RESUMO
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: 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.
RESUMO
Background: Cholecystectomy is one of the commonest, clean and contaminated surgery operations performed by the surgeons worldwide. Antibiotic prophylaxis in elective cholecystectomy is a controversial issue and our study was undertaken to evaluate the rate of infection and the usefulness and efficacy of antibiotic prophylaxis in elective cholecystectomies. Methods: The study comprised of 100 patients admitted for elective cholecystectomy. The first fifty patients undergoing elective cholecystectomy were given the prophylactic antibiotic outside the operation theater in the wards and the next fifty patients were given a single dose of injection cefuroxime (1.5 gm i.v). Results: In single dose antibiotic prophylaxis group 10.52% people developed surgical site infection in open cholecystectomy group while patients developed infection in laparoscopic cholecystectomy group but in multiple dose group 16.21% patients who underwent open cholecystectomy developed a surgical site infection while 10% developed an SSI in laparoscopic cholecystectomy group. In both the groups, results are statistically not significant. Conclusion: This study document that one single dose of prophylactic antibiotic, administered at induction of anaesthesia, is sufficient to prevent post-operative infective complications in patients undergoing elective cholecystectomy.