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BACKGROUND: In orthopedic surgeries, there has been an increase in the usage of the neuraxial blockade to provide excellent surgical conditions and prolonged postoperative analgesia. The introduction of the sequential combined spinal epidural anesthesia (SCSEA) technique provides benefits for both spinal anesthesia (SA) and epidural anesthesia. The focus of this study was to analyze the time needed to attain a desired level of sensory block, to compare the period of sensory block, and to study the intraoperative hemodynamics in the SCSEA and SA groups. MATERIALS AND METHODS: The study was conducted on patients admitted for elective lower limb orthopedic surgeries. The sample size for this prospective randomized study is two groups of 67 subjects each. Patients aged between 18 and 65 years, posted for orthopedic surgeries for two to three hours, and of American Society of Anaesthesiologists (ASA) Grades 1 and 2 were included and divided into two groups. Group A patients received SCSEA with an epidural-test dose of 3 ml lignocaine (2%) with adrenaline and spinal bupivacaine (0.5%) of 1.5 ml-7.5 mg + fentanyl .25 mic if the sensory level was below T8. An epidural top-up was given with 2 ml per segment of 0.5% bupivacaine to bring the sensory level to T8. Group B patients received SA with spinal bupivacaine (0.5%) of 3 ml-15 mg + fentanyl .25 mic. Intraoperative hemodynamics, the duration to achieve a sensory level of T8, the time for two-segment regression of sensory block, and the complications that occurred were recorded. RESULTS: The study included a total of 134 subjects with each group having 67 subjects admitted for lower limb surgery. The mean value (SD) of the time taken to attain sensory block in the SCSEA group was prolonged when compared to the SA group (7.15 ± 0.75 and 5.01 ± 0.88). The time for two-segment regression in the SCSEA group was 86.77 ± 3.60 and the SA group was 106.4 ± 8.01, which indicated that the SA group has a longer and better sensory block. Substantially, the study shows that the SCSEA group (P < 0.05) has better hemodynamics when compared to the SA group. CONCLUSION: The SCSEA technique has better intraoperative hemodynamic stability with a longer analgesic effect when compared to SA. SA shows a sudden change in hemodynamics but reveals a greater sensory block.
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Background This study aimed to compare intraoperative blood sugar level fluctuations between a group of patients receiving Ringer's lactate (RL) fluid as maintenance fluid and another group receiving 0.45% dextrose normal saline with 20 mmol/liter potassium. Materials and methods This randomized double-blind study was conducted on 68 nondiabetic patients undergoing elective major surgeries at R. Laxminarayanappa Jalappa Hospital, Sri Devaraj Urs Medical College, Kolar, during the academic year from Jan 2021 to May 2022. Informed consent was obtained from these patients concerning their participation in this study. There were two groups of patients: Ringer lactate (RL) was administered to group A, and 0.45% dextrose normal saline and 20 mmol/L potassium chloride (KCl) were administered to group B. The vitals and blood glucose levels were measured among the patients. A p-value of 0.05 was considered statistically important. Results The mean age of the patients was found to be 43.60 ± 15 years, with comparable age and gender distribution between the groups. On comparison of the mean blood glucose levels immediately after induction was not important between the groups. The mean levels were comparable between the groups (p>0.05). After completion of the surgery, the mean blood glucose level significantly increased in group B patients when compared to those in group A (p<0.05). Conclusion The study found a substantial increase in intraoperative blood glucose levels among patients receiving 0.45% dextrose normal saline with 20 mmol/liter potassium instead of RL solution as maintenance fluid.
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BACKGROUND: Patients with hip fractures will be experiencing excruciating pain, which would prevent the ideal positioning of the patient for the neuraxial blockade. There is growing interest in using regional nerve blocks for pain in the elderly associated with a fractured hip. Pericapsular Nerve Group (PENG) block is gaining popularity as a provider of adequate analgesia in patients suffering from a hip fracture. The present study aimed to assess the effectiveness of PENG block using ropivacaine alone or ropivacaine with dexamethasone in reducing pain scores during patient positioning for the central neuraxial blockade and to compare the duration of postoperative analgesia. MATERIALS AND METHODS: This randomized double-blinded study was conducted on patients posted for hip surgery under spinal anesthesia at a tertiary care referral hospital between January 2021 and May 2022. Twenty-eight patients (14 in each group) were randomly allocated to receive either group A (20 ml of 0.5% ropivacaine for PENG block) or Group B (20ml of 0.5% ropivacaine with 8mg Dexamethasone for PENG block) before patient positioning for subarachnoid block. Intra-operative hemodynamic variables, pain scores on a visual analog scale (VAS), at rest and with movement, before block, at the time of positioning for spinal anesthesia, time for first rescue analgesic request, and the total dosage of rescue analgesia in the first 24 hours after PENG block were measured. RESULTS: Pain scores at rest and with movement at baseline and at the time of positioning for spinal anesthesia were significant within the groups (p< 0.01). The time for the first rescue analgesic requirement was significantly longer in group B (445.0 ±17.4 minutes) than in group A (388.9±19.0 minutes) (p<0.05). The mean average number of doses of rescue analgesia (Tramadol in milligrams) was significantly lower in group B (190 ± 60) than in group A patients (250 ± 70) (p<0.05). CONCLUSION: The present study documented the effectiveness of PENG for patient positioning during the neuraxial blockade. Further, the addition of dexamethasone as an adjunct to ropivacaine yields a significantly longer duration of postoperative analgesia with a lower postoperative analgesic requirement.
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BACKGROUND: Hypothermia is a condition characterized by a decreased body temperature. It takes place when the body is exposed to cold weather or water for a longer period of time. Different types of hypothermia include acute hypothermia, exhaustion hypothermia, and chronic hypothermia. Excessive shivering, breathing difficulty, slurred speech, confusion, drowsiness, a weak pulse, and a loss of consciousness are the symptoms related to hypothermia. AIMS: The aim of this study was to see how effective co-warming and pre-warming are at reducing the risk of intraoperative hypothermia. MATERIALS AND METHODS: A randomized, prospective, comparative clinical study was conducted in a population of 60 participants. Participants were divided into two groups. Participants in group A received pre-warming for 30 minutes at 40°C before transport to the operation theater and also received co-warming before induction of anesthesia. Group B includes those who received co-warming at 40°C from the point of induction of anesthesia. RESULTS: The mean age (years) of participants in groups A and B was identified as 43.3 ± 11.84 and 45.93 ± 15.87, respectively. The majority of the participants in the study population were males in groups A and B, with 66.67% and 73.33%, respectively. The medians of core temperature and peripheral temperature at the baseline were identified as 36.80 (36.20 to 37.12) and 32.55 (32.38 to 32.72) in group A. Similarly, it was observed as 36 (35.70 to 36.20) and 32 (31.60 to 32.02) in group B. The medians of core temperature and peripheral temperature after the surgery were identified as 34.50 (34.20 to 35) and 32.65 (31.95 to 33) in group A. Similarly, it was identified as 34 (33.80 to 34.25) and 32 (32.10 to 32.25) in group B. CONCLUSION: Our study concluded that it is important to prevent hypothermia in patients undergoing surgery under general anesthesia. Pre-operative and intraoperative warming showed a decrease in the rate of fall in core temperature. Hence, both techniques are effective in reducing hypothermia.
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Introduction Unless specifically asked, many patients may be hesitant to discuss their experiences. Some people might not recall what happened right after surgery, but they might remember it 1-2 weeks later. We undertook the current study to estimate the incidence of awareness among patients under general anesthesia (GA). Methodology We conducted a cross-sectional, analytical study for three months. The study included patients who underwent functional endoscopic sinus surgery (FESS), septoplasty, mastoidectomy, or laparoscopic appendicectomy under general anesthesia. Patients who refused to take part and had low Glasgow Coma Scale (GCS) scores (less than 9) or didn't meet extubation criteria were all excluded from the study. We used a pre-validated semi-structured questionnaire for data collection. It had two sections. The first one includes demographic details, and the second section contains the modified Brice questionnaire. By using this questionnaire, we classified the patients as A, B, and C. Class A experiences are those that were remembered under anesthesia or surgery and were confirmed or disproved by the attending medical personnel present in the operating room. Class B, which stands for "potential awareness," was defined as a state in which the patient could not specifically recollect any occurrence that occurred during anesthesia or surgery but could have made connections between memories and the surgical procedure. We define Class C as a lack of recalled intraoperative events with probable memories of scenarios from the immediate pre- or postoperative period. We analyzed the data collected using IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. Results About 240 patients took part in this study. Most of the people (68%) were men in the age group of 31 to 50 years. About 2% of the patient's experience awareness during general anesthesia. Only 2.5% of patients experienced dreaming. The association between awareness and comorbidity was statistically significant (P < 0.001). Conclusion It is about to know that our study results suggest that awareness had an association with comorbidity among the patients undergoing surgery under general anesthesia.
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Background and Objectives Functional endoscopic sinus surgery (FESS) is a type of minimally invasive surgery done for acute and chronic sinus diseases or paranasal illnesses. The idea of FESS is to preserve the normal anatomy, which is non-obstructing and mucous membrane while removing tissue obstructing OMC (osteo metal complex) and facilitating drainage. The critical structures, including the brain, orbit, and carotid veins, the lack of adequate operating room, and bleeding that obscures endoscopic vision throughout the procedure may increase the likelihood of unfavorable surgical results. This study seeks to examine the hemodynamic effects of intubation and extubation as well as the impact of fentanyl infusion on lowering blood pressure during FESS procedures. Materials and Methods Sixty-eight patients from the American Society of Anesthesiologists classes 1 and 2 who were planned for functional endoscopic sinus operations were randomly split into two groups for this randomized prospective trial. Group 1 patient belonging to the fentanyl 2 mcg per kg bolus 30 minutes before induction followed by 2 mcg per kg per hr infusion for 90 minutes of surgery, and Group 2 patient belonging to fentanyl 1 mcg per kg bolus 30 minutes before induction followed by 1 mcg per kg per hr infusion for 90 minutes of surgery. The significance of the difference in quantitative measures was measured using the student-t test, and the Chi-square test was used to measure up the difference in proportion. Statistically significant was set at P<0.05. Results Mean systolic blood pressure was higher in members of Group 2 than in Group 1. In contrast to Group 2, Group 1 had considerably better surgical field conditions, surgeon satisfaction on the AONO'S scale, post-operative nausea and vomiting, and a post-operative VAS Score during the first 24 hours. Conclusion Pre-induction Fentanyl with infusion can effectively control hypotension during functional endoscopic sinus surgery.
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CONTEXT: In day-to-day practice, subarachnoid block remains the most common type of anesthesia. Bupivacaine is commonly used local anesthetic of neuraxial blockade, though earlier 5% xylocaine and now ropivacaine and levobupivacaine are also used. Additives such as opioids and α2 agonists are also used. We are using neostigmine as an additive with bupivacaine to see the duration of postoperative analgesia. AIMS: To compare the efficacy of intrathecal hyperbaric bupivacaine with neostigmine when compared to hyperbaric bupivacaine with normal saline with regard to time of onset and duration of sensory and motor blockade, time to two-segment regression. SETTINGS AND DESIGN: Randomized, double-blinded study. SUBJECTS AND METHODS: One hundred patients admitted for lower abdominal and lower limb surgeries done under spinal anesthesia (SA) during the period of February 2015-August 2016. STATISTICAL ANALYSIS USED: Data were entered into Microsoft excel data sheet and analyzed using SPSS 22 version. Categorical data were represented in the form of frequencies and proportions. Chi-square was used as a test of significance. Continuous data were represented as a mean and standard deviation. Independent t-test was used as a test of significance to identify the mean difference between two groups. RESULTS: Mean onset of sensory blockade with neostigmine group was 174.1 ± 107.1 s and in normal saline group 171 ± 35.6 s. Mean onset of motor blockade with neostigmine group was 197.4 ± 111.6 s and in normal saline group was 219.4 ± 73.2 s. Mean two-segment regression with neostigmine group was 110.6 ± 22.7 s and in normal saline group was 71.5 ± 17.1 min. Duration of analgesia with neostigmine group was 336.3 ± 54.5 min and in normal saline group was 188.8 ± 18.4 min. CONCLUSIONS: Intrathecal neostigmine is associated with significantly prolonged sensory, motor blockade, and effective postoperative analgesia.
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INTRODUCTION: Endotracheal extubation causes transient hemodynamic stimulation leading to increase in blood pressure and heart rate (HR) due to increase in sympathoadrenergic activity caused by epipharyngeal and laryngopharyngeal stimulation. Lignocaine, a sodium channel blocker, attenuates the hemodynamic response to tracheal extubation by inhibiting sodium channels in the neuronal cell membrane, decreasing the sensitivity of the heart muscles to electric impulses. Diltiazem, a calcium channel blocker, attenuates hemodynamic response by blocking voltage-sensitive L type channels and inhibiting calcium entry-mediated action potential in smooth and cardiac muscle. AIMS AND OBJECTIVES: The aims and objectives of this are to study and to compare the efficacy of combination of intravenous (i.v.) diltiazem 0.1 mg/kg and i.v. lidocaine 1.0 mg/kg, diltiazem 0.2 mg/kg and lidocaine 1.0 mg/kg, lignocaine 1.0 mg/kg with normal saline given to attenuate exaggerated hemodynamic extubation responses and airway reflexes during extubation. MATERIALS AND METHODS: This study was undertaken with 105 patients belonging to the age group 20-65 years with physical status ASA Classes I and II of either sex. Group A received injection diltiazem 0.1 mg/kg and preservative-free lignocaine 1 mg/kg. Group B received injection diltiazem 0.2 mg/kg and lignocaine 1 mg/kg. Group C received injection lignocaine 1 mg/kg with normal saline. In this study group, the drug dosage was fixed based on the previous studies. RESULTS: At postextubation, significant difference in HR, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) were observed from 1 to 10 min between three groups. The difference in HR, SBP, DBP, and MAP were statistically significant between Group C in comparison with Group A and Group B from 1 min postextubation to 10 min. CONCLUSION: Combined diltiazem and lidocaine are more effective prophylaxis than lidocaine alone for attenuating the cardiovascular responses to tracheal extubation.
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CONTEXT: Subarachnoid block or spinal anesthesia is a commonly used technique for lower abdominal and lower limb surgeries. Bupivacaine is the commonly used cost-effective drug which gives satisfactory analgesia for 90-120 min. Additives such as opioids and α2 agonists extend the analgesia in the postoperative period. In this study, we compared the effects of nalbuphine with fentanyl. AIMS: The aim of this study is to compare the effects of intrathecal nalbuphine and fentanyl as adjuvants to hyperbaric bupivacaine in regard to time of onset of sensory blockade, duration of sensory blockade, two-segment sensory regression time, duration of effective postoperative analgesia, and incidence of side effects. SETTINGS AND DESIGN: This was a prospective, randomized double-blind study. SUBJECTS AND METHODS: After ethical committee permission and patient consent, 124 patients aged 18-55 years with American Society of Anesthesiologists physical status I and II were randomly divided into two groups - Group N: hyperbaric bupivacaine with nalbuphine (300 µg); Group C: hyperbaric bupivacaine with fentanyl (25 µg). RESULTS: Duration of onset of sensory blockade was 3.9 ± 0.35 min in Group C and 3.1 ± 0.18 min in Group F. Two-segment sensory regression time was prolonged in Group C (193.16 ± 39.55) compared to Group F (167.41 ± 30.17 min). CONCLUSIONS: Intrathecal nalbuphine at a dose of 300 µg in 3 ml 0.5% heavy bupivacaine in patients undergoing elective lower abdominal surgeries showed delay in onset time for sensory blockade and produced prolonged postoperative analgesia, prolonged sensory blockade, and minimal bradycardia which could be easily managed.
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Spinal anaesthesia is a suitable choice for emergency LSCS (lower segment caesarian section). High spinal is common in parturients. We report a case of 25-year-old primigravida with cephalo pelvic disproportion coming for emergency LSCS with no comorbidities. The patient became unresponsive after 5 min of Sub Arachnoid Block (SAB), managed as a case of high spinal. Still the patient remained unresponsive at the end of surgery, 50 min after SAB. Patient started responding to oral commands after correction of hypoglycemia with 25% dextrose infusion.
