Comparison of conventional dose and low dose infusion of dexmedetomidine on hemodynamic stress response, dose of induction agent and postoperative analgesia in patients undergoing laparoscopic cholecystectomy

Background and Aim: Anesthetic techniques are based on hemodynamic stability during anesthesia and surgery. Dexmedetomidine is centrally acting α2 agonist with sedative, sympatholytic and analgesic. Aim of this study was to compare effect of conventional dose with low dose infusion of dexmedetomidine on hemodynamic stress response, induction agent requirement & postoperative analgesia. Materials and methods: Single randomised prospective study done on 100 ASA Ι and ΙΙ patients aged 18-65 years scheduled for elective laparoscopy cholecystectomy under general anesthesia. Patients were divided in to two groups of 50 each, Group A: 1 µg/kg loading dose of Rolaniya SL, Dhawan S, Meera Kumari, Jain R, Pareek A, Sehtia S. Comparison of conventional dose and low dose infusion of dexmedetomidine on hemodynamic stress response, dose of induction agent and postoperative analgesia in patients undergoing laparoscopic cholecystectomy. IAIM, 2017; 4(7): 111-117. Page 112 dexmedetomidine I.V. started 15 min before procedure and infusion. 5 µg/kg/hr after induction and continued till end of surgery. Group B: 0.5 µg /kg/hr of dexmedetomidine I.V. started 15 min before procedure and continued till end of surgery. Results: Hemodynamic stability more in group B by avoiding complications like hypotension and bradycardia (p value < .05). Reduction of induction dose was more in group A than group B as compared to standard doses (P value <0.01). Hypotension and bradycardia were observed in 5 cases after 15 min of infusion in group A ( p value <.01). Mean VAS score in Group A was at 330 min was 3.10.39 and 3.150.94 at 210 min in group B. Conclusion: Low dose infusion of dexmedetomidine provides more hemodynamic stability. Requirement of induction agent was decreased more in group A than group B. Postoperative analgesia more in group A.

Post-operative analgesic efficacy of fentanyl via different routes A comparative study of nebulisation, intranasal and intravenous routes

Background: Pain is main post operative adverse outcomes causing patient distress, prolonging hospital stay, and increasing the incidence of admissions after surgery. Study was done to assess and compare the post-operative analgesic effects of fentanyl via nebulisation, intranasal and intravenous routes to provide better analgesia, anxiolysis and sedation to the patient. Materials and methods: After approval from ethical committee of SPMC, Bikaner and written informed valid consent from patients, sixty patients of either sex belonging to ASA class I and II, were randomised into three group (Group I - Nebulised Fentanyl, Group II - Intranasal Fentanyl, Group III - Intravenous Fentanyl). With all aseptic precaution, subarachnoid block was instilated via 23/25 gauze spinal needle by injecting sufficient dose of bupivacaine heavy 5% to achieve an adequate sensory and motor block for the proposed surgery. When patient complained pain 1st time, fentanyl was given via nebulisation in group I, intranasal in group II, and intravenous in group III with dose 4 mcg/kg, 1.5 mcg/kg, 2 mcg/kg respectively. Patients were assessed for pain by VAS score. For statistical data, SPSS 10.0 software was used. Results: In present study, Ramsay sedation score, patient satisfaction score and duration of analgesia was better in group II as compared to group I and III. Group III had lesser time of onset of analgesia in comparison to group II and I respectively. Singh R, Pareek A, Kumari M, Khilji MY, Sirohiya P. Post-operative analgesic efficacy of fentanyl via different routes – A comparative study of nebulisation, intranasal and intravenous routes. IAIM, 2016; 3(6): 16-22. Page 17 Conclusion: On the basis of analgesic efficacy, we concluded that intranasal group was better than nebulisation and intravenous route.