Effect of Intravenous Dexmedetomidine Before Extubation on Emergence Delirium after Nasal Surgeries.

OBJECTIVE: To investigate the role of single dose of dexmedetomidine (0.5 mcg/kg) in reducing the incidence and severity of postoperative emergence delirium (EmD). STUDY DESIGN: A randomised controlled trial. Place and Duration of the Study: Department of Anaesthesia, Security Forces Hospital, Riyadh, Saudi Arabia, from 1st December 2022 to 30th March 2023. METHODOLOGY: Patients, aged between 18-65 years, with ASA 1-3 scheduled to undergo nasal surgeries under general anaesthesia, were inducted in the study. Exclusion criteria were patient refusal, later request for removal from the study, inability to give consent, known allergy to dexmedetomidine, body mass index (BMI) more than 35, history of obstructive sleep apnoea, history of psychiatric illness, pregnancy, and presence of liver and renal diseases. The primary outcome measure of the study was the incidence of emergence delirium in the postoperative period. RESULTS: The frequency of EmD after nasal surgery was 52.38% in the control group compared to 14.28% in the dexmedetomidine group (p = 0.01). Pain scores were not statistically different between the two groups. The duration of post anaesthesia care unit (PACU) stay was significantly lesser in dexmedetomidine group (p <0.001). The satisfaction score on the visual analogue scale (VAS) was also found to be higher in patients who received intravenous dexmedetomidine (p <0.001). CONCLUSION: The use of single dose dexmedetomidine before extubation in nasal surgeries reduces the EmD and improves patient satisfaction. KEY WORDS: Dexmedetomidine, Emergence delirium, Nasal surgery, Opioid consumption, Pain control.

Intravenous ketamine in gynaecological surgeries reduces pain score and opioid consumption.

OBJECTIVE: To assess the effect of intravenous ketamine on postoperative pain control, opioid consumption, and the incidence of postoperative adverse events in gynaecological surgeries. METHODS: The systematic review and meta-analysis were conducted in July 2020 and the search was repeated in July 2021 to ensure accuracy. The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) as ID-CRD42020188637 in July 2020. The search, done on online databases Medline and Science Direct, comprised studies on patients who underwent general anaesthesia for gynaecological surgeries and received intravenous ketamine intraoperatively, and the findings included opioid consumption, postoperative pain control, and associated side-effects. RESULTS: Of the 79 randomised controlled trials found, 9 (11.4%) were subjected to meta-analysis. The use of intravenous ketamine reduced pain score at 2h (p=0.003) and 24h (p=0.002) postoperatively in gynaecological surgeries. In laparoscopic gynaecological surgeries, lower pain scores were reported at 1h (p=0.01) and 2h (p=0.002) postoperatively. Lower pain scores were reported at 24h postoperatively in open gynaecological surgeries (p=0.002). Intravenous ketamine increased the time to first-request analgesia postoperatively (p=0.03), and reduced postoperative 24h opioid consumption (p=0.002). CONCLUSIONS: The use of intravenous ketamine significantly reduced postoperative pain at 2h and 24h after gynaecological surgeries and at 1h and 2h after laparoscopic gynaecological surgeries.

Anaesthesia Management of a Patient with Glucose-6-Phosphate Dehydrogenase Deficiency Undergoing Total Thyroidectomy.

We present here, anaesthesia management of a patient having glucose-6-phosphate dehydrogenase (G6PD) deficiency who underwent thyroidectomy. The main concern is to avoid any precipitating factor which could lead to oxidative stress in these patients. There is very limited data available on anaesthesia management of thyroid surgery in such patients.  Key Words: Glucose-6-phosphate dehydrogenase deficiency, Oxidative stress, Anaesthesia management.

Anaesthetic Management of a Patient with Left Ventricular Non-Compaction Undergoing Laparotomy.

We report a case of left ventricular non-compaction as patient underwent laparotomy for ovarian cystectomy. Left ventricular non-compaction is a rare congenital cardiomyopathy with clinical features of heart failure, systemic thromboembolic events and arrhythmias. Perioperative management of these patients can be very challenging. We used general anaesthesia with subarachnoid block for our patient. We used perioperative, goal-directed, fluid therapy using LiDCO rapid in this case. Patient was monitored in high dependency unit for the risk of perioperative arrhythmias and discharged home in next 24 hours.