ABSTRACT
Background: Bezold Jarisch reflex is important cause of hypotension and bradycardia which occur after spinal anaesthesia. This reflex is elicited by stimulation of peripheral serotonin receptors 5- hydroxytryptamine (5- HT3 type). These receptors have antinociceptive effect, which is confirmed by many studies.The two most commonly used 5HT3 antagonist are ondansetron and granisetrone. Very few comparative studies of the two drugs on the effect after spinal anaesthesia are available.Methods: Ninety adulted patients of either sex aged 18-58 years scheduled for elective infraumbilical surgeries were randomly allocated in three groups to receive intravenous ondansetron 4mg, granisetrone 2mg or normal saline in equal volume 5mins before spinal anesthesia. Hemodynamic changes and time to sensory motor onset and regression were evaluated.Results: There was statistically significant difference in fall of systolic diastolic and mean blood pressure among the three groups. Time to two segment regression of sensory block and time to regression to S1 was faster in ondansentron (76.6±17.2mins, 176±22mins) and granisetrone group (69±17.3mins, 165±19.2mins) in comparision to control group(77.4±24.3mins, 178±21mins) which was statistically significant also p value-0.019, 0.0001 respectively.Conclusions: The prophylactic therapy with 4mg i.v. ondansetron, given five minutes before spinal anaesthesia appears to be significantly most effective and safe for attenuating haemodynamic response after spinal anaesthesia without affecting the duration of sensory block in patients undergoing infraumbilical surgeries.
ABSTRACT
Background: Airway manipulation and surgical stimulation lead to variable changes in hemodynamic profile due to increase in plasma catecholamine levels, but these changes can be attenuated by appropriate premedication. The present study was designed to compare the clinical efficacy of intravenous premedication of clonidine with nalbuphine on intraoperative hemodynamic profile of patients during surgery under general anaesthesia.Methods: Sixty adult consenting patients of ASA physical status I and II of either gender were randomized into two groups of 30 patients each, to receive either intravenous clonidine (2 μg/kg) or nalbuphine (0.2 mg/kg), 10 min before induction with propofol. Direct laryngoscopy and intubation were facilitated with vecuronium bromide. Changes in heart rate, blood pressure and electrocardiogram were recorded at specific time intervals and were noted as primary variable. Any adverse effects and complications were recorded as secondary outcomes.Results: After laryngoscopy and intubation, the increase in mean heart rate and mean blood pressure occurred immediately in patients of both groups, but persisted up to 6 to 10 min in patients of clonidine group, thereafter the changes returned back to baseline values, while in patients of nalbuphine group, this increase persisted up to 8 to 10 min. The differences in hemodynamic changes between the groups were statistically significant throughout the surgery and post extubation.Conclusions: Intravenous clonidine was more effective than nalbuphine to attenuate the hemodynamics changes during stressful period of laryngoscopy, intubation and surgery.
ABSTRACT
Laparoscopic Cholecystectomy (LC) has been conventionally done under general anaesthesia (GA). Regional anaesthesia is usually preferred in patients where GA is contraindicated. In this study, we present experience of using spinal anaesthesia (SA) for LC with the contention that it is a good alternative to GA. Spinal anaesthesia was used in 134 patients in whom LC was planned. There was no modification in the technique, and the intra abdominal pressure was kept at 8mm Hg to 12 mm Hg. Sedation was given if required, and conversion to GA was done in patients not responding to sedation or due to failure of SA. Results were compared with 100 patients who had undergone LC under GA. Out of 134 patients, two patients required conversion to GA. Hypotension requiring support was recorded in 28 (20.89%) patients, and 32 (23.88%) experienced neck or shoulder pain, or both. Postoperatively, 2.9% (4) of patients had vomiting as compared to 33% (33) of patients who were administered GA. Injectable diclofenac was required in 36.56% (49) for abdominal pain within 2 hours postoperatively and oral analgesic was required in 106 (79.10%) patients within the first 24 hours in SA group. However, 96% of patients operated under GA required injectable analgesics in the immediate postoperative period. Postural headache was experienced by 8 (5.9%) patients postoperatively. Average time of discharge was 1.9 days in patients operated under SA.