ABSTRACT
Background:The benefits of laparoscopic surgeries include less pain,early mobilization,shorter hospital stay which have further increased its applications.But during laparoscopic surgeries, CO2 is routinely used to create pneumoperitoneum,which causes increased plasma levels of catecholamine and vasopressin.Elevation of intraabdominal pressure with raised diaphragm causes adverse effects on cardiovascular system such as decreased cardiac output,elevated arterial pressure and elevated systemic vascular resistence leading to hypertension and tachycardia.Hence drug which can blunt hemodynamic response to laryngoscopy,intubation and pneumoperitoneum without any adverse side effect is required for this purpose.Dexmedetomidine is a alpha 2 adrenergic agonist which has properties of sedation,sympatholysis and analgesia without having any adverse side effects. AIM: PRIMARY OBJECTIVES:1)To compare two doses of dexmedetomidine(0.50mcg/kg and 0.75mcg/kg) in attenuatuating stress response during laryngoscopy and intubation in patients undergoing laparoscopic surgeries.2)To compare the effects of two doses of dexmedetomidine in attenuating intraoperative hemodynamic changes during laparoscopic surgeries.3)To compare reduction in intraoperative analgesic requirements with two doses of dexmedetomidine used as premedicants. SECONDARY OJECTIVES:1)To study and compare the sedation score and duration of post operative analgesia with two different doses of dexmedetomidine.2)To study the side effects and complications related to dexmedetomidine if any.Material and Method:It was a randomized, prospective, double blinded, comparative hospital based study at Department of Anaesthesiology, Gandhi Medical College, Bhopal. 60 ASA Grade I-II patients, age ranging from 18-60 years of either sex, scheduled for laparoscopic surgeries were randomly allocated into three groups of 20 patients each:ŸGroup P(n=20): received 20 ml of normal saline as placebo over 10 minutes prior to induction.ŸGroup D(n=20): received i/v dexmedetomidine 0.5mcg/kg diluted upto 20ml with normal saline slowly over 10 minutes prior to indution.ŸGroup M(n=20): received i/v dexmedetomidine 0.75mcg/kg diluted upto 20 ml with normal saline slowly over 10 minutes. Results:There was significant decrease in mean HR and MAP in group M as compared to saline group and group D (Dxm=0.50mcg/kg) through-out the surgery (P< 0.05) which shows that dexmedetomidine (0.75 mcg/kg/h) was effective in reduction of HR and BP due to stress response of laparoscopic surgery and endotracheal intubation. The duration of analgesia was significantly higher in the patients belonging to the Group M. Likewise, the average number of rescue analgesic doses received by Group D patients were more compared to patients in Group M. Conclusion: From our study we conclude that Dexmedetomidine 0.75μg/kg is significantly superior to Dexmedetomidine 0.50μg/kg in attenuating hemodynamic respose to laryngoscopy ,pneumoperitoneum,sedation and postoperative analgesia when used as premedicant in patients undergoing laparoscopic surgeries.
ABSTRACT
Ibusuki hotspring sand bath (SB)(Sunamushi) is a special thermal therapy using heated sands by natural hotspring gushed at the seashore of Ibusuki city. Heated heavy sands (50°C, 40-60kg) was piled on the lied body. It has traditionally been used here for 250 years to relieve muculoskeletal and neuralgic pain, and still accepts 260 thousands visitors a year. In the present study, cardiovascular and metabolic effects by SB was studied from the viewpoint of accelerated circulation.<BR><b>Subjects and Methods: </b>General physical parameters (BP, HR, sublingual temperature) and plasma chemistry were examined in 20 healthy males(36 ± 10yrs). The subjects wore thin bathrobe and a venous catheter for blood sampling were set in the forearm. They kept rest in the supine position for 30min and subjected 10min SB at the municipal SB institute with hotspring piping under the sands. In another 28 healthy subjects (44.3 ± 2.4yrs), cardiac outputs and plasma catecholamines (CA) and renin activity (PRA) were measured. In 6 subjects intracardiac study by Swan-Ganz catheterization were performed. <BR><b>Results: </b>Diastolic pressure were significantly decreased by 6mmHg, and heart rate and sublingual temperature were significantly increased by +20bpm and +1.1°C, respectively, after 10min SB. Venous blood pO<sub>2</sub> and pH was significantly increased by 20mm Torr and 0.03pH, and pCO<sub>2</sub> was significantly reduced by 5mm Torr. Lactate, pyruvate and L/P ratio were significantly reduced suggesting improved oxidative metabolism of peripheral tissues. Plasma CAs and PRA were elevated after SB. All of these results gradually returned to the resting level after 30min. Cardiac output (CO) measured by dye dilution or thermo-dilution method was significantly increased from 5.6l/min to 10.5 l/min after 10min SB, and reduced to 8.1 l/min by removing piled heavy sands. Calculated total peripheral resistance (TPR) was significantly decreaased suggesting thermal vasodilation. Although mean right atrial pressure and pulmonary arterial pressure were increased during SB, they were immediately decreased by removing piled sands.<BR><b>Discussion: </b>All of these results indicate that the basic effects of SB are derived from strong hydrostatic pressure of piled heavy sands and thermal vasodilation. Increased CO due to accelerated venous return and reduced afterload (TPR) will induce sufficient oxygen supply and increased discharge of wasted matters from peripheral tissues. These data seem to be compatible with the clinical effects of SB to relieve musculoskeletal pain and fatigue.<BR><b>Conclusion: </b>Significant clinical effects is induced by increased CO due to the increased hydrostatic pressure of piled sands and thermal vasodilation.
ABSTRACT
Ibusuki hotspring sand bath (SB)(Sunamushi) is a special thermal therapy using heated sands by natural hotspring gushed at the seashore of Ibusuki city. Heated heavy sands (50°C, 40-60kg) was piled on the lied body. It has traditionally been used here for 250 years to relieve muculoskeletal and neuralgic pain, and still accepts 260 thousands visitors a year. In the present study, cardiovascular and metabolic effects by SB was studied from the viewpoint of accelerated circulation. Subjects and Methods: General physical parameters (BP, HR, sublingual temperature) and plasma chemistry were examined in 20 healthy males(36 ± 10yrs). The subjects wore thin bathrobe and a venous catheter for blood sampling were set in the forearm. They kept rest in the supine position for 30min and subjected 10min SB at the municipal SB institute with hotspring piping under the sands. In another 28 healthy subjects (44.3 ± 2.4yrs), cardiac outputs and plasma catecholamines (CA) and renin activity (PRA) were measured. In 6 subjects intracardiac study by Swan-Ganz catheterization were performed. Results: Diastolic pressure were significantly decreased by 6mmHg, and heart rate and sublingual temperature were significantly increased by +20bpm and +1.1°C, respectively, after 10min SB. Venous blood pO2 and pH was significantly increased by 20mm Torr and 0.03pH, and pCO2 was significantly reduced by 5mm Torr. Lactate, pyruvate and L/P ratio were significantly reduced suggesting improved oxidative metabolism of peripheral tissues. Plasma CAs and PRA were elevated after SB. All of these results gradually returned to the resting level after 30min. Cardiac output (CO) measured by dye dilution or thermo-dilution method was significantly increased from 5.6l/min to 10.5 l/min after 10min SB, and reduced to 8.1 l/min by removing piled heavy sands. Calculated total peripheral resistance (TPR) was significantly decreaased suggesting thermal vasodilation. Although mean right atrial pressure and pulmonary arterial pressure were increased during SB, they were immediately decreased by removing piled sands. Discussion: All of these results indicate that the basic effects of SB are derived from strong hydrostatic pressure of piled heavy sands and thermal vasodilation. Increased CO due to accelerated venous return and reduced afterload (TPR) will induce sufficient oxygen supply and increased discharge of wasted matters from peripheral tissues. These data seem to be compatible with the clinical effects of SB to relieve musculoskeletal pain and fatigue. Conclusion: Significant clinical effects is induced by increased CO due to the increased hydrostatic pressure of piled sands and thermal vasodilation.
ABSTRACT
BACKGROUND: Glidescope(R) is a video-assisted intubation device.It offers a clear view and is easy to use, giving it several advantages over conventional intubation devises.This study was designed to compare the hemodynamic effects and POGO scores between conventional and video laryngoscopic intubation. METHODS: Sixty adult patients with ASA 1 or 2 were randomly allocated into two groups; Glidescope(R) (group G) or Macintosh (group M).Anesthesia was induced with propofol and remifentanil.Blood pressure and heart rate were recorded just prior to intubation and 1, 3, and 5 minutes after intubation.POGO scores, intubation time and the severity of sore throat were also recorded. RESULTS: There were no significant differences in SBP, MBP, DBP, HR, POGO score, intubation time and the severity of sore throat between two groups. CONCLUSIONS: The POGO scores and hemodynamic changes associated with tracheal intubation using the Glidescope(R) were almost the same as that of the Macintosh group.
Subject(s)
Adult , Humans , Blood Pressure , Heart , Heart Rate , Hemodynamics , Intubation , Pharyngitis , PropofolABSTRACT
BACKGROUND: Various hemodynamic changes occur during left ventriculography, such as myocardial depression, hypotension, peripheral circulatory changes, ECG changes(such as arrhythmias and conduction abnormalities) and anaphylactic reaction etc. These effects are somewhat caused by osmolality, ionic concentration of Na+, viscosity and molecular weight of contrast dye and underlying various heart disease itself during left ventriculography. We compared the hemodynamic differences between ionic(ioxaglate) and non-ionic(iopromide) low osmolar contrast agents during routine ventriculography. METHODS: In a prospective, randomized, double blind study of 124 patients underwent left ventriculography, we examined the various hemodynamic effects of the two contrast agents on left ventricle. All subjects were divided into 2 groups : ioxaglate and iopromide groups. Also, each agent was used in randomized double blind fashion in both groups ; normal control subjects(14 in ioxaglate group : 12 in iopromide group) and subjects whose ejection fraction less than 50%(12 in ioxaglate group : 16 in iopromide group). Left ventricular systolic pressure(LVSP), left ventricular end-diastolic pressure(LVEDP), maximum dP/dt, (dP/dt)/P ratio, peak - dP/dt and Tau were obtained immediately before and left ventriculography. RESULTS: 1) In total(normal+angina+MI) subjects of both groups, LVEDP(p<0.001) and maximum dP/dt(p<0.001) were increased and T(au) was reduced significantly(p<0.05). But LVSP(p<0.001) and peak - dP/dt(p<0.005) were increased significantly only in ioxaglate group. 2)In normal(control) subjects, there were no significant differences in both groups, except LVEDP that was increased by equal magnitude(p<0.001). 3) In subjects with ejection fraction less than 50%, there were no significant hemodynamic differences in both contrast agent groups bur LVEDP increased significantly in both groups(p<0.001). CONCLUSIONS: This present study showed that both ionic(ioxaglate) and non-ionic(iopromide) low osmolar contrast agents were very safe without any significant side effects except two agents caused an increase in LVEDP and did not show major differences between ioxaglate and iopromide contrast agents from a hemodynamic point of view. Two contrast agents tend to improve contractilities and diastolic properties of left ventricle since both caused an increase in maximum dP/dt and a reduce in Tau, in total subjects. This effect may be caused by cardiac compensation, probably because of osmolality, volume loading by contrast agents and secondary activation of sympathetic system immediately after injection of contrast agents. Thus, it is concluded that two ioxaglate and iopromide contrast agents amy be used safely in left ventriculography in patients with and without left ventricular dysfunction, with paying attention to an increase in LVEDP.
Subject(s)
Humans , Anaphylaxis , Arrhythmias, Cardiac , Compensation and Redress , Contrast Media , Depression , Double-Blind Method , Electrocardiography , Heart Diseases , Heart Ventricles , Hemodynamics , Hypotension , Ioxaglic Acid , Molecular Weight , Osmolar Concentration , Prospective Studies , Ventricular Dysfunction, Left , ViscosityABSTRACT
On account of its histamine releasing and ganglionic blocking properties tubocurarine is known to have significant hemodynamic effects. Methylation of the compound produces metocurine and should decrease both histamine release and ganglionic blockade. The hemodynamic effects of these two compounds were compared in 40 patients anesthetized with halothane, nitrous oxide, oxygen. These 40 patients were divided into two groups by administering tubocurarine or metocurine. Group I: When patients had no responses to surgical stimuli after induction, mean arterial blood pressure, pulse rate, pulse pressure were measured 1, 3, 5 min before administration of tubocurarine as control value. After administration of tubocurarine 0.51 mg/kg (ED), mean arterial blood pressure, pulse rate, pulse pressure were measured every minute for twenty minutes as experimental value. (n= 20) Group IL Metocurine 0,2S mg/kg (ED) was administered in the same way as the group I. (n=20) Result: Tubocurarine produced a decreaaed mean arterial blood pressure 22.9%, pulae pressure 16%, and an increaaed pulee rate 14.3%, 2 min after administration of drug(p<0.05). Also mean arterial blood pressure decreased for whole 20 min, pulse pressure for 7 min, and pulse rate increased for 4 min, significantly. But metocurine produced no significant hemodynamic effects. These data suggest that the hemodynamic margin of safety of metocurine is much grater than tubocurarine.