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Background: The incidence of propofol injection pain during induction of general anaesthesia varies from28% to 85%. Purpose: To Study the Effect of I.V. Dexmedetomidine by Two Different Means for Preventionof Pain Due to Propofol Injection. Material and Methods: This prospective, randomized study we evaluatedthe effect of dexmedetomidine for reducing the incidence and severity of propofol injection pain by twodifferent approaches while evaluating the hemodynamic stability. 120 Patients undergoing elective surgicalprocedures were randomly divided into four groups; in group I and II with the aim of keeping the drug withinthe vein the forearm was squeezed with a tourniquet up to 70 mmHg for 20 sec; the patients were administered0.5µg/kg dexmedetomidine in Group 1 (n 30), 0.75µg/kg dexmedetomidine in Group 2 (n 30) for 5 min,followed by 15 ml of 1% propofol in all patients over 25 seconds to induce anaesthesia. In Group 3 and 4;0.5µg/kg and 0.75µg/kg dexmedetomidine was premixed with 15ml propofol respectively and administeredfor induction. Pain is graded on a 0– 6 scale. Results: Overall median propofol injection pain score reductionwas 65.75% with the maximum reduction of 80% seen in group 4 and minimum reduction of 50% in group1. There were statistically significant differences (p Â0.05) in both SBP and DBP and heart rate with themaximum decrease in all hemodynamic parameters in group 2 and 4. Conclusion: Pre-treatment withintravenous dexmedetomidine 0.75µg/kg, 5min prior to injection of long-chain triglyceride propofol is effectiveand safe in reducing the incidence and severity of pain due to propofol injection.
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A popular method of providing anaesthesia for I-Gel insertion is with the use of propofol. However, boluspropofol has been associated with adverse effects such as hypotension, apnea and pain on injection. Hence,time is needed to search an alternative. We aimed to compare the induction characteristics, ease of I-Gelinsertion, hemodynamic changes and complications with inhalation of 8% sevoflurane vital capacity breathand propofol. A prospective randomized study of 60 American Society of Anaesthesiologists’ Grade I and IIpatients was conducted and distributed among two groups with 30 each undergoing minor surgical proceduresunder general anaesthesia. Group P received the injection propofol and Group S received sevoflurane. At theend point of induction, the I-Gel insertion was attempted. Scoring systems were used to grade the conditionsfor insertion of the I-Gel. Induction, I-Gel insertion characteristics and hemodynamic changes were assessed.Data were recorded and analysed. Comparison among the study groups was done with unpaired t-test,Mann–Whitney test and Chi square test. Sevoflurane took a longer time for induction and for I-Gel insertionthan propofol. There was no statistically significant difference between the two groups, with respect to I-Gelinsertion characteristics, heart rate, and mean arterial pressure. It is concluded that sevoflurane is associatedwith good hemodynamic stability and may prove useful in cases where propofol is to be avoided. However,the ease of insertion provided with propofol is better.
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To have a definite airway is must in case of intraoral bleeds or long surgeries. Highest challenge of difficultintubation is when mouth opening is nil or it is impossible to relax the jaw even after administration of musclerelaxants. In this study conventional retrograde intubation technique was compared and evaluated with improvisedretrograde and antegrade intubation for securing airway in difficult intubation cases on the basis of efficacyand complication rate. Patients were randomized into two groups of 10 each. They were prepared for awakenasal intubation and were kept NPO overnight with the procedure explained beforehand. Premedication donewith injection glycopyrrolate 0.04 mg/kg IV and injection midazolam 0.03 mg/kg IV. In operation theatrestandard monitoring was done. Induction and maintenance of anaesthesia was done as per routine protocol.Independent observer recorded the time required for securing the ETT from cricothyroid puncture to theconfirmation of tube placement, number of attempts required, any desaturation during the procedure andhaemodynamic changes. Postoperatively assessment was done two hours later for hoarseness of voice, painin throat, coughing, subcutaneous emphysema, assessment for any cartilage injury and/ or local haematomaby an ENT surgeon. During the study, it has been seen that the retrograde and antegrade intubations might bemore efficacious with lower complication rates. Hence this modified technique with improvisation ofconventional technique can be recommended for regular use in Indian scenario.
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In a prospective, double-blind, placebo-controlled, randomized trial one-hundred-sixty eight ASA I-II adults, undergoing laparoscopic cholecystectomy were randomly assigned into 3 groups of 56 each. Group L received lidocaine 2% (40 mg), Group B-1 received butorphanol 1 mg. and Group B-2 received butorphanol 2 mg. One min after pretreatment patients received one-fourth of the total calculated dose of propofol (2.5 mg/kg) over 5 s. In the lignocaine group 28 (50.00%) patients had pain during propofol injection as compared with 11 (19.64%) and 9 (16.07%) in the butorphanol 1mg and butorphanol 2mg groups, respectively (P < 0.05). Intergroup comparison revealed that although the incidence of pain at propofol injection was more in lignocaine group, the severity was primarily mild and comparable among the three groups (P > 0.05). Butorphanol decreased the frequency (P < 0.05) of propofol pain when compared with lidocaine. However severity of pain on injection of propofol was comparable among both the groups given pretreatment with butorphanol. (P > 0.05). No difference in complications, such as pain, edema, wheal, or flare response, were observed at the injection site within the first 24 h after the operation. Duration of analgesia was higher in Group-B-2 compared to other two groups. (142.5±33.96 minutes in Group-B-2, 76.07±23.56 minutes in Group-B-1 and 80.35±21.48 minutes in Group -L). However this was also associated with higher number of patients in deep sedation at 30 minutes. Pretreatment with butorphanol 1 mg or 2mg are equally effective in relieving pain on injection of propofol & more effective than lignocaine.
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Background & objectives:Severe sepsis and septic shock are major health problems. Stress dose of hydrocortisone infusion reduces the time of cessation of vasopressor therapy in septic shock. This study was planned to see the role of low dose corticosteroids on duration of vasopressor therapy in patients with septic shock along with their outcome. Methods: The study was carried out in 40 patients of septic shock. The patients were randomized into two groups i.e. treatment (Group A) and the placebo (Group B) groups of 20 each. Both groups received antibiotics, vasopressors i.e. Dopamine and Norepinephrine and IV fluids along with low dose hydrocortisone being administered only to Group A. Mean values were compared statistically using t-test and z-test. Results: The mean time spent in shock (hours) in survivors was 44.00 ± 11.2 (p< 0.001) while in group B was 72.00 ± 0.00 (p< 0.05). Also, the number of survivors in group A was more with cortisol levels of 5-25 mcg/ml. Interpretation & conclusion:Low dose hydrocortisone reduced the time spent in shock in survivors of group A, thereby reducing duration of vasopressor therapy. It also reduced mortality in subgroup of patients with serum cortisol levels of 5-25 mcg/ml proving that moderately low cortisol levels are benefitted more with hydrocortisone therapy than those with relatively high cortisol levels.
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Background & Objectives: To study the clinical profile of hospitalised patients of malaria aged 15-60 years. Methods: This was a prospective analysis of patients suffering from malaria diagnosed by malaria serology and/or peripheral smear. The mode of presentation, clinical course, treatment history, laboratory investigations and complications were recorded and the data statistically analyzed.Results: P. vivax was the most common (80.39%) plasmodium species, the rest (19.61%) being P. falciparum. The mortality rate was 6.54%. A fall in hemoglobin (p=0.005) and platelet count (p=0.040) was observed in the patients who expired. There was an improvement in the final platelet counts in both the groups (p=0.00052). The mean total bilirubin at admission was higher in P. falciparum group than P. vivax group (p = 0.00789). Renal failure was observed in 16.34% patients. The mean systolic and diastolic blood pressure in patients who expired was lower than patients who were discharged (p=0.007, 0.001). The mean heart rate was higher (109.40) in patients who expired (p = 0.002). Conclusion: Factors associated with poor prognosis in malaria are moderate grade fever, hypotension, tachycardia, anaemia, thrombocytopenia, hyperbilirubinemia, high transaminase and renal failure. A high clinical suspicion, early diagnosis and treatment is recommended in highly prone areas.
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The present study was designed to compare induction and recovery characteristics of sevoflurane and halothane for rigid bronchoscopy for removal of foreign bodies in tracheobronchial tree in children. Forty four children (age 1-4 years) were allocated randomly to two groups to receive either halothane (group H; n=22) or sevoflurane (group S; n=22) in oxygen. A graded inhalation technique was used with maximum inspiratory concentration of 5% for halothane and 8% for sevoflurane. Time for loss of consciousness and induction time in group H and group S were 2.3+/-0.4 min vs 2.2+/-0.4 min (p>0.05) and 4.6+/-0.7 min vs 4.9+/-0.6 min (p>0.05) respectively. Intubation conditions with rigid bronchoscope were similar in both groups. Fewer children in group H had vocal cord movements as compared to group S on laryngoscopy (3 vs 8, p>0.05). Six children in group H and two children in group S had disturbances of cardiac rhythm (p>0.05). Emergence time was significantly shorter in group S as compared to group H (group H - 29.6+/-10.7 min vs group S- 12.3+/-7.6 min, p<0.05). Modified Aldrete's score of 8 was achieved significantly faster in group S as compared to group H (group H - 33.8+/-9.3 min vs group S- 17.3+/-6.8 min, p<0.05). Adverse events during induction and recovery were comparable between the two groups except for significantly high incidence of excitement in group S. In conclusion, halothane is as suitable as sevoflurane for children undergoing rigid bronchoscopy for airway foreign body retrieval, but sevoflurane has a quicker recovery.