Background and Purpose: Conventional treatment of postoperative pain with routine analgesics during orthopaedic surgery leads to undesirable side effects, especially in the elderly. Therefore, this study was designed to evaluate the efficacy of compartment block of the fascia iliaca in postoperative analgesia with ropivacaine. Methods: We performed compartment block of the fascia iliaca with 30 ml of 0.5% ropivacaine in 20 patients undergoing lower limb orthopaedic surgery under general anaesthesia. Results: Verbal pain score (VPS) decreased significantly 1 hour after blockade, and the mean duration of analgesia was 4.85±2.86 hours. Conclusion: Compartmental block of the iliac fascia is a very useful method for postoperative analgesia in orthopaedic procedures of the lower limbs.
Background: Awake beroptic intubation (AFOI) is the principal techniques in the management of difcult airway in oral cancer surgery. The aim of study was to evaluate the efcacy of dexmedetomidine and fentanyl-midazolam combination on awake beroptic intubation in oral cancer surgery. An ideal sedation regimen would ensure patient's comfort and co-ordination attenuation of airway reexes, hemodynamic stability and sedation. 60 patients Methods: of age group 18-60 years with American Society of Anaesthesiologist I and II posted for oral cancer surgery under general anaesthesia were randomly divided into two groups of 30 each in this prospective randomised and comparative study. Group-D (30 pt): Received an infusion of 1 µg /kg in 100ml Normal saline infusion IV over 10 min. Group-FM (30 pt): Received an infusion of fentanyl 2 µg /kg and midazolam 0.02mg/kg IV in 10ml of normal saline. All Patients were assessed for vocal cord movement, coughing, physical movement, comfort score, Ramsay sedation score, patient satisfaction score, and intubation time and hemodynamics variables. The demographic characteristics w Results: ere comparable in two groups (P>0.05).Group-D has more incidence of vocal cord opening than Group-FM. Group-D has less cough score than group-FM. Limb movement scores were more in group-FM than group-D. Group-D were more satised than group-FM (P=0.0002). RSS Score was signicantly better in Group-D than in Group-FM (P=0.041). Group-D showed signicantly reduced hemodynamic response to AFOI than group-FM. Conclusion: Dexmedetomidine is more effective than fentanyl-midazolam during AFOI, as it provides better intubation condition, hemodynamics stability and sedation
Recent advances in medicine have made it possible to successfully treat numerous disorders through surgical procedures, which frequently need the use of general anaesthetic. There is a rising interest in the CNS (central nervous system) issues related to anaesthetics, and concerns about the safety of general anaesthetic are on the rise as their usage becomes more commonplace. Recent years have seen a wealth of research pointing to the involvement of blood-brain-barrier (BBB) dysfunction and neurological inflammation in the emergence of CNS problems in the wake of anaesthesia. More research is needed to determine whether or not general anaesthesia causes BBB failure and neuroinflammation, and whether or not this interaction might be an option for treatment for CNS problems
In the last few decades, there has been a resurgence of interest in using regional anaesthetic methods for a wide variety of routine surgical procedures. The hyperbaric solution of bupivacaine is used frequently for practically all types of surgery by the great majority of anesthesiologists across the world. But they fail to see the additional benefits of spinal anaesthesia. This method is best suited for specific types of patients. This article demonstrates the relationship between spinal anaesthesia and sensory and motor blocking using hyperbaric and isobaric solutions. The feasibility of administering spinal anaesthesia to just one side of the body is discussed. Using posterior spinal anaesthesia demonstrates that only sensitive spinal anaesthesia may be administered, without motor block. The scope of surgery that can benefit from isobaric and hypobaric solutions has expanded greatly. Recent years have seen an increase in the usage of thoracic continuous spinal anaesthesia, as it was demonstrated to be effective and safe for a variety of surgical procedures. Spinal anaesthesia for laparoscopic surgery, including thoracic spinal anaesthesia, segmental spinal anaesthesia, and continuous procedures, are all demonstrated in this article.
Background: To evaluate hyperglycaemic response to an anti-emetic dose of dexamethasone in diabetic subjects undergoing Cholecystectomy surgery. Materials and Methods: A prospective study was conducted, over 120 ASA I and II, aged 16-60 years patients posted for Cholecystectomy under General Anaesthesia for a period of October 2021 to October 2022. Prior to the anaesthetic induction, diabetic and non-diabetic patients were randomly distributed by numbers generated computationally in two groups: Group A, 60 diabetic patients received 8 mg dexamethasone. Group B, 60 non-diabetic patients received 8 mg dexamethasone. Data were analysed using Statistical Package for Social Sciences, version 23 (SPSS Inc., Chicago, IL). Student t-test was used for group comparison. A p-value of
Introduction: To reduce the morbidity associated with cardiopulmonary by-pass (CPB), off-pump coronary artery by-pass grafting (OPCAB) has gained popularity. Methodology: A randomized double - blind study with patients undergoing off -pump coronary surgeries under anesthesia was carried out in Pondicherry Institute of Medical Sciences during October 2013 to April 2015. Sample size was 60 and those were patients randomized into two groups that is each group having 30 patients. Patient age group between 18 to 80 years were included. Results: The study population included 63 patients with coronary artery disease-triple vessel disease coming for off pump coronary artery bypass surgery under anesthesia to Pondicherry Institute of Medical Sciences. Of the 63 patients, 30 were allotted to each group after randomization into – Group T-receiving Tranexamic acid 30mg/kg after heparin and 30 to Group S -receiving normal saline. Discussion: Tranexamic acid significantly reduces intra as well post-operative bleeding in off pump coronary artery bypass (OPCAB) surgeries and also significantly reduces the requirement for allogeneic blood transfusion in patients undergoing OPCAB surgeries. There were no complications or adverse reactions related to the use of drug like hypotension, seizures, renal dysfunction, thrombosis or anaphylactic reactions.
Objective: It has been demonstrated that dexmedetomidine can extend the time that spinal anaesthesia and postoperative analgesia last. The study's objective was to examine the impact of dexmedetomidine delivery via intrathecal vs intravenous routes on patients posted for lower extremities surgery under spinal anaesthesia with 0.5% hyperbaric bupivacaine. Methods: A prospective observational study involving 60 ASA PS I & II adults between the ages of 18 & 60 years posted for elective lower extremity surgeries under spinal anaesthesia was conducted from January to June 2022.The participants were randomly assigned to two groups: (1) IT group (n=30) patients received 3 ml of 0.5% hyperbaric bupivacaine and 5 µg of dexmedetomidine intrathecally (100 µg/1 ml ampoule raised in a 40 IU/ml insulin syringe, giving 5 µg=2 IU=0.05 ml) and (2) the IV group (n=30) received 3 ml of 0.5% hyperbaric bupivacaine and 0.05 ml normal saline intrathecally, followed 5 minutes later by IV dexmedetomidine 0.5 µg/kg via infusion pump over 10 minutes as a single dose. Results: In the IT group, the time from injection to the greatest sensory level was shorter and the sensory beginning occurred statistically substantially sooner at T10 (p 0.001). The IT group had substantially shorter regression times for two dermatomes, to the S1 dermatome, and to the Bromage 3 motor block, however the regression time to the Bromage 0 dermatome was longer (p 0.001). In comparison to the IV group, the IT group demonstrated a considerably longer duration to the need for rescue analgesia and reduced analgesic intake in the first 24 hours (p 0.001). In addition, the IT group experienced much less discomfort than the IV group (p 0.001). The IT group experienced fewer total side effects and a lower sedation score when compared to the IV group, although these differences were not statistically significant (p>0.05). Conclusion: Dexmedetomidine, when given intrathecally instead of intravenously (IV), had superior analgesic qualities, better hemodynamic stability, and fewer overall adverse effects when used for lower extremities surgeries under bupivacaine spinal anesthesia.
Background: Breast surgery is mostly done under general anesthesia, although regional anesthesia in the form of peripheral nerve blocks and epidural anesthesia has also been used. The aim is to present this case in which mid-thoracic segmental spinal anesthesia was used for excision of the breast tumor. Method: A 28 years old ASA grade I female patient was given mid-thoracic segmental spinal anesthesia for excision of phylloid tumour of the breast. Adequate analgesia was achieved from T2-T12. One episode of bradycardia was treated with Atropine injection. Result: Adequate analgesia, stable hemodynamics, no nausea or vomiting, less analgesic requirement, early ambulation, cost effective and high patient satisfaction level.
Introduction: Geriatric patients with significant autonomic dysfunction are the ones who present for hip fracture surgeries, Hence we undertook our study which compares ultralow dose bupivacaine with fentanyl which causes minimal hemodynamic instability with conventional dose of bupivacaine. Opiods and local anaesthetics administered together intrathecally have potent synergistic analgesic effect. Aim: To compare ultra low dose bupivacaine with fentanyl and conventional dose of bupivacaine in ASA II and ASA III patients posted for hip surgeries in regards to 1. hemodynamic stability, use of vasopressors and perioperative morbidity. 2. Duration of motor and sensory block Methodology: After obtaining approval from the Institutional Ethical Committee, the study was conducted on 52 patients belonging to physical status ASA classes II and III, aged 60–90 years, scheduled to undergo hip surgeries under spinal anesthesia. Group A will receive 1mL of 0.5% bupivacaine(5mg) + 20 mcg fentanyl and group B will receive 2mL of 0.5% bupivacaine(10 mg). Results: The demographic data (age, weight, sex and ASA grading) were comparable and statistically non significant. Mann- Whitney test was used for statistical analysis. The time of onset of adequate level of sensory block(T10) was longer for group A (128.96 +/- 2.53 sec) than group B (95.57 +/- 2.41 sec) and was statistically significant. Duration of motor block was longer in group B (111.23 +/- 3.64 min) as compared to group A (88 +/- 3.77 min) and was statistically significant. Duration of sensory block for group B (147.5 +/- 3,46 min) was slightly more compared to group A (141.86 +/- 4.34) and was found to be statistically significant. Conclusion: The use of ultralow dose bupivacaine plus fentanyl for spinal anaesthesia for surgical repair of hip fractures in elderly patients provides successful anaesthesia and incurs a minimum of hypotension.
Introduction: Positioning intertrochanteric fracture cases for subarachnoid block is challenging. Fascia iliaca compartment block (FICB) helps in positioning and provides analgesia. AIM: To study and compare FICB with inj bupivacaine with dexmedetomidine (DMT) and inj bupivacaine with regard to: 1. Positioning of patient during subarachnoid block 2. Duration of postoperative analgesia. Methods: After obtaining approval from institutional ethics committee and written informed consent from the patient,120 patients aged between 30-80 years belonging to American Society of Anaesthesiologist class 1 and 2 scheduled for closed reduction and internal fixation for intertrochanteric fracture were allocated into two groups. Group A received FICB with inj. bupivacaine 0.25% of 20ml and inj. DMT 0.5µg/kg and Group B received FICB with inj. bupivacaine 0.25% of 20ml. Onset and duration of analgesia were recorded in terms of VAS. Data were analyzed using SPSS 22.0 software and t-test was used as test of significance and P
Without a question, the most important part of patient care in dentistry is local pain management. The advancements in local anaesthetic equipment, agents, and techniques are perhaps the most significant achievements in dentistry science, allowing the profession to make major therapeutic advances that would not have been feasible otherwise. The capacity to administer safe and effective local anaesthetic is essential in clinical oral surgery. Like any regional anesthetic technique, the use and effectiveness depends on patient considerations, the extent and duration of the procedure, choice of drug and technique, and the skill and experience of the practitioner. Every clinician should be aware of his or her skill limitations, and the limitations of the contemplated technique and agent. The administration of local anesthetics is often complicated by the existence of multifactorial psychological considerations associated with the delivery of dental care. It is imperative for health care professionals to understand and appreciate these issues to properly implement perioperative behavioral or pharmacologic management strategies to reduce fear and anxiety to acceptable levels.
OBJECTIVE:None of the advanced monitorisation procedures, which are focusing only on the haemodynamic and blood gas parameters, are sufficient to estimate tissue perfusion adequately. The search for new parameters that are non-invasive and reliable to provide information about tissue hypoperfusion is significant. The purpose of the present study was to evaluate the relationship between urine partial pressure of oxygen (PuO2) and routine systemic tissue perfusion parameters in patients with sepsis-like syndrome and impaired cardiac pressure-volume relationship after an open cardiac surgery.METHODS:The study was designed in 50 patients who had elective coronary bypass surgery. Patients were assessed for arterial lactate levels, arterial partial oxygen pressure (PaO2), cardiac output (CO) and PuO2 in bladder urine at 180, 360 and 540 min postoperatively.RESULTS:Tissue perfusion parameters were found to be similar throughout the surgery in addition to no significant rise in plasma creatinine levels. PuO2 was found to be 91±22, 99±22 and 97±13 mmHg, respectively, at the time points described above. Any correlation between PuO2 and other measurements was not determined at any time points.CONCLUSION:The present study suggests that urine PuO2 has no relationship with routine systemic tissue perfusion parameters, such as PaO2, lactate levels and CO. In our opinion, since the COs of the patients were within the normal limits, and none of the patients developed renal injury, the present study might have been unable to determine any correlation. Further studies focused on patients with transient renal ischaemia are needed.
Background: Suxamethonium induced fasciculation (SIF) and post-operative myalgia (POM) is one the side effects occurred following administration of suxamethonium.Objective: The present study aimed to assess the incidence and severity of SIF and POM, and their association with different IV induction agents among adult patients underwent elective surgery at Jimma medical center (JMC).Methods: Prospective cohort study design was employed among a sampled 140 patients whoinduced by four IV induction agents (propofol, thiopentone, ketamine and ketofol) where in each group 35 patients were equally distributed.SIF and POM were assessed by separated structured grading and scoring toolsintraoperatively and post-operatively (respectively) after exposing patients toalready mentioned four induction agents.Data was entered into Epidata version 4.3.1 and finally exported to SPSS version 20 for further analysis.Cross tabulation/chi square and binary logistic regression were applied to determine their association.P-value < 0.05 was declared as statistically significant.Results: The incidence of SIF was 94.3% and differs among induction agents (non-statistically significant difference) (propofol 32(22.9%),thiopentone 34(24.3%),ketamine 33(23.6%)and ketofol 33(23.6%)(P-value=0.204).The incidence of POM was 29.3% and highest among ketamine group 15(10.7%)and also varies among groups (propofol 6(4.3%), thiopentone and ketofol (each10(7.1%))(P-value=0.255).The likelihood of POM occurrence was more likely among patients induced by ketamine [OR 1.8(0.7-5.1),p=0.215)] and thiopentone [OR 1.1(0.3-2.8),p=0.999)] but less likely among patients induced by propofol [OR 0.5(0.1-1.6), p=0.259)] by taking patients induced by ketofol as reference.The likelihood of SIF occurrence was also varies among IV induction agent(about two fold among thiopentone groups [OR 2.1(1.2-23),p=0.563]), but not showed statistically significant difference among groups.Conclusion and Recommendation: Even though, the incidence of both SIF and POM were profound and no statistically significant safe IV inductions that mitigate this adverse effect(fasciculation and POM) following administration of suxamethonium, other option of muscle relaxant was warranted.
Background: Postanesthesia shivering is one of the potential complications of anesthesia which may increase patient morbidity.Various methods had been employed to control postoperative shivering.This study assessed the effectiveness of prophylactic low dose intravenous ketamine and pethidine for postoperative shivering after general anesthesia.Methods and Materials: This prospective cohort study recruited 76 ASA I and II patients aged 18-65 years old and underwent elective surgery under general anesthesia.The patients were grouped by blinded anesthetist to take either ketamine 0.5mg/kg or pethidine 0.5 mg/kg 20 minutes before completion of the surgery.The incidence and severity of postoperative shivering were compared between the two groups every 10 minutes until one hour postoperatively.The side effects of the study drugs were also compared between the two groups in the recovery room.Categorical data were analyzed with the Chi-Square test.Parametric andnon-parametric data between the groups were analyzed using independent samples t-test and Mann-Whitney U test respectively.A p-value of <0.05 was considered statistically significant. Results:The incidence of shivering between the ketamine and pethidine groups was11(28.2%)and 14 (35.9%)respectively (p=0.467).The severity of shivering was not significantly different between the two groups (p=0.893).The occurrence of nausea and vomiting and sedation attributed to the drugs was significantly less in the ketamine group (p<0.05).PACU stay duration and occurrence of hallucination among the groups were comparable.(p>0.05)Conclusion and Recommendation: This study revealed administering low dose IV ketamine (0.5mg/kg) 20 minutes before completion of surgery reduced postoperative shivering as effectively as pethidine.The study also showed clinically better outcomes in favor of ketamine since it was associated with fewer side effects.Thus, we recommend low dose IV ketamine 20 minutes before completion of surgery under general anesthesia to prevent postoperative shivering.
The various factors associated with post-operative pain may be grouped as; patient-related and surgery-related.The factors like previous pain experiences, social, cultural and psychological status, as well as genetic and sexual factors are major patient-related factors.However, surgical factors include the type of anaesthesia and surgical technique including ability to diagnose and avoid
SARS COV2 infection can produce pneumothorax and spontaneous pneumomediastinum complications, which are associated with a worse prognosis. Here we present a series of cases of patients who presented subcutaneous emphysema caused by pneumothorax or spontaneous pneumomediastinum during care in the intensive care unit for pneumonia and COVID 19. This group of patients showed, in all cases, prolonged mechanical ventilation, refractory hypoxemia and hypercapnia, acute renal failure, bacterial superinfection, need for broad-spectrum antibiotics, and vasopressor support. Keywords: Subcutaneous Emphysema, Spontaneous Pneumothorax, Spontaneous Pneumomediastinum, COVID 19
This study was performed at a tertiary care centre after the approval of the Institutional Ethical Committee and obtaining written informed consent from all patients. Sixty ASA I and II, aged 18- 65yrs, bodyweight 45-70kgs scheduled for gynaecological surgeries under spinal anaesthesia were chosen for the study and were divided into two groups named Group B and Group BN each comprising 30 patients. Group B received 3ml of 0.5% hyperbaric bupivacaine with 0.5 ml normal saline and Group BN received 3ml of 0.5% hyperbaric bupivacaine with 0.5ml (150mcg) of buprenorphine. Vital parameters like pulse rate, blood pressure, respiratory rate, SpO2 were recorded at 0 (basal) 15, 30, 45, 90 and 180 minutes. Postoperatively heart rate, blood pressure, respiratory rate and SP02 were monitored at 3 ,6 ,12 and 24 hrs. The mean age, height, weight, duration of surgery were comparable. Time of onset of sensory blockade and motor blockade were noted. The time for rescue medication was 909.0±216.9 min in group BN with a range from 690 min to 1500 min and in group B it was 412.0±89.28 min with a range from 130 min to 195 min. Comparing both groups duration of effective analgesia was significantly higher in group BN with P<0.0001.thus, it can be concluded that addition of buprenorphine as an adjuvant in spinal anaesthesia excellently prolongs duration of analgesia in postoperative period with minimal side effects.
Providing complete and integrated anaesthesia care beyond the protected, familiar and controlled boundary of the traditional operating room setting is a challenge to the anaesthesia provider. Over the past few decades, there has been a tremendous surge in the domains where procedures are being performed under sedation in the paediatric age group- imaging facilities, dental offices, subspecialty procedure suites, emergency departments and ambulatory surgery centres. The number and complexity of such cases is increasing over time. Another major shift has been the changing face of the caregivers. Initially, the anaesthetist played an exclusive role in non-operating room anaesthesia. However, it has now emerged as a multispeciality practice and sedation for children is now being provided by a wide range of specialists around the world. In this article we have discussed the guidelines for practicing paediatric sedation in remote locations and the role of the anaesthetist in the current scenario.
Type 1 respiratory failure secondary to ventilation-perfusion mismatch by micro-thrombus in the pulmonary vasculature and subsequent damage to the endothelial cells is by far the most typical presentation of Covid-19 pneumonia. Computed tomography pulmonary angiogram remains the investigation of choice to diagnose pulmonary embolism or micro-thrombi; however, it is not possible due to extreme hemodynamic instability or oxygen requirements in patients, making the transfer to the scanner a precarious affair. Therefore, clinicians worldwide use anticoagulant treatment doses based on clinical features, blood investigations, or echocardiography following local or national guidelines. In this report, we describe a case of bilateral pectoralis major hematoma due to treatment dose of enoxaparin in an elderly Covid-19 patient admitted in our ICU. This case report emphasises the need for extra precaution and vigilance while using treatment dose of anticoagulants for suspected pulmonary embolism in Covid-19 patients.
