RESUMO
Background and Aims: Effectiveness of oral gabapentin premedication in suppressing response to laryngoscopy and tracheal intubation suggests its potential for attenuating skull pin insertion response. The present study was therefore planned to evaluate the effect of add-on oral gabapentin premedication to local anesthetic injection at pin insertion site in obtunding hemodynamic response. Material and Methods: Sixty adult patients posted for elective craniotomy were enrolled for a prospective, randomized and double-blinded study. Group I patients received gabapentin 900 mg orally as premedication whereas Group II patients received oral placebo. Both groups were administered subcutaneous (s.c.) injection (Inj) 2% lignocaine 2 mL at all four pin insertion sites. Mean arterial pressure (MAP) and heart rate (HR) were measured every 30 s for the initial 10 min. Increases in HR beyond 20% and MAP 30% above baseline were treated with bolus intravenous (IV) Inj propofol 30 mg. Quantitative data was compared using Student's t-test and Mann Whitney U test, while categorical data was compared using Chi-square (χ2) test. Results: The increase in HR and MAP from baseline was significantly greater and it remained above baseline levels longer in Group II as compared to Group I. Twenty-one patients (70%) received rescue boluses of propofol with a mean dose of 45.00 ± 39.98 mg in Group II as compared to nine (30%) patients receiving mean of 18.20 ± 29.04 mg in Group I. (P = 0.015). The mean emergence time and sedation scores in both the groups were statistically similar (P = 0.060).The incidence of adverse effects like hypotension, bradycardia, nausea/vomiting, sedation or dry mouth were similar in both the groups. Conclusion: Add-on oral gabapentin premedication potentiates the effect of s.c. lignocaine Inj for suppression of skull pin insertion response.
RESUMO
BACKGROUND AND AIMS: The aim of the study was to evaluate the effect of mode of mechanical ventilation; pressure-controlled ventilation (PCV) vs. volume-controlled ventilation (VCV) on airway pressures, intra-abdominal pressure (IAP) and intra-operative surgical bleeding in patients undergoing lumbar spine surgery. METHODS: This was a prospective, randomised study that included 50 American Society of Anesthesiologists class I and II patients undergoing lumbar spine surgery who were mechanically ventilated using PCV or VCV mode. The respiratory parameters (peak and plateau pressures) and IAP were measured after anaesthesia induction in supine position, 10 min after the patients were changed from supine to prone position, at the end of the surgery in prone position, and after the patients were changed from prone to supine position. The amount of intraoperative surgical bleeding was measured by objective and subjective methods. RESULTS: The primary outcome was the amount of intraoperative surgical bleeding. It was significantly less in the PCV group than in the VCV group (137 ± 24.37 mL vs. 311 ± 66.98 mL) (P = 0.000). Similarly, on comparing other parameters like peak inspiratory pressures, plateaupressures and IAP, the patients in PCV group had significantly lower parameters than those in VCV group (P < 0.05). No harmful events were recorded. CONCLUSION: In patie,nts undergoing lumbar spine surgery, use of PCV mode decreased intraoperative surgical bleeding, which may be related to lower intraoperative respiratory pressures and IAP.
