was 34.9 years, 59% of women came from rural areas and 41% from urban ones, 65% delivered inside the hospital while 35% delivered outside, 71% were multiparous, 65% had no antenatal care and 29.7% irregular one, 12% were complaining of concomitant diseases, 77.5% labored with cesarean section, 17% died before labor, 36% during and 47% after labor. Causes of death are given in the order of the most leading cause of death to the least as follows: postpartum hemorrhage, eclampsia, pre-eclampsia, postpartum eclampsia, ruptured uterus, amniotic fluid embolism, accidental hemorrhage, anesthesia and at last unexplained causes. Conclusions: Maternal mortality was 953 per 100,000 cases and the greatest number of deaths took place among women considered to be at low risk. Anesthesia was responsible for about 8% of the causes of death. Difficult airway management during general anesthesia was the major anesthetic reason for maternal mortality.

This case report describes the first case in intraoperative magnetic resonance imaging operating theater (iMRI OT) (BrainSuite;) of awake craniotomy for frontal lobe glioma excision in a 24-year-old man undergoing eloquent cortex language mapping intraoperatively. As he was very motivated to take pictures of him while being operated upon, the authors adapted conscious sedation technique with variable depth according to Ramsey's scale, in order to revert to awake state to perform the intended neurosurgical procedure. The patient tolerated the situation satisfactorily and was cooperative till the finish, without any event. We elicit in this report the special environment of iMRI OT for lengthy operation in pinned fixed patient having craniotomy.

A 59-year-old obese female patient was diagnosed to be having severe pulmonary hypertension secondary to mixed connective tissue disease and pulmonary fibrosis. She presented for right hemi-colectomy for a large right-sided colonic polypoid mass and multiple polyps diagnosed by colonoscopy. Her surgery was postponed by 2 months by the anesthesiologist due to dyspnea at rest and high pulmonary artery pressure (70-80 mmHg) for further optimization of medical treatment. After 2 months, she was adequately fit enough to undergo surgery. High lumbar epidural anesthesia was adopted and weaned off. She was discharged after 5 days of surgery from the hospital without any sequel. This report presents the merits and recommendations for such patients.

Depressed patients with brain tumors are often not referred to awake craniotomy because of concern of uncooperation which may increase the risk of perioperative complications. This report describes an interesting case of awake craniotomy for frontal lobe glioma in a 41-year-old woman undergoing language and motor mapping intraoperatively. As she was fearful and apprehensive and was on antidepressant therapy to control depression, the author adopted general anesthesia with laryngeal mask airway during initial stage of skull pinning and craniotomy procedures. Then, the patient reverted to awake state to continue the intended neurosurgical procedure. The patient tolerated the situation satisfactorily and was cooperative till the finish, without any event.

A case of congenital lung cyst disease is presented here. The inhalational induction of anesthesia with sevoflurane failed to ensure satisfactory intubation condition. Then, intravenous ketamine and rocuronium were given and they facilitated the intubation.