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Background: Nebulized dexmedetomidine has been used for procedural sedation and allaying separation anxiety in children. Literature regarding its use in the attenuation of laryngoscopy and intubation response via the nebulized route is scarce. We evaluated preoperative dexmedetomidine nebulization on the hemodynamic response arising from laryngoscopy/intubation, hemodynamics, analgesic consumption, and postoperative sore throat. Objectives: The primary objective was to evaluate/compare the hemodynamic effects of preoperative intravenous and nebulized dexmedetomidine on laryngoscopy/intubation and compare the efficacy of the two routes in blunting the sympathoadrenal response. The secondary objective was to evaluate their effects on intraoperative analgesic consumption and incidence and sore throat postoperatively. Methods: 120 ASA I & II adult patients undergoing elective surgeries requiring tracheal intubation were randomized to receive intravenous dexmedetomidine (1 µg/kg over 10 minutes) and nebulized dexmedetomidine (1 µg/kg in 3 - 4 mL of 0.9% saline), 30 min before anesthesia induction. Heart rate and non-invasive blood pressure were monitored for 10 min following laryngoscopy and then throughout the surgery. Intraoperative analgesic consumption, postoperative sore throat, and recovery from anesthesia were assessed. Results: No significant hemodynamic difference was found between the two groups till three minutes. Then, the difference turned significant owing to a greater fall in the heart rate and mean arterial pressure in the intravenous group. Nebulized dexmedetomidine exhibited a lesser tendency of hypo/hypertension and brady/tachycardia, while hemodynamics was more stable. There was lesser sore throat and sedation in the nebulized group. Intraoperative analgesic and propofol consumption was comparable between the two groups. Conclusions: Nebulized dexmedetomidine attenuated laryngoscopy and intubation response, although to a lesser extent than the intravenous group in equivalent doses. However, the nebulized route provided greater hemodynamic stability in the intraoperative period and lesser sedation/sore throat postoperatively without an increase in adverse effects. Nebulized dexmedetomidine may provide a more holistic and viable alternative in patients who poorly tolerate hypotension, bradycardia, and sedation.
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Background: Perioperative pain management is a major challenge for anaesthesiologists. IV lidocaine and dexmedetomidine have been utilised for peri-operative pain management. Aims and Objectives: To analyse the effects of intraoperative intravenous lignocaine/dexmedetomidine on pain relief, opioid consumption, peri-operative hemodynamic and side-effect profiles/unique interactions in patients undergoing laparoscopic surgeries. Materials and Methods: Prospective, interventional, single-centric, double-blind, randomised, active-controlled, Helsinki protocol-compliant clinical study was conducted on 90 ASA I/II class patients aged 18-60 yrs. This Patients were block-randomised to Group-L (2% Lignocaine), Group-D (dexmedetomidine) and Group C (Control/Placebo/0.9% normal saline). Hemodynamic were noted at pre-defined time frames intra-/post-operatively. Post-operative VAS score and Richmond Agitation Sedation Score monitoring was done. Results: Demographic parameters of were comparable. Mean intra-operative fentanyl consumption amongst the three groups were 20.5 ± 20.05 mcg, 26.5 ± 17.57 mcg and 46.83 + 21.31 mcg (Group-L, Group-D, Group-C; P value Group-L vs Group-D:0.22, Group L/D vs Group C: <0.0001). Group-D exhibited the lower heart rates and MAP (P < 0.05). Extubation- First rescue analgesic phase was comparable for the Group-C and Group-L (59.17 ± 46.224 min vs 61.64 ± 53.819 min) and significantly greater in Group-D (136.07 + 55.350 min; P < 0.0001). Conclusion: Both Dexmedetomidine and lignocaine can be useful intra-operative pain relief adjuncts. Dexmedetomidine delayed First rescue analgesic and total analgesic consumption more than lignocaine. Dexmedetomidine patients exhibited bradycardia intraoperatively more than the other groups. we recommend, Dexmedetomidine in the intra-operative phase and lignocaine in the post-operative phase can be an alternative in patients who are poor candidates for post-operative opioids/sedation/contraindicated regional anaesthesia regimes.
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Primary total knee joint arthroplasty (TKA) is a frequently performed procedure as part of osteoarthritis treatment. Optimal perioperative analgesia will augment functional recovery, improve knee mobility, and reduce postoperative morbidity. Octa- and nonagenarians undergoing TKA are often considered particularly difficult to manage and involve high levels of competence due to associated comorbidities these patients present with. We report a case of a geriatric patient with coronary artery disease and low ejection fraction with pulmonary fibrosis who underwent successful total knee arthroplasty under sequential combined spinal-epidural anesthesia.
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Background: Open inguinal hernia repair is one of the routine day-care procedures performed across the world. A multitude of anesthetic techniques have been outlined for painless inguinal hernia repair, comprising general anesthesia and regional anesthesia such as spinal, epidural, and nerve blocks; with regional anesthetic techniques often favored for uncomplicated open inguinal hernia repair. Ultrasound-guided peripheral nerve blocks have made rapid strides and are gaining popularity because of the reduced incidence of adverse events. Aims: We aim to compare the efficacy of two regional anesthesia techniques to compare the adequacy of surgical anesthesia and their efficacy to ease postoperative pain with least potential side effects. Settings and Design: This prospective, interventional, single-centric, double-blind, randomized, parallel-group, active-controlled, Helsinki protocol-compliant clinical study was registered with the Clinical Trial Registry of India (CTRI/2021/04/033109). It was conducted after obtaining written informed consent from all patients and approval from the institutional review board. Materials and Methods: Sixty patients of American Society of Anesthesiologists physical status classes I/II, in the age group of 18-60 years of either sex, scheduled for elective open inguinal hernia repair, were enrolled into two groups of 30 patients each according to the anesthetic technique used. Group T comprised patients receiving ultrasound-guided transversus abdominis plane block (TAP block), whereas the Group S comprised patients administered spinal anesthesia for elective open inguinal hernia repair. The primary end points of this study were to assess the adequacy of surgical anesthesia and duration of postoperative analgesia, whereas the secondary end points included assessment of patients' hemodynamic profile post institution of the block and comparing the incidence of adverse events associated with the two techniques. Statistical Analysis: SPSS version 20.0 was used for analysis. Frequency, mean distribution, standard deviation, Chi Square test and student t Test were calculated to p value. P < 0.05 was considered statistically significant. Continuous variables were expressed as mean + SD, whereas categorical variables were expressed as absolute numbers and percentages. Intergroup nominal categorical data were compared by Chi-square test. Results: The visual analog scale score was found significantly lower in Group T at all time points except immediate postsurgery (3, 6, 12, 24, and 48 h) as compared to Group S (0.357 ± 0.4880 vs. 1.393 ± 1.8527; P = 0.006, 1.393 ± 0.4973 vs. 2.893 ± 2.3148; P = 0.001, 2.429 ± 0.9201 vs. 3.321 ± 2.0377; P = 0.039, 1.214 ± 0.4179 vs. 2.286 ± 1.9217; P = 0.006, and 1.143 ± 0.3563 vs. 1.643 ± 1.5685; P = 0.106, respectively), and the duration of postoperative analgesia was highly significant (P < 0.001) in Group T (724.00 ± 103.2914 min) as compared to Group S (256.643 ± 73.4218 min). Difference in the number of rescue analgesics administered over the first 24 and 24-48 h was significantly higher in the spinal group which comprised patients administered with the TAP block. Conclusion: Ultrasound-guided TAP block provides better intra-operative and postoperative analgesia as compared to subarachnoid block especially in respiratory and cardiovascular cripples without any significant adverse events and hemodynamic changes.