Comparative study of the effect of esmolol, fentanyl and their combination for attenuating haemodynamic responses of laryngoscopy and intubation.

Background&Objectives: Laryngeal, tracheal and bronchial receptors are stimulated by mechanical and chemical irritants during laryngoscopy, intubation and extubation. The reflex increases in sympathoadrenergic activity caused by these manipulations leads to an increase in catecholamine release, arterial blood pressure and heart rate. The aim of present study was to evaluate the efficacy of Fentanyl (2 mcg/kg), Esmolol (1mg/kg) and their combination in half the dose(fentanyl 1 mcg/kg +esmolol 0.5mg/kg) in attenuating the pressure response during laryngoscopy and tracheal intubation. Methods: This is a prospective double blind study comprising ninety patients between 21-60 yrs and ASA grade I and II scheduled for elective surgery under general anesthesia. Patients were randomly divided into group E (injection Esmolol 1mg/kg iv), group F (inj.Fentanyl 2mcg/kg iv) and group C (inj.Esmolol 0.5mg/kg and inj.Fentanyl 1mcg/kg). The study drug was given 2 minutes before induction of anaesthesia. All the vital parameters of patients were observed during intra operative and postoperative period .Values of heart rate and mean blood pressure were recorded at pre-induction, after giving study drug, after induction, immediately after intubation and at 1 min, 3 min, 5 min, 7 min and 10 min. after intubation. Results: Inter group comparison of groups E, F & C showed greater attenuation of heart rate in group F as compared to group C and group E. Inter group comparison of groups E, F & C in attenuating increase in MAP showed greater attenuation of MAP in group F as compared to group E ( p=0.880) and group C (p=0.0005). Conclusion: Among the fentanyl (2 mcg/kg), esmolol (1 mg/kg) and their combination drug in half doses, injection fentanyl is best in attenuating haemodynamic responses to laryngoscopy and tracheal intubation.

The Role of Diagnostic Laparoscopy in Detection of Endometriosis.

In the the present study patients were divided into three study groups of thirty patients each, group 1 included Infertility patients, group 2 comprised of patients undergoing laparoscopy for ovarian cyst, chronic pelvic pain, fibroid uterus, adnexal mass etc. and group 3 had patients undergoing laparoscopic sterilization without any symptoms. Prevalence of endometriosis was found to be 12.2%.Highest being in Group 1(23.3%), followed by Group 2 (13.3%) and no cases of endometriosis were detected in Group 3. Peritoneum was involved in maximum cases with commonest lesion being subtle red lesion (71.4%).On comparing ultrasound with laparoscopy in endometriosis diagnosis, sensitivity of ultrasound was only 9%. Thus it is recommended that diagnostic laparoscopy in gold standard for the diagnosis of endometriosis.

Spontaneous Pregnancy in a Patient with Sheehan's Syndrome.

Spontaneous pregnancy in patients with Sheehan's syndrome is very rare, even after ovulation induction in such patients' pregnancy outcome is poor. We report a case of women with Sheehan's syndrome who became pregnant without ovulation induction with successful outcome of pregnancy

Spontaneous Pregnancy in a Patient with Sheehan's Syndrome.

Spontaneous pregnancy in patients with Sheehan's syndrome is very rare, even after ovulation induction in such patients' pregnancy outcome is poor. We report a case of women with Sheehan's syndrome who became pregnant without ovulation induction with successful outcome of pregnancy.