ABSTRACT
BACKGROUND: The biggest anesthetic challenge in infants with thoracolumbar /sacral meningomyelocele is securing the airway. For securing the airway, most of the anesthesiologist's practices supine position with doughnut or head ring placed around the swelling to prevent rupture, which has got disadvantages like risk of rupture, infection and damage to neural structure. Left lateral position has been recommended previously for tracheal intubation in post-tonsillectomy hemorrhage. Several studies have shown successful ventilation in lateral position using laryngeal mask airway and intubation using video laryngoscopes. AIMS AND OBJECTIVES: Primary objective is to compare the time taken for intubation, number of attempts required for intubation. Secondary objective is to compare ease of mask ventilation, Cormack Lehane grading and Backwards Upward Rightwards Pressure [BURP] manoeuvre. MATERIALS AND METHODS: A comparative, prospective randomized, controlled trial of 60 infants undergoing thoracolumbar/sacral meningomylocele repair. Infants were allocated to one of two groups of 30 patients each, by computer-generated randomization into Group S: mask ventilation, laryngoscopy and intubation in supine position and Group L: mask ventilation, laryngoscopy and intubation in lateral position. STATISTICAL METHODS: Chi-square/Fisher Exact test was used to find the significance of study parameters on categorical scale between two or more groups. RESULTS: Mean intubation time of sixteen seconds were clinically acceptable and comparable in each of the two positions P = 0.145. Ten patients in the left lateral position, eight patients in the supine position required second intubation attempts before the airway was secured. Only 8.3% of our patients required third intubation attempts. CONCLUSION: Anesthesiologist should pay more attention to the safety and quality of mask ventilation, laryngoscopy and intubation in meningomylocele infants. Both supine and lateral position were comparable.
ABSTRACT
BACKGROUND: Caudal epidural analgesia is a proven technique for providing analgesia for spinal surgeries. Prolonged pain relief with no motor blockade is desired for early mobilization. OBJECTIVE: The objective of this study is to compare the effect of adding 1 µg/kg of clonidine to injection ropivacaine 0.2% with respect to duration of analgesia, hemodynamic effects, and associated side effects. METHODOLOGY: In this prospective double-blind study, a total of 60 patients undergoing lumbosacral spine surgery were randomized to receive 25 cc caudal epidural injection of either injection ropivacaine 0.2% (Group R, n = 30) or a mixture of injection ropivacaine 0.2% and injection clonidine 1 µg/kg (Group RD, n = 30) under general anesthesia after the patient was positioned prone for surgery. Visual analog scale (VAS) scores, heart rate, blood pressures, and time to rescue analgesia and sedation score were recorded at regular intervals for the first 24 h. RESULTS: Mean VAS scores were significantly lower in the RC Group for up to 12 h following the caudal block. The time to first rescue analgesic was prolonged in the RC group compared to the R Group, and it was statistically significant. No clinically significant hemodynamic changes were noted in either of the groups. No other side effects were seen in both the groups. CONCLUSION: These results suggest that injection clonidine is an effective additive to injection ropivacaine for caudal epidural analgesia in lumbosacral spine surgeries.
ABSTRACT
BACKGROUND: The application of the skull-pin head-holder, used to stabilize the head during neurosurgical procedures, produces an intense nociceptive stimulus and results in abrupt increases in blood pressure and cerebral blood flow under general anesthesia. Different anesthetic and pharmacologic techniques, including local anesthetics, narcotics, antihypertensives, and deepening of anesthesia with inhalation anesthetics, have been used to blunt this deleterious effect with variable success. AIM: To compare the analgesic and hemodynamic effects of ropivacaine scalp block, and intravenous (IV) clonidine in attenuating the hemodynamic response to the scalp pin insertion in neurosurgical patients. SETTINGS AND DESIGN: A comparative two group's clinical study of 64 patients undergoing elective craniotomy in Department of Anaesthesiology, Bangalore Medical College and Research Institute. METHODOLOGY: Sixty-four patients were allocated into any one of two groups of 32 patients each, by means of computer-generated randomization: (1) Group S: Patients receiving scalp block with injected ropivacaine 0.25% 30 ml. (2) Group C: Patients receiving 2 µg/kg IV clonidine. STATISTICAL METHODS: Descriptive and inferential statistical analysis has been carried out in the present study. Results on continuous measurements are presented on mean ± standard deviation (minimum-maximum) and results on categorical measurements are presented in number (%). Significance is assessed at 5% level of significance. RESULTS: Increase in heart rate and blood pressure during pin insertion was attenuated by clonidine hydrochloride (P < 0.001). The number of patients who required more fentanyl and propofol to stabilize the hypertensive response were more in control group than clonidine group. CONCLUSION: IV clonidine maximally attenuated the hemodynamic response to application of head pins in a dose of 2 µg/kg compared to ropivacaine scalp block, thus maintaining intracranial pressure for neurosurgical anesthesia.
ABSTRACT
INTRODUCTION: Pre-emptive caudal epidural is a proven technique for providing analgesia for spinal surgeries. Prolonged pain relief with no motor blockade is desired for early mobilisation. AIM: Present study aimed to evaluate the effect of addition of Inj dexmedetomidine to caudal ropivacaine on the duration of analgesia, haemodynamic profile and the associated side effects. MATERIALS AND METHODS: In this prospective double-blind study a total of 60 patients undergoing lumbosacral spine surgery were randomised to receive 20 cc of pre-emptive caudal epidural injection of either inj ropivacaine 0.2% (Group R, n =30) or a mixture of Inj ropivacaine 0.2% and Inj dexmedetomidine 1 µg/kg (Group RD, n =30) under general anaesthesia after the patient was positioned prone for surgery. VAS scores, heart rate, blood pressures and time to rescue analgesia were recorded at regular intervals for the first 24 hours. Data analysis was carried out using Statistical Package for Social Science (SPSS, V 10.5 package). RESULTS: Mean VAS scores were significantly lower in the RD group for up to 12 hours following the caudal block. No clinically significant haemodynamic changes were noted in either of the groups. No other side effects were seen in both the groups. CONCLUSION: These results suggest that inj dexmedetomidine is an effective additive to inj ropivacaine for pre-emptive caudal epidural analgesia in lumbosacral spine surgeries.
