Clinical vs. bispectral index-guided propofol induction of anesthesia: a comparative study

Clinically optimized focusing of drug administration to specific need of patient with bispectral index [BIS] monitoring results in reduced dose and faster recovery of consciousness. This study was planned with an aim to study and compare the conventional clinical end point or BIS on the requirement of dosage of propofol, hemodynamic effects, and BIS alterations following propofol induction. 70 patients, ASA I and II, 20-60 years undergoing elective surgical procedure under general anesthesia with endotracheal intubation were selected and divided into two groups. Group A received [inj.] fentanyl [2 micro g/kg], followed 3 min later by inj. propofol at the rate of 30 mg/kg/hr infusion till the loss of response to verbal command while group B received inj. fentanyl [2 micro g/kg], followed 3 min later by inj. propofol at the rate of 30 mg/kg/hr infusion. The end point of hypnosis was when the BIS value was sustained for 1 min at 48 +/- 2. The patients were intubated. Total induction dose of propofol was noted in each group. The value of BIS and hemodynamic parameters [heart rate, systolic/diastolic blood pressure] were noted at the time of loss of consciousness, at the time of intubation, and 1 min after intubation, thereafter every minute for first 10 min and thereafter every 10 min till end of surgery. Any involuntary muscle activity such as jerky movements, dystonic posturing, and opisthotonos were also recorded. The mean dose of propofol used in groups A and B were 1.85 +/- 0.48 mg/kg and 1.79 +/- 0.41 mg/kg, respectively. The dosage used in group B were less but not clinically significant [P=0.575]. On comparing the dosage of propofol in males among the groups there was a significantly lower dosage of propofol required in group B [2.06 +/- 0.45 mg/kg and 1.83 +/- 0.32 mg/kg, respectively, P=0.016]. This decrease however was not seen in female patients dosage being 1.65 +/- 0.44 mg/kg and 1.75 +/- 0.49 mg/kg, respectively [P=0.372]. The hemodynamic variables including heart rate, systolic/diastolic blood pressure and BIS were comparable within the group at induction, post-induction, and intubation. However, there was a significant increase in all the parameters at postintubation readings [P<0.001]. No significant difference in the induction dose of propofol was observed when assessed clinically [loss of verbal response] or by BIS monitoring. Traditional teaching to titrate the dose of propofol and depth of anesthesia during intubation by loss of verbal response is as good as BIS value monitoring

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