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Background: Spinal anesthesia for caesarean section has several advantages over general anaesthesia like decreased risk of failed intubation, decreased risk of pulmonary aspiration of gastric contents, avoidance of the depressant effects of general anesthetics on neonate etc.Aim and Objectives: This comparative study was designed to evaluate the efficacy of Mephentermine and Phenylephrine in treating hypotension during spinal anaesthesia for cesarean section. The incidence of undesirable side effects like maternal bradycardia, nausea and vomiting also noted.Methodology: The study was conducted in the Department of OBG the Maternity Hospital, Osmania Medical College during the year August 2018- November 2019.The study includes 60 patients grouped into two groups.Results: Both Phenylephrine and Mephentermine maintained the arterial pressure effectively within 20% of baseline values. The mean value of heart rate was high in Mephentermine group compared with Phenylephrine group. The mean values of Systolic BP, Diastolic BP and MAP were higher in Phenylephrine group compared with Mephentermine group throughout the study period. Phenylephrine group required fewer number of bolus doses when compared with Mephentermine. The heart rate generally remained low throughout the study period in Phenylephrine group and the incidence of bradycardia was more in Phenylephrine group when compared with Mephentermine group. The occurrence of nausea and vomiting were similar in both groups.Conclusion: Thus, it can probably enhance organ blood flow more than mephentermine. Mephentermine increases heart rate and thus may be avoided in population where the effect may be detrimental.

Background and Aims: Spinal anaesthesia induced hypotension (SAIH) and bradycardia may prove deleterious to both parturient and baby, hence vasopressors play a vital role in their management. Recent studies on norepinephrine as rescue vasopressor during subarachnoid block (SAB) enlighten its role for SAIH. This randomised double-blind trial was conducted to compare the effect of intermittent intravenous boluses of norepinephrine and frequently used mephentermine for management of SAIH in caesarean section (CS) to prove whether norepinephrine produces comparable effects or superior to mephentermine. Methods: After approval from Institutional Ethics Committee and registration in Clinical Trials Registry India (CTRI/2019/06/019652), 256 parturients posted for elective CS under SAB were randomly allocated into Group-N and Group-M (n = 84) using chit system, who received boluses of intravenous norepinephrine 8μg and mephentermine 6mg for SAIH, respectively. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), Response%, Apgar score and maternal complications were analysed. Results: The changes in SBP and DBP were comparable in both the groups. It was significantly low after SAB compared to baseline and significantly high compared to 1st hypotensive value in both the groups throughout the study period (

Background: The present study compared intravenous norepinephrine and mephentermine for maintenance of blood pressure during spinal anaesthesia for caesarean section in known patients. Materials & Methods: The present study was conducted on 62 females planed for elective surgery. Patients were divided into 2 groups of 31 each. Group I received bolus intravenous norepinephrine 8µg and group II received mephentermine 6mg for the maintenance of intraoperative systolic blood pressure. HR, SBP and DBP were recorded at every 2 min interval till 20 min and thereafter at every 5 min interval till the completion of surgery. Complications were also recorded. Results: There was fall in SBP from baseline till 15 minutes in both groups then started increasing till 60 minutes. There was fall in DBP from baseline till 20 minutes in both groups then started increasing till 60 minutes. The difference was non- significant (P>0.05). There were 6 cases in group I and 7 in group II having nausea/vomiting, shivering was seen 5 in group I and 6 in group II, headache 4 in group I and 3 in group II and hypertension 3 in group I and 4 in group II. The difference was non- significant (P>0.05). Conclusion: Authors found that intravenous norepinephrine was better than mephentermine in maintaining blood pressure.

Hypotension after subarachnoid block for caesarean section is the commonest but serious complication encountered by anaesthesiologists. Various vasopressors are used to prevent/treat this complication. This study was done to compare the efficacy of three commonly used vasopressors – phenylephrine, ephedrine, mephentermine for treatment of perioperative hypotension. Sixty American Society of Anaesthesiologists (ASA) physical status class II parturients undergoing elective caesarean section under subarachnoid block were randomly allotted three groups (P, E, M) (n = 20) to receive intravenous boluses of phenylephrine 100 mcg, ephedrine 6mg & mephentermine 6mg respectively, following hypotension. Maternal Haemodynamic parameters, complications & neonatal APGAR scores were recorded. P-value < 0.05 was considered significant and P-value < 0.001 considered highly significant. Demographic values, baseline vital parameters and mean number of vasopressor boluses required were similar in the three groups (P > 0.05). The mean trends of systolic blood pressure (P = 0.06), diastolic blood pressure (P = 0.7) and mean arterial pressure (P = 0.6) were similar in the three groups. Heart rate was raised during periods of hypotension; the mean heart rate was lower in the phenylephrine group after vasopressor administration. The overall trend was similar (P = 0.1) among the three groups. There was (P = 0.003) higher incidence of bradycardia in the phenylephrine group. The neonatal APGAR scores were > 7 in the three groups at the 1st and 5th minute (P = 0.5). All three vasopressors effectively maintained arterial blood pressure during the subarachnoid block for caesarean section. Phenylephrine caused a significant reduction in heart rate compared to ephedrine or mephentermine.

Introduction: Hypotension is a common side effect when neuraxial analgesia is administered to the obstetric population. To find out the efficacy of mephentermine and phenylephrine for management of hypotension following spinal anesthesia in cesarean section. The study has been undertaken at the Department of Anesthesiology of ESI- PGIMSR, Manicktala, Kolkata, after obtaining approval from Institute Ethical Committee Study Design: Uni-centric randomized, single blind, prospective & comparative study Statistical Analysis Used: Unpaired Student’s t-test, chi-square test, Fisher’s exact test Materials and Methods: The 40-female scheduled for elective caesarean section were randomly divided into two groups of 20 each. Subarachnoid block was performed with 2.2mL of 0.5% hyperbaric bupivacaine. Prophylactic infusion of vasopressor started at a rate of 60 ml/h 0f 50 mcg/min for phenylephrine (group P, n=20) and 600 mcg/min for mephentermine (Group M, n=20) Hemodynamic parameters were monitored. At the end of surgery and the patients were transferred to the postoperative care unit (PACU). Results: Considering absolute values of hypotension, both groups are comparable in terms of preventing hypotension; however, phenylephrine had better control of maintenance over blood pressure than that of mephentermine. Reactive hypertension is common in phenylephrine infusion. Bradycardia is more prevalent in phenylephrine infusion than that of mephentermine while tachycardia is more common in mephentermine. Side effects like dyspnea, nausea/vomiting, headache is more common during hypotensive episodes. None of the drugs causes any untoward effect on fetus. Keywords: Phenylephrine, Mephentermine, Intraoperative hypotension, Procedural Sedation, Spinal Anesthesia.

Case presentation: A 32-year-old professional bodybuilder presented with acute decompensated heart failure. He gave a history of anabolic androgenic steroids (AAS) use for >2 years and mephentermin...

Background The optimal choice of vasopressor drugs for managing hypotension during neuraxial anaesthesia for Caesarean delivery is unclear. Although phenylephrine was recently recommended as a consensus choice, direct comparison of phenylephrine with vasopressors used in other healthcare settings is largely lacking. Therefore, we assessed this indirectly by collating data from relevant studies in this comprehensive network meta-analysis. Here, we provide the possible rank orders for these vasopressor agents in relation to clinically important fetal and maternal outcomes. Methods RCTs were independently searched in MEDLINE, Web of Science, Embase, The Cochrane Central Register of Controlled Trials, and clinicaltrials.gov (updated January 31, 2019). The primary outcome assessed was umbilical arterial base excess. Secondary fetal outcomes were umbilical arterial pH and Pco2. Maternal outcomes were incidences of nausea, vomiting, and bradycardia. Results We included 52 RCTs with a total of 4126 patients. Our Bayesian network meta-analysis showed the likelihood that norepinephrine, metaraminol, and mephentermine had the lowest probability of adversely affecting the fetal acid-base status as assessed by their effect on umbilical arterial base excess (probability rank order: norepinephrine > mephentermine > metaraminol > phenylephrine > ephedrine). This rank order largely held true for umbilical arterial pH and Pco2. With the exception of maternal bradycardia, ephedrine had the highest probability of being the worst agent for all assessed outcomes. Because of the inherent imprecision when collating direct/indirect comparisons, the rank orders suggested are possibilities rather than absolute ranks. Conclusion Our analysis suggests the possibility that norepinephrine and metaraminol are less likely than phenylephrine to be associated with adverse fetal acid-base status during Caesarean delivery. Our results, therefore, lay the scientific foundation for focused trials to enable direct comparisons between these agents and phenylephrine.

Background: Mephentermine is a sympathomimetic agent derived from methamphetamine. It is a commonly used drug for the treatment of hypotension during anaesthesia. Its abuse has markedly increased especially in the young population due to its stimulant properties and ability to boost performance in competitive sports or bodybuilding. Very few cases of Mephentermine dependence with or without psychosis have been reported from India and worldwide. Case Description: A 24-year-old male presented with a sudden onset of behavioural abnormalities a few hours following the use of Mephentermine. He was very agitated and restless. On physical examination, tachycardia, elevated BP and bilaterally dilated pupils were found. His symptoms remitted within a few hours of using Injection Haloperidol 10 mg with Lorazepam 4 mg once. He was found to have grossly deranged liver and kidney function tests. There was no past and family history of any psychiatric illness. No past history of any physical illness. Conclusion: No previous report of mephentermine induced psychosis with acute kidney and liver injury has been reported in the literature. Cases such as this may be common among the general public. Long term follow-up is required to know the course and outcome in such unusual cases.

Mephentermine is an α-adrenergic agonist, indicated for treatment of hypotensive states. It is not a common drug used for recreational purposes; rather for its performance enhancing properties. How...

Mephentermine is a sympathomimetic amine, frequently used as a vasopressor. It is structurally comparable to amphetamines, and World Anti-Doping Agency has prohibited its use as a performance-enhancing drug. However, its illegal consumption by several sportspersons and those appearing for physical endurance tests is a growing concern for health-care professionals. We present a case of misuse of intravenous mephentermine by a young male who abruptly increased its amount a few days prior to the sports competition and developed acute psychosis. The case report highlights the need for strict regulations for procuring methamphetamine and effective treatment strategies for managing its misuse.

Background and aim: Spinal anesthesia is the most common type of anesthesia administered for caesarean section and it is frequently associated with hypotension. When post-spinal hypotension is accompanied with bradycardia, the condition may become more complicated. Numerous pharmacological agents have therefore been tried for prevention of hypotension and 5HT3 antagonists are the latest in the armamentarium. However, studies have shown conflicting evidence regardings the effectiveness of 5HT3 inhibitors (ondansetron and granisetron) in preventing spinal hypotension. We have tried to address this controversy and also wanted to explore the adverse effects of granisetron on the foetus, if any. Materials and methods: Two hundred patients were included in the study and divided into two groups of 100 patients each. Group S patients received 5ml of 0.9% normal saline while Group G patients received IV granisetron 1mg (diluted to 5ml) 10 minutes prior to administration of spinal anesthesia. Analysis of variance (ANOVA) test was used for comparing the data, Student t-test was applied to compare the difference between the two means and Chi-Square test was used to test significance of difference of proportions. Results: The incidence of hypotension in Group S was 69%, whereas it was 37% in Group G (p

Mephentermine is a vasopressor drug closely related to amphetamine and methamphetamine. Cases of abuse and dependence to mephentermine have dotted medical literature for a long time. Till date, 11 cases of dependence to mephentermine have been published. In this report, a case of mephentermine dependence is being discussed. The patient was a young adult male who was dependent to mephentermine for nearly 3 years. He was an athlete and was introduced to mephentermine by his peer for enhancing performance. He did not develop any major physical or psychiatric issue due to the drug. He was managed on out patient basis. Though cases of mephentermine dependence are few and far in medical literature, reports from other sources indicate that the problem could be more common and could be on rise. High index of suspicion and holistic care is likely to help patients and treating clinicians.

Mephentermine is structurally similar to methamphetamine and is banned by world anti-doping agency due to its abuse as performance enhancing drug. Reports of Mephentermine abuse and dependence are emerging recently in competitive sports which might lead to psychosis and harmful effects. Here we describe a case of Mephentermine misuse in a body builder prescribed by his trainer in gym which led to psychosis. The client showed improvement with parenteral haloperidol and promethazine combination followed by oral haloperidol and motivation enhancement therapy. Our case report highlights the need of effective treatment options and spreading awareness regarding harmful effects among athletes and also need of the vigilance on drugs availability in gym which further emphasizes to concentrate on this area by the policy makers. Keywords: Mephentermine abuse, Gym trainers, Psychosis, Dependence, Performance enhancer.

Dependence on Mephentermine, a widely used sympathomimetic pressor agent, is so far not extensively reported. In current report, we describe a male patient consuming extraordinary high amount of Mephentermine who developed psychosis which was successfully treated but relapsed after 5 months. In this background we also tried to highlight this trend of shift from more traditional drugs to new synthetic ones and look into the magnitude of the problem and challenges that lie ahead of us.

Introduction: Spinal anesthesia during elective cesarean section often induces maternal hypotension, and vasopressors are the most reliable agents to counteract this. We conducted a systematic review and network meta-analysis to compare and specifically evaluate the efficacy of vasopressors in preventing maternal hypotension (effectiveness) and decreasing fetal acidosis (safety) in parturients undergoing spinal anesthesia for cesarean section. Methods: We performed a systematic and comprehensive search to identify all randomized controlled studies on vasopressors to manage maternal hypotension during cesarean section under spinal anesthesia, which had been published until June 30, 2019 and updated until September 20, 2020. A network meta-analysis was conducted to combine direct and indirect comparisons of vasopressors. The primary outcomes included minimum systolic blood pressure, the incidence of hypotension, and fetal acidosis. Stata SE 15.0 was used for the meta-analysis. Results: Forty-five studies (n = 3,369) with six different vasopressors injected using various methods were included. Based on the surface under the cumulative ranking curve (SUCRA) value, intravenous (IV) continuous infusion of mephentermine (SUCRA value 83.4%) was the most efficacious vasopressor with the lowest incidence of hypotension, followed by continuous infusion of ephedrine with norepinephrine bolus (81.6%) and norepinephrine (76.4%). Compared with an IV bolus injection, all analyzed vasopressors were more effective when they were infused continuously for managing maternal hypotension. In terms of safety, only angiotensin II as an IV continuous infusion (94.7%) was efficacious in preventing fetal acidosis, resulting in a pH closer to 7.4, and there were no significant differences in umbilical arterial pH between the test and control groups. Conclusion: Clinicians should continuously infuse vasopressors to manage maternal hypotension during cesarean section under spinal anesthesia. According to SUCRA, norepinephrine administered as an IV continuous infusion was the third most efficacious vasopressor with the lowest incidence of maternal hypotension, and it could be a potential alternative to phenylephrine. Meanwhile, only angiotensin II administered as an IV continuous infusion caused less umbilical arterial acidosis than the control group.

Regional anesthesia is the preferred modality for obstetric patients undergoing cesarean section due to the risks associated with general anesthesia in pregnant women. Single-shot spinal anesthesia is usually administered, which may be associated with post-block maternal hypotension, despite adequate intravenous fluid therapy. This is deleterious for the uteroplacental circulation, leading to poor outcomes in both the mother and fetus. There are several vasopressors which are used for treatment of these hypotensive episodes. Mephentermine is a sympathomimetic, having both direct and indirect actions. It has many side effects, however, including increased risks of arrhythmias, hypertension, central nervous system stimulation and abuse potential. Yet, it is still used in many developing countries, due to low cost and easy availability. We hereby report a case of rhythm disturbance with missed beats following use of mephentermine to counter hypotension after spinal anesthesia for cesarean section. The rhythm disturbance had a spontaneous resolution, with the patient maintaining hemodynamic stability during and after the episode.

Mephentermine is structurally related to amphetamines and is banned for its use as a performance-enhancing drug in competitive sports. Limited literature is available on management of mephentermine dependence. Here, we describe a case of mephentermine dependence followed by review of literature and a discussion about its management. A 20-year-old professional wrestler presented with high-dose intravenous mephentermine use, and rapid development of dependence, in the absence of any comorbid substance use or psychiatric disorder. The client showed improvement with bupropion and individual counseling sessions. The present report highlights the need to explore effective treatment options for individuals who have been addicted to mephentermine.

A case report of 32 years old male presented to the drug addiction OPD and treatment center for the withdrawal symptoms of mephentermine. Mephentermine a synthetic derivative of amphetamines with cardiac stimulatory action is been misused for boast of endurance in bodybuilders. Abuse of mephentermine result in psychosis, cardiovascular disorder and development of tolerance and dependence over time. Given its potential of causing harm, the abuse and dependence liability of mephentermine needs to be highlighted to gym instructors and general public.

Introduction: Subarachnoid block, although being highly efficient with lesser drug doses, often has limitation such as hypotension, continues to be a matter of concern to the anesthetist. The present study was aimed to compare the use of phenylephrine, ephedrine, and mephentermine bolus for maintenance of blood pressure during spinal anesthesia in lower abdominal surgeries. Subjects and Methods: In a randomized, prospective study, 90 adult patients of either sex who developed hypotension during surgery under subarachnoid block were allocated into three groups to receive bolus phenylephrine, ephedrine, and mephentermine. The number of boluses and time taken to recover from hypotension was noted. Occurrence of adverse effects in the perioperative and postoperative period was also noted. Results: Results were analyzed by Student's paired t-test and Chi-square test. The ANOVA test was used to compare the group variances among the study groups. P < 0.05 was considered statistically significant. Thirty-four hypotensive events (average 1.03 events/patient) took place in mephentermine group. In phenylephrine group, a total of 53 hypotensive events took place. On an average, the group had a total of 1.61 hypotensive events per patient. No hypotensive event took place in ephedrine group after the first bolus of drug (average 1 event/patient). Mean heart rate in phenylephrine group was significantly lower as compared to the other two groups (P < 0.001). Conclusion: Mephentermine and ephedrine were similar in performance, offered a better hypotensive control, and had lower recurring events as compared to phenylephrine.

Background: Spinal blockade provides excellent anesthesia for patients undergoing cesarean section. However, hypotension after spinal anesthesia is a common adverse effect that is commonly experienced in patients undergoing cesarean section. The aim of our study was to analyze if a simple technique like leg wrapping with elastic crepe bandage would be effective in controlling postspinal hypotension. Materials and Methods: Sixty full-term pregnant patients who were posted for cesarean section belonging to American Society of Anesthesiologists I and II were divided into two groups. Patients in Group W had their legs wrapped with elastic crepe bandage and in the other Group N, leg wrapping was not done. All the patients were preloaded with Ringer lactate at 10 ml/kg before the spinal anesthesia. The hemodynamic parameters were monitored every 3 min until the delivery of the baby and every 5 min until the end of surgery. If hypotension occurred, then along with crystalloid loading a bolus dose of mephentermine 6 mg was given intravenously. Statistical Analysis: Statistical software “Numbers version 3.6.1 (2566)” was used for statistical calculations. Results: Frequency of hypotension in Group W (10%) was significantly less compared to Group N (60%). Vasopressor requirement was significantly less in Group W (P = 0.009), which was highly significant. Conclusion: Wrapping of lower extremities was a simple, easy, and an effective method of decreasing episodes of hypotension and vasopressor requirement after spinal anesthesia in cesarean patients and needs to be practiced routinely.

The goal of this study was to confirm the vasopressor and cardiac effects of POTENAY® INJETAVEL (POT), a mephentermine-based product, given to cattle with induced vascular/cardiac depression. Ten healthy Holstein cattle (206 ± 13 kg) followed a randomized-complete-block design (RCBD) utilizing crossover study design. Each animal randomly received (1 ml/25 kg, IM) of either POT (n = 10) or volume-matched placebo control (0.9%NaCl, CP, n = 10). A subset of animals (n = 5) received POT first (day 0) while the remaining (n = 5) received CP; after a six-day washout period, cattle received the opposite compound. Animals were anesthetized and catheterized for systemic/left ventricular hemodynamic monitoring. Myocardial dysfunction/hypotension was induced by increasing the end-tidal isoflurane concentration until arterial blood pressure was 20% lower than at baseline and remained stable. Once the animal was determined to be hypotensive and hemodynamically stable, steady-state hypotensive baseline data (BL2) were acquired, and treatment with either POT or CP was given. Data were acquired post-treatment at every 15 min for 90 min. POT improved cardiac output (+68 L/min, ±14%, p

Purpose: Drug wastage is a major concern in anaesthesia. In addition to increasing the cost on the patient, it can increase the occupational hazard to the health care and sanitary workers and also cause environmental pollution. The principal objective of this study was to ascertain the extent of drug wastage in anaesthetics and ancillary drugs and calculate the financial costs of it at a tertiary care hospital. Methodology: This was a prospective study and was conducted to ascertain the quantity of drug wastage. This pilot study was conducted in the operation theatre between the months of March and April 2016. The prescription of the anaesthetic drugs, the recommended dose, the quantity used and remainder (waste) left were recorded. Costs of the drugs used and wasted were calculated. The financial loss incurred was thus calculated. Results: The results of this study indicated that maximum wastage of the anaesthetic drugs was for atropine sulphate (71.67%), fentanyl (40%), mephentermine sulphate (40%) and bupivacaine (33.62%). The cost analysis indicated that propofol contributed to the maximum as the financial loss was estimated to be 29.27% of the total loss, followed by bupivacaine 18.95%. Conclusion: The results indicate that the quantity and the financial impact of anaesthetic drug wastage were considerable and that efforts should be at minimising the expenditure without risking the patient's life or health.

BACKGROUND: Spinal anesthesia is the more commonly administered procedure for pelvic, lower abdominal and lower limb procedures. Hypotension is the most common complication of spinal anesthesia. It is a common practice to give intravenous fluids, usually crystalloids, prior to centro neuraxial block in order to prevent hypotension and this is usually referred as preloading. AIMS: Compare the efficacy of preloading with crystalloid to that of colloids in reducing the incidence and severity of hypotension in spinal anesthesia for lower abdominal surgery and also to find out if hydroxyl ethyl starch (HES) is a better colloid than polygelatin. STUDY DESIGN: The study population included 150 patients belonging to either sex undergoing elective lower abdominal surgeries under spinal anesthesia. METHODS AND MATERIAL: One hundred and fifty ASA I and II patients posted for lower abdominal surgeries under spinal anesthesia were randomly allocated to receive either 10mL/Kg of HES (Group A), 10mL/Kg of polygelatin (Group B) or 10mL/Kg of Ringer's lactate solution as preloading solution. Heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded once in two minutes for the first ten minutes and once in five minutes for the next fifty minutes. The incidence of hypotension and the mean dose requirement of mephentermine were noted after spinal anesthesia. STATISTICAL METHODS: The analysis of variance to find the significance difference of pulse rate, SBP and MAP between the three groups of patients. The Post hoc test by Tukey to find the pair wise significance between the three groups. The Chi-square test to find the significance of proportions of mephentermine dose requirement between the three groups. RESULTS: The incidence of hypotension was 9 of 50 (18%) in Group A, 17 of 50 (34%) in Group B and 27 of 50 (54%) in group C. The mephentermine bolus requirements were also less in group A (9 times) when compared to group B (18times) and group C (32 times), which was statistically significant. INTERPRETATION AND CONCLUSION: HES reduced the incidence of hypotension after spinal anesthesia and required lesser mean dose requirements of mephentermine when compared to polygelatin and ringers lactate. It can be concluded from the present study that colloids offset hypotension and hypovolemia more effectively than crystalloids. Also it can be concluded that hydroxyethyl starch is a better

Context: The purpose of adding an adjuvant to local anesthetic in a central neuraxial blockade is to augment the desirable pharmacological actions of the agent and/or to minimize its undesirable pharmacological effects. Clonidine is an alfa-2 receptor agonist which has gained popularity in recent times as an adjuvant in spinal anesthesia. Aims: To evaluate the influence of clonidine on the hemodynamic stability and the duration of anesthesia when added to intrathecal hyperbaric bupivacaine. Settings and Design: Prospective randomized double blind study. Subjects and Methods: Fifty patients scheduled for spinal anesthesia were randomized into two Groups A and B with 25 in each. Group A patients received 3 ml 0.5% heavy bupivacaine + 30 μg (0.2 ml) clonidine and Group B patients received 3 ml 0.5% heavy bupivacaine + 0.2 ml normal saline in the subarachnoid space. The blood pressure and heart rate were closely monitored. The time for attaining peak sensory block, time for two segment regression, decrease in the heart rate, total requirement of mephentermine to counter the hypotension, and the number of patients requiring mephentermine in each group was tabulated and analyzed. Statistical Analysis Used: Descriptive and inferential statistical methods were used to analyse the data. The power of the study was calculated using online power calculator for two independent sample study. Results: The time for attaining peak sensory block was similar in both the groups. The time for two segment regression in Group A was 62.6 min and in Group B was 38.08 min. Twelve percent of patients in Group A and 52% of patients in Group B required mephentermine with the mean consumption being 0.72 mg in Group A and 5.65 mg in Group B. Conclusions: Addition of low-dose clonidine to intrathecal bupivacaine not only prolonged the duration of spinal anesthesia but also provided a stable intraoperative hemodynamic profile.

Introduction: It is important to find an effective method to prevent and treat hypotension during subarachnoid block. Hence we compare the bolus doses of Phenylephrine and Mephentermine to treat hypotension post subarachnoid block. Methods: This randomized study was conducted in 100 patients of ASA I or II physical status undergoing infraumbilical surgeries under subarachnoid block. Patients were randomized into 2 groups of 50 each. Group P-Phenylephrine of 0.1 mg I.V bolus and Group M-Mephenteramine 6mg I.V bolus given when patient develops hypotension >20% basal respectively. Both the groups received 3ml of 0.5% hyperbaric bupivacaine for subarachnoid block. Vital parameters like blood pressure, heart rate and oxygen saturation were recorded. Any side effects observed were also recorded. Results: The demographic profile were comparable and statistically similar in both the groups. Both the vasopressors were able to maintain blood pressure above the hypotensive values in their respective groups successfully. The number of hypotension episodes was higher in Group P(34%) than Group M(32%) but statistically insignificant. The average number of drug doses required for recovery from hypotension was higher in the Group P(1.41) than Group M(1.25). The number of episodes of bradycardia was higher in the phenylephrine group(16%) than in the mephentermine group(4%). Conclusion: We conclude that intravenous bolus of phenylephrine and mephentermine are both effectve at maintaining intraoperative blood pressure during spinal anaesthesia in infraumbilical surgeries but mephenteramine is better than phenylephrine in maintaining BP persistently high and has lesser incidence of bradycardia.

An Evaluation of Vasopressor Therapy for Maternal Hypo - tension during Spinal Anesthesia. By James FM III, Griess FC, Kemp RA. Anesthesiology 1970; 33:25-34. Abstract reprinted with permission from Wolters Kluwer Health.† Abstract: During hypotension resulting from conduc - tion anesthesia in gravid ewes, uterine blood flow (UBF) decreased roughly in proportion to the decrease in maternal blood pressure. Ephedrine or mephentermine significantly increased UBF over that accomplished by metaraminol. Presumably, the preferential effects of these agents were the result of increased cardiac output owing to inotropic and chronotropic actions. However, UBF never exceeded 90% of prespinal levels with any vasoactive agent, and, for a given maternal system, the UBF response was variable, generally increasing but frequently remaining constant or decreasing. For these reasons, all other methods of com - bating hypotension should be used initially. If vasopressors are still required, agents of choice are those whose princi - pal mode of action lies in cardiac stimulation rather than peripheral vasoconstriction.

Summary This study compared the effects of intravenous infusions of phenylephrine and mephentermine on the prevention of maternal hypotension and neonatal outcome in patients receiving spinal anaesthesia for caesarean section. Sixty ASA 1-2 patients with term, uncomplicated singleton pregnancy undergoing caesarean section under spinal anaesthesia were randomly divided into two groups of 30 each, to receive a prophylactic intravenous infusion of either phenylephrine or mephentermine. The incidence of hypotension was statistically similar in the two groups. However, in patients receiving phenylephrine, 7 (23%) developed bradycardia and 6 (20%), reactive hypertension. Neonatal outcome, in terms of Apgar scores and umbilical artery pH, was similar in both the groups. To conclude, phenylephrine and mephentermine infusions are equally effective in preventing post spinal hypotension in patients undergoing caesarean section and are associated with a similar neonatal outcome.

The urine specimens of numerous athletes were found to be positive for mephentermine both in-competition and out-of-competition in Taiwan. The donor of one specimen claimed she had only taken Mucaine® (contains oxethazaine) for relieving symptomatic peptic ulcer and gastritis. Oxethazaine is not included in the prohibited list of the World Anti-Doping Agency; however, its metabolized compounds, mephentermine and phentermine, are included in that list. This study applied LC–MS–MS to analyze the excretions of three volunteers who ingested oxethazaine and presented positive results for mephentermine and/or phentermine. Thus, oxethazaine is the source of mephentermine and phentermine. Moreover, the results showed that 48 brands of gastric medicines containing oxethazaine were legally imported or locally manufactured in Taiwan, information which could be useful for limiting the misuse of oxethazaine by athletes. The data suggested that the sports associations should warn athletes about the risks of taking oxethazaine.

This study compared the effects of intravenous infusions of ephedrine and mephentermine for maintenance of maternal arterial pressure and neonatal outcome in pregnant women receiving subarachnoid block for lower segment Caesarean section. Sixty patients who developed hypotension following subarachnoid block for Caesarean section were randomly divided into two groups of 30 each to receive an intravenous infusion of ephedrine or mephentermine. Hypotension was defined as a decrease in systolic blood pressure of > or = 20% from the baseline value or an absolute value of

This study was designed to determine the minimum effective dose (ED50) of mephentermine for prevention of post-spinal hypotension in women undergoing elective caesarean section. Dixon's up-down method of sequential allocation was used to determine the patient's dose of vasopressor drug. In our previous study, mephentermine appeared to be much more potent than ephedrine, so the present study was conducted using a lower initial dose and smaller dose interval for this vasopressor. Following administration of spinal anaesthesia, a prophylactic infusion of mephentermine was started with 5 mg infused over a period of 30 minutes as the initial dose and a dose interval of 1 mg. The ED50 of mephentermine of 3.7 mg (95% confidence interval 2.4 to 5.7 mg) was much less than that of ephedrine, as calculated in our previous study using the same methodology. Using these values gives a potency ratio of ephedrine to mephentermine of 1:6.8 (95% confidence interval 6.0 to 7.5).

Background: Hypotension following spinal anaesthesia (SA) is a common problem. Vasopressors play an important role in its management. The common approach in the routine clinical setting is immediate action after detection of hypotension rather than as a preventive measure. There are studies which compare bolus and intravenous (IV) infusion in the management of maternal hypotension, but literature about comparison of efficacy of intramuscular (IM) vasopressors is very limited. Hence, this study was planned in elective caesarean deliveries to compare the efficacy of IM phenylephrine, ephedrine, and mephentermine for the maintenance of arterial pressure during SA. Materials and Methods: A prospective, randomized, double-blind study was conducted where 120 parturients belonging to American Society of Anaesthesiologists II undergoing elective caesarean section under SA were evaluated after being randomized into four groups receiving either preemptive phenylephrine 4 mg IM, ephedrine 45 mg IM, mephentermine 30 mg IM, or normal saline 0.9% 2 ml IM as placebo, immediately following SA. The mean arterial blood pressure and heart rate were primarily evaluated and any other complications were also recorded. Results: It points toward significantly decreased incidence of hypotension in phenylephrine group compared to the other groups (P = 0.034). The incidence of rescue IV ephedrine requirement was maximum with the placebo group, least with mephentermine compared to ephedrine and placebo group. However, there was no statistical difference between the groups with respect to doses of IV ephedrine used (P = 0.08). Maternal nausea, vomiting, and newborn Apgar score were also comparable. Conclusion: All the vasopressors are effective in reducing the severity of hypotension, though phenylephrine was found to be better for the prevention of hypotension.

Background: Spinal anesthesia is often used for both elective and emergency cesarean section. One earlier study has shown that intrathecal levobupivacaine given in L 3-4 space did not provide satisfactory intraoperative analgesia in all parturients. We assume that the same dose may work if given in L 2-3 intrathecal space, especially in our population with shorter stature. Materials and Methods: After Institutional Ethical Committee approval, 100 parturients (American Society of Anesthesiologists I-II, aged 18-40 years) and after obtaining written informed consent to received spinal anesthesia for cesarean section were randomized into four groups: Group I (0.5% hyperbaric bupivacaine 7.5 mg in L 2-3 intrathecal space), Group II (0.5% hyperbaric levobupivacaine 7.5 mg in L 2-3 intrathecal space), Group III (0.5% hyperbaric bupivacaine 10 mg in L 3-4 intrathecal space), and Group IV (0.5% hyperbaric levobupivacaine 10 mg in L 3-4 intrathecal space), respectively. Hypotension (systolic blood pressure 20% from baseline) was treated with injection mephentermine 3 mg intravenous (iv) increment (s). For the ethical reason, inadequate analgesia was treated with 0.5 mg/kg iv ketamine. Statistical analysis was performed using the SPSS version 20 software windows. A P < 0.05 was considered significant. Results: Time to onset of sensory block was faster in 0.5% hyperbaric levobupivacaine 10 mg given in L 3-4 intrathecal space (Group IV P = 0.013). No significant difference was found in time to reach maximum block level (T 4 -T 6 ). Median peak sensory block level was significantly lower in Group II as compared with other group T 6 versus T 4 ; F = 106.159; P < 0.001). Time to regression by two dermatomes was significantly shorter with a lower dose of either bupivacaine or levobupivacaine given at L 2-3 intrathecal space (P = 0.028). The degree of motor block or motor block regression was similar in all the groups. Intraoperative rescue analgesia was required in 20% of patients in Group II (levobupivacaine 7.5 mg in L 2-3 ); it was 4% in each of the remaining groups (P = 0.082). Injection mephentermine used was 24%, 32%, 48%, and 28%, respectively, in Group I to IV though it did not reach statically significance. Conclusion: Levobupivacaine 7.5 mg can be used in lower segment cesarean section when given in L 2-3 space. Onset is faster, and hemodynamic stability is more with levobupivacaine. At the higher dose, the duration of action bupivacaine seems to be longer.

Oxethazaine, an over-the-counter (OTC) antacid, is a precursor of phentermine, which is the most abused anorectic by methamphetamine users in Korea. However, no studies have investigated the abuse potential of oxethazaine. Therefore, we examined and compared the consequences of oxethazaine and phentermine treatment on animal models of conditioned place preference (CPP) and self-administration. Furthermore, oxethazaine and its metabolites in rat plasma were monitored using liquid chromatography-tandem mass spectrometry (LC-MS/MS) after oxethazaine administration, and compared with phentermine itself after phentermine administration to clarify the relationship between phentermine production by oxethazaine ingestion and the possible oxethazaine dependence. Oxethazaine metabolites were also determined by LC-MS/MS in rat hair after oxethazaine administration to investigate the possibility of phentermine detection in hair from oxethazaine abusers. In the behavioral experiment, phentermine (3mg/kg) produced CPP in mice while oxethazaine (5, 10, and 15mg/kg) did not. Moreover, phentermine (0.25mg/kg/infusion) was self-administered by rats at 80% of free-feeding weight, whereas oxethazaine was not. In the analytical study, mephentermine and phentermine, both oxethazaine metabolites, were detected below the limit of quantitation or not detected in both plasma and hair from rats that had ingested oxethazaine (10mg/kg, single dose or for 2weeks). On the other hand, phentermine was detected in plasma and hair samples from rats that had ingested phentermine (10mg/kg, single dose or for 2weeks). Consequently, phentermine induced significant rewarding effects, but oxethazaine did not. Presumably, either oxethazaine does not have any abuse potential or oxethazaine metabolism to phentermine does not result in a pharmacologically active level of psychostimulant in the body. Furthermore, phentermine was not a major metabolite in hair obtained from oxethazaine abusers, which should make it possible to differentiate between chronic oxethazaine and phentermine users.

INTRODUCTION: Hypotension is common following spinal anesthesia. Various vasopressors have been indicated to prevent it. The study compares three such agents namely phenylephrine, ephedrine and mephentermine. METHODS: The study included 90 patients undergoing elective and emergency cesarean section who developed hypotension following subarachnoid blockade. Parturient were randomly divided into three groups each group had 30 patients. Group P received bolus of Phenylephrine 25 microgram, where as group E received Ephedrine 5mg and Group M received Mephentermine 6mg. RESULTS: It was found that rise of blood pressure was significantly higher in case of phenylephrine group in first six minutes, after the bolus, there was significant reduction in the heart rate in phenylephrine group, but there was tachycardia following administration of bolus ephedrine and mephenteramine. Neonatal APGAR score were similar in all three groups. CONCLUSIONS: All three drugs maintained hemodynamics within 20 percent of the baseline values on intravenous administration. Keywords: APGAR, ephedrine, hypotension, mephentermine, phenylephrine, spinal anesthesia.

The dosages and potency of intravenous mephentermine for prevention of post-spinal hypotension are not available in English literature. This study was designed to determine the minimum effective dose (ED50) of mephentermine and to compare its potency with that of ephedrine for prevention of post-spinal hypotension in parturients undergoing caesarean section. Dixon's up-down method of sequential allocation was used for vasopressor doses. Following administration of spinal anaesthesia, patients received a prophylactic infusion with 50 mg infused over a period of 30 minutes as the initial dose and dose intervals of 5 mg, of either ephedrine or mephentermine. The ED50of ephedrine was 25.0 mg (95% CI 15.5 to 40.4 mg). For mephentermine, the up-down method was abandoned due to the success of the minimum dose possible but the ED50appeared to be less than 5 mg. In conclusion, the minimum effective dose of mephentermine is much less than that of ephedrine for prevention of post-spinal hypotension. Another trial with a lower starting dose and smaller dose interval of mephentermine is required to determine the potency ratio of mephentermine and ephedrine.

Context Efforts to find a better adjuvant in regional anesthesia have been underway since long. Dexmedetomidine and sodium bicarbonate have been proven to be effective in providing the same pharmacological benefit through two different mechanisms of action. In this study, we sought to investigate which is superior between the two. Aims The aim of the study was to compare the efficacy of dexmedetomidine and sodium bicarbonate as adjuvants to lidocaine in epidural anesthesia. Settings and design This was a prospective, randomized, double-blind study. Materials and methods Sixty patients scheduled for lower-limb trauma orthopedic surgeries under epidural anesthesia were divided into two groups group D and group S, with 30 patients in each. Patients in group D received 12.5 ml of 2% lidocaine+dexmedetomidine 0.5 mg/kg in 1.5 ml solution, making a total volume of 14 ml. Patients in group S received 12.5 ml of 2% lidocaine+1.5 ml of 7.5% sodium bicarbonate, making a total volume of 14 ml. Onset, time for peak sensory level, time for two-segment regression, and the total mephentermine consumed to maintain the hemodynamics were recorded, tabulated, and statistically analyzed. Results The onset of sensory block was quicker in group D. The time for attaining peak sensory level and the mephentermine consumption was nearly the same in both groups. The time for two-segment regression was more in group D than in group S. Conclusion Dexmedetomidine is more effective than sodium bicarbonate in hastening the onset and prolonging the duration of blockade when used as an adjuvant to epidural lidocaine.

BackgroundIntrathecal ketamine produces a short period of analgesia with stable haemodynamics. Midazolam with bupivacaine prolongs the duration of analgesia when administered intrathecally but does not prevent hypotension. The objective of this study was to assess the effect of a combination of intrathecal bupivacaine, ketamine and midazolam on the duration of analgesia and haemodynamic parameters.MethodsA prospective, randomized, double-blind study was carried out in 60 ASA I and II patients undergoing lower limb surgery under spinal anaesthesia. Patients were divided into three groups of 20 each. Patients in all the three groups received 3 mL of hyperbaric bupivacaine (0.5%) intrathecally. In addition, patients in Groups II and III received intrathecal ketamine (0.1 mg kg−1) and the same dose of ketamine along with midazolam (0.02 mg kg−1), respectively. All patients were evaluated for block characteristics, duration of pain-free period, total rescue analgesic requirement in the 24-h postoperative period, total dose of mephenteramine to treat hypotension and any central or neurological complication.ResultsNo patients in Group II required mephenteramine while 40% of patients in Group I and 10% in Group III required mephenteramine to maintain blood pressure after spinal anaesthesia. The mean ± standard deviation duration of pain-free period was 331.5 ± 89.9, 369.7 ± 124.2 and 730.5 ± 81.5 min in Group I, II and III, respectively. The pain-free interval was significantly greater in Group III compared to Groups I and II (P < 0.001). No patient had any complications.ConclusionA low dose of midazolam and ketamine with bupivacaine intrathecally results in prolonged analgesia and less haemodynamic fluctuations. However, the safety of this combination needs to be proved before its use in clinical practice.

A total of 200 cases were evaluated for post-spinal hypotension during caesarean section in TU teaching hospital Maharajgunj. Hypotension was reported in 76 (38%) cases. P value >0.05.The Maximum dose of mephentermin given was 30mg and minimum was 6mg. One patient had Spinal block as high as T1 sensory level. Another patient had severe drop of blood pressure followed by unrecorded blood pressure and pulse which was treated with endotracheal intubation, 100%oxygen and vasopressor (Mephentermine). Severe bradycardia (heart rate

Although mephentermine (Termin) and ephedrine are commonly used drugs for the treatment of hypotension during anesthesia but their abuse have markedly increased, especially in the young population due to its stimulant properties. Here, we report a case of 23-year-old man with a history of chronic mephentermine abuse, posted for Achilles tendon repair under spinal anesthesia. During intraoperative period, spinal induced hypotension showed unusual resistance to ephedrine boluses and was managed by using directly acting vasoconstrictor, that is, phenylephrine.

Dear Editor, Mephentermine is an amphetamine-derived phenethylamine which shares a strong chemical similarity with both methamphetamine and the resulting stimulant actions of the alpha and beta adrenoceptors. It has been proposed that phentermine, which is a main metabolite of mephentermine, acts by inhibiting

Background Substance abuse is a serious health concern. This report presents the case of a 22-year-old Brazilian man with a history of mephentermine use who fulfils all the criteria for chemical dependence listed by ICD-10. Mephentermine is a sympathomimetic agent derived from methamphetamine which, in Brazil, is restricted to veterinary use. Case description The subject used the substance at a high dose (120 mg) to improve his physical performance while working out at a gym. His symptoms included anorexia and insomnia. After days of intense activity, he felt fatigue and soreness. A physical examination revealed scars on both forearms from the injections and a psychological examination revealed moderate speech and motor agitation. Conclusions Cases such as this may be common among the general public. They should have some bearing upon medical practice and public health policies involving drugs.