Comparison of dexmedetomidine and clonidine as an adjuvant to lignocaine with adrenaline in infiltration anesthesia for tympanoplasty

Background: Adjuvants to local anesthetics enhance the quality and duration of analgesia. Dexmedetomidine, a potent alpha2-adrenoceptor agonist, is approximately eight times more selective towards the alpha2-adrenoceptor than clonidine. Dexmedetomidine was compared with clonidine in infiltration anesthesia when added to local anesthetic in infiltration anesthesia in tympanoplasty

Methodology: Sixty patients of age group 18-60 years, scheduled for tympanoplasty under local anesthesia were randomly divided into two equal groups. In Group C [n = 30], 12 ml of 2% lignocaine with adrenaline + clonidine 1 microg/kg; and in Group D [n =30], 12 ml of 2% lignocaine with adrenaline + dexmedetomidine 1 microg/kg were infiltrated. Onset and duration of analgesia, hemodynamic parameters, sedation score and grade of bleeding were recorded. All the Quantitative data are presented as mean and standard deviation and compared using student's t-test. Qualitative data such as sedation score, grade of bleeding are presented as frequency and percentage and analyzed using chi-square test. P-value of < 0.05 was considered as significant and p < 0.001 was considered as highly significant

Results: Both groups were comparable in terms of demographic and surgical parameters. Duration of postoperative analgesia was lasted longer in Group D as compare to Group C [690.00 +/- 80.12 vs 417.67 +/- 58.64 min, P < 0.001] and sedation scores were higher in Group D. No difference was observed in both of the groups regarding other parameters including onset of analgesia, mean pulse rate, mean blood pressure and grade of bleeding at different time intervals [P > 0.05]

Conclusion: Dexmedetomidine when used as an adjuvant to local anesthetic in infiltration anesthesia for tympanoplasty was found to be more effective than clonidine in terms of duration of postoperative analgesia and sedation score, with no difference in terms of onset of analgesia, grade of bleeding and hemodynamic parameters

Airway management in a patient with large antrochoanal polyp

Anesthetic management of patients with large antrochoanal polyps needs anticipation and adequate preparation for the associated problems. Presenting as nasal polyps, these may mislead and cause unexpected problems in ventilation as well as intubation. We present a case of a large antrochoanal polyp leading to bilateral nasal obstruction undergoing general anesthesia for polypectomy. A brief review of literature is included

Comparative study of thoracic epidural fentanyl with sufentanil for postoperative pain relief in thoracic surgery

Both fentanyl and sufentanil have been used, either alone or with local anesthetics, for thoracic epidural analgesia. This study was undertaken to compare quality and safety of thoracic epidural fentanyl and thoracic epidural sufentanil for providing postoperative analgesia for 48 hours after thoracic surgery. In a prospective randomized, controlled study, 70 patients age group between 20-60 years, of either gender, scheduled for routine thoracic surgery were randomly distributed into two groups of 35 patients each. Postoperatively, fentanyl 50 ug in Group-F and sufentanil 20 ug in Group-S, diluted in 10 ml of normal saline was injected in the thoracic epidural space [between T6 - T8] through the catheter and then repeated 6 hourly. Pain intensity score, onset of analgesia, number of top-ups required and overall patient satisfaction score were recorded. Mean onset of analgesia was 10.31 +/- 1.5 min with sufentanil group as against 14.23 +/- 1.2 min with fentanyl group. Pain Intensity [PPI] score < 1 was observed in 78.21% observations belonging to sufentanil group and in 50% observations belonging to fentanyl group. Twenty five patients [71.4%] from sufentanil group and 30 patients [85.7%] from fentanyl group required rescue analgesia. The patient's feedback on pain relief was graded as very good or good by 78.5% of the patients in Group-S and 69% patients in Group-F. Though both drugs are equally safe, sufentanil is faster acting, more potent and efficient analgesic than fentanyl when used for postoperative pain relief in thoracic surgeries via thoracic epidural approach

Cerebral fat embolism: a diagnostic challenge

Fat embolism syndrome [FES] is a rare but a serious clinical catastrophe occurring after traumatic injury to long bones. Cerebral involvement in the absence of pulmonary or dermatological manifestation on initial presentation may delay the diagnosis of cerebral fat embolism [CFE]. We discuss a case series of CFE which posed a challenge in diagnosis. The clinical presentations of these patients did not satisfy the commonly used clinical criteria for aiding the diagnosis of FES. Early MRI brain [DWI and T2 weighted sequences] in patients with neurological symptoms after trauma even in the absence of pulmonary and dermatological findings should be the goal