ABSTRACT
Background: The changing trend from an inpatient to outpatient has urged us to use short-acting local anesthetic with adjuvantssuch as opioids to intensify sensory block without affecting sympathetic blockade in spinal anesthesia. This study was designedto compare the safety and efficacy of 25 µg fentanyl as an adjuvant to either 10 mg levobupivacaine or 40 mg chloroprocaineintrathecally.Materials and Methods: In this prospective, randomized, clinical trial, 60 patients of 18–60 years were randomly divided into twogroups of 30 each, to receive either 4 ml of 1% chloroprocaine (40 mg) plus 25 µg fentanyl (Group C) or 2 ml of 0.5% isobariclevobupivacaine (10 mg) plus 25 µg fentanyl (Group L) intrathecally. Patients were monitored for 24 h for sensory and motor blockcharacteristics as a primary outcome and post-operative analgesia, hemodynamics, and side effects as a secondary outcome.Results: Onset of sensory block and time to maximum sensory block were rapid in Group C (2.53 ± 1.20 min and 4.40 ± 1.45 min)as compared to Group L (4.43 ± 1.12 min and 8.10 ± 0.83 min) (P < 0.001). The maximum sensory block was T4 in Group C and T6in Group L. Maximum Bromage score was 2 in both groups but achieved earlier in Group C as compared to Group L (P < 0.001).Duration of sensory and motor block was significantly prolonged in Group L (264.47 ± 29.97 min and 173.80 ± 31.47 min)as compared to Group C (101.50 ± 10.30 min and 75.93 ± 10.41 min). The total duration of analgesia was also prolonged inGroup L (259.83 ± 29.60 min) as compared to Group C (96.50 ± 9.84 min). Patients remained hemodynamically stable and nosignificant side effects and complications were noted.Conclusion: Chloroprocaine provides adequate duration and depth of surgical anesthesia for short procedures with theadvantages of faster block resolution.
ABSTRACT
Enhanced recovery after surgery (ERAS) protocols termed as “fast track surgery” have now become an essential componentin the perioperative period to improve post-operative outcomes. It is both the patient and the health services who receive thebenefits of ERAS. It is a new and different approach when compared to traditional practices which aims at enhanced care ofsurgical patients. It includes pre-operative, intraoperative, and post-operative components which when applied altogether givebest possible results. Effective implementation of ERAS protocols is associated with fast recovery of gut function and reducedrate of complications. All these factors further lead to decreased post-operative hospital stay, thereby decreasing hospital costand increasing patient satisfaction.
ABSTRACT
Background: Priming is one of those techniques in which a small dose of non-depolarizing muscle relaxants is administeredfollowed by a large intubating dose. Cisatracurium is the newly introduced drug with Hoffman elimination. The problem with itsuse is delayed onset of action. The present study was conducted to compare the onset of cisatracurium for tracheal intubationwith and without priming dose of rocuronium.Materials and Methods: A total of 60 American Society of Anesthesiologist physical Status Ι and ΙΙ patients undergoing surgeryunder general anesthesia were included in the study. Patients were divided into two groups of 30 each. Patients in Group Rreceived priming dose of rocuronium 0.06 mg/kg before intubating dose of cisatracurium (0.14 mg/kg). Group C patients didnot get any priming, only normal saline was given before intubating dose of cisatracurium (0.15 mg/kg).Results: Time gap between administration of the cisatracurium and complete loss of T1 was recorded as intubation time.The intubation time was significantly less in Group R, i.e., 130 ± 11.02 s as compared to Group C, i.e., 230.33 ± 12.82 s. Theintubating conditions were similar in both the groups. The hemodynamic changes were statistically insignificant. The time to25% recovery of the T1 response is defined as the clinically effective duration of neuromuscular block. The rate of recovery isdescribed by the recovery index, which is defined as the time from 25% to 75% T1 recovery.Conclusion: Priming with rocuronium decreased the onset time without increasing the clinical duration of action or recovery index.
ABSTRACT
Background: Both pharmacological and non-pharmacological strategies for pain relief in labor have been tried and tested sincelong. Combined spinal-epidural analgesia (CSEA) satisfies the basic requisites of labor analgesia. Various concentrations oflocal anesthetics along with the addition of opioids can be used. The objective of this study is to compare the quality of laboranalgesia with two different concentrations of ropivacaine (0.2% vs. 0.125%) and assess fetomaternal outcome.Materials and Methods: A total of 60 primipara women with a singleton pregnancy in active labor were given CSEA afterrandomly allocating them in two groups of 30 each. Both Group A and Group B received intrathecal injection of 4 mg (2 ml)0.2% ropivacaine + 25 µg (0.5 ml) fentanyl: Group A - epidural dose of 15 ml of 0.2% ropivacaine solution + 2 µg/ml fentanyland Group B - epidural dose of 15 ml of 0.125% ropivacaine + 2 µg/ml fentanyl. Then, continuous epidural infusion was startedat the rate of 10 ml/h which was continued until the end of delivery.Results: GroupA showed better maintenance of analgesia and better maternal satisfaction while parturients in Group B neededrescue top-up analgesia due to breakthrough pain.Conclusions: It was concluded that ropivacaine in both concentrations (0.2% and 0.125%) with fentanyl is effective forinitiation of labor analgesia. However, quality of analgesia with 0.2% ropivacaine concentration is superior to 0.125%concentration.
ABSTRACT
Introduction: Laryngeal mask airway (LMA) cuff pressure has been implicated as a prime reason for post-operative sore throat.LMA cuff pressure increases when the air is used for the cuff inflation during oxygen: Nitrous oxide (O2: N2O) anesthesia, whichresults in post-operative pharyngolaryngeal adverse events. We conducted this study to compare the effect of LMA supremecuff inflation with air, air: Oxygen, and oxygen: Nitrous oxide mixture in adults.Aim: The aim of the study was to compare the changes in cuff pressure intraoperatively with different gas composition (air,air: Oxygen mixture, and oxygen: Nitrous oxide mixture) used to inflate the LMA supreme by a manometer and post-operativepharyngolaryngeal morbidity.Design: It was a potential randomized double-blind study which was conducted on 120 patients admitted for elective surgeryunder general anesthesia.Materials and Methods: A total of 120 patients were randomly allocated into three groups of 40 each according to thecomposition of gases used to inflate the supreme LMA cuff to achieve 40 cm H2O cuff pressure, air was used as cuff inflationmedium in Group A, air: Oxygen mixture in Group AO, and oxygen: Nitrous oxide mixture in Group ON.Statistical Analysis: The cuff pressure, ventilatory parameters, and post-operative pharyngolaryngeal complications werenoted. The analysis was done by Student’s t-test and Chi-square test. P < 0.05 was considered statistically significant.Results: In Group A and Group OA cuff pressure significantly increased from initial cuff pressure of 40 cm H2O until the end ofthe surgery to 74.35 ± 7.41 cm H2O and 56.35 ± 3.63 cm H2O, respectively. An initial decrease in cuff pressure was observedat 15 min to a mean of 32.85 ± 1.42 cm H2O in Group ON which again gradually increased to near initial pressures to a meanof 40.10 ± 2.31 cm H2O toward the end of surgery. Cuff volume increased in Group A and Group AO; however, it decreased inGroup ON (23.18 ± 4.45 ml, 18.73 ± 2.61 ml, and 11.50 ± 1.93 ml, respectively) from initial values. Ventilatory and hemodynamicparameters were comparable in all the three groups. A significant difference in pharyngolaryngeal morbidity was observedbetween Group A and Group ON.Conclusion: Cuff inflation with 50% O 2: N2O mixture provided more stable cuff pressure in comparison to air and O2: Air mixtureduring O2: N2O anesthesia. Ventilatory parameters and hemodynamic parameters did not change with variation in SLMA cuffpressure. Post-operative pharyngolaryngeal morbidity had a strong correlation with cuff pressure and was more in Group Aand least in Group ON.