ABSTRACT
Introduction: Laryngoscopy induces haemodynamic responsewhich has implications for patients with cardiovascularillnesses. We devised this study to compare the laryngoscopicview of the glottis obtained with the Macintosh, McCoy andMiller blades, and corresponding haemodynamic changes.Material and Methods: 105 ASA grade I and II patientsrandomly divided into three groups were intubated usingMacintosh, McCoy and Miller blade respectively. Cormackand Lehane grade of glottic view obtained, heart rate, systolicand diastolic blood pressure at baseline, immediately beforeinduction, following induction, and at 1, 3 and 10 minutesafter intubation were noted. Epi Info 7.2 was used forstatistical analysis. Chi square and ANOVA tests were appliedto compare haemodynamic parameters.Results: 18 patients (51.4%) were CL grade I and 17 (48.6%)were CL grade II in Macintosh, 24 (68.6%) were CL gradeI and 11 (31.4%) were CL II in McCoy and, 32 (91.4%)were CL I and 3 (8.6%) were CL II in Miller group. Risein heart rate following intubation was greatest with Millerblade, followed by Macintosh and least with McCoy, andwas statistically significant (P< 0.01). Rise in both, systolicand diastolic blood pressure following intubation was highestwith the Miller blade, followed by Macintosh and least withMcCoy, and the difference compared with baseline values wasstatistically significant (P<0.01).Conclusions: Miller blade provides best visualization of larynxbut McCoy blade produced least haemodynamic response,hence the latter is preferable when less haemodynamicresponse is desired.
ABSTRACT
Introduction: With the increase in the life span of humanbeings and added to that the culture of processed food thereare increase in life style disorders in humans. The commonestorthopedic problem which we see due sedentary life style,lack of healthy wholesome diet are bone related disordersmainly osteoarthritis.Ropivacaine, an alternative to bupivacaine is structurallyclosely related to bupivacaine and supplied as the pureS-enantiomer. We therefore decided to compare the efficacy ofcontinuous infusion of levo bupivacaine against ropivacaine toidentify the differences or superiority of one drug over other.Material and methods: After obtaining the Ethics Committeeapproval, we recruited 110 patients undergoing Total KneeReplacement (TKR) surgery under Combined Spinal Epidural(CSE) Anaesthesia. Sample size of study which was calculatedas 110. All patients underwent a routine pre anaesthetic checkup including the spine examination. Pre-anaesthetic check- upwas done a day prior to surgery. All routine investigationswere advised. The details of our study were explained to thepatients, in the language understood by them. Consent wasobtained for post-operative use of Elastomeric infusion pump.They were explained about the use of VAS.Results: Both groups were comparable with respect todemographic profile. The patients in ropivacaine group showedsignificantly lower pulse rate as compared to levobupivacainegroup. Patients in ropivacaine group recorded significantlylower systolic blood pressure throughout the infusion periodas compared to those in the levobupivacaine group. Thedifference in diastolic blood pressure was not significant. Thetime taken for the sensory block to regress to L1 was longerin ropivacaine group as compared to levobupivacaine group.Conclusion: Patients in both the group had comparable VASpost operatively. Although Patients in the ropivacaine grouphad better VAS score as compared to levobupivacaine, thedifference was not statistically significant. There were noside effects like motor weakness, hypotension, bradycardia orPNOV in any group. Our present study thus concludes thatas far as analgesic properties are concerned Ropivacaine withits more suitable toxicity profile and less motor block is morefavourable for continuous infusion for patients undergoingTKR when used in equipotent doses.