Background: Pain management is a major challenge after any surgery. Painful experiences in post operative period leads to unwanted side effects like altered metabolic response, aggravated autonomic reflexes, causing ileus, nausea, impairs coagulation, delays wound healing and delays mobilization. To prevent such effects we use opioids, local anaesthetics and NSAIDs. In this study we aimed to compare the postoperative analgesic effects of gelfoam Soaked with ropivacaine and gelfoam soaked with dexamethasone with Placebo in a single-level lumbar laminectomy. Materials and Methods: 98 patients scheduled to undergo single-level lumbar laminectomy under general anesthesia in the age group between 18 and 60 years were enrolled in the study. They were randomly divided in three equal groups. Data was collected for post operative pain score and other side effects. All tests were evaluated for 95% confidence limits. P <0.05 was considered significant. Results: VAS score in placebo was 4.133 ± 1.105, in ropivacaine group was 1.866 ± 0.899 and in ropivacaine with dexamethasone group was 1.7 ± 0.749, which was highly significant with P < 0.0001. Total analgesia consumption with tramadol was 279.1 ± 41.77 mg in the placebo group, 124.6 ± 43.44 mg in the ropivacaine group (R), and 97.7 ± 39.92 mg in the ropivacaine and dexamethasone group (RD). Conclusion: Gelfoam soaked in 0.5% ropivacaine and 0.9% NS when placed epidurally provides adequate postoperative analgesia. Gelfoam soaked in 0.5% ropivacaine and 2 mL dexamethasone when placed epidurally provides prolonged postoperative analgesia. No side effects were noted in the 0.5% ropivacaine and 2 mL dexamethasone group.
Background: Most of the previous studies comparing epidural analgesia (EA) with intravenous (i.v.) analgesia in blunt trauma chest (BTC) patients are retrospective in nature. This prospective, observational study was done to evaluate the effect of EA with i.v. analgesia in BTC patients who were managed by noninvasive ventilation (NIV). Aim: The aim of this study was to compare the effect of EA with i.v. analgesia in BTC patients managed conservatively with NIV and to compare the length of intensive care unit (ICU) stay. Settings and Design: A prospective observational study was conducted in tertiary-level ICU patients. Materials and Methods: Adult patients of BTC neither requiring surgery nor invasive mechanical ventilation were included. Patients with contraindication to NIV or EA were excluded. Forty-six patients were divided into two groups. One group received EA and other i.v. analgesia. Oxygenation and pain relief were compared in terms of PaO2/FiO2 ratio and Visual Analog Scale (VAS), respectively. Statistical Analysis: Result interpretation was done using the Student’s t-test and Chi-squire test. Results: At 36 h after EA and thereafter up to 72 h, there was significant difference in P/F ratio. Better oxygenation was noted in EA group. Patient’s VAS scoring shows significantly low (P < 0.001) in patients receiving EA after 1 h. Mean ICU stay in EA and i.v. group was 10.17 ± 4.697 and 13.83 ± 4.96 days, respectively (P = 0.013). Conclusions: EA provides excellent pain relief as compared to i.v. analgesia, which results in improved respiratory exchange, effective coughing, better secretions clearance, and higher P/F ratio. ICU stay was significantly lower in patients receiving EA.
Background and Aims: Propofol is a potent intravenous (i.v.) anesthetic that attenuates pharyngeal, laryngeal, and tracheal reflexes and provides an adequate depth of anesthesia for intubation. However, its major disadvantage is the fall in blood pressure (BP) and heart rate (HR). Ephedrine being a potent alpha-adrenergic vasoconstrictor and a beta-adrenergic cardiac stimulant can combat this hemodynamic effect of propofol. The objective of this study was to compare the decrease in hypotension and bradycardia caused by propofol with two prophylactic doses of ephedrine. Further, the intubating conditions with prophylactic ephedrine with atracurium were noted. Settings and Design: Patients posted for elective surgeries under general anesthesia in a tertiary care hospital in South India were recruited by randomized computer-generated tables and allocated using sealed envelopes into three groups after written informed consent. A randomized control study was done between three groups of patients who received saline, 100 μg.kg−1 or 150 μg.kg−1 of ephedrine. Materials and Methods: A total of 87 patients between 18 and 59 years of the American Society of Anesthesiologists physical status classes I and II were recruited and randomized into three groups of 29 each. Each group received normal saline (S1), 100 μg.kg−1 (E1) and 150 μg.kg−1 (E2) of ephedrine i.v. All patients were given i.v fentanyl 2 μg.kg−1, followed by the study drug depending on the group they were in. This was immediately followed by 2 μg.kg−1 of propofol i.v over 30s. Muscle relaxation was given with atracurium and patients were intubated 3 min later. The patients’ HR, systolic and diastolic BPs (SBP and DBP), and mean arterial pressures (MAPs) were recorded at preinduction, 2 min after induction, 1 min after intubation, then 3 min, 5 min, 10 min, 15 min, and 30 min later. Further, the anesthesiologist intubating assessed the conditions of intubation and later scored it. Statistical Analysis: The Chi-square test was used as the test of significance for the qualitative data. Continuous data were represented as mean and standard deviation. Analysis of variance was the test of significance used to identify the mean difference between more than two groups for quantitative and qualitative data. “Paired t-test” was used as the test of significance for paired data. P value (Probability that the result is true) of <0.05 was considered statistically significant after assuming all the rules of statistical tests. Results: Mean HR was significantly higher in the E2 Group than in the E1 and S1 Groups. Mean SBP, DBP, and MAP were higher in the E2 Group, followed by E1 and lower in the S1 Group during these intervals. Hence, all groups had hypotension effects from induction but the least was noted with the group that received 150 μg.kg−1 of ephedrine. All groups had similar intubating conditions with no significant difference between the groups. Conclusion: 100 μg.kg−1 and 150 μg.kg−1 of ephedrine had significant effects in reducing the hypotension associated with propofol, however, high doses also caused significant tachycardia.
Low back pain generally involves lumbosacral radicular syndrome, nerve root pain, and nerve root entrapment/irritation. Management options for patients are variable and diverging. To the highlight the efficacy of combined early decompressive surgery plus intraoperative steroid injections in terms of postoperative back pain in patients managed by our combined team. A prospective study conducted by reviewing all consecutive patients managed, over a 1-year period (2018-2019). This study showed that adjunct use of intraoperative foraminal and epidural steroids injections to treat back pain in patients with degenerative spine disease could significantly improve the pain score which leads to significant decrease in working days off and the need for pain killer medications or even obviating the usage rate.
Background: Neuraxial techniques provide good postoperative analgesia for painful procedures in the pediatric population. However, any injury to the spinal cord can lead to irreversible long-term effects. Aims: We aimed to evaluate dura-to-cord (DTC) distance from computerized tomography (CT) images of thoracolumbar spine in pediatric age group (1–16 years) at T8–9, T9–10, and L1–2 interspaces to identify the safe space for epidural insertion in Asian children. Settings and Design: It was a retrospective study including 141 children aged 1–16 years who underwent routine CT scan of the thoracolumbar region for unrelated diagnostic indications. Materials and Methods: Patients with spinal abnormalities were excluded. Sagittal CT images of the thoracolumbar spine were obtained to calculate the DTC at T8–9, T9–10, and L1–2 interspaces. The measurements at all levels were obtained perpendicular to the long axis of the vertebral body. Statistical Analysis Used: Continuous data were depicted as mean with standard deviations. The categorical data were presented as counts with percentages. Results: The mean DTC distance at T8–9, T9–10, and L1–2 interspaces was 3.51 ± 0.98 mm (95% confidence interval [CI]: 3.35–3.67), 2.73 ± 0.94 mm (95% CI: 2.57–2.89), and 2.83 ± 1.08 mm (95% CI: 2.66–3.02), respectively. A significant difference was found between the genders at T9–10 (P = 0.02) and L1–2 levels (P = 0.04). No difference in DTC was found in toddlers, preschool children, school-going children, and adolescents. DTC at T8–9 showed a significant correlation with age (R2 = 0.0479; P = 0.04), weight (R2 = 0.038; P = 0.02), and height (R2 = 0.037; P = 0.03). Conclusion: Thoracic epidural space can be used in children and adolescents for epidural catheter placement. T8–9 level showed maximum DTC distance and significant correlation with age, height, and weight in CT imaging in the present study.
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.
Background: Caudal epidural block (CEB) is a commonly performed neuraxial block to provide effective pain relief and analgesia in pediatric patients undergoing infraumbilical surgery. Aims: This study aimed to compare the effectiveness of adding CEB to general anesthesia (GA) in terms of intra- and postoperative pain management. Design: Prospective, randomized case-controlled trial study. Setting: Operation theater, and postoperative recovery rooms at Salmaniya Medical Complex, Bahrain. Materials and Methods: A total of 74 patients aged 2 months to 6 years with American Society of Anesthesiologists physical status classification I were recruited over a 6-month period between December 2019 and May 2020. Patients were allocated into two groups (Group A, with CEB) or (Group B, without CEB). Both groups were compared based on hemodynamic stability, pain scores, level of sedation, analgesia need, and parental satisfaction. Statistical Analysis: Data were analyzed using SPSS program. Categorical and numerical variables of both the groups were compared. Results: Patients with CEB had better hemodynamic stability during the surgical procedure based on heart rate (P = 0.039). Pain intensity scores were less in patients with CEB than those without (P < 0.001). Fentanyl consumption was lower in Group A compared to Group B at the end of surgery (P = 0.002). They were also ambulated earlier and discharged sooner than those without CEB. Parental satisfaction was 92.1% in Group A compared to 63.9% in Group B (P = 0.012). Conclusions: Adding CEB to GA for intraoperative and perioperative pain control in pediatric patients undergoing infraumbilical surgery makes it more effective, safe, and with better parental satisfaction.
Background: The incidence of postoperative recall under total intravenous anesthesia (TIVA) is not yet fully established. Avoidance of inhalational agent is a known risk factor for awareness. In addition, lack of reliable technique to monitor drug concentration needed for adequate depth of anesthesia makes TIVA challenging. Hence, we intend to evaluate our standard anesthesia practice for postoperative recall. Methodology: This questionnaire-based observational study was done over the period of 2 years. We enrolled 1080 adult (American Society of Anesthesiologists physical status Class I or II) patients undergoing TIVA for Endoscopic retrograde cholangiopancreatography (ERCP). All patients received fentanyl, midazolam and propofol-based anesthesia. Manual boluses of propofol were given to achieve adequate sedation. (Ramsay sedation scale of 5) in accordance with clinical signs as judged by the primary anesthesiologist. Postoperatively within 12–24 h, patients were assessed for recall using Brice questionnaire. Primary outcome was number of patients reporting postoperative recall in the Brice interview. Secondary outcome was the incidence of dreaming. Results: On postoperative interview, none of the patients reported awareness. 12.5% of patients had dreams which were pleasant. None of the dreams was unpleasant. The worst thing about surgery was pain. Conclusion: Our study suggests that if adequate doses of propofol are adhered to and necessary action is taken against responses indicating wakefulness, postoperative recall under TIVA is an uncommon occurrence.
Background: Spinal subarachnoid block (SAB) is the first choice anesthesia in lower abdominal and lower limb surgeries. It produces a varying degree of sensory analgesia, motor blockade, and sympathetic blockade depending on the dose, concentration, and volume of the local anesthetic given. This study was undertaken to assess the degree of sensory and motor block with 150 μg of oral versus intramuscular clonidine as an adjuvant to bupivacaine for spinal anesthesia. Aims and Objective: To compare the efficacy of oral versus intramuscular clonidine as an adjuvant to bupivacaine for the prolongation of sensory and motor block in patients undergoing lower abdominal and lower limb surgeries under SAB. Materials and Methods: After institutional ethical clearance, 90 patients were randomized into three groups scheduled for lower abdominal and lower limb surgeries under spinal anesthesia. • Group O: Bupivacaine 0.5% (heavy) 3.0 mL and oral clonidine 150 μg 1 h before spinal anesthesia. • Group I: Bupivacaine 0.5% (heavy) 3.0 mL and intramuscular clonidine 150 μg 1 h before spinal anesthesia. • Group C: Control group – 3 mL bupivacaine 0.5% (heavy) alone. Result: The onset of sensory block in Group O was 4.9 ± 0.52 min, whereas in Group I, it was 4.6 ± 0.42 min than Group C (5.1 ± 0.60). Onset of motor block was also significantly lower in Group O and Group I (3.9 ± 0.53 and 3.7 ± 0.42 min) than in Group C (4.4 ± 0.6 min) which was a control group. There was also a significant difference in the duration of the sensory block between Group O (206.4 ± 9.2 min), Group I (219 ± 8.6 min), and Group C (184.3 ± 9.1 min). The duration of motor block was significantly higher in Group O (183.6 ± 8.2 min) and Group I (197.8 ± 9.6 min) when compared to Group C (162.8 ± 8.9 min). The timing of rescue analgesia in Group O was 222.4 ± 11.7 min, whereas in Group I, it was 243.46 ± 10.9. Conclusion: On the basis of finding of our study, we conclude that the use of clonidine as a premedication at a dose of 150 μg significantly increased the duration of sensory block, motor block, and duration of analgesia and shortened the time of onset of sensory and motor blockade.
Background: Postoperative nausea and vomiting (PONV) is one of the most unpleasant complications of anaesthesia and is more common following middle ear surgeries. Ondansetron, a 5-HT 3 (5-hydroxytryptamine type 3) receptor antagonist provides significant reduction in early PONV. The other 5-HT 3 antagonist ramosetron, with long duration of action, has been found to be more effective than ondansetron in reducing the early as well as delayed PONV. The antiemetic effects of glucocorticoids (dexamethasone and methylprednisolone) are well documented. So, the present study was designed to compare the efficacy of the combination of intravenous methylprednisolone and ondansetron with combination of intravenous methylprednisolone and ramosterone in preventing postoperative nausea and vomiting in patients undergoing middle ear surgeries. Methods: Sixty patients in the age group of 18-60 years, with American Society of Anaesthesiologists (ASA) physical status classification I or II, undergoing middle ear surgery were randomly allocated to receive a combination of methylprednisolone 40 mg (given at the beginning of surgery) and ondansetron 4 mg (given near the end of surgery) (group MO, n=30) or combination of intravenous methylprednisolone 40 mg and ramosetron 0.3 mg (near the end of surgery) (group R, n=30), by a computer-generated randomization table. Incidence of PONV in the both groups were studied and compared. Results: There was no significant difference in PONV between the groups in the first 2 h after the surgery. Between 2 and 24 h, the incidence of nausea was significantly lower in the methylprednisolone and ondansetron group compared to the methylprednisolone and ramosetron group (P=0.01). Between 24 and 48 h, there was no difference between the two groups with respect to incidence of nausea and vomiting. Conclusion: The combination of methylprednisolone and ondansetron is superior to combination of methylprednisolone and ramosetron for prevention of PONV after middle ear surgery especially in treatment of early PONV. Therefore, we recommend combination of methylprednisolone and ondansetron for prophylaxis for PONV in middle ear surgeries.
Context: Hemostatic abnormalities are more common in patients with brain tumors than systemic malignant diseases. Conventional coagulation tests (CCT) are poor assays for dynamic assessment of clot strength in whole blood. Thromboelastography (TEG) gives us detailed information on the dynamics of clot development, stabilization, and dissolution reflecting in vivo hemostasis. TEG can assess both thrombosis and fibrinolysis. Aims: This study aimed to investigate the temporal trends in hemostatic profile occurring during surgery for primary brain tumors, using a combination of TEG and CCT, and to assess perioperative blood component support. Subjects and Methods: A prospective, observational study was done on 40 patients with primary brain tumors larger than 4 cm in maximum diameter on computed tomography or magnetic resonance imaging. The tests (TEG and CCT [PT, INR, activated partial thromboplastin time, and platelet count]) were performed preoperatively (on the day of surgery), intraoperatively (2 h into surgery), and postoperatively (the day after surgery). Statistical Analysis: SPSS Version 21.0 statistical analysis software was used. Results: We found a universal trend toward hypercoagulability (persistent decrease in R-time, K-time and increase in MA, α-angle, Coagulation Index) in all the TEG parameters measured intraoperatively and postoperatively even though the values were within normal limits. Results of CCT had poor correlation with TEG parameters. The mean intraoperative blood loss was 737.7 ± 185.6 mL, for which PRBC was transfused in 17 patients, FFP in 13, but no platelet transfusion was done intraoperatively. Conclusions: We found a trend toward hypercoagulability in our study in intraoperative and postoperative period using TEG which was not evident on CCT. TEG was a useful diagnostic tool to identify coagulation abnormalities and to guide perioperative blood transfusion.
Background: Routine tests before ophthalmologic surgery in adult patients are no longer recommended. However, there are limited data on the utility of routine preoperative tests for children. Aims: We aimed to describe the effect of routine preoperative tests on systemic perioperative complications by hospital discharge or by day 30 following eye surgery. Settings and Design: This was a single-center, observational, and descriptive study. Subjects and Methods: We examined all patients ≤ 17 years old for whom ophthalmologists consulted with anesthesiologists before eye surgery under general anesthesia in an academic teaching tertiary care hospital from January 2010 to December 2019. Results: A total of 708 pediatric patients were analyzed. The mean patient age was 8.5 ± 4.6 years. The most frequently performed procedure was strabismus surgery in 433 patients (61.2%). Following anesthetic consultations, 15 patients (2.1%) underwent surgery postponed due to abnormalities at the physical examination. Routine tests identified that the two patients (0.3%) required additional evaluations due to elevated serum creatine kinase and electrocardiographic abnormalities. However, further examinations found that these abnormalities were unremarkable. The remaining 691 patients (97.6%) underwent surgery as scheduled. Substantial intraoperative blood loss was observed only in three patients with malignant tumors or trauma. The incidence of systemic complications was 0 (0%; 95% confidence interval, 0%–0.05%). Conclusions: These data indicated that the development of systemic perioperative complications following pediatric ophthalmic surgery is rare. Preoperative tests should be requested only if they are clinically indicated or before potentially bleeding procedures, such as malignancy or trauma surgery.
Introduction: Severe preeclampsia can lead to various complications including increased intracranial pressure (ICP) which can be catastrophic but difficult to detect because of variable nonspecific symptoms. Ultrasonography has been used as noninvasive measure to monitor optic nerve sheath diameter (ONSD) as a marker of raised ICP. Effect of MgSO4 on ICP can modify the management approach, need for additional monitoring, targeting hemodynamic goals, timing of delivery, and choice of anesthesia. We evaluated the effect of MgSO4 on raised ICP in severely preeclamptic patients using ultrasound-guided ONSD as a surrogate marker of ICP. Methodology: This prospective observational study was conducted after ethical committee approval and written informed consent from patients. Ultrasound-guided ONSD was measured and compared in 47 severe preeclamptic patients before and at 1 h, 4 h, 12 h, and 24 h after starting MgSO4 therapy. The analysis of data was done by one-way analysis of variance using Statistical Package for the Social Science. Results: Mean ONSD was 5.56 ± 0.30 mm in our study group. ONSD above 5.8 mm was seen in 17 (36.17%) patients and was considered as marker of raised ICP. There was a significant decrease in ONSD after 4 h of administration of MgSO4. No significant correlation was observed between mean arterial pressure, serum magnesium level, and ONSD. Conclusion: Ultrasound-guided ONSD measurement can be used as a quick, noninvasive bedside tool in severe preeclamptic patient on MgSO4 treatment as marker of ICP which help us in determining clinical severity, therapeutic response, and to decide further course of management.
Background and Aim: While administering general anesthesia requiring endotracheal intubation, it is a common practice to inflate the cuff with air. Continuous pressure exerted by cuff on mucosa may lead to postoperative complaints such as sore throat, cough, and dysphagia, which are very disturbing to the patient. Hence, we hypothesized that inflation of cuff with propofol may reduce the incidence of these complications as a result of cushioning effect as well as non-diffusion of nitrous oxide into it. Our aim was to compare the effects of inflation of endotracheal tube cuff with 0.9% saline, 4% lignocaine, and 1% propofol on the incidence of postoperative morbidity in terms of cough, sore throat, dysphonia, and dysphagia with general anesthesia using nitrous oxide. Methods: Patients scheduled for elective surgery under general anesthesia were randomly allocated into four equal groups of thirty each as per cuff inflation media: air (Group A), 0.9% saline (Group S), 4% lidocaine (Group L), and 1% propofol (Group P). The incidence of cough was noted at 15, 30 and 60 min after extubating. The occurrence and severity of postoperative sore throat (POST) was evaluated at 2, 6, and 24 h after extubating. Results: The incidence of cough was maximum in Group A and minimum in Group P (P < 0.05). The occurrence of POST was highest in Group A, followed by Group S and Group L, and least in Group P. The hemodynamic parameters were comparable with no statistical difference in all the four groups (P < 0.05). Conclusion: The intracuff 1% propofol is superior to 4% xylocaine and normal saline in the prevention of cough and sore throat postoperatively, whereas inflation of cuff with air leads to maximum incidence of these complications.
Background and Aims: Video laryngoscopy has been shown to improvise Cormack–Lehane grading and rate of successful tracheal intubation and is now incorporated in most of the difficult airway guidelines. Since there is scarce literature regarding the use of channeled blade of King Vision video laryngoscope (KVVL) in anticipated difficult intubation, we planned to undertake this randomized control trial to assess the performance of channeled blade of KVVL and Macintosh laryngoscope in patients with anticipated difficult intubation. Design and Setting: This prospective randomized study was conducted in a tertiary care hospital. Materials and Methods: Patients fulfilling the inclusion criteria were randomly assigned equally to the KVVL group or Macintosh group. The primary outcome of the study was intubation success in the first attempt and number of attempts required for intubation, and the secondary outcomes were Cormack–Lehane grading and time required to intubate in both the groups. Results: The first-pass success of intubation was 88.6% in the KVVL group and 76.5% in the Macintosh group (P = 0.035). The second attempt of intubation was required in 11.4% and 20.6% of patients in the KVVL and Macintosh groups, respectively. Cormack Lehane Grade I was achieved in 100% of patients of the KVVL group as compared to 29.4% of patients in the Macintosh group. Moreover, the difference was statistically significant (P = 0.035). The mean duration of intubation was prolonged in the KVVL group as compared to the Macintosh group, and the difference was statistically significant (P = 0.04). Conclusion: The channeled blade of KVVL had a higher first-pass success rate and required fewer attempts to intubate when used in patients with anticipated difficult intubation. Further, the KVVL was found to be significantly better than the Macintosh laryngoscope in terms of Cormack–Lehane grading, but the time taken to intubate the trachea was more in the KVVL group.
Background: Awake fiberoptic intubation (AFOI) is the gold standard for managing a difficult airway. To make the patient comfortable and cooperative during the procedure, many drugs such as benzodiazepines, opioids, or dexmedetomidine are used. Most of these intravenously given drugs may cause respiratory depression and hypoxia. Aim: We compared the efficacy of dexmedetomidine through nebulization and transtracheal route with intravenous routes with the primary aim of comparing patient tolerance score (PTS) and secondary objectives of comparing sedation score, cough score, and total duration required for awake fiberoptic nasotracheal intubation. Settings and Design: This study was a prospective randomized double-blind study. Subjects and Methods: Seventy-six patients, scheduled for elective surgery requiring AFOI between 18 and 75 years, were included in the study. They were randomly divided into two groups of 38 each. Group I patients received intravenous dexmedetomidine 1 μg.kg−1 and Group L patients received local dexmedetomidine through nebulization 0.5 μg.kg−1 and transtracheal injection 0.5 μg.kg−1. Statistical Analysis Used: Statistical Package for the Social Sciences version 22 was used. Results: Patients who received dexmedetomidine through nebulization and transtracheal route have significantly better PTSs and less cough scores as compared to patients who received dexmedetomidine by intravenous route (P < 0.05). Hemodynamic parameters and sedation scores between the two groups were statistically insignificant (P > 0.05). The time required for the procedure was significantly less in Group L compared to Group I (P < 0.05). Conclusion: Dexmedetomidine by nebulization and transtracheal route provides optimal conditions for AFOI with good patient tolerance and less cough score as compared to the intravenous route.
Background: An ideal anesthetic solution should provide good anesthesia and akinesia with minimal pain on injection. Aims: The aim of this study is to determine the effect on pain perception and efficacy of sodium bicarbonate over hyaluronidase in the local anesthetic mixture during peribulbar anesthesia. Settings and Design: A prospective, randomized, double-blind study. Materials and Methods: An independent observer labeled two injections as A (hyaluronidase 1500 IU in 30 mL of lignocaine) and B (7.5% sodium bicarbonate 1 mL in 30 mL of lignocaine). Group 1 was injected with injection A while Group 2 was injected with injection B. The visual analog scale (VAS) was used to determine the intensity of pain. Onset and degree of anesthesia and akinesia were recorded. Statistical Analysis: Computer software Microsoft Excel SPSS version 26 (Chicago Inc) for windows was used. The qualitative data and quantitative data were reported as proportions and mean ± (standard deviation), respectively. Chi-square test for proportions was used for the comparison of qualitative variables and unpaired Student's t-test was used to test the significance between quantitative variables. P < 0.05 was considered statistically significant. All P were two-tailed. Results: Out of 123 patients, 23 were excluded from the study. Hundred patients were divided into Group 1 and Group 2. The mean age in Group 1 was 64.92 ± 10.77 years while in Group 2 was 62.86 ± 11.17 years. The mean heart rate and mean systolic blood pressure in both groups were statistically insignificant. Group 2 experienced very less pain (mean pain score VAS = 5.12 ± 1.17) as compared to Group 1 (mean pain score was 7.16 ± 1.09) and the difference between both the groups was found to be statistically significant. There was a significant difference in the onset of anesthesia in both groups (P = 0.001). In the sodium bicarbonate group, the onset was faster. The onset of akinesia was better in Group 1 (4.76 ± 2.06 min). Grading of akinesia was better in Group 1. Conclusion: Sodium bicarbonate reduces pain on injection in peribulbar anesthesia and also results in a quicker onset of anesthesia.
Background: Ambulatory surgeries are increasing all over. While searching for an ideal anesthetic, the use of lidocaine was linked to a greater rate of transitory neurological symptoms and bupivacaine delays discharge due to a longer duration of motor blockade. 2-chloroprocaine (2CP) with a shorter duration of action is gaining popularity. We aimed to compare intrathecal bupivacaine and 2CP for the subarachnoid block for elective ambulatory gynecological surgeries. Methods: A single-blind study was conducted on 90 patients comparing 40 mg 2CP and 10 mg 0.5% bupivacaine heavy measuring pinprick sensation, motor block, time to ambulation, and voiding of urine so as to get ready for discharge. Results: In both groups, the beginning of sensory blockage occurred at a similar time, while motor blockade achieved was faster in the 2CP group. The resolution of motor blockade was 1.7 times faster in the 2CP group than in the bupivacaine group. Time taken for ambulation was delayed significantly in the bupivacaine group, i.e., 263.04 ± 29.08 min compared to the 2CP group, i.e., 225.44 ± 29.48 min which was a delay of almost 38 min. Voiding of urine was also delayed in the bupivacaine group by 60 min compared to the 2CP group and was significant finding leading to delay of discharge of patients. Adverse effects were comparable in both groups. Conclusion: Intrathecal preservative-free 2CP provides satisfactory surgical block, and has a considerably faster rate of block regression, resulting in earlier ambulation and voiding, allowing the patient to be discharged from the hospital sooner as compared to intrathecal bupivacaine.
Background: Dexmedetomidine, alpha 2 agonist, with its anxiolytic, sympatholytic and sedative property can be good adjuvant in anesthesia by modifying stress response to various stimuli during laparoscopic cholecystectomy including laryngoscopy, intubation, pneumoperitoneum, and extubation. We aimed to evaluate low dose dexmedetomidine for reducing hemodynamic perturbations to stressful events with secondary aim of evaluating propofol dose reduction and postoperative analgesia. Methods: Sixty patients of American Society of Anesthesiologists Physical Status (ASA PS) Classes I and II were randomized to two groups of 30 each to receive dexmedetomidine infusion (0.5 mcg.kg−1.h−1) starting 15 min before induction (Group A) and normal saline (Group B). Patient induced and maintained with propofol infusion to keep BIS value 55–60 in both groups and heart rate (HR) and mean arterial pressure (MAP) were recorded. We stopped infusions at surgical closure. VAS score recorded till 24 h of surgery. Total propofol required in both groups were recorded. Data were statistically analyzed using the SPSS software version 15.0. Results: MAP and HR remain elevated following intubation in Group B and remain so throughout procedure and during all stressful events including CO2 insufflation and tracheal extubation and were statistically significant. Significantly lower doses (almost 30%) of Propofol required in Group A to achieve similar BIS values compared to Group B. Visual Analog Scale score remained on the lower side in Group A for 24 h than Group B. Conclusion: Low dose dexmedetomidine (0.5 mcg.kg−1.h−1) can effectively maintain hemodynamics during stressful events, reduces propofol requirement and improves postoperative analgesia in patients undergoing laparoscopic cholecystectomy.
