ABSTRACT
Introduction: Coadministration of drugs with synergistic effects considered one of the methods to increase the effectivenessof analgesia. The aim of this study is to evaluate the efficacy of midazolam to potentiate the analgesic effect of fentanyl as anadjuvant to bupivacaine.Materials and Methods: This is a hospital based prospective, randomized, double-blind interventional control study conductedat SMS medical college and hospitals, Jaipur. A total of 90 patients were enrolled in the study. They were allocated into threegroups, 30 in each. A total of 3.7 ml study drugs injected in each group. Intraoperative monitoring of hemodynamic parameters,duration of surgery, onset of sensory and motor block, duration of analgesia, sensory and motor block, and incidence of adverseeffects was done and compared.Results: There was no significant difference in mean pulse rate, systolic blood pressure, diastolic blood pressure, and meanarterial pressure (P > 0.05). The mean duration of surgery in Group A, B, and C was 101.3 ± 13.08, 92.93 ± 15.28, and 95.93± 16.03 min, respectively (P > 0.05). The mean onset time of sensory block in Group A was 7.29 ± 1.23, in B 4.92 ± 0.60, andin C 4.79 ± 0.91 min (P < 0.05). The mean onset time of motor block in Group A was 8.75 ± 0.55, in B 7.79 ± 0.42, and in C7.57 ± 0.29 min. In Group A, mean time of sensory block was 194.4 ± 6.80, in B 236.60 ± 12.79, and in C 254.30 ± 7.32 min. InGroup A, mean duration of motor block was 180.2 ± 5.22, in B 188.7 ± 4.04 and in C 199.6±6.69 min. In Group A, mean durationof analgesia was 215.7 ± 14.6, in B 445.8 ± 18.92, and in C 522.3 ± 16.33 min. The incidence of adverse effects was insignificant.Conclusion: We conclude that midazolam potentiates the effect of fentanyl in terms of prolonged duration of analgesia andprolonged motor and sensory block when used as an adjuvant of bupivacaine without any significant hemodynamic compromise.
ABSTRACT
Introduction: Sevoflurane is a volatile anesthetic agent, which is non-irritant with low solubility and lack of arrhythmogenicity, which makes it an ideal agent for ambulatory anesthesia. The aim of our study is to compare the cardiovascular effects at equivalent minimum alveolar concentration (MAC) doses and the recovery profile of sevoflurane and isoflurane, in patients undergoing valvular replacement surgery. Materials and Methods: This is a hospital-based, randomized, interventional, comparative study with sample size of seventy participants divided into two groups. Group A (35) received sevoflurane (1MAC) and Group B (35) received isoflurane (1MAC). Patients were of the American Society of Anesthesiologists Grade 2–4. The age group was 20–25 years with body weight of 30–65 kg, undergoing valvular heart surgery. The primary outcomes are to compare the changes in heart rate, systolic and diastolic blood pressures, mean arterial pressure, cardiac output (CO), cardiac index, systemic vascular resistance index (SVRI), and stroke volume variable, during maintenance of anesthesia. The secondary outcomes are the time taken for eye opening on verbal commands and extubation. Results: There was a decrease in blood pressure, CO, and SVRI with both agents (statistically insignificant, P > 0.05), but comparatively hemodynamics was more stable along with early recovery with sevoflurane (statistically insignificant). Conclusions: Sevoflurane and isoflurane can safely be used for fast-track anesthesia in patients undergoing valvular heart surgery. Sevoflurane provided a better hemodynamic profile, early awakening, and extubation as compared with isoflurane, even though the difference was insignificant. Thus, sevoflurane with opioids may be preferred in patients undergoing valvular heart surgery