ABSTRACT
Introduction: Laparoscopic cholecystectomy is one of thecommonest surgery performed under general anesthesiain our set up but maintaining the hemodynamic stability ischallenging in these patients .Due to its well-known advantageslike less post-operative pain, shorter hospitalization and fasterfunctional recovery, laparoscopic cholecystectomy is alsotermed as patient friendly surgery. The Dexmedetomidine isa relatively new potent and highly selective α2-adrenoceptoragonist that has been used to provide sympatholysis,analgesia and sedation in the perioperative period. Thepresent prospective, randomized study was designed toanalyse the effect of IV dexmedetomedine on intraoperativehemodynamics, and the incidence of side effects in patientsscheduled for laparoscopic cholecystectomy.Material and methods: After obtaining approval fromHospital Ethics Committee, Study was conducted on 80 adultpatients aged 18-60 years, of ASA grade I or II of either sex,scheduled for laparoscopic cholecystectomy under generalanesthesia. Patients were randomized into two groups of 40patients each. Patients of Group D received dexmedetomedineinfusion (loading: 0.7μg/kg and maintenance: 0.4μg/kg/hr)and Group C (control group) received normal saline infusionwith the same rate as group D. Patients were monitored forchanges in heart rate, ECG, systemic blood pressure andEtCO2, at baseline, at 5 min and 10 min after giving studydrug bolus, after induction, intubation, skin incision and CO2insufflation. Thereafter, these changes were recorded at 15min intervals till the end of surgeryResults: It was found that dexmedetomidine significantlyreduces heart rate, systolic, diastolic and mean arterialblood pressure .It was observed that perioperative use ofdexmedetomidine infusion maintained better hemodynamicstability as compared to the normal saline in control groupand has sparing effect on other anaesthetic drug mainly onproppfol and fentanyl.Conclusion: Dexmedetomidine infusion was a betteroption for maintaining hemodynamic stability duringlaparoscopic surgeries. Dexmedetomidine effectivelyattenuates haemodynamic stress response during laparoscopiccholecystectomy with reduction in requirement ofconcomitantly-administered anaesthesia maintaining drugs.
ABSTRACT
Introduction: Regional anaesthesia in children was firststudied by August Bier in 1899 Intraoperative blockade ofthe neuraxis, whether by the spinal or epidural route providesexcellent analgesia with minimal physiologic alteration.This study was done with the primary aim to compare spinalanaesthesia with caudal anaesthesia in lower paediatric agegroup patients undergoing elective infraumbilical surgery forduration of analgesia and hemodynamic stability. We alsocompared the characteristics of sensory and motor block.Material and methods: In this study 100 patients whofulfilled the eligibility criteria were chosen and the procedurewas explained to the patients attendant. After obtainingwritten and informed consent, patients were randomizedinto two equal groups of 50 each. Group S was given spinalanaesthesia- hyperbaric bupivacaine (0.5%) in a dose of 0.5mg/kg was injected. Group C was given caudal block-0.5%plain bupivacaine 2mg/kg plus normal saline. Postoperativelypatients were observed for analgesia, sedation, hemodynamicand complications if any.Result: The sensory level achieved in all cases of group S wasT10 while in group C it was in 93%.Mean onset time, durationand regression of sensory block as well as for motor block washigher in caudal group than spinal group.The time required forfirst supplement was delayed in caudal group.Cries scale wasnot the limiting factor in both the groups.Conclusion: In short surgeries requiring immediate relaxationspinal anaesthesia is preferable while in surgeries withmoderately prolonged duration caudal is preferable.
ABSTRACT
Introduction: Propofol is an anaesthetic drug which is given toinduce and maintain anaesthesia in adults undergoing surgery.This prospective, randomized, controlled study was designedto evaluate the efficacy of cisatracurium as a pretreatment drugin reducing incidence and severity of propofol injection pain.Material and methods: Patient undergoing generalanaesthesia were randomized in four groups of 25 patientseach. Group A received normal saline (control group), GroupB received Cisatracurium 0.05mg/kg IV, Group C receivedCisatracurium 0.1mg/kg IV, Group D received Cisatracurium0.15mg/kg IV. All drugs were administered into the largestdorsal vein of the hand with venous occlusion for 30 sec,followed by propofol (0.5mg/kg). Pain was evaluated usinga four point scale.Result: Cisatracurium 0.15mg/kg significantly lowers bothincidence and severity of propofol induced pain. Cisatracurium0.1mg/kg and cisatracurium 0.05mg/kg both significantlylower the severity of pain but not the incidence as comparedto control group.Conclusion: Cisatracurium is an effective drug in reducingpropofol induced pain. It reduces the incidence and severityboth of pain in 0.15mg/kg dose. Whereas only severityis decreased with 0.10 mg/kg and 0.05 mg/kg dose ofcisatracurium without any significant complications.
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Introduction: This randomized placebo controlled study wasdesigned to evaluate the effectiveness of magnesium sulphateas an agent to induce hypotensive anaesthesia in lumbar spinesurgery.Material and Methods: The study included 100 patients ofboth sexes who were equally distributed in two groups, theGroup Mg(Magnesium sulphate group) and Group C (controlgroup). The Magnesium group received magnesium sulphate40mg/kg administered as a slow IV bolus over a period of 10minutes before induction and 15mg/kg/hr by continuous IVinfusion during surgery. The same volume of isotonic salinewas administered to the control group. Surgical time, heartrate and mean arterial blood pressure was measured.Results: In the magnesium group there was reduction insurgical time (103.54 mins vs 117.34 mins), although theanaesthestic time was 9 minutes longer in the Magnesiumgroup denoting a longer emergence time. The mean arterialpressure and heart rate were significantly reduced inMagnesium group(p<0.005). Postoperative shivering was alsoless in Magnesium group.Conclusion: Magnesium infusion resulted in a steady andsmooth reduction in mean blood pressure and reduced heartrate, with no episodes of severe hypotension. Furthermoremagnesium causes reduction in duration of surgical time andpostoperative shivering
ABSTRACT
Introduction: Study was conducted to determine the conditionsfor insertion of LMA following induction of anaesthesia with(Propofol, 2 mg/kg) and (Thiopentone, 5 mg/kg, preceded by10%Lignocaine spray to the posterior oropharyngeal wall) byobserving six different parameters (gagging, laryngospasm,body movements, coughing, ease of insertion, jaw relaxation)and assessing all six parameters together with Lund andStovner gradingsystem. The hemodynamic parameters wererecorded during induction of anaesthesia and following LMAinsertion.Material and Methods: Patients were allocated randomlyinto two groups, (40 patients per group), Group A- Propofoland Group B- Thiopentone, preceded with 10%Lignocainespray.Results: In Group A significant decrease in HR (p<0.05),systolic BP (p<0.01), diastolic BP (p<0.01) and mean BP(p<0.01) was observed as compared to Group B. The overallassessment for the ease of insertion of LMA was 100%inGroup A and 97.5%in Group B which was statistically notsignificant (p=0.314). No significant difference was observedin gagging (p=0.152), laryngospasm (p=0.314), bodymovements (p=0.221), coughing (p=0.221), jaw relaxation(p=0.314) and the ease of insertion (p=0.314).Discussion: 10% Lignocaine spray suppresses upper airwayreflexes in Thiopentone group and facilitates LMA insertionwithout any adverse response.Conclusion: Thiopentone preceded with 10%Lignocainespray to the posterior oropharynx (Group B) provides almostequal conditions for LMA insertion as compared to Propofol(Group A) with better hemodynamic stability
ABSTRACT
Background: Subarachnoid block is a safe and effective alternative to general anaesthesia when surgical site is located on the lower extremities, perineum or lower body wall. Spinal anaesthesia produces intense sensory and motor blockade as well as sympathetic blockade. Intrathecal α-2-agonists are used as adjuvant drugs to local anaesthetics successfully over the last decade .They potentiate the effect of local anaesthetic and decrease the required doses. Clonidine is a partial α-2-adrenorecptor agonist used intrathecally, with a well- established record of efficacy and safety. Its addition to local anaesthetics prolongs the duration of both motor and sensory spinal blockade. Dexmedetomidine is an α-2-adrenorecptor agonist. It has α-2/α1 selectivity ratio which is eight times higher than that of Clonidine. With this background, this study was conducted to compare the effects of intrathecal Ropivacaine plus Dexmedetomidine versus Ropivacaine plus Clonidine during procedures. Methods: The present prospective study was carried out in the Department of Anaesthesiology, M.G.M. Medical College and M.Y. Hospital, Indore (M.P.), India. Study period was from June 2011 to July 2012. Patient were randomly allocated to one of the following three group in a double blinded fashion based on computer generated code: Ropivacaine (R), Ropivacaine + Dexmedetomidine (D); Ropivacaine + Clonidine (C). Nominal categorical data between study groups were compared using the Chi – squared test or Fisher’s exact test as appropriate. p<0.05 was considered to be significant. Results: In all age groups patients were equally distributed in three Groups. Mean time taken for the onset of sensory and motor block was quite low in group D patients. Thereby showing statistically highly significant difference in onset of sensory and motor blocks (P<0.001). Whereas mean duration of sensory and motor block was also quite prolonged in group D patients. (p<0.001) There is significant difference between all the three groups. Conclusion: In conclusion our study shows that intrathecal Dexmedetomidine or Clonidine added with isobaric Ropivacaine produces rapid and prolonged sensory and motor block as compared to plain Ropivacaine.