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Introduction: Currently, the effects of combined anesthesia(propofol and ketamine) for patients with depressive disorderwho have undergone electroconvulsive therapy (ECT) areunclear. Study aimed to evaluate the effect of ketamine,propofol, and ketofol on hemodynamic profile, duration ofseizure activity, and recovery times in patients undergoingECT.Material and methods: Sixty patients who were scheduledfor ECT treatment were enrolled. The study population wasrandomly assigned to receive one of three anesthetic agents:ketamine, propofol, or ketofol. The required total dose of thethree agents was recorded. Mean arterial pressure (MAP),heart rate (HR), and oxygen saturation values were recordedat baseline, at induction, and at 1, 3, 5, and 10 min after theend of seizure.Results: We found that both ketamine and ketofol have anincreased mean seizure duration compared to propofol, ketofolhad more favorable hemodynamic effects than ketamine andpropofol, and ketamine was found to have longer recoverytimes compared to both propofol and ketofol.Conclusion: We found that both ketamine and ketofol have anincreased mean seizure duration compared to propofol.
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Aim: To compare epidural 0.25% bupivacaine with 0.25% ropivacaine for post operative pain relief in cases of abdominal surgeries. Methods: 60 patients belonging to ASA physical status I & II of both sexes (each group 30 patients n=30) were randomly selected for the study. The sensory and motor block, analgesia, hemodynamic status, complications and need for rescue analgesia were compared in both the groups. Group B patients received 0.25% Bupivacaine as continuous epidural. Group R patients received 0.25% Ropivacaine as continuous epidural. Results: The sensory block was almost similar in both groups. No significant association is observed between the ASA class, age and sex of the groups (P>0.05). The difference in mean VAS between Bupivacaine and Ropivacaine was found to be statistically significant at 24 hours (P<0.05). Motor block was significantly more (17%) in group B than group R (3%) (P< 0.05). Haemodynamic changes did not differ in patients of either group (P >0.05). The rescue analgesia requirement were minimal in group R compared to group B. Complications were less in group R. Conclusion: Our study compared clinical efficacy of 0.25% Ropivacaine and 0.25%Bupivacaine in respect to analgesia, motor blockade, hemodynamic stability, requirement of rescue analgesia and complications. Sensory block and hemodynamic stability was comparable in the two groups. Ropivacaine group had significantly less motor block than Bupivacaine group.
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The efficiency of 0.75% Ropivacaine as a single shot epidural anaesthetic in comparison to 0.5% Bupivacaine is less studied. Our study focuses on comparing the efficiency of sensory block between 0.75% ropivacaine and 0.5% bupivacaine for epidural anaesthesia. Methods: The study was done with 0.75% Ropivacaine and 0.5% Bupivacaine in epidural anaesthesia in orthopedic hip surgeries given as a single shot technique for which 60 patients of ASA I/II each were chosen and 15ml of the drug was given. Onset of the sensory sensations at T12 and regression at the same level were measured with the aid of response to pin prick and thus duration of epidural anaesthesia was calculated individually in group B and group R respectively. Results: Onset of sensory block was faster in group R than in group B and regression was slower in group R than in group B. Conclusion: It can be concluded that duration of epidural anaesthesia was prolonged and longer with 0.75% Ropivacaine than 0.5% Bupivacaine.
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Background: Shivering is commonly encountered both after regional and general anaesthesia (GA) with a little higher incidence in patients receiving GA. The aim of study was to compare the effectiveness of dexmedetomidine and tramadol in decreasing postoperative shivering in patients undergoing laparoscopic surgery.Methods: Total 120 patients were included in this study. In order to get a 5% level of significance and 80% power number of patients required in each group was 40, with a total of 120 patients. Randomization of groups was done based on closed envelope method. Patients were allocated into three groups group I, II and III of 40 patients each. Patients in group I and group II were administered 0.75 μg/kg of dexmedetomidine and 1.5 mg /kg of tramadol in 100 ml NS respectively half a before extubation, while patients in group III did not receive any pharmacological intervention.Results: All three groups were comparable regarding distribution of age, gender, ASA grade and temperature at beginning and end of surgery and were non-significant.Conclusions: Dexmedetomidine seems to possess anti-shivering properties and was found to reduce the occurrence of shivering in patients undergoing general anaesthesia with minimal side effects although its anti-shivering effect was not superior to tramadol.
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Intrathecal opioids when added to local anaesthetics decrease their dosage and provide haemodynamic stability. Subarachnoid block is a common anesthesia procedure for lower abdominal or lower limb surgeries including perineal surgeries. Objectives: To assess the efficacy of anesthesia and analgesia between intrathecal fentanyl and butorphanol with bupivacaine heavy 0.5% for lower limb orthopaedic surgery. Methods: About 120 patients, aged 18-75 years, belonging to American society of anesthesiologists (ASA) physical status 1 or 2 and scheduled for elective, lower limb orthopedic surgeries was randomized into two groups. Group A received 2.5ml of 0.5% hyperbaric bupivacaine with 0.5ml (25μg fentanyl) a total volume of 3ml intrathecally. The Butorphanol was diluted using distilled sterile water to obtain 25μg in 0.5ml. This was then added to 2.5ml of 0.5% hyperbaric bupivacaine to make a total volume of 3ml which was given to group B. Results: The times required for onset of sensory and motor blockade were comparable among the two groups. Significantly slower block regression to S2 level was observed in the group receiving intrathecal butorphanol as compared to intrathecal fentanyl (P<.001). A higher number of patients in group A requested for rescue analgesia during the postoperative period than in group B (11 versus 3; P=0.0326). The average times to first request for rescue analgesia were 254.47±9.31 minutes and 291±8.45 minutes in group A and B, respectively (P<0.001). Conclusion: Both 25μg fentanyl and 25μg butorphanol given intrathecally along with 12.5 mg of hyperbaric bupivacaine provide effective anesthesia for lower limb surgeries. Intrathecal bupivacaine-butorphanol mixture provides longer duration of sensory blockade and superior analgesia than intrathecal fentanyl-bupivacaine mixture.
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Background: Infra-umbilical surgeries may be performed under local, regional (spinal or epidural) or general anaesthesia, spinal block is still a first choice, because of its rapid onset, high quality of blockade, lack of catheter related infection, less failure rate and also cost effective but the duration of block and postoperative analgesia is limited. The purpose of study was to compare the efficacy of adding ketamine to 0.5% hyperbaric bupivacaine with midazolam to 0.5% hyperbaric bupivacaine in elective infraumbilical procedures.Methods: A randomized, single blinded, clinical study. 60 subjects were enrolled from the patients presenting for elective infraumbilical surgeries after following the inclusion and exclusion criteria laid down for the study. Sixty ASA Grade I and II patients undergoing infra umbilical surgeries were randomly divided into one of the two equal groups (n=30).Results: Total 60 patients were included in this study. The mean time to achieve T10 sensory level and modified bromage scale III was prolonged in group M (4.33±1.09, 6.66±1.26 min) as compared to group K (3.3±0.7, 4.96±1.21 min) which was statistically significant (P value <0.05).Conclusions: The present study concludes that addition of intrathecal midazolam to hyperbaric bupivacaine provide very good and prolonged post-operative analgesia without significant intra-operative and post-operative side effects compared to intrathecal ketamine.
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Introduction: During the last three decades, abortion laws have been liberalized in many parts of the world, so that termination of pregnancy is now permitted on broadly interpreted medical, psychological or social grounds. Aim: Randomised study was undertaken to compare the manual vacuum aspiration with electrical vacuum aspiration in 1st trimester MTP. Materials and methods: The study consisted of 100 pregnant women for termination of pregnancies in 1st trimester (6-12 weeks) admitted, during period of 2 years this study was carried out by using manual vacuum aspiration syringe in 50 women who formed the study group and compared with electrical vacuum aspiration in 50 women who formed the control group. Results: Majority of the patients belongs to age group between 21-25 years, Most of them were married and multigravidae requesting MTP, Longer the average procedural time observed with electrical vacuum aspiration (8.1 min) than manual vacuum aspiration (7.6 min). Average amount of blood loss compared with gestational age in both the procedure there is excessive amount of blood loss with increasing gestational age and blood loss is comparatively more with electrical vacuum aspiration (21.6 ml) than manual vacuum aspiration (16.6 ml). There are no complications during procedure with both vacuum sources. Incomplete evacuation rate with MVA was 4% and with electrical vacuum aspiration 2%. In the follow up after 1 month complications are nil with both the procedures. Conclusions: MVA procedure leads to marked improvement in the quality of abortion care, being its low maintenance, relatively inexpensive and easily transportable instrument, with eliminating need for electricity with these features combined with success in first trimester pregnancy termination.