Efficacy of epidural 0.25 ml fentanyl versus 0.5 ml dexmedetomidine with 0.75% ropivacaine in lower abdominal surgeries

Background: Epidural anesthesia alloyed with opioids facilitates a dose sparing effect of local anesthetic and superior analgesia. The drugs such as dexmedetomidine and fentanyl are effective adjuvants to ropivacaine to provide efficient post-operative analgesia. Still, the findings are contradictory. Aims and Objectives: The aims of the study were to assess the efficacy of 0.75% ropivacaine with 0.25 ml fentanyl and 0.5 ml dexmedetomidine in the patients undergoing lower abdominal surgeries. Materials and Methods: A total of 80 cases undergoing lower abdominal surgeries above 21 years were recruited. Group RF administered with 18ml of 0.75% ropivacaine + 0.25 ml fentanyl. Group RD administered with 18ml of 0.75% ropivacaine + 0.5 ml dexmedetomidine. During intraoperative period, parameters such as sensory block, motor block by modified Bromage scale, pain score, and hemodynamic parameters were recorded. The sedation score was assessed using Ramsay sedation score. Results: The mean difference of the events of sensory block and motor block between two study groups was statistically significant (P < 0.05). The mean systolic blood pressure (SBP) was comparatively less in Group RD than Group RF during the entire study period. The mean difference of SBP, heart rate, and mean arterial pressure was statistically significant (P < 0.05). Preoperatively, the diastolic blood pressure was higher in Group RD; later stages, the levels were lesser than Group RF. The mean sedation score was less in Group RD till 15 min, later, it was higher in Group RD than Group RF. Bradycardia was commonly associated post-operative complication in both the study groups followed by nausea and vomiting. Conclusion: The fentanyl and dexmedetomidine are effective adjuvants to ropivacaine. However, dexmedetomidine has better efficacy in terms of prolonged duration of sensory block, motor block, and postoperative analgesia, minimal requirement of rescue analgesia and with less post-operative complications.

Comparative efficacy of 600 mg oral gabapentin and 300 mcg oral clonidine in attenuation of pre-operative anxiolysis and hemodynamic response to endotracheal intubation and laryngoscopy

Background: Endotracheal intubation and laryngoscopy are harmful stimulus, which can trigger unwanted cardiovascular conditions such as hypertension, dysrhythmia, and tachycardia. Various drugs have been used to attenuate the cardiovascular response. Drugs such as clonidine and Gabapentin are in extensive usage to stabilize the hemodynamic responses. Aim and Objectives: The aim of the study was to assess the efficacy of 600 mg oral Gabapentin and 300 mcg oral clonidine in attenuating pre-operative anxiolysis and hemodynamic response to endotracheal intubation and laryngoscopy. Materials and Methods: This prospective randomized study consists of 100 cases between the age group 21 and 65 years posted for elective surgery under general anesthesia. The study cases were randomly divided into two groups. Group 1 (n = 50) administered with 600 mg oral Gabapentin and Group 2 (n = 50) administered with 300 mcg oral clonidine. The baseline and pre-operative hemodynamic parameters and levels of sedation score and anxiety scores were recorded. Results: The total duration of intubation was 26.53 min in Group 1 and 26.86 min in Group 2. The systolic blood pressure, diastolic blood pressure, mean heart rate, mean arterial pressure, sedation score, and anxiety score were comparable between the two study groups and the mean difference between the two study groups was statistically significant (P < 0.05). Conclusion: Both study drugs had similar significant anxiolysis and sedation scores. However, 300 ?g oral clonidine has better hemodynamic stability to laryngoscopy and intubation than 600 mg oral gabapentin.

Dexmedetomidine and esmolol for induced hypotension for functional endoscopic sinus surgery-a comparative study

Background: Functional endoscopic sinus surgery is a minimally invasive surgical procedure performed under controlled hypotensive anesthesia. This technique has the advantage of minimal blood loss and visualizes surgical field distinctly. Aim and Objectives: To compare the efficacy of Dexmedetomidine and Esmolol for the induction of controlled hypotension in functional endoscopic sinus surgeries. Materials and Methods: A total of 80 cases with paranasal sinus pathologies posted for functional endoscopic sinus surgeries between 21 and 60 years were recruited. Study participants were randomly divided into two study groups, i.e. Group 1 administered with dexmedetomidine and Group 2 administered with Esmolol. Parameters such as hemodynamics, total intraoperative fentanyl consumption, duration of surgery, and total blood loss were noted. Results: The mean difference of systolic blood pressure, diastolic blood pressure and mean arterial pressure was not statistically significant (P > 0.05). The mean difference of heart rate between two study groups was statistically significant (P < 0.05). The mean duration surgery in Group 1 was 87.9 min and in Group 2 was 89.5 min. The estimated blood loss was 132.2 ml in Group 1 and 134.2 ml in Group 2. No desaturation was observed in the study participants during recovery and the postoperative period. Conclusion: Both dexmedetomidine and esmolol infusion are efficacious and are safe drugs for maintaining controlled hypotension and improve the quality of surgical field. Dexmedetomidine was associated with good postoperative sedation while esmolol associated with early recovery time. Surgeon satisfaction score was similar was similar in both groups.

Propofol and Thiopentone as induction agents in Obstetric anesthesia – A comparative study.

Background: In Cesarean, two anesthesia techniques are commonly used i.e. general and regional techniques. Regional anesthesia is most preferable under some circumstances. Commonly used induction agents include thiopental, Ketamine and propofol, depending on availability and the maternal clinical condition. Aim: Propofol 2.5 mg/kg was compared with Thiopentone 5 mg/kg as on induction agent for elective Cesarean section. Materials and methods: A total 103 healthy patients were included in an open randomized study, among whom 51 patients received Thiopentone and 52 received Propofol. These patients were unpremedicated, after induction dose the maintenance was similar for both groups. Results: Both Propofol and Thiopentone group produced a rapid and smooth induction of anesthesia with a low incidence of side effects. Diastolic blood pressure was lower in Propofol group during the induction to delivery interval. Other hemodynamic changes were similar for both groups. Respiratory upsets occurred less frequently with Propofol (7.8%) than with Thiopentone (22.5%), but Propofol caused more pain (28.8%) on injection compared to Thiopentone. Recovery time was shorter after Propofol as evaluated by time to open eyes on commands. There was no significant neonatal depression as assessed by Apgar score. Conclusion: Propofol appears to be a suitable alternative to Thiopentone as induction agent for Obstetric anesthesia.