ABSTRACT
Background and Aims: Laparoscopic surgeries result in increased intra abdominal pressure and cephalad displacement of the diaphragm. The Trendelenburg position can augment these respiratory changes. The primary objective of this study was to compare diaphragmatic excursions before and after a major laparoscopic pelvic surgery under general anaesthesia in the Trendelenburg position using ultrasonography (USG). Methods: This prospective observational study included 90 patients of either gender, aged 20-60 years, with American Society of Anesthesiologists physical status I/II. M-mode USG was used to assess diaphragm inspiratory amplitude (DIA) before induction of anaesthesia and 10 minutes after tracheal extubation. Factors such as age, gender, body mass index, positive end-expiratory pressure (PEEP), pain, peak airway pressures, duration of pneumoperitoneum, duration and degree of Trendelenburg position and duration of anaesthesia were recorded. Pearson's correlation and multiple linear regression were used to analyse the factors affecting change in DIA (ΔDIA). Results: The mean difference (95% confidence interval (CI)) of measured DIA was 0.70 (0.598-0.809), P < 0.001. ΔDIA had a weak positive significant correlation with age, anaesthesia duration, pneumoperitoneum, and visual analogue scale (VAS) score 10 minutes after extubation. Multiple linear regression analysis showed 14.86% of the variance in DIA. Age (ß = 0.008, P = 0.049), duration of anaesthesia (ß = 0.002, P = 0.02) and VAS score 10 minutes after extubation (ß = 0.128, P = 0.001) were significant independent predictors. Conclusion: DIA decreased significantly after pelvic laparoscopic surgeries performed in the Trendelenburg position. Age, duration of anaesthesia and pain after the procedure were significant independent predictors.
ABSTRACT
BACKGROUND AND AIMS: i-gel® insertion necessitates adequate depth of anaesthesia to prevent laryngospasm, gagging or limb movements. We aimed to compare i-gel® insertion conditions with propofol induction after pre-treatment with dexmedetomidine or fentanyl. METHODS: Eighty ASAI/II patients undergoing general anaesthesia were randomised into Groups D (n = 40) and F (n = 40). Group D received 1 µg/kg dexmedetomidine over 10 minutes followed by 5ml of 0.9%normal saline (NS) over 2 minutes. Group F received 10 ml of 0.9%NS over 10 minutes followed by fentanyl 1 µg/kg over 2 minutes. Thirty seconds after study drugs, propofol 2 mg/kg was given. Ninety seconds after propofol, i-gel® was inserted. Overall insertion conditions were assessed by Modified Scheme of Lund and Stovener. Heart-rate (HR) and mean arterial pressure (MAP) were noted at baseline, after study drug, propofol induction and 1,3,5,10 minutes after i-gel® insertion. Respiratory rate and apnoea times were recorded. RESULTS: Insertion conditions were comparable between both groups. Moderately relaxed jaw, coughing and movement was observed in more patients of Group F. Incidence of apnoea was significantly higher (P < 0.0001) in group F (18/40) than group D (3/40).Mean duration of apnoea in group F (284.5 ± 11.19 sec) was significantly higher than group D (217.17 ± 16.48 sec). Percentage drop in MAP from baseline after propofol was more in group F (10.3%) than group D (5.6%). MAP after induction was significantly lower in group F compared to group D (P = 0.002), but similar after i-gel® insertion, 1,3,5 and 10 minutes after insertion. After propofol (P = 0.003) and i-gel® insertion (P < 0.001), HR was significantly lower with dexmedetomidine. CONCLUSION: Dexmedetomidine and fentanyl provide comparable conditions for i-gel® insertion with propofol.
ABSTRACT
INTRODUCTION: Proseal Laryngeal Mask Airway (PLMA) is a newer supraglottic airway device that requires adequate depth of anaesthesia and suppression of upper airway reflexes thereby providing optimal insertion conditions. AIM: To compare dexmedetomidine and fentanyl for co-induction with propofol with respect to PLMA insertion conditions, haemodynamic variation and the total dose requirement of propofol. MATERIALS AND METHODS: This was a prospective randomized double-blinded study conducted in 60 cases of American Society of Anaesthesiologists (ASA) class I/II undergoing elective surgery under general anaesthesia. They were randomly divided into two equal groups, D and F, each receiving 1µg/kg of dexmedetomidine and fentanyl respectively followed by Propofol 2.5mg/kg as per protocol. The ease of PLMA insertion was Young's Criteria and Modified scheme of Lund and Stovener. The haemodynamic parameters (mean heart rate, mean arterial pressure, Respiratory rate, SPO2) were monitored at: Baseline, Pre-medication, Pre PLMA, Post LMA (at insertion), 1, 3, 5, 10, 15 and 20 minutes. RESULTS: PLMA insertion conditions and haemodynamics were comparable between the dexmedetomidine-propofol and fentanyl-propofol groups according to the Young's criteria and Modified scheme of Lund and Stovener. Total induction dose of propofol and its increments were significantly reduced in the dexmedetomidine group. CONCLUSION: Dexmedetomidine and fentanyl when both used individually for co-induction with propofol for PLMA insertion give excellent overall insertion conditions with haemodynamic stability. Dexmedetomidine also significantly reduces the requirements of induction dose propofol for PLMA insertion.
