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Background:Although the role of TIVA has been well described in adult patients but there remains the paucity of such data in paediatric patients for laparoscopic surgeries and moreover the physiological implications of abdominal insufflations are not well documented in paediatric literature and cannot be simply extrapolated from adult data. Methods: 50 ASA grade I/II patients of either sex in the age group of 1 to 12 years, who underwent elective laparoscopic surgeries were divided in two group, total intravenous anaesthesia (Group T) and inhalation anaesthesia (Group G). Variables studied were hemodynamic variables (Heart rate, systolic and diastolic blood pressure), Respiratory parameters (change in EtCO2, Peak inspiratory pressure), Postoperative recovery profile (Agitation, Postoperative nausea and vomiting, Pain), Surgeon’s satisfaction score. Results & Conclusion: TIVA with propofol and sufentanil as compared to inhalational anesthesia with Isoflurane and N2O in paediatric laparoscopic surgery provides better haemodynamic stability, lesser incidence of emergence agitation, short recovery time in PACU, better surgeon satisfaction score. But, it doesn’t have much influence on postoperative nausea vomiting and postoperative pain.
RESUMO
Background: Fascia iliaca is one of the most commonly performed and safest block. Local anaesthetic diffuses under the fascia ilIiaca to block femoral nerve, lateral cutaneous femoral nerve, and obturator nerves. Clonidine, α2-adrenergic receptor agonist, has potent central and peripheral antinociceptive properties. Dexmedetomidine, is a potent α2-adrenoceptor agonist with dose dependent α2 receptor sensitivity. Receptors for α2 are found in the peripheral and central nervous system, platelets, and a variety of organs, such as the liver, pancreas, kidney, and eye. It exhibited dose dependent protection against brain matter loss in vivo and improved the neurologic functional deficit induced by the hypoxic ischemic insult. Aim: To compare clonidine and dexmedetomidine as an adjuvant to ropivacaine under ultrasound guided fascia iliaca for post-operative analgesia scheduled for hip and femur surgeries under subarachnoid block. Methods: It was a Randomized controlled trial study. The patients were allocated one of the three groups which are group R (n=30), Control group – 40 ml of 0.25% Ropivacaine in fascia iliaca compartment block, group RC (n=30) Clonidine group– 40ml of 0.25% Ropivacaine+ 0.5μg/kg Clonidine in fascia iliaca compartment block and group RD (n=30) Dexmedetomidine group – 40ml of 0.25% Ropivacaine + 0.5μg/kg Dexmedetomidine in fascia iliaca block by random number chart. 90 patients of both sexes in the age group of 20-60 years were taken in the study. This study was conducted in the department of Anesthesiology, Dr. R.P.G.M.C, Tanda at Kangra, Himachal Pradesh. Results: Time to first rescue analgesia was maximum in RD group as compared to RC group followed by R group and it was statistically significant amongst groups. Mean of total number of rescue analgesic i.e. inj. diclofenac required was 2.60 ± 0.50 (dose) in R group as compared to 1.50 ± 0.51 in RC group and 1.03 ± 0.18 in (RD) group. There was statistically significant difference in need for analgesia amongst R, RC and RD groups (P<.001). Conclusion: It is recommended that dexmedetomidine in a dose of 0.5μgm/kg can be used as an adjunct to ropivacaine (less cardio toxic) under ultrasound guided fascia iliaca compartment block, for better postoperative pain relief and prolonged duration of postoperative analgesia. It reduces the postoperative rescue analgesic requirement with arousable sedation and without any adverse effect.
RESUMO
Background: The cardiovascular implications due to CO2 insufflation during laparoscopic surgeries have been a subject of research. Animal studies have reported life threatening increase in serum potassium levels during rise in intra-abdominal pressure. Methods: Induction of 30 patients undergoing laproscopic cholecystectomy was done by giving Thiopentone sodium 5 mg/kg and orotracheal intubation was facilitated by 0.1 mg/kg of vecuronium bromide. Blood samples for potassium were taken at pre-induction, pre insufflation, every 20 minutes during insufflations, immediate post exsufflation and immediately after extubation. Results: Serum potassium increased significantly (p<0.01) after insufflation of carbon dioxide (pre-induction 3.9 ± 0.3 vs. 4.5 ± 0.3 at 40 minutes of insufflation). The haemodynamics i.e blood pressure and pulse rate remained fairly (p>0.05) throughout the study period. Conclusion: Based on the findings of this study, we recommend that monitoring of serum potassium should be done in patients undergoing laparoscopic procedures of prolonged duration.
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Background: Laparoscopic surgeries are commonly done in patients suffering from cholelithiasis. However, laparoscopic surgeries are associated with pneumoperitoneum, increased intra-abdominal pressure and insufflation of carbon dioxide leading to altered haemodynamic stability. We conducted a prospective randomised study to evaluate the effects of Clonidine and fentanyl in premedication for intraoperative haemodynamic stability in patients undergoing laparoscopic cholecystectomy. Methods: 70 patients of either sex posted for elective laparoscopic cholecystectomy were included for our study. All patients were randomised using computer generated program and divided into two groups; Group F (35 patients): received Inj. Fentanyl (2 μg/kg IV) 5 minutes prior to induction of anaesthesia, whereas Group C (35 patients) received Inj. Clonidine (1 μg/kg IV) at the similar time before induction of anaesthesia. Haemodynamic parameters (heart rate, mean arterial pressure) of all patients were assessed prior to premedication, before induction, following laryngoscopy and intubation and after pneumoperitoneum. Results: The baseline mean heart rate and mean arterial pressure between Group C was found to be statistically insignificant on comparing with Group F. However, the mean heart rate after intubation, after creation of pneumoperitoneum and after extubation was observed to be statically significant between Group F and Group C (p=0.001). Similar statistical significance was observed between fentanyl group and Clonidine group after premedication and after intubation. Conclusion: Both Clonidine and fentanyl as a premedication had effectively attenuated intraoperative haemodynamic responses but the role of Clonidine was observed to be more appreciable.