Introduction: Traditional spinal anesthesia produces significant levels of sensory block leading to spinal hypotension in the elderly population that affects the clinical outcomes postoperatively. Hence, the epidural volume extension (EVE) technique, a variation of combined spinal epidural anesthesia, is used on elderly patients to avoid the abrupt hypotension brought on by the higher level of sensory blockade in spinal anesthesia. Here, we compare the hemodynamic response following EVE technique and spinal anesthesia. Materials and Methods: In this study, 108 patients of age >60 years were divided into two groups: Group EVE receiving combined spinal epidural anesthesia, 10 ml saline was injected in epidural space after low dose spinal anesthesia and Group nonepidural volume extension (NVE) received spinal anesthesia only. The primary outcome was hemodynamic stability. Secondary outcomes were maximum levels of sensory block, motor block, two-segment regression time, duration of analgesia, total analgesic doses consumed in 24 h, and adverse effects if any. Results: In Group NVE, the mean arterial pressure (MAP) at 1 h was 88.28 and 86.73 in group EVE which was statistically significant (Friedman Test: χ2 = 37.4, P ≤ 0.001). There was no significant difference in the trend of MAP over time between the two groups (P = 0.123). Sensory and motor level block achieved in Group EVE was higher (P < 0.005). Two-segment regression time was earlier in Group NVE. The duration of analgesia in Group EVE was more. There was no statistically significant difference in 24 h analgesic consumption and adverse effects. Conclusion: EVE approach offers superior hemodynamic stability following induction than spinal anesthesia.
Introduction: Preoperative anxiety in the pediatric population leads to tachycardia, agitation, excessive crying, and postoperative emergence delirium. The intranasal route of premedication is effective, easy, has high bioavailability, and a rapid onset due to the highly vascularized nasal mucosa. This study compares the efficacy of intranasal ketamine with dexmedetomidine versus intranasal ketamine with midazolam as premedication for sedation in children. Materials and Methods: This randomized, double-blind study included 56 children aged between 3 and 8 years undergoing elective infraumbilical surgeries. Patients were randomized into Group “KD” – intranasal ketamine 1 mg/kg with dexmedetomidine 1 µg/kg and Group “KM” – intranasal ketamine 1 mg/kg with midazolam 0.2 mg/kg. The drugs were given 30 min before the induction of anesthesia. The level of sedation was assessed using the Modified Observer’s Assessment of Alertness/Sedation Score, Parental Separation Score, Parent Satisfaction Score, Mask Acceptance Score, and Postoperative Emergence Score. Results: TheMean Sedation Score, Postoperative Sedation Score, Parental Separation Score, Mask Acceptance Score, and Parent Satisfaction Score between the two groups were found to be statistically significant between both groups (P < 0.05). The mean Postoperative Emergence Score (Cravero score) between the two groups showed no statistically significant difference in score (P > 0.05). Two patients in Group KD had tachycardia, and one patient from each group developed hypotension in the postoperative area. Conclusion: A combination of intranasal ketamine (1 mg/kg) with midazolam (0.2 mg/kg) is better than intranasal ketamine (1 mg/kg) with dexmedetomidine (1 mcg/kg) in terms of premedication, mask acceptance, and separation anxiety.
Background and Aims: Laryngoscopic manipulation and endotracheal (ET) intubation are noxious stimuli capable of producing tachycardia, arrhythmias, and hypertension. This study compared the efficacy of 3 different doses of intranasal dexmedetomidine (0.75 µg/kg, 1 µg/kg, and 1.5 µg/kg) in attenuating the hemodynamic responses to laryngoscopy and ET intubation. Methods: After taking informed written consent, a total of 90 patients were divided into 3 groups. Group-1 was given dexmedetomidine 0.75 µg/kg, Group-2 given 1 µg/kg and Group-3 was given 1. 5 µg/kg. In all the patients, drugs were diluted to 1 ml with 0.9%normal saline. Intranasal drug was dripped into both nostrils in equal volume using 1 ml syringe in a supine head-down position about 40 min before induction (T0). The primary objective of this study is to compare pressor response of laryngoscopy and ET intubation in the preoperative period among 3 groups. Secondary objectives are the observation of sedation status via Ramsay sedation scale and to document side effects. Results: Groups were well matched for their demographic data. Hemodynamics were stable in both Group 2 and 3, but significant hypotension and bradycardia were noted in Group 3 in two cases, which were treated with a fluid bolus and a single dose of mephenteramine. Patients who were given dexmedetomidine at a dose of 1.5 µg/kg were significantly sedated during intubation (P = 0.013) as well as during extubation (P < 0.001) compared to patients in Groups 1 and 2. Conclusion: Dexmedetomidine in the dose of 1.0 µg/kg administered as intranasal drops produced a more satisfactory attenuation of hemodynamic response during laryngoscopy and ET intubation with hemodynamic stability.
