Evaluation of the Effect of Continuous Infusion of Dexmedetomidine or a Subanesthetic Dose Ketamine on Transcranial Electrical Motor Evoked Potentials in Adult Patients Undergoing Elective Spine Surgery under Total Intravenous Anesthesia: A Randomized Controlled Exploratory Study

Methods@#A total of 90 American Society of Anesthesiologist grade I–III patients, aged 18–65 years, with a motor power of ≥4/5 grade as per the Medical Research Council Scale in all four limbs who were scheduled for elective spine surgery under transcranial electrical motor evoked potential monitoring were enrolled. The subjects were randomly allocated into the following three groups: group PD who received 0.5 μg/kg/hr dexmedetomidine infusion, group PK who received 0.5 mg/kg/hr ketamine infusion, and group PS who received normal saline infusion, along with standard propofol–fentanyl based TIVA regime. Amplitude and latency of bilateral motor evoked potentials of the tibialis anterior and abductor halluces muscle were recorded at Ti (at train-of-four ratio >90%), T30 (30 minutes post-Ti), T60 (60 minutes post-Ti), and Tf (at the end of spine manipulation). @*Results@#Baseline median amplitudes were comparable among the study groups. In group PK, we noted a gradually enhanced response by 24%–100% from the baseline amplitude. The median amplitudes of all the muscles were higher in group PK than those in groups PS and PD at time points T60 and Tf (p <0.05). @*Conclusions@#The present study demonstrated that compared with dexmedetomidine and control treatment, a subanesthetic dose of ketamine caused gradual improvement in amplitudes without affecting the latency.

Efficacy of trospium for prevention of catheter-related bladder discomfort: a prospective, randomized, placebo-controlled, double-blind study / 대한마취과학회지

Background@#Catheter-related bladder discomfort (CRBD) is a frequent complaint after awakening from anesthesia in patients receiving perioperative bladder catheterization. Overactive bladder (OAB) and CRBD show similar symptoms; thus, drugs used for the management of OAB influence symptoms of CRBD. Trospium chloride has been found effective in managing resistant cases of OAB. We evaluated the efficacy of oral trospium on CRBD in the postoperative period. @*Methods@#Sixty-four male and female adult patients, with planned spinal surgery and requiring urinary bladder catheterization, were randomly divided into two groups of 32 each. Group T patients received 60 mg extended-release oral trospium (extended-release) 1 h before induction of anesthesia and Group C patients received a similar-looking placebo. The anesthetic technique was identical in both groups. The CRBD score was evaluated in the postoperative ward using a 4-point scale (1 = no discomfort, 2 = mild, 3 = moderate, 4 = severe). Readings were recorded on arrival (0 h), and 1 h, 2 h, and 6 h postoperatively. All patients received fentanyl for postoperative pain relief. @*Results@#The incidence of CRBD was significantly higher in group C than in group T at 0 h (66% vs 22%, P=0.001) and 1 h postoperatively (72% vs 28%, P=0.001). The incidence of moderate to severe CRBD was higher in group C at postoperative 2 h (82% vs 14%, P=0.004). There was no significant difference in postoperative fentanyl requirements. @*Conclusions@#Pretreatment with 60 mg ER trospium reduced the incidence and severity of CRBD in the early postoperative period.

Effect of continuous magnesium sulfate infusion on spinal block characteristics: a prospective study

Spinal anesthesia is an established mode of anesthesia for lower limb orthopedic surgeries. The limitations of the technique are short duration of action and limited post-operative analgesia. Concomitant use of intravenous infusion of magnesium sulfate may have an effect on the block characteristics and duration of action of intrathecal bupivacaine. A total of 80 American Society of Anesthesiologists I and II patients, either sex, 20-60 years of age scheduled for elective orthopedic fixation of fracture of long bones of lower limbs under spinal anesthesia were included. Spinal anesthesia administered with 2.5 ml heavy bupivacaine mixed with 10 mcg fentanyl. The groups were then divided to receive an infusion of injection magnesium sulfate 50 mg/kg/h over 15 min followed by 15 mg/kg/h until the end of the surgery [Group M] and 15 ml of Normal Saline over 15 min followed by 100 ml/h until the end of surgery [Group S]. Onset, duration of sensory and motor block and amount of post-operative analgesic were noted. A total of 6 patients [Group M] and seven patients [Group S] had inadequate block and excluded from the study. Mean block height was T6. Time required to achieve block height was 8.82 min versus 7.42 min in Groups M and S respectively [P = 0.04]. Mean duration of motor block was longer in group M [160.63 +/- 17.76 min] compared with Group S [130.12 +/- 20.70 min] [P = 0.000]. Time for regression of sensory block to T12/L1was 206.88 +/- 20.96 min [Group M] and 163.88 +/- 15.46 min [Group S] [P = 0.000]. Hemodynamic parameters were similar and statistically not significant. Need for first analgesic requirement was after 262.88 +/- 21.11 min in group M and 193.25 +/- 17.74 min in the group S [P = 0.000]. Mean dosage of tramadol needed in first 24 h was less in group M [190 +/- 30.38 mg vs. 265 +/- 48.30 mg, P = 0.000]. Use of intravenous magnesium with spinal anesthesia reduces post-operative pain and analgesic consumption

Evaluation of preoperative Strepsils lozenges on incidence of postextubation cough and sore throat in smokers undergoing anesthesia with endotracheal intubation

Post-operative sore throat [POST] is an undesirable side effect of endotracheal intubation. Pharmacological and non-pharmacological measures have been utilized for minimizing the morbidity caused by POST. We have tested use of Strepsils lozenges in providing effi cacy for decreasing POST in smokers presenting for surgery under general anesthesia with endotracheal intubation. 100 patients, 20-65 years, American Society of Anesthesiologists [ASA] physical status I and II, either sex, history of smoking, posted for elective surgical procedure of more than 1 hour, requiring general anesthesia with endotracheal intubation were included and randomly divided into groups [n = 50] to receive Strepsils [Group A] and sugar candy [Group B]. The patients were assessed for cough, sore throat, and hoarseness of voice after extubation, 30 min, 12 hrs, and 24 hrs after extubation. At extubation no cough was seen in 39 [78%] patients [group A] compared to 23 [46%] patients [Group B], and mild cough in 22% [Group A] and 52% [Group B]. Incidence of sore throat at extubation was lower in group A compared to Group B [P = 0.04]. At other times of observations [30 min,12 hrs and 24 hrs] there was a significant decrease in incidence of sore throat in Group A compared to Group B [P = 0.000]. Hoarseness of voice was not observed in any patient in either group. Use of preoperative Strepsils lozenges decreases incidence of POST and maybe utilized as a simple and cost-effective measure for decreasing the symptoms of POST and increasing the satisfaction of patients.

Prevalence of obstructive sleep apnea in surgical patients presenting to a tertiary care teaching hospital in India: a preliminary study

Obstructive sleep apnea [OSA] is often not diagnosed in patients presenting for surgical procedures thereby increasing the incidence of adverse perioperative course. Early diagnosis of this disease is important in modifying anesthetic management as well as utilizing specific means which may decrease the complications and improve the patient outcome. Patients greater than eighteen years of age, ASA I-III scheduled for elective surgical procedures under anesthesia were randomly selected. Their demographic data, diagnosis and nature of surgery were noted in a semi-structured performa. They were then screened for the presence of OSA with the help of a STOP BANG questionnaire. This study included two hundred four patients randomly selected. Slight female predominance was seen in this sample [55.4%]. Mean age of the subjects was 42.7 years [SD=15.08]. 24.5% subjects were at high risk for OSA [STOP-BANG>3] with a male predominance [72% versus 37% in low risk group; X[2] =18.62; P<0.001]. High risk OSA subjects had higher prevalence of cardiovascular risk factors [57% vs. 11.7% in low risk group; X[2] =33.35; P<0.001]. Similarly, this group had a higher prevalence of asthma and chronic obstructive pulmonary disease [COPD] [14% versus 3.8% in low risk group; X[2] =6.54; P=0.03]. Prevalence of diabetes mellitus [22%] and hypothyroidism [6%] was also higher in this group [5.2% and 1.9% in low risk group respectively; X[2] =15.42; P<0.001]. High degree of suspicion and knowledge of association of OSA and medical diseases may help in detection of such cases and decrease the rate of perioperative complications thus improving patients safety

Bezold Jarisch reflex as a cause of haemodynamic alterations during surgery in prone position

Haemodynamic dysfunction and cardiac conduction abnormality in patients undergoing spine surgery in prone position is multifactoriaL Here we present a case report of an elderly male patient undergoing multiple level dissectorny under general anaesthesia, who developed bradycardia and hypotension after prolonged surgery and was managed successfully. The case description and review of literature is presented

Single Shot Epidural Injection for Cervical and Lumbosaccral Radiculopathies: A Preliminary Study

BACKGROUND: Epidural steroid injection is an established treatment modality for intervertebral disc prolapse leading to radiculopathy. In cases where two levels of radiculopathy are present, two separate injections are warranted. Herein, we present our experience of management of such cases with a single epidural injection of local anaesthetic, tramadol and methylprednisolone, and table tilt for management of both radiculopathies. METHODS: 50 patients of either sex aged between 35-65 years presenting with features of cervical and lumbar radiculopathic pain were included and were subjected to single lumbar epidural injection of local anaesthetic, tramadol and methylprednisolone, in the lateral position. The table was then tilted in the trendelberg position with a tilt of 25 degrees, and patients were maintained for 10 minutes before being turned supine. All patients were administered 3 such injections with an interval of 2 weeks between subsequent injections, and pain relief was assessed with a visual analogue scale. Immediate complications after the block were assessed. RESULTS: Immediate and post procedural complications observed were nausea and vomiting (20%), painful injection site (4%), hypotension (10%) and high block (4%). Pain relief was assessed after the three injections by three grades: 37 (74%) had complete resolution of symptoms; 18% had partial relief and 8% did not benefit from the procedure. CONCLUSIONS: This technique may be used as an alternative technique for pain relief in patients with unilateral cervical and lumbar radiculopathies.

Comparative evaluation of intravenous propofol, thiopentone sodium and ketamine for short surgical procedures

The increasing popularity of outpatient surgery has prompted the search for new anaesthetic agent that can provide safe and effective anaesthesia with a rapid and smooth recovery We compared three induction agents, namely propofol, thiopentone sodium and ketamine to find the most suitable agent for this purpose. This prospective study was conducted at HIMS, Dehradun on 90 ASA I, II patients of either sex and in age group 16-65 years undergoing minor surgical procedures under general anaesthesia not requiring endotracheal intubation. The patients were randomly allocated into three groups of 30 patients to receive either inj propofol 2-2.5 mg/kg 1V [Group A], inj thiopentone 3-5 mg/kg IV [Group B], or inj ketamine 1-2 mg/kg IV [Group C]. It was noted that the induction time was shortest with Inj thiopentone and recovery was quickest with Propofol. Heart rate, SBP, DBP decreased with injection thiopentone and Propoiil being more in case of injection Propofol in comparison to injection to thiopentone. Inj Ketamine led to increase in all the parameters. Propofol is an ideal choice for short surgical procedures