Résumé
Objectives: Intravenous regional anesthesia is used for short procedures for hand and upper limb surgeries. IVRA with adjuvants like opioids, muscle relaxants, NSAIDS increases the efficacy in terms of analgesic duration and quality of anesthesia. We conducted this comparative study for evaluating the effect of adding magnesium sulphate and clonidine with lignocaine in IVRA for upper limb surgeries
Methodology: Seventy five patients ASA class 1 and 2 of either sex, age 18-60 years undergoing upper limbs surgeries were enrolled. They were divided into three groups [25 each] according to drug received. Group L: 9 ml of 2% lignocaine [preservative free] diluted with normal saline to make a total volume of 36 ml of 0.5% lignocaine. Group M: 3 ml of 50% magnesium sulphate with 9 ml of 2 % lignocaine diluted with normal saline to make a total volume of 36 ml, 0.5% lignocaine. Group C: 1 microg/kg clonidine with 9 ml of 2% lignocaine diluted with normal saline to make a total volume of 36 ml of 0.5% lignocaine. Sensory and motor block [onset and recovery time], intraoperative tourniquet pain, time to first tramadol requirement and mean tramadol dosage, quality of operative conditions, hemodynamic parameters, postoperative pain [VAS] scores were recorded
Results: Both groups were comparable in terms of age, sex, ASA grade, baseline hemodynamic parameters, duration of surgery and tourniquet inflation time. Shortened sensory and motor block onset times were established in Group M [p < 0.05]. Recovery from sensory and motor blockade was significantly prolonged in Group M [p < 0.05]. Anesthesia excellence as determined by anesthesiologist and the surgeon was significantly better in C group as compared to rest two groups [p<0.05]. There was statistically significant difference [p>0.05] in intraoperative VAS in group M and C as compared to group L, throughout the procedure. Time to First analgesic requirement in group C 43.04+/-27.46, group M 42.72+/- 18.06 and group L was 27.08+/-4.45 minutes [p<0.05]. Postoperative VAS scores for 24hours were higher in group L as compared to group M and C [p<0.05]
Conclusion: Magnesium sulphate as an adjuvant to lignocaine hydrochloride for IVRA for upper limb surgeries shorten the onset of sensory and motor block to greater extent as compared to clonidine and lignocaine alone though postoperative analgesia was found to be of longer duration with clonidine as an adjuvant?
Résumé
Cardiovascular disease is the leading cause of mortality among patients with end stage kidney disease [ESKD]. Left ventricular hypertrophy [LVH] and left ventricular dilation [LVD] are independent risk factors for mortality and make the management of a patient with dilated cardiomyopathy [DCM] and ESKD stage 5. undergoing noncardiac surgery is a real challenging task as the perioperative course may be complicated by cardiac arrhythmias or cardiac failure at any time and associated with high perioperative morbidity and mortality. An adequate knowledge of the pathophysiology of these diseases and treatment modalities is essential to manage these cases successfully. Meticulous planning is the key to success. We stress that adequate preoperative preparation and a planned anesthesia leads to a successful management of dilated cardiomyopathy with ESKD
Résumé
Clonidine diminishes stress response by reducing circulating catecholamines and hence increases perioperative circulatory stability in patients undergoing laparoscopic surgeries. The aim of this study was to compare intravenous [IV] clonidine [2 microg/kg] with intramuscular [IM] clonidine [2 microg/kg] for attenuation of stress response in laproscopic surgeries. Eighty adult patients classified as ASA physical status I or II, aged between 20 and 60 years undergoing elective cholecystectomy under general anesthesia were enrolled for a prospective, randomized, and double-blind controlled trial. They received either IV clonidine [2 microg/kg] 15 min prior to the scheduled surgery [Group I] or IM clonidine [2 microg/kg] 60-90 min prior to the scheduled surgery [Group II]. Hemodynamic variables [Heart rate, systolic [SBP], diastolic [DBP], mean arterial pressure [MAP]], SpO[2] and EtCO[2] were recorded at specific times - baseline, prior to induction, 1 min after intubation, before CO[2], insufflation, after CO[2] insufflation at 1, 5, 10, 20, 30, 45, 60 min, after release of CO[2], at 1 and 10 minutes after extubation. Secondary outcomes included evaluation of adverse effect profile of the two groups. No significant difference was observed in the HR throughout the intraoperative period in between the two groups [P>0.05]. There was statistically significant difference in SBP between the two groups starting from 1 minute after induction till 1 min after extubation [P<0.05] but not in DBP except at 1 minute after intubation [P=0.042]. Significant difference in MAP was noted at 1 minute after intubation [P=0.004] and then from 5 minutes after CO[2] insufflation to 1 minute after extubation [P<0.05]. Incidence of adverse effects were higher in group II [P=0.02] especially incidence of hypertension requiring treatment [0.006]. We conclude that under the conditions of this study, hemodynamic parameters [SBP, DBP and MAP] were better maintained in the IV as compared to the IM route that had significantly higher incidence of hypertension requiring treatment