Comparison of dexmedetomidine and fentanyl as intrathecal adjuvants to 0.5% hyperbaric bupivacaine for total abdominal hysterectomy under subarachnoid block: a prospective randomized double blind study

Background: Subarachnoid block is still the most commonly used anesthetic technique for lower abdominal surgeries, however local anesthetics alone are associated with relatively short duration of action.The intrathecal adjuvants has been reported to improve the quality of anesthesia along with prolongation of postoperative analgesia and has gained popularity nowadays. So the aim of our study was to compare the dexmedetomidine and fentanyl as intrathecal adjuvant to 0.5% hyberbaric 0.396 bupivacaine with regards respect to onset and duration of sensory and motor block, duration of analgesia, hemodynamic variations and incidence of side effects

Material and Methods: Sixty four female patients, aged 30-60 years, belonging to American Society of Anesthesiologists [ASA] physical status I or II, scheduled for elective total abdominal hysterectomy with or without bilateral salpingo-oophorectomy were randomly allocated into two groups, Group BD received 2.5 ml of 0.5% hyperbaric bupivacaine and 5 microg dexmedetomidine diluted in 0.5 ml preservative free normal saline while Group BF received 2.5 ml of 0.5% hyperbaric bupivacaine and 25microg [0.5 ml] fentanyl

Results: There was no statistically significant difference between two groups with respect to onset of sensory and motor block, [p > 0.05]. The mean time for two segment sensory regression was significantly slower in Group BD as compared to Group BF, [p < 0.05]. Patients in Group BD had significantly prolonged duration of sensory and motor block as compared to Group BF [p < 0.05]. Similarly the duration of analgesia was significantly prolonged in Group BD [p < 0.05], along with reduced requirement of rescue analgesics. The patients in both groups did not show any significant difference with respect to hemodynamic changes and incidence of side effects [p > 0.05]

Conclusion: Dexmedetomidine as intrathecal adjuvant was found to have prolonged sensory and motor block, provide good quality of intraoperative analgesia, stable hemodynamics, minimal side effects and prolonged postoperative analgesia along with reduced demand for rescue analgesics as compared to fentanyl

Anesthetic management of a patient with atrial fibrillation posted for emergency exploratory laparotomy for perforation peritonitis: a review of literature

Atrial fibrillation is very common cardiac arrythmia which is encountered during the perioperative period.Atrial fibrillation in perioperative period may lead to haemodynamic impairment and thromboembolic events resulting into significant morbidity and mortality.So it is very crucial for an anesthesiologist to maintain the haemodynamic stability of the patient with atrial fibrillation and prevent furthur complications associated with it.Here we report a case of forty year old female patient posted for emergency exploratory laparotomy for perforation peritonitis with pre-existing atrial fibrillation

Comparison of intubating conditions and hemodynamics during rapid sequence induction and intubation using propofol and rocuronium with low dose ephedrine and without ephedrine

Background: Rocuronium, a non-depolarizing neuromuscular blocking agent, has been used for rapid sequence induction and intubation, as it has rapid onset and acceptable intubating conditions at higher doses. Propofol, when used as an induction agent reduces cardiac output, thereby may decrease delivery of neuromuscular blocking agent at neuromuscular junction and thereby time of onset of action of rocuronium can be increased. Ephedrine has been described to speed up the onset of action of rocuronium and provide better intubating conditions during induction of anesthesia. We conducted this study to quantify the effect of ephedrine on intubation conditions and hemodynamic profile during induction of general anesthesia with propofol and rocuronium

Methodology: Sixty adult patients of ASA Grade 1 and 2, aged between 18-55 years scheduled for various elective surgeries under general anesthesia, were randomly allocated into two groups with 30 patients in each group; Group A [n = 30] received inj ephedrine 70 microg/kg followed one minute later by propofol 2.5 mg/kg with rocuronium 0.6 mg/kg and Group B [n = 30] received normal saline followed one minute later by propofol 2.5 mg/ kg and rocuronium 0.6 mg/kg. Intubating conditions and hemodynamic parameters were assessed in both groups

Results: The demographic data and baseline hemodynamic parameters were comparable between the two groups, [P > 0.05]. However, there was a significant difference in hemodynamic parameters after induction in both groups, [P < 0.05] but clinically the difference was insignificant. The intubating conditions were significantly better in Group A as compared to Group B, [P < 0.05]

Conclusion: The use of low dose ephedrine before induction with propofol and rocuronium [0.6 mg/kg] provided better intubating conditions as compared to induction with propofol and rocuronium alone at 60 seconds. The variations in hemodynamic parameters were found to be statistically significant but clinically insignificant from their baseline values