ABSTRACT
Endotracheal intubation during general anaesthesia has been associated with change in haemodynamic parameters such as pulse rate and blood pressure. In this study we have compared propofol, etomidate and propofol-etomidate combination as induction agent in patients undergoing laparoscopic cholecystectomy. Material & Methods:After approval from the institutional ethical committee and informed written consent, prospective randomised double blind study was done with ASA physical status I and II. Three groups propofol(P),etomidate(E) and propofol-etomidate combination(PE) including 30 patients in each group were assigned. Haemodynamic parameters heart rate(HR), systolic blood pressure(SBP), diastolic blood pressure(DBP),mean bood pressure(MBP),side effects and complications were seen just before induction, at 0 hr soon after intubation, than from 1min to 7min and at 10 min after intubation. Result:There was no significant differences in HR,SBP,DBP,MBP after intubation and post intubation in etomidate group as compared to propofol-etomidate and propofol group. Conclusion: Etomidate has better haemodynamic stability than etomidate-propofol combination alone at 1 min after intubation, though propofol-etomidate combination was equally stable.
ABSTRACT
Background And Aim: Ropivacaine being comparatively less cardiotoxic and neurotoxic than bupivacaine, it also produces minimal motor blockade of shorter duration when used in spinal anaesthesia. This study was aimed to compare the intrathecal 0.75% isobaric ropivacaine for caesarean delivery with 0.5% bupivacaine heavy in pregnant patients. Method: 100 parturient belonging to ASA grade I & II scheduled for elective caesarean section were randomly selected for the study and are divided into two groups of 50 each. Group B patients received 2ml of 0.5% hyperbaric Bupivacaine intrathecally. Group R patients received 2ml of 0.75% isobaric Ropivacaine intrathecally. Onset and duration of sensory block, onset and duration of motor block, highest level of sensory block, quality of anaesthesia, and time of request for analgesia, hemodynamic parameters and adverse effects if any were studied. Results: Baseline demographic variables were similar in two groups. Neonatal outcome were also similar in two groups. Onset of sensory block at T8, time to request for analgesia, total duration of analgesia was comparable in both groups. Mean highest level of sensory block in both groups was T5 but in group R having slightly higher range (T3-T6) as compare to group B (T4-T6). Regression of sensory block at L1, duration of motor block was shorter but having longer onset of motor block in Group R as compare to group B. Conclusion: Ropivacaine 15 mg (2 ml of 0.75% isobaric Ropivacaine) provides comparable quality of sensory block but has slower onset and significantly shorter duration of motor block compared to bupivacaine.
ABSTRACT
Background And Objective: Alpha-2 agonists are being increasingly used as adjuncts in general anaesthesia, Fentanyl an opioid analgesic, is popular as an intraoperative agent due to the cardiovascular stability provided by it, even in critically ill patients.Present study was carried out to evaluate the effect of dexmedetomidine and fentanyl for attenuation of haemodynamic responses during laryngoscopy and tracheal intubation. Methods: Sixty patients scheduled for elective general surgery under general anaesthesia were randomized into two groups: A and B (n=30 in each group). Study group A patients were given inj. dexmedetomidine 1μg kg-1 diluted to 20ml normal saline infused in 10 minutes with infusion pump and group B were given inj. fentanyl 2μg kg-1 diluted to 20ml normal saline infused in 10 minutes with infusion pump, inj. Propofol (2mg/kg) i.v were used as induction agent. Anaesthesia was maintained with 40:60 oxygen: nitrous oxide, isoflurane (0.6%) and muscle relaxant vecuronium bromide in incremental doses throughout the surgery. Haemodynamic parameters were recorded at regular intervals during induction, intubation, surgery and extubation. Results: After induction there was significant decrease in pulse rate with dexmedetomidine and significant decrease in Mean blood pressure was seen with fentanyl group. After laryngoscopy and intubation, increase in pulse rate and mean arterial blood pressure was more in fentanyl group than in dexmedetomidine group. Interpretation and Conclusion: we conclude that dexmedetomidine 1μg/kg is more effective in attenuating hemodynamic pressure responses to laryngoscopy and intubation than 2μg/kg fentanyl when given as premedication.
ABSTRACT
Background&Objectives: Laryngeal, tracheal and bronchial receptors are stimulated by mechanical and chemical irritants during laryngoscopy, intubation and extubation. The reflex increases in sympathoadrenergic activity caused by these manipulations leads to an increase in catecholamine release, arterial blood pressure and heart rate. The aim of present study was to evaluate the efficacy of Fentanyl (2 mcg/kg), Esmolol (1mg/kg) and their combination in half the dose(fentanyl 1 mcg/kg +esmolol 0.5mg/kg) in attenuating the pressure response during laryngoscopy and tracheal intubation. Methods: This is a prospective double blind study comprising ninety patients between 21-60 yrs and ASA grade I and II scheduled for elective surgery under general anesthesia. Patients were randomly divided into group E (injection Esmolol 1mg/kg iv), group F (inj.Fentanyl 2mcg/kg iv) and group C (inj.Esmolol 0.5mg/kg and inj.Fentanyl 1mcg/kg). The study drug was given 2 minutes before induction of anaesthesia. All the vital parameters of patients were observed during intra operative and postoperative period .Values of heart rate and mean blood pressure were recorded at pre-induction, after giving study drug, after induction, immediately after intubation and at 1 min, 3 min, 5 min, 7 min and 10 min. after intubation. Results: Inter group comparison of groups E, F & C showed greater attenuation of heart rate in group F as compared to group C and group E. Inter group comparison of groups E, F & C in attenuating increase in MAP showed greater attenuation of MAP in group F as compared to group E ( p=0.880) and group C (p=0.0005). Conclusion: Among the fentanyl (2 mcg/kg), esmolol (1 mg/kg) and their combination drug in half doses, injection fentanyl is best in attenuating haemodynamic responses to laryngoscopy and tracheal intubation.