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

efficacy of tamsulosin in lower reteral calculi

There has been a paradigm shift in the management of ureteral calculi in the last decade with the introduction of new less invasive methods, such as ureterorenoscopy and extracorporeal shock wave lithotripsy [ESWL]. Recent studies have reported excellent results with medical expulsive therapy [MET] for distal ureteral calculi, both in terms of stone expulsion and control of ureteral colic pain. We conducted a comparative study in between watchful waiting and MET with tamsulosin. We conducted a comparative study in between watchful waiting [Group I] and MET with tamsulosin [Group II] in 60 patients, with a follow up of 28 days. Independent 't' test and chi-square test. Group II showed a statistically significant advantage in terms of the stone expulsion rate. The mean number of episodes of pain, mean days to stone expulsion and mean amount of analgesic dosage used were statistically significantly in Group II [P value is 0.007, 0.01 and 0.007, respectively] as compared to Group I. It is concluded that MET should be considered for uncomplicated distal ureteral calculi before ureteroscopy extracorporeal lithotripsy. Tamsulosin has been found to increase and hasten stone expulsion rates, decrease acute attacks by acting as a spasmolytic, reduces mean days to stone expulsion and decreases analgesic dose usage

Correlation between high-resolution computed tomography features and patients' characteristics in chronic obstructive pulmonary disease

During the last few decades, high-resolution computed tomography [HRCT] has come up as a new diagnostic modality to diagnose emphysematous and chronic bronchitis components of chronic obstructive pulmonary disease [COPD]. The present study was undertaken to evaluate for various quantitative and qualitative HRCT features in patients with COPD, and to detect patients' characteristics that correlate with these HRCT features. Forty male patients with COPD attending the COPD clinic at a tertiary referral hospital and postgraduate medical institute were included in the study. Various HRCT features, including tracheal index, thoracic cage ratio, sterno-aortic distance, thoracic cross-sectional area, vascular attenuation, vascular distortion, mosaic attenuation pattern, and directly visible small airways, were evaluated and correlated with patients' characteristics, including age, duration of illness, quantum of smoking, dyspnea score, quality-of-life index, and various spirometric indices. We found significant correlations of various quantitative and qualitative HRCT features with age, duration of illness, quantum of smoking, quality-of-life index, and the spirometric indices showing the extent of airways obstruction. Various quantitative and qualitative HRCT features were found to correlate with patients' characteristics, spirometric indices, and health-related quality-of-life score, suggesting that HRCT is useful not only in detecting emphysema and its various subtypes but also in predicting the extent and severity of COPD