Cisatracurium Pretreatment with Tourniquet - Role in Propofol Injection Pain: A Prospective, Randomized, Double Blind and Control Study

Introduction: Propofol is an anaesthetic drug which is given toinduce and maintain anaesthesia in adults undergoing surgery.This prospective, randomized, controlled study was designedto evaluate the efficacy of cisatracurium as a pretreatment drugin reducing incidence and severity of propofol injection pain.Material and methods: Patient undergoing generalanaesthesia were randomized in four groups of 25 patientseach. Group A received normal saline (control group), GroupB received Cisatracurium 0.05mg/kg IV, Group C receivedCisatracurium 0.1mg/kg IV, Group D received Cisatracurium0.15mg/kg IV. All drugs were administered into the largestdorsal vein of the hand with venous occlusion for 30 sec,followed by propofol (0.5mg/kg). Pain was evaluated usinga four point scale.Result: Cisatracurium 0.15mg/kg significantly lowers bothincidence and severity of propofol induced pain. Cisatracurium0.1mg/kg and cisatracurium 0.05mg/kg both significantlylower the severity of pain but not the incidence as comparedto control group.Conclusion: Cisatracurium is an effective drug in reducingpropofol induced pain. It reduces the incidence and severityboth of pain in 0.15mg/kg dose. Whereas only severityis decreased with 0.10 mg/kg and 0.05 mg/kg dose ofcisatracurium without any significant complications.

Role of Laryngeal Spasm in Negative Pressure Pulmonary Oedema.

Negative-pressure pulmonary edema (NPPE) is a clinical entity of anaesthesiologic relevance, peri-operatively caused by obstruction of the conductive airways (upper airway obstruction, UAO) due to laryngospasm in approx. 50% of the cases, its early recognition and treatment by the anaesthesiologist is mandatory. Laryngospasm, a brief closure of the vocal cords is not an uncommon peri-operative occurrence. If recognized and managed appropriately, the effects are transient and reversible. However, in rare cases where recognition and management are delayed, the consequences are associated with a high morbidity including desaturation, awareness, negative pressure pulmonary edema, and mortality.

Gasping infant for emergency neck exploration, anaesthesiologist’s nightmare.

Children are not small adults. They have certain anatomical & physiological differences as compared to adults. Paediatric patients have limited body reserve and so they deteriorate very fast. Anaesthetising paediatric patient requires good clinical judgment and thorough knowledge of paediatric anatomy and physiology. Anaesthetising an infant who has respiratory distress preoperatively increases risk several folds. Also the cause of respiratory distress is vital and that can have an important anaesthetic implications. Here we report a case of a gasping infant operated for emergency neck exploration under anaesthesia, where the cause of respiratory distress was unknown, making the case further interesting and challenging.

Attitude of Patients towards Anaesthesia: Comparing the Use of a Single Consent for Anaesthesia versus the Combined Surgical and Anaesthetic Consent

Anaesthesiology is a specialty which is less well known and the public usually have little knowledge regarding anaesthesia and the roles of Anaesthesiologist. Many hospitals now use a single dedicated consent for anaesthesia. This study was conducted to compare the effectiveness of a single consent for anaesthesia with the combined surgical and anaesthetic consent. A total of 109 patients, scheduled for elective surgery requiring anaesthesia were interviewed with a standardised questionnaire. Patients were divided into two groups, where one group used a single anaesthetic consent while the other used a combined surgical and anaesthetic consent. A single consent for anaesthesia was found to be more effective than the current combined surgical and anaesthetic consent (p<0.05). Regarding information about anaesthesia, 89.91% respondents agreed that the Anaesthesiologist should tell them all material risks of anaesthesia, no matter how serious it is and 81.65% respondents would like to meet Anaesthesiologist every time prior to the operation. In terms of knowledge, 94.5% patients recognized that Anaesthesiologist is the one who delivers anaesthesia during surgery. However, patients had little knowledge regarding the extended roles of Anaesthesiologist. The present study confirmed that a single consent for anaesthesia was better than the current combined surgical and anaesthetic consent.