ABSTRACT
Background: To conduct a prospective observational study to compare the haemodynamic changes in two age groups, group A: 60-75yrs and group B: >75yrs during cemented bipolar hemiarthroplasty for hip fractures under spinal anaesthesia.Methods: Patients of either sex belonging to above two groups, with no contra-indications for central neuraxial block received spinal anesthesia at lumbar level. Heart Rate (HR), Systolic Blood Pressure(SBP), Diastolic Blood Pressure(DBP) and Mean Arterial Pressure(MAP), pulse pressure variability(PPV), arterial oxygen saturation (SpO2), Electrocardiogram for any changes and nasal end tidal CO2 (EtCO2) were recorded at the following time points: baseline(on table), after giving spinal, after giving surgical position, at the start of surgery, at femoral canal reaming, immediately after cement insertion, every 2 minutes after cement insertion, femoral joint reduction and the end of the surgery. Hypotension, bradycardia, arrythmias, desaturation or unexpected loss of consciousness occurring in peri-cementation period suggestive of ‘Bone cement implantation syndrome’(BCIS) or any other adverse event was recognized and treated.Results: The SBP, HR, PPV, ETCO2, SPO2 and incidence of adverse events; were comparable in both the groups. The difference in the DBP and MAP was statistically significant.Conclusions: The difference in the occurrence of haemodynamic alterations was more in the older age group. Continuous vigilant monitoring during bipolar hemiarthroplasty is required.
ABSTRACT
Background:Laryngoscopy and tracheal Intubation are invariably associated with certain stress responses due to the sympatho-adrenal stimulation. These cardiovascular and neurohumoral alterations may directly affect the physiology and increase the risk. So far, various drugs have been tried but none has been considered ideal for blunting this presser response. We therefore, planned this comparative study to evaluate and compare the efficacy of intravenous magnesium sulphate (30mg/kg) versus sublingual nitroglycerine spray (0.4mg/spray) in attenuating the presser response to Laryngoscopy and Tracheal Intubation.Methods:Fifty patients, aged 15–50 years, scheduled for elective surgery under general anaesthesia, were randomly assigned to one of the two groups of 25 each, Group A (magnesium group) and Group B(nitroglycerine group). Study drug was given 90-120 seconds before tracheal intubation. Heart rate, Systolic blood pressure and Rate pressure product were recordedat different intervals after administering the study drug till 3 minutes after intubation.Results:Mean heart rate was significantly higher from the baseline at all times after administering the study drug in both the groups. Increase in systolic blood pressure as a presser response was limited to 7.25% in Group A and 5.83% in Group B from the baseline after tracheal intubation. There was relative hypotension after administration of the study drug in both the groups. Conclusions: Intravenous magnesium or sublingual nitroglycerine pre-treatment is found to be effective in attenuating the presser response to laryngoscopy and intubation. These drugs may lead to rise in HR but it is transient and dose dependent. However, both the drugs can significantly control the hypertensive response after laryngoscopy and intubation.