To Study the Effect of I.V. Dexmedetomidine by Two Different Means for Prevention of Pain Due to Propofol Injection

Background: The incidence of propofol injection pain during induction of general anaesthesia varies from28% to 85%. Purpose: To Study the Effect of I.V. Dexmedetomidine by Two Different Means for Preventionof Pain Due to Propofol Injection. Material and Methods: This prospective, randomized study we evaluatedthe effect of dexmedetomidine for reducing the incidence and severity of propofol injection pain by twodifferent approaches while evaluating the hemodynamic stability. 120 Patients undergoing elective surgicalprocedures were randomly divided into four groups; in group I and II with the aim of keeping the drug withinthe vein the forearm was squeezed with a tourniquet up to 70 mmHg for 20 sec; the patients were administered0.5µg/kg dexmedetomidine in Group 1 (n 30), 0.75µg/kg dexmedetomidine in Group 2 (n 30) for 5 min,followed by 15 ml of 1% propofol in all patients over 25 seconds to induce anaesthesia. In Group 3 and 4;0.5µg/kg and 0.75µg/kg dexmedetomidine was premixed with 15ml propofol respectively and administeredfor induction. Pain is graded on a 0– 6 scale. Results: Overall median propofol injection pain score reductionwas 65.75% with the maximum reduction of 80% seen in group 4 and minimum reduction of 50% in group1. There were statistically significant differences (p Â0.05) in both SBP and DBP and heart rate with themaximum decrease in all hemodynamic parameters in group 2 and 4. Conclusion: Pre-treatment withintravenous dexmedetomidine 0.75µg/kg, 5min prior to injection of long-chain triglyceride propofol is effectiveand safe in reducing the incidence and severity of pain due to propofol injection.

Comparative Study of Evaluation of Pain on Injection of Propofol Pretreatment with two Different Doses of Butorphanol.

In a prospective, double-blind, placebo-controlled, randomized trial one-hundred-sixty eight ASA I-II adults, undergoing laparoscopic cholecystectomy were randomly assigned into 3 groups of 56 each. Group L received lidocaine 2% (40 mg), Group B-1 received butorphanol 1 mg. and Group B-2 received butorphanol 2 mg. One min after pretreatment patients received one-fourth of the total calculated dose of propofol (2.5 mg/kg) over 5 s. In the lignocaine group 28 (50.00%) patients had pain during propofol injection as compared with 11 (19.64%) and 9 (16.07%) in the butorphanol 1mg and butorphanol 2mg groups, respectively (P < 0.05). Intergroup comparison revealed that although the incidence of pain at propofol injection was more in lignocaine group, the severity was primarily mild and comparable among the three groups (P > 0.05). Butorphanol decreased the frequency (P < 0.05) of propofol pain when compared with lidocaine. However severity of pain on injection of propofol was comparable among both the groups given pretreatment with butorphanol. (P > 0.05). No difference in complications, such as pain, edema, wheal, or flare response, were observed at the injection site within the first 24 h after the operation. Duration of analgesia was higher in Group-B-2 compared to other two groups. (142.5±33.96 minutes in Group-B-2, 76.07±23.56 minutes in Group-B-1 and 80.35±21.48 minutes in Group -L). However this was also associated with higher number of patients in deep sedation at 30 minutes. Pretreatment with butorphanol 1 mg or 2mg are equally effective in relieving pain on injection of propofol & more effective than lignocaine.

Implicaciones anestésicas de un caso de leucodistrofia metacromática / Anaesthetic implications in a case of metabolic leukodystrophy

Metachromatic leukodystrophy is a progressive, inherited and neurodegenerative disease. A patient suffering from this disease poses a lot of anaesthetic problems. We have successfully anaesthetized a female child with general anaesthesia who was suffering from metabolic leukodystrophy.

La leucodistrofia metacromática es una enfermedad progresiva hereditaria y neurodegenerativa. Un paciente que sufre de esta enfermedad representa múltiples problemas anestésicos. Hemos anestesiado exitosamente una niña que sufre de leucodistrofia metacromática con anestesia general.

Comparison of Esmolol and Lignocaine for Atttenuation of Cardiovascular Stress response to Laryngoscopy and Endotracheal Intubation.

Direct laryngoscopy and endotracheal intubation frequently induces a cardiovascular stress response due to reflex symbathetic stimulation. This response may be hazardous in patients with Hypertension, Coronary artery disease, Myocardial disease, cerebrovascular disease. Numerous agents have therefore been utilized to blunt this response. The present study was undertaken in view of above mentioned facts, to compare effectiveness of intravenous esmolol and lignocaine in suppressing the cardiovascular stress response. Patients were divided in to three groups of 20 patients each. Group-C did not receive any drug under study. Group-L received lignocaine and Group-E received esmolol three minutes before intubation. All the groups were observed for changes in haemodynamic parameters i.e. heart rate (HR) systolic and diastolic blood pressure every minute after intubation till 5 minutes post intubation. It was found that patients given esmolol had better attenuation of stress response to laryngoscopy and intubation than patients given lignocaine.

An unusual variation in the anatomy of the uncinate process in external dacryocystorhinostomy.

Variations in the bony components of the nose are often encountered. One such variation was found in a 49-year-old male who had undergone conventional external dacryocystorhinostomy for adult onset nasolacrimal duct blockage. Intraoperatively, a thick bar of bone was seen beneath and parallel to the lacrimal sac fossa after a complete osteotomy had been made. Another osteotomy had to be fashioned in this bone to reach the nasal cavity. Postoperative 3D computed tomographic scan revealed the bone to be an anatomical variation of the uncinate process of the ethmoidal bone which was rather anteriorly placed, much thicker than usual, and attached to the nasal roof. The uncinate process is thin, curved and its anterior edge may frequently overlap some part of the lacrimal fossa. However, to our knowledge, the presence of such a large and thick uncinate process necessitating an additional large osteotomy has not been reported.

Sudoriferous cyst of the orbit of adult origin after trauma.

A rare case of sudoriferous cyst of the orbit occurring in an adult, who had facial trauma, is reported. Several factors suggest its adult onset. The only other case reported in an adult is of presumed childhood origin. Very few congenital cases have been reported. A 65-year-old lady presented with recent onset of left-sided ptosis and a painless mass below the left supraorbital margin. The patient had traumatic ptosis after a road traffic accident 13 years ago. The ptosis was surgically repaired, which resulted in symmetrical palpebral apertures. Computed tomographic scan revealed a well-defined cystic mass in the anterior orbit. The mass was removed in toto by anterior orbitotomy. Histopathological examination revealed a single cyst lined by double-layered cuboidal epithelium in some areas and transitional epithelium at others. A periodic acid Schiff (PAS) positive, diastase-resistant glycocalyx lined the inner epithelium. Apical snouting suggested an apocrine nature. This confirmed a diagnosis of sudoriferous cyst.

An Accessory Uterine Cavity As A Cause of Pelvic Pain.

Mullerian abnormality is a rare cause for pain abdomen and especially in multiparae who have dysmenorrhoea. It may interfere with quality of life. Surgical treatment if offered early may reduce suffering. We hereby report a case to increase the awareness regarding the mullerian abnormality as a cause of chronic pelvic pain in females.

Prophylactic Antiemetic Therapy with Ondansetron, Granisetron and Metoclopramide in Patients Undergoing Laparoscopic Cholecystectomy Under GA.

The aim of the present study was to compare the antiemetic effect of intravenous Granisetron, Ondansetron & Metoclopramide in a randomized blinded study for prophylaxis of post operative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy under general anaesthesia. 60 patients (ASA I & II) undergoing laparoscopic cholecystectomy under general anaesthesia were randomly allocated into three equal groups (n=20). Emetic episodes in first 24 hours were recorded and compared in different study groups. Results were analyzed. Minimal emetic episodes were observed in early post-operative period (1-12hrs) in patients who had received intravenous granisetron in comparison to ondansetron and metoclopramide. However, after 12 hours emesis free periods were statistically insignificant between group A and B while patients in group C had no antiemetic effect.