ABSTRACT
Background: Orthopaedic surgeries of upper and lower limb extremities often require a tourniquet as it enables a surgeon to work in a bloodless operative field. The changes occurring due to tourniquet inflation and deflation may go unnoticed in ASA I & ASA II patients. However they may be significant in higher risk group. We planned this observational study to determine the changes occurring in EtCO2 after toutniquet deflation in orthopaedic surgeries.Methods: Study was conducted in 100 patients, belonging to ASA grade I & II, 18 – 65 years of age, posted for elective & emergency upper or lower limb surgery requiring tourniquet. At the end of surgery pre release EtCO2 was recorded. Then after deflating the tourniquet EtCO2 was recorded at following intervals – 0 minute ( just after deflation of tourniquet ), then at 1, 5, 10, 15, 20 and 30 minutes. Results: Increase in EtCO2 following tourniquet release was reported in all type of anaesthesia cases. Conclusion: There was a peak rise in EtCO2 at one minute in all type of anaesthesia cases.EtCO2 remained significantly high for 15 minutes following tourniquet deflation and came to baseline at 20 minutes in GA ( ventilation controlled ) cases. In spontaneously breathing ( regional anaesthesia ) patients, EtCO2 remained significantly high for 10 minutes and came to baseline at 15 minutes.
ABSTRACT
Context: Electrical cardioversion is a short painful procedure to regain normal sinus rhythm requiring anaesthesia for haemodynamic stability, sedation, analgesia and early recovery. Aims: To compare propofol and etomidate as sedatives during cardioversion. Settings and Design: Single centred, prospective and randomized single blind study comprising 60 patients. Subjects and Methods: Patients more than 18 years, American Society of Anesthesiologists I/II/III grades undergoing elective cardioversion, randomly divided to receive propofol 1 mg/kg intravenous (IV) bolus followed by 0.5 mg/kg (Group P, n = 30) or etomidate (Group E, n = 30) 0.1 mg/kg followed by 0.05 mg/kg. All patients received IV fentanyl (1 μg/kg) before procedure. Heart rate, blood pressure (BP) (systolic BP [SBP], diastolic BP [DBP], mean arterial pressure), respiratory rate, Aldrete recovery score (ARS) and Ramsay sedation score (RSS) were assessed at 1, 2, 5, 10, 15, 20 and 30 min post cardioversion. Incidence of hypotension, respiratory depression and side effects were compared. Statistical analysis used: Student’s unpaired t‑test, Chi‑square test and Mann–Whitney test. P < 0.05 was taken as significant. Results: Group P showed significant fall in SBP, DBP, and mean BP at 2 min after cardioversion. Hypotension (33.3% Group P vs. 16.65% Group E) occurred more with propofol (P < 0.05). Group E showed better ARS at 1, 2, 5, 10, 15 and 20 min. Time required to attain RSS = 2 (659.1 s Group P and 435.7 s Group E) indicated longer recovery with propofol. Left atrial size (35.5-42.5 mm) did not affect success rate of cardioversion (80% Group P vs. 83.3% Group E). Incidence of myoclonus (Group E 26.67% vs. Group P 0%) showed significant difference. Conclusions: Etomidate/fentanyl is superior over propofol/fentanyl during cardioversion for quick recovery and haemodynamic stability.