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Introduction: Sevoflurane is a volatile anesthetic agent, which is non-irritant with low solubility and lack of arrhythmogenicity, which makes it an ideal agent for ambulatory anesthesia. The aim of our study is to compare the cardiovascular effects at equivalent minimum alveolar concentration (MAC) doses and the recovery profile of sevoflurane and isoflurane, in patients undergoing valvular replacement surgery. Materials and Methods: This is a hospital-based, randomized, interventional, comparative study with sample size of seventy participants divided into two groups. Group A (35) received sevoflurane (1MAC) and Group B (35) received isoflurane (1MAC). Patients were of the American Society of Anesthesiologists Grade 2–4. The age group was 20–25 years with body weight of 30–65 kg, undergoing valvular heart surgery. The primary outcomes are to compare the changes in heart rate, systolic and diastolic blood pressures, mean arterial pressure, cardiac output (CO), cardiac index, systemic vascular resistance index (SVRI), and stroke volume variable, during maintenance of anesthesia. The secondary outcomes are the time taken for eye opening on verbal commands and extubation. Results: There was a decrease in blood pressure, CO, and SVRI with both agents (statistically insignificant, P > 0.05), but comparatively hemodynamics was more stable along with early recovery with sevoflurane (statistically insignificant). Conclusions: Sevoflurane and isoflurane can safely be used for fast-track anesthesia in patients undergoing valvular heart surgery. Sevoflurane provided a better hemodynamic profile, early awakening, and extubation as compared with isoflurane, even though the difference was insignificant. Thus, sevoflurane with opioids may be preferred in patients undergoing valvular heart surgery
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Background: Airway manipulation and surgical stimulation lead to variable changes in hemodynamic profile due to increase in plasma catecholamine levels, but these changes can be attenuated by appropriate premedication. The present study was designed to compare the clinical efficacy of intravenous premedication of clonidine with nalbuphine on intraoperative hemodynamic profile of patients during surgery under general anaesthesia.Methods: Sixty adult consenting patients of ASA physical status I and II of either gender were randomized into two groups of 30 patients each, to receive either intravenous clonidine (2 μg/kg) or nalbuphine (0.2 mg/kg), 10 min before induction with propofol. Direct laryngoscopy and intubation were facilitated with vecuronium bromide. Changes in heart rate, blood pressure and electrocardiogram were recorded at specific time intervals and were noted as primary variable. Any adverse effects and complications were recorded as secondary outcomes.Results: After laryngoscopy and intubation, the increase in mean heart rate and mean blood pressure occurred immediately in patients of both groups, but persisted up to 6 to 10 min in patients of clonidine group, thereafter the changes returned back to baseline values, while in patients of nalbuphine group, this increase persisted up to 8 to 10 min. The differences in hemodynamic changes between the groups were statistically significant throughout the surgery and post extubation.Conclusions: Intravenous clonidine was more effective than nalbuphine to attenuate the hemodynamics changes during stressful period of laryngoscopy, intubation and surgery.
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Abstract Background: The postoperative care of patients subjected to cardiac surgery frequently require a complete recovery with intravenous fluids, but crystalloid solutions like normal saline may increase the interstitial oedema, and it is also well known that fluid overload increases mortality. Objective: To compare the effect of 7.5% hypertonic saline (HS) with 0.9% normal saline (NS) on lactate clearance, as well as the haemodynamic response of patients during the first day after cardiovascular bypass surgery. Methods: The study included patients 18 years of age and older with coronary artery disease and/or heart valve disease, and who underwent bypass surgery and/or cardiac valve replacement and were randomly assigned to receive 4 mL/kg of HS or NS intravenously for 30 min once they were admitted to the ICU. Lactate, arterial blood gases, heart rate, central venous pressure, and pulmonary wedge pressure were measured at 0, 6, 12, and 24 h after being admitted to the ICU. The analyses were carried out with an intention-to-treat principle. Results: Out of a total of 494 patients evaluated, 102 were included and assigned to the HS groups (51 patients) or NS (51 patients). The mean age of the participants was 59 ± 14 years, and 59.8% were male. No statistically significant differences were observed between two groups in the lactate clearance, or in any of the secondary outcomes. Conclusions: Our study failed to show a better lactate clearance in the group on hypertonic saline, and with no evidence of a higher incidence of adverse effects in that group. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Resumen Introducción: El cuidado postoperatorio de pacientes sometidos a cirugía cardíaca requiere frecuentemente una reanimación completa con líquidos intravenosos, pero las soluciones cristaloides pueden incrementar el edema intersticial y la sobrecarga de líquidos incrementa la mortalidad. Objetivo: Comparar el efecto del salino hipertónico (SH) al 7.5% con respecto al salino normal (SN) del 0.9% en la depuración de lactato y la respuesta hemodinámica durante el primer día postoperatorio de pacientes con cirugía cardiovascular con circulación extracorpórea. Métodos: Pacientes mayores de 18 años con cirugía de arterias coronarias o de enfermedad valvular cardíaca fueron aleatorizados a recibir 4 ml/kg de SH o SN intravenosos en los primeros 30min de admisión a UCI. Se midieron los valores de lactato, estado ácido-base, frecuencia cardíaca, presión venosa central y presión en cuña pulmonar a las horas 0, 6, 12 y 24 después del ingreso a UCI. Se hizo un análisis con el principio de intención de tratar para un modelo de datos longitudinales. Resultados: Se evaluaron 494 pacientes y se aleatorizaron 102 a los grupos de SH (n = 51) o SN (n = 51). El promedio de edad fue 59 ± 14 años y el 59.8% fueron hombres. No se observó ninguna diferencia estadísticamente significativa entre los 2 grupos en la depuración de lactato o en cualquiera de los desenlaces secundarios. Conclusiones: Nuestro estudio no mostró mejor depuración de lactato con el uso de una dosis de SH ni mayor frecuencia de efectos adversos en ese grupo. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Postoperative Care/methods , Saline Solution, Hypertonic/administration & dosage , Cardiopulmonary Bypass , Lactic Acid/metabolism , Saline Solution/administration & dosage , Cardiac Surgical Procedures , Double-Blind Method , Hemodynamics/drug effectsABSTRACT
Introduction: Post-operative pain and swallowing difficulty following tonsillectomy remain one of the most difficult pain states to manage in Otolaryngology. Many therapeutic modalities - ranging from non-steroidal anti-inflammatory drugs (NSAIDs) to systemic opioids, acetaminophen, and tramadol - have been used for posttonsillectomy pain control in patients. Gabapentin has been recently found to be useful for reducing acute post-operative pain when administered preoperatively. Although various dose regimens have been tried in different surgical settings, the minimum effective dose is not established. The aim of the study: To study the analgesic property of a single of dose oral Gabapentin for postoperative pain relief, to study the hemodynamic variables in patients receiving oral Gabapentin Materials and methods: A total number of, 60 patients were included in the study group between 6 to 16 years. P group (Placebo group) 30 ASA I patients for tonsillectomy receiving oral placebo, G group 30 ASA I patients for tonsillectomy receiving oral gabapentin during a 24-hour post-operative period, the outcomes of interest being postoperative pain intensity; rescue analgesic consumption; or adverse effects such as sedation, nausea and vomiting, dizziness, and headache. Results: The pain score reported by the physician during the first 8 hours, as well as the need for analgesics during 24 hours postoperatively, were significantly decreased in the gabapentinoids group versus the control group. Additionally, there was no significant difference between gabapentinoids and control groups for adverse effect during 24 hours postoperatively. Statistically, significant Paul Praveen, Ranjini O.M., T. Murugan. Single dose oral gabapentin as a pre-emptive analgesic for post-operative pain relief in patients undergoing tonsillectomy. IAIM, 2018; 5(5): 27-32. Page 28 sedation was observed up to 4 hours in the postoperative period. After 5 hours there was no statistically significant difference in both groups. Conclusion: Oral Gabapentin is effective for postoperative pain relief, reduces the requirement of supplementary analgesics in the postoperative period. Oral Gabapentin has a better hemodynamic profile. Gabapentin is safe for use in pediatric patients.
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Carotid sinus nerve blockade (CSNB) has been shown to be effective for management of post-carotid endarterectomy (CEA) hypotension. The underlying hemodynamic changes are unknown. We retrospectively analyzed a recorded arterial blood pressure (ABP) waveform using a Modelflow technique. After declamping, total peripheral resistance (TPR) decreased (-65% of predeclamping value), but cardiac output (CO) and stroke volume (SV) increased (+60 and +57% of predeclamping value, respectively). CSNB abruptly increased blood pressure (BP) and TPR (75 and 95% of nadir, respectively), while CO and SV gradually decreased to -21 and -16% of maximum value, respectively). In conclusion, we found that severe decline of TPR was a cause of severe hypotension after declamping and CSNB increased BP mainly through increase in TPR, with little change in CO and SV.