Cisatracurium Pretreatment with Tourniquet - Role in Propofol Injection Pain: A Prospective, Randomized, Double Blind and Control Study

Introduction: Propofol is an anaesthetic drug which is given toinduce and maintain anaesthesia in adults undergoing surgery.This prospective, randomized, controlled study was designedto evaluate the efficacy of cisatracurium as a pretreatment drugin reducing incidence and severity of propofol injection pain.Material and methods: Patient undergoing generalanaesthesia were randomized in four groups of 25 patientseach. Group A received normal saline (control group), GroupB received Cisatracurium 0.05mg/kg IV, Group C receivedCisatracurium 0.1mg/kg IV, Group D received Cisatracurium0.15mg/kg IV. All drugs were administered into the largestdorsal vein of the hand with venous occlusion for 30 sec,followed by propofol (0.5mg/kg). Pain was evaluated usinga four point scale.Result: Cisatracurium 0.15mg/kg significantly lowers bothincidence and severity of propofol induced pain. Cisatracurium0.1mg/kg and cisatracurium 0.05mg/kg both significantlylower the severity of pain but not the incidence as comparedto control group.Conclusion: Cisatracurium is an effective drug in reducingpropofol induced pain. It reduces the incidence and severityboth of pain in 0.15mg/kg dose. Whereas only severityis decreased with 0.10 mg/kg and 0.05 mg/kg dose ofcisatracurium without any significant complications.

Evaluation of laryngoscopic view, intubation difficulty and sympathetic response during direct laryngoscopy in sniffing position and simple head extension: a prospective and randomized comparative study.

Background: Airway management is critical to the care of patients and direct laryngoscopy is the mainstay of airway management. Despite the proliferation of difficult airway devices, sniffing position for laryngoscopy remains the gold standard and ideal position. This prospective, randomized and single-blind study was done to evaluate and compare the laryngoscopic view, complexity of intubation and sympathetic response during laryngoscopy in sniffing position and simple head extension. Methods: One hundred and twenty patients, aged 20-50 years with American Society of Anesthesiologists (ASA) status 1 and 2 undergoing general anesthesia requiring orotracheal intubation were randomized into two groups. Group A used sniffing position and group B was put in simple head extension. Glottis visualization was assessed using Cormack and Lehane grade and ease of intubation was assessed on intubation difficulty scale. Laryngoscopic sympathetic response in two positions was also assessed. Results: Both the groups were comparable in demographic profiles. Glottic visualization and intubation difficulty score were better and statistically significant in sniffing position as compared to simple head extension. Although, sympathetic response was lower in sniffing position as compared to simple head extension, it was statistically insignificant. Conclusion: Sniffing position provided better glottis visualization and intubation difficulty score and increased the success rate of intubation as compared to simple head extension.