A Comparison between Diltiazem and Nitroglycerine for Hypotensive Anaesthesia in Total Hip Arthroplasty.

Background: To compare controlled induced hypotension for facilitating surgical exposure and reducing intraoperative blood loss, using diltiazem and nitroglycerin in total hip arthroplasty under general anesthesia. Methods: 60 adults of American Society of Anesthesiologists (ASA) grade I and II posted for total hip arthroplasty in the department of orthopaedics were selected for prospective, randomized study and allocated randomly into three groups: Group A (control group), group B (diltiazem-controlled hypotension), and group C (nitroglycerin-controlled hypotension).Statistical analysis done using SPSS 20 software. Analysis of variance (ANOVA) test was used to compare the demographic data. Intergroup comparison between A and B,B and C,A and C of the heart rate (HR) and mean arterial pressure (MAP)were done using student t test. A P value <0.05 was considered significant. Results: The mean HR of group B showed a statistically significant decrement which continued 30 min after stoppage of infusion compared to group A (p=0.001)and C(p=0.001).The mean HR of group C showed a statistically significant increase upto the stoppage of infusion compared to group A(P=0.001) and group B(P=0.001). MAP of group C (59.9+4.28)is decreased to the target MAP between 15 and 45min after starting infusion whereas group B (71.2+4.65)remained above target MAP even after 45min. Group B showed a significant decrease in mean MAP (64.43+4.34)continuing upto 30 min after stoppage of infusion(p=0.001) compared to group A(105.8+3.86) and group C(106.4+4.9). Conclusion: Diltiazem is a poor agent for the management of controlled hypotension.

A Comparative Study of the Effect of Priming and Sevoflurane on Intubating time and Intubating Conditions with Rocuronium as Intubating Agent in Neurosurgical Patients.

Background: Rocuronium provides good intubating conditions but large doses causes prolongation of its duration of action, making it unsuitable for short surgical procedures. Aims: This study was designed to compare the effects of rocuronium with 3min priming interval and 2% sevoflurane on the time of intubation and intubating conditions. Methods: the study design is that of randomized, prospective double‑blind trial. Forty five adult patients were randomly allocated into three equal groups: Group R received 0.8 mg/kg rocuronium, Group RS received 0.8 mg/kg of rocuronium with 2% sevoflurane andGroup RP patients received a priming dose of 0.08 mg/kg of rocuronium followed by 0.72 mg/kg rocuronium 3 min later. Onset time of intubation, intubating conditions and time for loss of thumb adduction were assessed. Analysis of variance (ANOVA) test was used to compare the demographic data and intubating conditions among the groups.Intergroup comparison between R and RS,R and RP,RS and RP of the time for intubation and time for the loss of thumb adduction were done using student t test. A P value <0.05 was considered significant. Results: The onset time of intubation (loss of T1 of TOF) was 100.53+2.03s in group 62.9+1.9 s in-group RS, and 61.88+1.9s in group RP. The time for the loss of thumb adduction in R,RS,RP were 98.53+2.03, 60.93+1.9, 60+2.12 respectively. There is statistical significance p=0.001 between R and RS ,R and RP group while comparing the onset time for intubation and time for the loss of thumb adduction. Mean intubating scores were excellent in all the three groups.Conclusion: Both rocuronium (0.08mg/kg) along with 2% sevoflurane and priming principle for rocuronium provide excellent intubating conditions within 60-66 sec in neurosurgical patients.

The Variation in Plasma Cortisol Levels in Response to Anaesthetic Induction with Etomidate and Ketamine in Paediatric Patients Undergoing Patent Ductus Arteriosus Ligation.

Background: To compare the effect of anaesthetic induction with single dose etomidate versus ketamine on serum cortisol levels in paediatric patients posted for patent ductus arteriosus (PDA ) ligation surgery. Methods: A total of 60 paediatric patients in the age group of 2 to 8 yrs posted for PDA correction in the department of cardiothoracic surgery in a tertiary care centre, was selected for prospective randomized control study trial and allocated randomly into 2 groups–group E and K. Anaesthetic induction was done using single dose etomidate (group E) and ketamine (group K) and serum cortisol levels were compared in paediatric patients posted for PDA ligation surgery.Statistical analysis done using SPSS 20 software. Baseline continuous variables were compared using student ‘t’ test for independent samples. The primary outcome (serum cortisol ) was compared using Wilcoxon Signed Ranks Test and student ‘t’ test. The value less than 0.05 was considered significant. Results: The serum cortisol in group E was found to be significantly low 4 hour postoperatively compared to group K. However, serum cortisol increased 24 hour postoperatively in both groups and the increase was not found to be significant between the groups. Conclusion: Etomidate can be used for induction in paediatric cardiac surgery in patients without serious cortisol suppression lasting more than twenty four hours.

Effectiveness of Transversus Abdominis Plane Block using Ropivacaine for Postoperative Analgesia in Total Abdominal Hysterectomy Patients.

Background: Transversus abdominis plane (TAP) block is a safe, simple and effective technique of providing analgesia for below umbilical surgeries with easily identifiable landmarks. The study is done to study the analgesic efficacy and side effects of TAP block in total abdominal hysterectomy (TAH) patients using below umbilical incision. Methods: a prospective randomized control trial was performed.A bilateral TAP block was performed using 0.25% ropivacaine 1mg/kg in study group (T) using 22G needle, while in control TAP block was not given. The time taken to request for the first rescue analgesic, total consumption of tramadol and antiemetic in 48hrs,visual analog score (VAS) for 6, 12,24, 48 hr postoperatively.The results were analyzed with SPSS 21 software.A P value <0.05 was considered significant. Student t test/Mann Whitney U test were used to find the significance. Results: In Group T, the time to the first dose of rescue analgesic (20.9 + 4.12) was significantly more (p = 0.001) compared to group C (3.55 + 0.44). The total amount of tramadol consumption in 48 hrs in group T (175 + 25.2) was statistically significant (P=0. 001) compared to group C (291 + 24.1) The 48 HR analgesic requirement (11.52 + 2.8) (P=0. 001) and VAS at 6,12,24 and 48 h 0.00 (0-1), (2.4 + 0.8), (2.6 + 1.4), (1.8 + 0.75) respectively were less in the Group T compared to group C.Conclusion: Transversus abdominis plane block proved to be an effective means of postoperative analgesia for TAH patients with minimal sideeffects.