To Compare the Effect of Two Different Doses of Dexmedetomidine on the Attenuation of Airway and Pressor Response during Tracheostomy Tube Change in Traumatic Brain Injury Patients.

BACKGROUND: Tracheostomy tube (TT) change is the common procedure in trauma Intensive Care Unit (ICU) and almost always associated with cough reflex, increase in blood pressure, and heart rate. Dexmedetomidine (DEX) is a selective α2-adrenergic receptor agonist well studied for the prevention of pressor response during laryngoscopy and extubation, but literature on prevention of pressor response during TT change is lacking. AIMS: The aim of this study is to compare two doses (0.5 and 1.0 µg/kg) of DEX for prevention of cough and pressor response during TT change in traumatic brain injury patients. SETTINGS AND DESIGN: Prospective randomized, double-blind trial. MATERIALS AND METHODS: Sixty tracheostomized traumatic brain injury patients in ICU scheduled for TT change were randomized to two equal groups: Group A to receive DEX 0.5 µg/kg and Group B to receive DEX 1.0 µg/kg. Calculated dose of studied drug was given by infusion pump over 10 min after dilution in 50 ml. Hemodynamic parameters, cough reflex, and adverse event were recorded and statistically analyzed. STATISTICAL ANALYSIS: Statistical analysis was done with nonpaired (two tailed, independent) Student's t-test for continuous data. Demographic data were compared using Pearson's χ2 test. P < 0.05 was considered to be statistically significant. RESULTS: Both doses of DEX were able to attenuate the hemodynamic response of tracheal stimulation and cough reflex. Cough reflex was better controlled with 1.0 µg/kg dose but associated with increased incidence of hypotension and bradycardia. CONCLUSIONS: We conclude that 0.5 µg/kg dose provides desired attenuation of hemodynamic response during TT change without any significant adverse events.

Tuberculous constrictive pericarditis and atrial septal defect: Surgical challenge.

Tuberculous constrictive pericarditis with atrial septal defect is very rare. A 23-year-old man required pericardiectomy and atrial septal defect closure under cardiopulmonary bypass by cannulating the aorta and right atrium because femoral cannulation was not possible and the venae cavae could not be visualized. He was discharged in a satisfactory condition on the 15th postoperative day, but returned one month later with swelling all over his body and dyspnea on exertion. Echocardiography showed atrial septal defect patch dehiscence and a bidirectional shunt with a collection or mass compressing the right ventricle. Subxiphoid exploration was carried out, and the swelling subsided.

Clonidine versus nitroglycerin infusion in laparoscopic cholecystectomy.

BACKGROUND AND OBJECTIVES: Laparoscopic surgery offers the advantages of minimally invasive surgery; however, pneumoperitoneum and the patient's position induce pathophysiological changes that may complicate anesthetic management. We studied the effect of clonidine and nitroglycerin on heart rate and blood pressure, if any, in association with these drugs or the procedure, as well as the effect of these drugs, if any, on end-tidal carbon dioxide pressure and intraocular pressure. METHODS: Sixty patients (minimum age of 20 years and maximum age of 65 years, American Society of Anesthesiologists class I or II) undergoing laparoscopic cholecystectomy were randomized into 3 groups and given an infusion of clonidine (group I), nitroglycerin (group II), or normal saline solution (group III) after induction and before creation of pneumoperitoneum. We observed and recorded the following parameters: heart rate, mean arterial blood pressure, end-tidal carbon dioxide pressure, and intraocular pressure. The mean and standard deviation of the parameters studied during the observation period were calculated for the 3 treatment groups and compared by use of analysis of variance tests. Intragroup comparison was performed with the paired t test. The critical value of P, indicating the probability of a significant difference, was taken as < .05 for comparisons. RESULTS: Statistically significant differences in heart rate were observed among the various groups, whereas comparisons of mean arterial pressure, intraocular pressure, and end-tidal carbon dioxide pressure showed statistically significant differences only between groups I and III and between groups II and III. CONCLUSION: We found clonidine to be more effective than nitroglycerin at preventing changes in hemodynamic parameters and intraocular pressure induced by carbon dioxide insufflation during laparoscopic cholecystectomy. It was also found not to cause hypotension severe enough to stop the infusion and warrant treatment.