ABSTRACT
BACKGROUND: In the search for the ideal intravenous induction drug, etomidate is in the forefront as it provides haemodynamic stability without compromising on the end point of induction. It has been established that slowing the rate of infusion of propofol decreases the dose required for induction. Even though etomidate provides good haemodynamic stability while inducing, there is concern about its cortisol suppressive function. This study has been designed, with entropy guidance, to establish whether induction by slowing the rate of infusion of etomidate will reduce the dose required for induction and simultaneously assess whether adverse effects are reduced. METHODS: Ninety-six patients were randomly allocated into three groups based on etomidate dose. Etomidate dose was given till both loss of eyelash reflex and entropy50 was achieved. Total dose of etomidate consumed, time taken for loss of eye lash reflex and time to reach entropy50 were recorded. Cortisol levels were measured at different intervals. RESULTS: We observed that slowing the rate of infusion reduced the dose of etomidate for induction; however, it prolonged the time for induction of anaesthesia. Cortisol levels were suppressed in the first 6 h after induction in all three groups, but remained within normal limits and reached to pre induction levels by 24 h. CONCLUSION: The slower the rate of infusion, the lesser the dose of etomidate used for induction, but prolongs the time taken to reach the end point of induction. Incidence of myoclonus might be avoided by infusing etomidate for induction at a lower rate. CLINICAL TRIAL NUMBER AND REGISTRY URL: Clinical Trials Registry of India, CTRI/2016/04/006879, www.ctri.nic.in/.
Subject(s)
Anesthetics, Intravenous/administration & dosage , Etomidate/administration & dosage , Adult , Anesthesia, Intravenous , Drug Administration Schedule , Female , Humans , Hydrocortisone/blood , Infusions, Intravenous , Male , Middle AgedABSTRACT
BACKGROUND: Postoperative pain management by surgical site infiltration has an edge over other methods of analgesia as it is simple and has lesser side effects. This study was designed to compare the analgesic effects provided by bupivacaine, a classical long-acting local anesthetic and ropivacaine, a new amino amide local anesthetic agent. SUBJECTS AND METHODS: Ninety patients scheduled for elective inguinal herniorrhaphy were randomly allocated to one of the three groups: Group I - R 0.5, group II - R 0.25, and group III - B 0.25. General anesthesia was given. The surgical site was infiltrated before incision with 20 ml of drugs - ropivacaine 0.5% in group I, ropivacaine 0.25% in group II, bupivacaine 0.25% in group III. Intraoperatively hemodynamics were recorded every 15 min until the end of surgery and at the time of skin incision, at the time of cord pulling, and at the time of skin closure. Postoperatively, rest pain, pain on coughing, and pain on movements were assessed using visual analog scale (VAS) score immediately at the end of the surgery and hourly up to 4 h. The time of the first request for rescue analgesia was noted. RESULTS: VAS scores at rest, during coughing and movements were higher in group R 0.25 and the time of rescue analgesia was shorter with group R 0.25 when compared with other groups. CONCLUSION: Ropivacaine is less potent than bupivacaine at equal concentrations.
ABSTRACT
BACKGROUND: Osmotherapy is the frequently used for the treatment of intracranial pressure. The purpose of the study was to compare the effect of equiosmolar solution of 3% hypertonic saline and 20% mannitol on brain relaxation in supratentorial tumor surgery. METHODS: After institutional review board approval and written informed consent, 50 patients aged >18, Glasgow Coma Scale (GCS) >13 with ASA physical status 1, 2, and 3 scheduled to undergo craniotomy for supratentorial tumors were enrolled in this prospective, randomized study. Patients received 5 ml/kg of either 3% hypertonic saline (n = 25) or 20% mannitol (n = 25). Hemodynamic variables (heart rate [HR], SBP, DBP, MBP, and central venous pressure [CVP]), serum electrolytes, serum osmolality, urine output, and fluid balance were measured. The surgeon assessed the brain condition on four point scale (1 = perfectly relaxed, 2 = satisfactorily relaxed, 3 = firm brain, and 4 = bulging brain), who was blinded to study drug. RESULTS: Brain relaxation was comparable in two groups and there was no significant difference (P = 0.633). The number of brain conditions classified as perfectly relaxed, satisfactorily relaxed, firm brain, and bulging brain in the HS group was 8, 13, 3, and 1, respectively, whereas it was 5, 17, 3, and 0, respectively, in the M group. There was no significant difference in hemodynamic variables between the two groups except CVP at 30 min (P = 048). Compared with mannitol, hypertonic saline caused increase in the serum osmolality at 120 min (P = 0.008) and in serum sodium at 120 min (P = 0.001). Urine output was higher with mannitol than hypertonic saline (P = 0.001). CONCLUSION: 3% hypertonic saline and 20% mannitol are equally effective for brain relaxation in elective supratentorial tumor surgery and compared with mannitol, hypertonic saline was associated with less diuretic effect.
ABSTRACT
Peripartum cardiomyopathy (PPCM) is defined as onset of acute heart failure without demonstrable cause in last trimester of pregnancy or within the first 6 months after delivery. We report a case of PPCM with left ventricular ejection fraction less than 25% who had reported to us at 38 weeks of gestation for emergency caesarean section managed with graded epidural anaesthesia. PPCM is a form of dilated cadiomyopathy with left ventricular systolic dysfunction that results in signs and symptoms of heart failure.
