Intravenous dexmedetomidine vs. lignocaine in attenuating the hemodynamic responses during laryngoscopy and endotracheal intubation: a randomized double blind study

Background: The stress response to laryngoscopy and endotracheal intubation is a commonly encountered physiological phenomenon. Though the response can be transient and harmless in normotensive healthy patients, but it may prove hazardous amongst patient with underlying cardiac disease, or hypertensive disease and its sequelae. Present study was planned to evaluate the efficacy of IV dexmedetomidine infusion and IV lignocaine in attenuating the hemodynamic responses during laryngoscopy and intubation

Methodology: On approval from hospital ethical committee, 120 ASA grade I and II, normotensive patients in the age group of 18-60 years, planned for elective surgery under general anesthesia were enrolled in the study. Patients were divided into 3 equal groups of 40 each; Group A [Lignocaine group] received lignocaine 1.5 mg/kg IV 2 min before induction, Group B [dexmedetomidine group ] received dexmedetomidine 1 micro /kg IV infusion with syringe pump 10 min before induction, and Group C [control group] received normal saline before induction. Heart rate [HR], systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP], oxygen saturation of arterial blood [SpO2] and electrocardiogram [ECG] were monitored at induction, intubation and post intubation at one minute interval till 10th minute

Results: A better control of stress response was observed in patients receiving dexmedetomidine infusion. More decrease in HR was noted in Group B as compared to Group A [9.28 % vs. 13.40%] respectively. The decrease in MAP was also more in Group B as compared to group receiving lignocaine [5.49 % vs. 10.72%] respectively

Conclusion: Dexmedetomidine 1 micro g/kg IV is more effective in blunting stress response to laryngoscopy and endotracheal intubation as compared to lignocaine 1.5 mg/kg IV

Cauda equina syndrome after repeated spinal attempts: a case report and review of the literature

Spinal and epidural blocks are widely used for cesarean section. Spinal hematoma causing cauda equina syndrome is a rare complication after spinal anesthesia [SA], but can lead to severe neurological deficit. It is usually associated with difficult SA and requires surgical decompression in most of the cases