ABSTRACT
Background: There has been considerable debate regarding the ideal anaesthetic technique for Percutaneous Nephrolithotomy (PCNL). PCNL is usually performed under general anaesthesia (GA) in prone position. The prone position under GA is associated with various complications. To address these complications, our study was carried out to determine whether epidural anaesthesia [EA] with dexmedetomidine sedation can be a better alternative to GA for PCNL. Aims and Objectives: To compare the efficacy and feasibility of performing PCNL under EA in combination with dexmedetomidine infusion. Methods and Material: Out of 225 patients observed in this study, 115 patients (group A) underwent PCNL under EA with dexmedetomidine infusion and 110 patients (group B) underwent PCNL under GA. Results: Mean time to the first dose of rescue analgesia was significantly increased in Epidural group (328.17 ± 63.74) compared to GA group (72.09 min, p < .0001) and the mean Visual analog scale [VAS] scores were significantly lower in epidural compared to GA group at different time intervals during the first 24 h after surgery (p<0.05). Patients in epidural group had significantly less post-operative nausea, vomiting (6.1 % vs 13.6 %), and significantly less shivering (12.2% vs 33.6%). Mean patient satisfaction score in epidural group was significantly higher (8.75 ± 1.29 vs 8.14 ± 1.39, p=0.001); however, the mean surgeon satisfaction score was comparable among the two groups (8.76 ± 1.39 in Group A and 8.61 ± 1.35 in Group B, p=0.421). Conclusions: Our study shows that EA is an equally effective alternative to GA for PCNL, with more patient satisfaction, less postoperative pain, early ambulation and postoperative recovery, less systemic analgesic requirements and less adverse effects.
ABSTRACT
Background: Pediatric infraumbilical surgeries are often performed under general anaesthesia using different modes of ventilation through Laryngeal Mask Airway .Although controlled ventilation has been successfully used, very less studies have been done to compare them with spontaneous ventilation for short duration surgeries. Aims: We tried to measure quantitave differences in haemodynamic and respiratory parameters and assess the recovery profile between controlled and spontaneous ventilation using Proseal LMA. Settings and Design: This was a prospective, randomized, double-blind study that comprised 90 American Society of Anaesthesiologist (ASA) classes I and II pediatric patients posted for infra umbilical surgery. Materials and Methods: 90 paediatric patients undergoing infraumbilical surgeries were included. Three different ventilation strategies: spontaneous , pressure support and pressure-controlled ventilation were applied depending on attending anaesthesiologist's preference. Haemodynamic and respiratory parameters were recorded during the procedure. Post procedure parameters including need for supplementary oxygen, recovery time, complications were recorded. Statistical Methods: Analysis of variance (ANOVA) was employed for inter group analysis and for multiple comparisons, least significant difference (LSD) test was applied. Chi-square test or Fisher's exact test, whichever appropriate, was used for comparison of categorical variables. Results: The mean time interval between end of surgery and removal of LMA was significantly higher in PCV group in comparison to SV and PSV groups. In SV group lesser number of patients required oxygen supplementation and had shorter stay in recovery than PCV group. Conclusion: We conclude that spontaneous mode of ventilation can be used as safely as controlled /assist ventilation mode in short duration surgeries in high turn over settings.
