ABSTRACT
Background:Augmentation of postoperative analgesia with various adjuvants has become a standard in regional anesthesia. There are no studies about dexmedetomidine multiple approaches in supraclavicular brachial plexus block (BPB) was contrasted. We compare perineural dexmedetomidine and intravenous dexmedetomidine Bupivacaine as adjuvant in supraclavicular brachial plexus block.Materials and Methods: This prospective randomized controlled double-blind study was conducted on 120 patients with age between 20 and 60 years, both sexes, scheduled for elective upper limb surgery. Patients were randomly allocated into 3 groups, 40 patients in each received plain bupivacaine 0.5% (20ml) in supraclavicular BPB; group I (Control group): add 1mL normal saline perineural, group II: Bupivacaine with perineural dexmedetomidine (BDP) add 1 μg.kg 1dexmedetomidine perineurally. group III: Bupivacaine with intravenous dexmedetomidine (BDV) add 0.5 μg.kg-1 dexmedetomidine in 50 mL of normal saline administered as infusion over 10 min.Onset and duration of sensory and motor blocks, hemodynamic variables, adverse effects, and duration of analgesia were assessed.Results:Heart rate and mean arterial pressure was significantly decrease in group III &group II compared to group I were compared by ANOVA (F) test. onset of sensory &motor block was statistically significant shorter in group II compared to group I & III. Duration of sensory &motor block was statistically significant longer in group II compared to group I & III. there was statistically significant decrease VAS in group II were analysed using Kruskal-Wallis test between three groups. There was statistically significant increase RSS in group II & III. The first time of analgesic request was statistically significant prolonged in duration in group II.Conclusion:Perineural dexmedetomidine (1 μg/ kg) as an adjuvant to bupivacaine is significantly high thanIV dexmedetomidine (0.5 μg/ kg) and bupivacaine alone in supraclavicular BPB as regards to the onset and the duration of sensory block, so Increasingpostoperative analgesia
ABSTRACT
The present study sought to determine whether premedication with oral beta-blocker before hypotensive anesthesia with sodium nitroprusside could improve the quality of surgical field, decrease the blood loss, and decrease the need for homologous blood transfusion and duration of surgery. Eighty patients scheduled for spinal fixation surgery were included in a prospective, randomized, double-blinded study. Patients were classified into two groups: Group I received oral atenolol 50 mg twice one day before surgery; and Group II received placebo tablets identical in appearance to atenolol tablets for the same period and interval. All patients in both the groups received intraoperative sodium nitroprusside [SNP] as a hypotensive agent. Hemodynamic variables, amount of sodium nitroprusside used, quality of surgical field, and the amount of homologous blood transfusion and blood loss were compared between groups. Heart rate and amount of SNP used were significantly less [P < 0.0001] in the atenolol group, but no significant difference was found in intraoperative mean arterial blood pressure [MABP] between the two groups. The time of surgeries was significantly shorter in Group I than in Group II [185 +/- 15.21 vs 225 +/- 12.61 min], P < 0.0001. The quality of surgical field was better in Group I than in Group II in all times of measurements, P < 0.0001. The amount of blood loss and the amount of packed red blood cells transfused were significantly less in Group I than in Group II, P < 0.0001. No clinically significant complications were observed in either group. Premedication with oral atenolol 50 mg twice/day for one day before hypotensive anesthesia with SNP during spinal surgeries seems to be clinically safe and effective to reduce heart rate, amount of SNP used, amount of blood loss, and amount of blood transfused with better quality of surgical field
ABSTRACT
Although nalbuphine was studied extensively in labour analgesia and was proved to be acceptable analgesics during delivery, its use as premedication before induction of general anesthesia for cesarean section is not studied. The aim of this study was to evaluate the effect of nalbuphine given before induction of general anesthesia for cesarean section on quality of general anesthesia, maternal stress response, and neonatal outcome. Sixty full term pregnant women scheduled for elective cesarean section, randomly classified into two equal groups, group N received nalbuphine 0.2 mg/kg diluted in 10 ml of normal saline [n=30], and group C placebo [n=30] received 10 ml of normal saline 1 min before the induction of general anesthesia. Maternal heart rate and blood pressure were measured before, after induction, during surgery, and after recovery. Neonates were assisted by using APGAR0 scores, time to sustained respiration, and umbilical cord blood gas analysis. Maternal heart rate showed significant increase in control group than nalbuphine group after intubation [88.2 +/- 4.47 versus 80.1 +/- 4.23, P<0.0001] and during surgery till delivery of baby [90.8 +/- 2.39 versus 82.6 +/- 2.60, P<0.0001] and no significant changes between both groups after delivery. MABP increased in control group than nalbuphine group after intubation [100.55 +/- 6.29 versus 88.75 +/- 6.09, P<0.0001] and during surgery till delivery of baby [98.50 +/- 2.01 versus 90.50 +/- 2.01, P<0.0001] and no significant changes between both groups after delivery. APGAR score was significantly low at one minute in nalbuphine group than control group [6.75 +/- 2.3, 8.5 +/- 0.74, respectively, P=0.0002] [27% of nalbuphine group APGAR score ranged between 4-6, while 7% in control group APGAR score ranged between 4-6 at one minute]. All neonates at five minutes showed APGAR score ranged between 9-10. Time to sustained respiration was significantly longer in nalbuphine group than control group [81.8 +/- 51.4 versus 34.9 +/- 26.2 seconds, P<0.0001]. The umbilical cord blood gas was comparable in both groups. None of the neonates need opioid antagonist [naloxone] or endotracheal intubation. Administration of nalbuphine before cesarean section under general anesthesia reduces maternal stress response related to intubation and surgery, but decreases the APGAR score at one minute after delivery. So, when nalbuphine was used, all measures for neonatal monitoring and resuscitation must be available including attendance of a pediatrician
ABSTRACT
The purpose of this study was to investigate the efficacy and safety of controlled hypotension versus ANH as blood conservation methods during major orthopedic surgery. Forty patients, assigned to receive either ANH [HT= 30%] or controlled hypotension. General anesthesia was induced by fentanyl 2micro gm/kg intravenously, thiopental Na 5mg/kg intravenously and atracurim 0.5mg/kg. After induction of anesthesia but before surgery, the patients were classified into two groups according to the technique of blood conservation used: group I [20 patients] acute normovolemic hemodilution. The volume of blood withdrawn has been replaced simultaneously by infusion of identical volume of hydroxyethyl starch 6% in order to maintain normovolemia. Group II [20patients]: controlled hypotensive anesthesia. A mean of 1000 ml blood was predonated [20% of the total blood volume] in hemodilutio group. Blood loss was, significantly higher in ANH group. The total loss was 1500mL [ANH] vs. 1200 mL [in hypotensive group], [p < 0.05]. The average amount of blood transfusion was 262.5 ml [ANH group] vs. 187.5 ml [hypotensive group]. 50% went through surgery without receiving blood [ANH] vs. 60% [hypotensive group]. No renal, neurological or cardiopulmonary complications were registered. Also there was slight but significant metabolic acidosis. The acidosis was metabolic in origin because PaCO2 was kept constant and [Bic] and [BE] decreased significantly and it was not lactic acidosis as serum lactate remains within normal limit. It is considered as hyperchloermic metabolic acidosis as serum chloride significantly increased. Both ANH and hypotensive anesthesia can be used safely in patients undergo major orthopedic surgery however, Deliberate hypotension was the most effective means of reducing intraoperative bleeding and the time for this procedure was shorter than for normovolaemic haemodilution combined with autotransfusion. Also there was slight but significant metabolic acidosis
Subject(s)
Humans , Male , Female , Hemodilution/statistics & numerical data , Hypotension/therapy , Intraoperative Complications , Hemorrhage , Comparative StudyABSTRACT
The purpose of this study was to compare surgical conditions for nasal surgery under general anesthesia during controlled hypotension, using either preoperative oral beta blocker atenolol [50mg twice before surgery] or intraoperative infusion of sodium nitroprusside [SNP] or esmolol. Thirty patients, assigned to receive either of the drugs as the primary hypotensive agent, were studied. The same surgeon, blinded to the hypotensive agents used and the haemodynamic variables, performed all the operations. The surgeon used a category scale [0-5] to assess surgical conditions - a value of 2-3 being ideal. Patients were positioned in 15° reverse Trendelenburg position and the mean arterial blood pressure [MABP] was reduced in steps of 5 mmHg. The anesthetist prompted category scale estimations by the surgeon following a change in any of the haemodynamic variables. Average category scale [ACS] values were compared between the three groups. At mild sodium nitroprusside [SNP] induced hypotensive anesthesia surgical conditions were poor [ACS 3.8 +/- 0.53 mean +/- SEM], while in the atenolol and esmolol groups, ideal surgical conditions [ACS 2.7 +/- 0.74 and 2.8 +/- 0.63] were recorded at MABP > 60 mmHg. The combined effects of increased venous drainage due to the reverse Trendelenburg position, hypotension as well as capillary vasoconstriction due to unopposed alpha-adrenergic effect on the mucous membrane vasculature in the atenolol and esmolol groups [as opposed to vasodilatation in the SNP group] probably caused the superior surgical conditions. Preoperative oral Beta blocker was effective in reducing surgical bleeding during nasal surgery, provide good quality of surgical field, reduce operative time, simple in use, not need complex technique for infusion, more convenient for patients and save method for induce mild hypotensive anesthesia during nasal surgery