ABSTRACT
A neonate with glucose-6-phosphate dehydrogenase [G6PD] deficiency and Arnold-Chiari Malformation [ACM] type 2 underwent lumbar meningomyelocele [MMC] repair. Patients with G6PD deficiency are prone to develop haemolysis following any kind of oxidative stress and in ACM, there is a disturbed cranio-spinal pressure relationship. The neonate was managed under general anaesthesia with propofol for induction as well as for maintenance along with fentanyl and oxygen-nitrous mixture
ABSTRACT
We compared the duration of analgesia and adverse effects along with the hemodynamic changes, following intrathecal administration of dexmedetomidine or clonidine with bupivacaine. Seventy five patients of ASA grade I or II, ages between 20-50 years, were enrolled in the study. Patients were randomly allocated to three equal groups, Group B received hyperbaric bupivacaine [0.5%] 12.5 mg with normal saline as a placebo, group D received bupivacaine with 3 micro/g of dexmedetomidine and Group C received bupivacaine with 30 fig of clonidine. All solutions were made up to 3 rnl with addition of normal saline and injected at L3-L4 using a 25G spinal needle. The onset and duration of sensory and motor blockade, time to reach peak sensory and motor level and the sensory and motor regression times were recorded. Hemodynamic changes and time to use first rescue analgesia, diclofenac sodium 75 mg IM, were also recorded. In post anaesthesia care unit [PACU], pain scores were recorded using visual analogue scale [VAS], initially every 30 minutes for 8 hours, then every 2 hours till 24 hours. Descriptive statistics was used tor describing frequencies, mean and standard deviation. Analysis of variance [ANOVA] test was used to compare the quantitative variables in between the three groups which were independent of each other. Chi square test was used to compare categorical variables. All the data was analysed using SPSS vs. 17. P value < 0.05 was considered statistically significant. There was no significant difference in patients demographics or duration of surgery, in the time to onset of sensory block but motor block was early in Group D and Group C as compared to Group B. Duration of sensory and motor blockade was prolonged in Groups C and D, compared with Group B. The mean regression time to SI segment was 306.6 +/- 52 min in Group D, 278.6 +/- 27 min in Group C and 199.8 +/- 33 min in Group B. The regression of motor block to Bromage zero was 253.2 +/- 38.40 min in Group D, 229.00 +/- 42.57 min in Group C and 175.00 +/- 29 min in Group B. The time to analgesia was significantly prolonged in Group D compared with Group C the latter being longer than Group B. The addition of dexmedetomidine to intrathecal bupivacaine prolongs the motor and sensory block and postoperative analgesia when compared to bupivacaine with or without clonidine, with preserved hemodynamic stability in lower limb surgeries
Subject(s)
Male , Middle Aged , Young Adult , Humans , Clonidine , Injections, Spinal , Bupivacaine , Double-Blind Method , Anesthesia, Spinal , Lower Extremity/surgeryABSTRACT
This study was done to compare the heart rate [HR], systolic blood pressure [SBP], diastolic blood pressure [DBF] mean arterial pressure [MAP] ephedrine requirement and neonatal outcome between normotensive and severe pre-eclamptic women undergoing caesarean section under spinal anaesthesia. We enrolled a total of 30 healthy [control group] and 30 severe pre-eclamptic [BP > 160/110 mmHg] parturients [study group] above 18 years of age, undergoing elective cesarean section in the study. After preloading with 10 ml/kg of ringer lactate solution spinal anesthesia was administered with 12.5 mg of hyperbaric bupivacaine. SBP, DBP, MAP and HR were recorded before spinal anesthesia and at every 2 min intervals after spinal anesthesia for the first 20 min, and then after every 5 min till completion of surgery. Ephedrine was administered in 5 mg bolus dose when MAP decreased more than 20% of base line. Apgar score was noted at 1 and 5 min after birth. Hemodynamic variables were also noted four hourly in post-operative period for 24 hours in both of the groups. The blood pressure records were statistically lower at all intervals throughout the study in normotensive group as compared to pre-eclamptic group. The number of episodes of hypotension was more in normotensive group as compared to pre-eclamptic group and the result was statistically significant [p < 0.05]. The mean ephedrine requirement in the normotensive group [13.4 i: 7.66 mg] was significantly more [P-value 0.0005] than in pre-eclamptic group [6.6 i: 6.75 mg]. Apgar scores at 1 and 5 min after birth were comparable in both of the groups. Pre-eclamptic patients had less hypotension after spinal anesthesia, required less ephedrine than normotensives but had comparable fetal Apgar scores