ABSTRACT
Background: General inhalational anaesthesia associated with adjuvant intravenous agents provides better sedation, hypnosis and analgesia. Drugs with such effects already established in the literature include benzodiazepines and opioids. Aim: Aim of the study was to evaluate the effect of continuous infusion of Dexmedetomidine, on Sevoflurane requirement during general anesthesia with continuous monitoring of depth of anesthesia by BIS (Bispectral index) analysis in patients undergoing elective laparoscopic surgeries. Materials and methods: 60 patients with ASA grade I and II, aged between 35-55 years, submitted to elective laparoscopic cholecystectomies under General Anesthesia were randomly divided into two groups of 30 each, one group received a loading dose of Dexmedetomidine at 1 mcg/kg for 10 min (10 minutes before starting the surgery), followed by maintenance dose of 0.5 mcg/kg/hour, till the end of surgery. The other group received similar volume of IV Normal Saline. MAP, HR, SpO2, EtCO2 and BIS were evaluated. Results: There was no significant difference (p>0.05) between Dexmed and Saline groups with respect to mean age, weight, height, duration of anaesthesia and ASA grade. There was no significant difference (p>0.05) in the baseline heart rates and baseline mean arterial pressure between the two groups. There was a clinically and statistically significant reduction in HR and MAP in the Dexmed Nitesh Kabra, Nama Nagarjuna Chakravarthy, G. Venkateshwarlu. A bispectral index guided study on the effect of dexmedetomidine on sevoflurane requirements during elective laparoscopic surgeries. IAIM, 2018; 5(7): 67-80. Page 68 group throughout intraoperative period compared to Saline group (p <0.05). There was a statistically significant rise in HR and MAP in the Saline group during laryngoscopy and 15 minutes after the creation of pneumoperitoneum (p<0.05). Dexmed group had a stable hemodynamics during laryngoscopy and creation of pneumoperitoneum. No statistically significant difference was noted in the extubation time of both the groups. Mean RAMSAY Sedation score and Modified ALDRETE score was higher in Dexmed group. Usage of Sevoflurane (in ml) and usage of Sevoflurane /min was significantly low in Dexmed group. Conclusion: Dexmedetomidine as a preanesthetic medication and intraoperative infusion was effective in blunting stress response to laryngoscopy and creation of pneumoperitoneum. It also decreased intraoperative anaesthetic requirement and had significant anaesthetic sparing property during BIS guided general anaesthesia providing a lighter sedation without the prolongation of extubation time or without any significant adverse effects.
ABSTRACT
Background: Epidural opioids have unique advantages over conventional, intermittent IV/ IM administration, in that patients given epidural opioids have fewer respiratory complications and can be mobilized sooner in the postoperative period. Aim: To compare the effects of epidural 0.5%Bupivacaine with nalbuphine and 0.5% bupivacaine with fentanyl in lower abdominal and lower limb surgeries. Materials and methods: This prospective, randomized, single blind study, where in Epidural Nalbuphine (10 mg) with 0.5% bupivacaine and epidural fentanyl (50 g) with 0.5% bupivacaine in lower abdominal and lower limb surgeries. Results: There were statistically no significant difference between mean age, weight, gender, ASA grading, types of surgeries and baseline parameters in both groups. The duration of surgery and time of onset of sensory blockade, motor blockade and peak motor blockade were not statistically significant (p> 0.05). The duration of sensory blockade was highly significant (p < 0.01). Duration of motor blockade was not statistically significant (p > 0.05). Mean heart rates in both the groups were significant only at 6th, 7th, 8th, 9th and 10th hours. Mean arterial pressures in both the groups were significant only at 3rd, 6th, 7th, 8th, 9th and 10th hours. 30% of patients in group A had a pain score more than 4 during 6-12 hours of postoperative period as compared to 80% in group B. The pain scores were similar in both the groups in the first six hours of postoperative period. Number of rescue Nama Nagarjuna Chakravarthy, A Sagar, G. Venkateshwarlu. A comparative study of epidural 0.5% bupivacaine with nalbuphine and 0.5% bupivacaine with fentanyl in lower abdominal and lower limb surgeries. IAIM, 2018; 5(2): 124-134. Page 125 analgesics required in the first 24 hours of post-operative period in group B were significantly higher (p < 0.01) when compared with group A. 4 patients (13.2%) in Group B experienced respiratory depression which is significant statistically. Conclusions: Epidural Nalbuphine with 0.5%bupivacaine significantly prolongs the total duration of sensory blockade with better postoperative analgesia when compared to epidural fentanyl with 0.5%bupivacaine, with stable hemodynamics and less side effects.
ABSTRACT
Introduction: Laparoscopic surgery is a routinely performed surgery and it is desirable to have stable intra-operative hemodynamic states by avoiding hypertension and tachycardia. Various drugs have been employed to attenuate this hemodynamic response. No single drug is satisfactory. Thus there is a need to find a simple efficient and reliably consistent method. Aim: The present study was undertaken to evaluate the comparison of Dexmedetomidine and Esmolol on perioperative hemodynamic response during laparoscopic cholecystectomy. Materials and methods: Prospective, randomized, controlled, single blinded trial comparing dexmedetomidine (alpha 2- agonist) and esmolol (beta 1-antagonist) done by allocating into two groups. It was conducted in 60 patients of both sex, belong to ASA I and ASA II of age group 20-60 years admitted for laparoscopic surgery from 2016-2017. They were randomly divided into two groups of 30 patients each. The Heart rate (HR), Systolic blood pressure (SBP), Diastolic blood pressure (DBP), Mean arterial pressure (MAP) were recorded prior to induction, after the induction, after the intubation, 15 min, 30 min, 45 min, 60 min after creation of pneumoperitoneum, post pneumoperitoneum, after extubation. Results: Heart rate and systolic blood pressure were significantly lower in Group A after induction, after intubation, and maintained throughout intraoperative and postoperative period compared to Maskuri Soujanya, Nama Nagarjuna Chakravarthy, G. Venkateshwarlu. A study to compare the efficacy of dexmedetomidine with esmolol on hemodynamic response during laparoscopic cholecystectomy. IAIM, 2018; 5(8): 17-29. Page 18 Group B. Diastolic blood pressure were significantly lower in Group A after intubation, and maintained throughout intraoperative period and at extubation compared to Group B. Diastolic blood pressure was not significant after induction, at postoperative period. Mean blood pressure were significantly lower in Group A after induction, after intubation, and maintained throughout intraoperative period and at extubation compared to Group B. Mean blood pressure were not significant at postoperative period. Conclusion: Dexmedetomidine is more effective agent than esmolol in maintaining stable hemodynamics during and after pneumoperitoneum in laparoscopic cholecystectomy.