Assessment of Efficacy of Dexmedetomidine under Combined Spinal Epidural Anesthesia at a Tertiary Care Teaching Hospital

Background: Dexmedetomidine is a highly selective α2adrenergic agonist with an affinity of 8 times greater thanclonidine and hence allows the use of higher doses with lessα1 effect. Hence; the present study was undertaken forassessing the efficacy of Dexmedetomidine under combinedspinal epidural anesthesia.Materials and Methods: A total of 100 patients were enrolledin the present study. All the patients received isobariclevobupivacaine intrathecally and dexmedetomidine in normalsaline epidurally. Complete demographic details and clinicalhistory of all the patients was obtained. Preoperativehematological and biochemical profile of all the patients wasobtained. All the anesthetic procedures were carried out underthe hands of skilled and experienced anesthetists. Incidenceof intra-operative and postoperative adverse events wasrecorded separately. All the results were recorded in Microsoftexcel sheet and were analyzed by SPSS software. Chi- squaretest was used for assessment of level of significance.Results: Mean time taken for sensory regression to S1 was356.12 minutes. Mean time taken for rescue analgesia was362.55 minutes. In the present study, hypotension was foundto be present in 4 patients, bradycardia was found to bepresent in 3 patients and nausea and vomiting was found to bepresent in 5 patients.Conclusion: Dexmedetomidine is an effective agent undercombined spinal epidural anesthesia in patients undergoingelective surgical procedures.

Assessment of Complications and Haemodynamic Stability with the Use of Dexmedetomidine with Bupivacaine: An Institutional Based Study

Background: Lesser doses of local anesthetic in addition withadditives provides the necessary sensory level with enoughanalgesia. Dexmedetomidine is the S enantiomer ofmedetomidine that carries a high degree of specificity foradrenoreceptor. The present study was conducted with the aimto assess the complications and haemodynamic stability withthe use of dexmedetomidine with bupivacaine.Materials and Methods: The present study was conducted ina prospective manner for a period of 1 year at Department ofAnaesthesiology, Lady Hardinge Medical College & Smt. S. K.Hospital, New Delhi, India. No anesthesiologist enrolled in thepresent study was conscious of the group assigned till theentire 30 subjects were enrolled and the study was completed.After verifying a clear and free flow of the CSF, the drugadministration was completed and the subjects were placed atthe supine position. For every patient, heart rate and meanarterial pressure monitoring was done every 2 min for the initial10 minutes after spinal anesthesia, then after every 5 minutestill 30 minutes and then every 30 minutes till complete motorand sensory recovery. All the data thus obtained was arrangedin a tabulated form and analyzed using SPSS software.Probability value of less than 0.05 was regarded as significant.Results: The present study enrolled 30 subjects with15 patients in each group. The mean age of the subjects was39.22+/-4.67 years. The preoperative BP in Group I was94.67+/-8.22 and in group II was 91.52+/-5.38. There was nosignificant difference between them. There was 1 subject eachin Group I and II with nausea and shivering respectively.Conclusion: The study showed no significant alterations in thehaemodynamic stability the side effects between subjects whoreceived bupivacaine alone or bupivacaine plusdexmedetomidine.

Role of oxidative stress after routine Iron supplementation in normal and anemic women during pregnancy: Central Indian scenario

Iron deficiency anemia (IDA) is one of the most common nutritional disorders worldwide, affecting people of all ages in developed and developing countries. causes dimunition of various antioxidant enzymes like superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase. The objective of the study was to detect impact of iron supplementation in anaemic & non- anaemic pregnant subjects on oxidative stress. Patients are divided into two groups, Control groups (60 non-anemic pregnant women) & Study groups (60 anemic pregnant women). The blood sample (5 ml) was collected from different groups of subjects. In controls groups, a fall in catalase, superoxide dismutase, glutathione peroxidase and glutathione reductase were seen while lipid peroxidase was found to have increased significantly after iron therapy. In study group, and increment in all markers except lipid peroxidase was seen and the level of lipid peroxidase was decreased following iron supplementation which was statistically significant (p<0.001). it may be concluded that iron deficiency anaemia is associated with free radical generation and peroxidation of vital body molecules which implies increased risk for pregnant women.

Phacoemulsification without preoperative topical mydriatics: Induction and sustainability of mydriasis with intracameral mydriatic solution.

Context: Intracameral mydriatic solution can eliminate the disadvantages of repeated eye drop instillation regimen and provide adequate mydriasis for phacoemulsification with added advantages. Aims: Evaluating the role of intracameral irrigating solution (0.5% lignocaine + 0.001% epinephrine) in initiating and maintaining the pupillary mydriasis during phacoemulsification. Secondary aims were to observe the effect of surgical time, nucleus density and ultrasound time on mydriasis during the procedure. Settings and Design: The study is a prospective interventional case series, conducted at tertiary care institution. Materials and Methods: Thirty patients underwent phacoemulsification under topical anesthesia for visually significant cataract. Pupillary dilatation was achieved by intracameral irrigation of mydriatic solution alone. Pupillary diameter was measured serially during surgery and ultrasound time and total surgical time were noted. Statistical Analysis Used: Paired samples student–t test was done to compare means. Spearman correlation coefficient was used to study the effect of various parameters on mydriasis. Results: Thirty eyes completed the study. The pupil size increased from 2.1 mm (Range 2-3.5 mm SD ± 0.32) to 6.9 mm (Range 5-9 mm SD ± 1.02) in 30 seconds time after intracameral mydriatic solution delivery, and was 7.0 mm (Range 3.5 - 9 mm SD ± 0.20) at the end of surgery. Duration of surgery, grade of nucleus and ultrasound time had statistically insignificant effect on mydriasis. Conclusions: Intracameral solution containing 0.5% lignocaine and 0.001% epinephrine provides rapid mydriasis which is adequate for safe phacoemulsification and is unaffected by other parameters.

Cataract surgery under topical anesthesia using 2% lignocaine jelly and intracameral lignocaine: Is manual small incision cataract surgery comparable to clear corneal phacoemulsification.

A prospective comparative study was undertaken to compare the patients’ pain experience, surgical outcome and surgeon’s experience in phacoemulsification and manual small incision cataract surgery (MSICS) under topical anesthesia supplemented with intracameral lignocaine (TASIL). In Group 1 (n=88) phacoemulsification was done and in Group 2 (n=92) MSICS was done. Pain scores were marked by the patients on a Visual analog scale (VAS) after the surgery. The surgical experience was noted on a questionnaire by the operating surgeon. Descriptive analysis and one-tailed Mann-Whitney test were used to draw results. The average VAS score in Group 1 was 0.65 (SD 1.31) and in Group 2 it was 0.90 (SD 1.22). This difference in the average was not statistically significant with P=0.09. The study demonstrates that MSICS and phacoemulsification both can be done safely under TASIL with acceptable patient comfort, and the pain experienced by the patients during the procedures is comparable.