The Greek e-journal of Perioperative Medicine

2-12

Authors: Petsas D, Griffiths R

Fractures of the proximal femur are of the most frequent, especially in elderly patients. The increased frequency of these fractures highlights the need for effective management of those patients and the impact of these fractures regarding the cost to the national health system. The effects of pain in elderly patients is extremely aggravating, frequently leading to mental (confusion, delirium) and physical (cardiovascular) deterioration and complications. The pain management of these patients in the emergency department (ED) with intravenous administered analgesics might complicate the status of these patients. The use of non-steroidal anti-inflammatory drugs (NSAID’s) might increase the risk of gastric ulceration, gastric haemorrhage and coronary syndromes, while the use of IV opioids– especially in elderly-incorporates the risk of respiratory depression, delirium,hypotension and constipation. The pain management of these patients with the use of fascia iliaca block applied in ED, or even in a prehospital setting from doctors of various specialties, paramedics or nurses seems to gain acceptance because of its steep learning curve, the simple technique, the high success rate and the low rate of significant complications

36-48

Authors: Vrigga M, Papagiannopoulou P, Ntritsou V, Isaakidis A , Chatziiokimidis Ch, Kostoglou Ch, Zachariadou Ch

The aim of this study was to compare the combinati on of oral tramadol and midazolam to oral mi- dazolam alone, in children undergoing adenotonsillectom y, as an oral premedication, regarding also sedation and postoperative pain relief. Sixty children selected for elective adenotonsillectomy were enrolled in this randomized, controlled prospec tive study. Patients were randomly allocated into two groups. Group M (n=30) received 0.5 mg.kg -1 oral midazolam and group MT (n=30) received 0.2 mg.kg -1 oral midazolam with 1 mg.kg -1 oral tramadol as a premed ication 30min preoperatively. Standard general anesthesia technique was used. A 5 points-sedation score (1 asleep to 5 agitated) on arrival to the operating room, a 3 points-acceptance score of separation from the parents and a 3 points-mask cooperation score at induction of anesthes ia (1 easy to 3 markedly resistant) were used. Aldrete score, extubation time and intraoperatively consumption of remifentanil were also recorded. Pain intensity was assessed using a modification of the Hannallah pain score scale at 30min, 6h and 24h postoperatively. If pain score was higher than 3, additional anal gesics were provided. Cumula- tive analgesic consumption in 24hrs was also noted. A satisfactory le vel of sedation scores were re- corded in both groups. Group MT offered significantly more children in an awake, calm and quiet state, who were easily separated from th eir parents. The parental separation scores did not differ statistically significant between groups. The mask acceptance was statistic ally significant easier in group MT, while chil- dren in midazolam group (group M) were statistically significant re sistant compared to children in group MT. Pain and modified Aldrete scores were comparable between groups. The amount of re- mifentanil consumed intraoperatively was statisti cally significant lower in group MT. Postoperative analgesic consumption was lower in group MT comp ared to group M but with no statistic al signifi- cance. Adding oral tramadol to midazolam as a premedication in children provides good quality of sedation and decreases periope rative analgesic requirement s following adenotonsillectomy.

54-58

Authors: Stamatakis E, Aroni F, Loukeri A, Valsamidis D

Intrathecal drug administration extends beyond the purposes of anaesthesia, to therapeutic applications. Here, we describe the case of a patient with severe Systemic Lupus Erythematosus having affected multiple organs and had a meningococcal infection. She was treated with intrathecal antibiotic therapy resulting in a successful outcome.