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Medicine and Dentistry >
Anesthesiology and Pain Medicine
Indian Journal of Clinical Anaesthesia
Editor in chief:Dr. Rakesh Karnawat
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Efficacy And Potency Of Intrathecally Administered Bupivacaine And Bupivacaine With Midazolam In Lower Limb Surgery At Ahmadabad, India
Author:Vibhuti A. Shah, Hetavi Contractor
Volume: 3 | Issue no: 3-2016 | Pagination: 488-491
Background and Aim: Many drugs have been used for spinal anaesthesia in lower limb surgery e.g. Lignocaine, bupivacaine, ropivacaine etc. Bupivacaine is still considered as a standard drug as far as therapeutic and side effect profile is concerned. The aim of present study to evaluate efficacy and potency of intrathecally administered bupivacaine and bupivacaine with midazolam on sensory and motor blockade, hemodynamic stability, side effects and post operative pain relief in lower limb surgery. Methods: A randomized controlled study was conducted on 50 patients aged 20-70 years at AMC MET Medical College, Ahmadabad, Gujarat, India. Patients were scheduled for lower limb surgeries after taking informed consent. Patients who were selected and posted for surgeries were randomly allocated in two groups. Group A received 3 ml (15 mg) hyperbaric bupivacaine 0.5% plus 0.2 ml 0.9% saline and Group B received 3 ml (15 mg) hyperbaric bupivacaine 0.5% plus 0.2 ml (1 mg) preservative free midazolam. Duration of surgery for each case was noted. Pain measurement was done using VAS scale. Results: No statistically significant difference in duration of surgery was observed between the two groups. Difference between time to onset of sensory block and time to achieve maximum block height was not statistically significant between two groups (P > 0.05) maximum level of sensory block in both groups was between T6 ? T10. Conclusion: Addition of preservative free midazolam to intrathecal bupivacaine prolongs sensory blockade and postoperative analgesia without increasing motor blockade and any adverse effects.
Conscious Sedation For Cataract Surgery Done Under Retrobulbar Block ? A Comparative Study Evaluating The Effects Of Midazolam And Dexmedetomidine
Author:Iniya R, Vijay Narayanan S, Venkatesan K, Rajalekshmi M
Volume: 3 | Issue no: 3-2016 | Pagination: 478-487
Background: A comfortable co-operative stationary patient is essential for cataract surgery especially under retrobulbar block. This can be achieved by placing the patient under ?conscious sedation? in which the patient will be arousable but at the same time can tolerate pain. Aim: To compare the efficacy of midazolam with dexmedetomidine for conscious sedation in cataract surgery with regard to anxiolysis, patient?s cooperation, haemodynamic stability, surgeon?s satisfaction, recovery profile and incidence of complications. Materials and Methods: 90 adult patients undergoing cataract surgery were randomized to three groups. Group M (n=30) patients received midazolam in loading dose of 0.03mg/kg over 10 minutes and a maintenance dose of 0.05mg/kg/hr. Group D (n=30) patients received dexmedetomidine in loading dose of 0.3mcg/kg over 10 minutes and a maintenance dose of 0.3µg/kg/hr. Group C (n=30) are control group receiving normal saline infusion as loading and maintenance doses. Statistical analysis was done using Chi-square test and ANOVA test with p value <0.05 taken as statistically significant. Results: Anxiolysis, patient comfort and surgeon?s satisfaction were better in midazolam and dexmedetomidine groups when compared to the control group. In dexmedetomidine group there were significant incidences of hypotension and bradycardia when compared to midazolam group. Time to achieve sedation was faster in the dexmedetomidine group than in the midazolam group. Conclusion: Midazolam and dexmedetomidine are effective in the aspects of patient co-operation, surgeon?s comfort, sedation and recovery profiles, and is safe to administer in cataract surgeries.
A Comparative Study On Adding Dexmedetomidine Versus Clonidine To Epidural 0.125% Bupivacaine For Postoperative Analgesia In Patients Undergoing Upper Abdominal Surgeries
Author:Swarnalingam Thangavelu, Shankar Anand Radhakrishnan, Nazir Ahmed Mallick
Volume: 3 | Issue no: 3-2016 | Pagination: 472-477
Background: The pain experienced after upper abdominal surgery leads to a reduction in 70-75% of vital capacity which leads to postoperative pulmonary complications. The ideal adjuvant for epidural analgesia in patients undergoing upper abdominal surgery seems to be every effective for better outcome and early immobilization in the immediate postoperative period. With this background we planned to conduct a study on epidural analgesia by comparing two alpha 2 agonists. Methods: 50 patients who have planned for elective upper abdominal surgery under general anaesthesia were enrolled in our study. Before induction of general anaesthesia, epidural catheterization was done. The surgical procedure was carried out under routine general anaesthesia with endotracheal controlled ventilation. The patients were given either Dexmedetomidine or Clonidine in the dosage of 2mcg/Kg with 0.125% Bupivacaine via epidural catheter after extubation. Patients were shifted to Post Anaesthesia Care Unit for observation. Sedation and pain were assessed with monitoring of vital parameters. The side effects were also noted. Results: Statistical analysis showed that the duration of analgesia was prolonged in the patients who received Dexmedetomidine as an adjuvant with local anaesthetic agent (417.32±67.36 minutes, p value < 0.05). The time to first rescue analgesia was comparatively delayed in Dexmedetomidine group while comparing with Clonidine group (425.6±64.27 minutes, p value < 0.05). The incidence of hypotension and bradycardia was greater in Clonidine group. There was no significant statistical difference with respect to side effects in both groups. Conclusion: From our study we concluded that Dexmedetomidine provides both analgesia and sedation with better hemodynamic status while compared to Clonidine used as adjuvants in epidural analgesia. But needs further study to optimize the dosage of these two adjuvants while giving via epidural route along with local anaesthetic agent.
A Prospective Randomized Study For Comparison Of Epidural 0.5% Levobupivacaine With 0.5% Racemic Bupivacaine Using Fentanyl As Common Adjuvant In Lower Limb Orthopedic Surgeries
Author:Kavita Jain, Surendra Kumar Sethi, Vijay Kumar, Neena Jain, Veena Mathur, Vini Depal
Volume: 3 | Issue no: 3-2016 | Pagination: 464-471
Background: Levobupivacaine, an S(-) isomer of bupivacaine, has been shown a lower risk of cardiovascular and central nervous system toxicity than bupivacaine. This study was aimed to compare racemic bupivacaine and levobupivacaine in epidural anesthesia for lower limb orthopedic surgeries using fentanyl as a common adjuvant. Methods and Material: A randomized prospective study was planned on sixty patients of ASA grade I and II who were admitted for elective lower limb orthopedic surgeries under epidural anesthesia. Patients were randomly divided into two Groups, Group B (n=30) received bupivacaine 0.5% (13ml) and fentanyl 100 µg, Group L (n=30) received levobupivacaine 0.5% (13ml) and fentanyl 100 µg. In both the Group?s onset of sensory and motor block, highest level of sensory block, duration of sensory and motor block, degree of motor block and hemodynamic parameters and complications were assessed perioperatively. Results: Mean duration of onset of sensory block was 9.54±1.03 and 9.85±0.97 min for Group B and Group L respectively and onset of motor block for Group B was 19.48±1.58 min and for Group L was 19.01±1.30 min, which were comparable for both Groups (P >0.05). Mean duration of sensory block was 371.33±13.23 min and 366.17±5.83 min in Group B and L respectively and mean duration of motor block was 273.0±11.0 min and 274.9±18.45 min in Group B and L respectively which were comparable in both Groups, (P > 0.05). The degree of motor block assessed by modified bromage scale was higher in Group B than Group L. Hemodynamic changes and complications having no significant differences between two Groups, (P > 0.05). Conclusion: The combination of levobupivacine and fentanyl is equipotent to bupivacaine and fentanyl in epidural anesthesia. Rather it seems to be a better alternative local anesthetic agent in epidural anesthesia for lower limb orthopedic surgeries.
Comparison Of Ondansetron, Dexamethasone And Ondansetron Plus Dexamethasone For The Prevention Of Post-Operative Nausea And Vomiting After Laparoscopic Cholecystectomy
Author:Suman Chattopadhyay, Ananya Biswas, Sk Samim Ferdows, Dilip Kumar Bhowmik, Swagata Dey, Biswanath Bi
Volume: 3 | Issue no: 3-2016 | Pagination: 459-463
Introduction: Laparoscopic cholecystectomy is associated with an appreciably high rate of postoperative nausea & vomiting (PONV) which is considered as a reason of patient?s delay in discharge and disability aggravation. This study was designed to compare the effectiveness of Ondansetron, Dexamethason and Ondansetron plus Dexamethasone as an antiemetic prophylaxis for preventing PONV in patients after laparoscopic cholecystectomy. Methods: In this randomised double blind study, 153 patients of both sexes of ASA I and II aged between 16 to 60 yrs received 4 mg Ondansetron (Group O, n = 50), 8 mg Dexamethason (Group D, n =51) or Ondansetron 4 mg plus Dexamethasone 8 mg (Group OD, n=52) intravenously immediately before induction of anaesthesia. Perioperative care was standardised in all patients. Patient was then observed for 24 hours postoperatively for any episode of PONV and any adverse effects of the study drugs. Results: A complete response (defined as no PONV and no need for another antiemetic) was achieved in 62% of the patients receiving Ondansetron, 64.7% of the patient receiving Dexamethasone and in 84.6% of patients receiving Ondansetron plus Dexamethasone (P<0.05). The overall cumulative incidences (0-24 hrs) of PONV were 40% in Ondansetron group, 37.3% in the Dexamethasone group and 15.4% in combination group (P<0.05). No difference in adverse events was observed in between group. Conclusion: We concluded that combination of Ondansetron plus Dexamethasone is better than each drug alone as an antiemetic prophylaxis against PONV following laparoscopic cholecystectomy.
Tramadol Attenuates The Post Anaesthetic Emergence Events-A Randomised Clinical Trial
Author:D.G. Talikoti, Shivanand L Karigar, Shreedevi Mulimani
Volume: 3 | Issue no: 3-2016 | Pagination: 455-458
Introduction: General anesthesia is most commonly used anesthesia technique for most of the cases. Emergence phenomenon is very commonly encountered by the anesthesiologists during extubataion. Adverse emergence events can have harmful effects on the patient?s outcome, so controlling of emergence events is at most important to have good outcome after general anesthesia. Objectives: to assess the tramadol efficiency in suppressing post-anaesthesia emergence. Methods: A total of 100 adult patients age between 20-40 years, with ASA I and II undergoing surgeries under general anesthesia, were divided into two groups each of 50. One group received tramadol and other group receive saline of equal quantity and approximately 30 min before reversal. We have monitored and recorded the incidence of shivering, onset of cough (weak or forceful), post-extubation laryngeal spasm, breath holding and increased muscle tone and lastly awakening and restlessness. Results: Tramadol reduced the incidence of shivering, reduced the restlessness, own attempt to extubate, zero percentage of patients had increased muscle tone and breath holding. We also observed that zero percent of forceful cough in tramadol group and post extubataion laryngeal spasm. Conclusion: A dose of 1 mg/kg tramadol administered intravenously 30 min before reversal of anesthesia has decreased incidence of coughing, sudden awakening, restlessness, own attempt to extubate, post-extubation laryngeal spasm and incidence of shivering.
To Evaluate Fentanyl As An Adjuvant To Intrathecal Bupivacaine For Lower Segment Cesarean Section
Author:K. Hemnath Babu, Shashikanth G. Somani, Sonali Somani, Venugopalan Vm
Volume: 3 | Issue no: 3-2016 | Pagination: 451-454
Objective: To compare efficacy of subarachnoid block with bupivacaine alone and low dose bupivacaine with fentanyl as adjuvant in terms of, onset and duration of anaesthesia and post-operative analgesia. Materials and Methods: Present prospective randomized case control study was conducted in 60 patients undergoing elective caesarean section. They were randomly divided into two groups of 30 each. Subarchnoid block was standardized. Haemodynamic parameters, onset and duration of sensory and motor blockade, post-operative analgesia and side effects (if any) were compared. Data was analysed using student?s unpaired t-test. Results: Onset of analgesia was earlier in Group BF (1.36±1.30min) compared to Group B (1.81±1.61min) which was statistically significant(p<0.05). Duration of two segment regression in Group BF (81.21±9.40min) was significantly prolonged then Group B (62.4±14.81min) which was statistically significant(p<0.05). Duration of sensory blockade in Group BF (124±9.36min) was significantly more than Group B (104.7±6.40min) which was statistically significant(p<0.05). In Group BF, onset of motor blockade was delayed and duration of motor blockade was less as compared to Group B, which was statistically not significant (p>0.05). Postoperative analgesia in Group BF (194±16.82min) was significantly prolonged then Group B (108.57±7.90 min) which was statistically significant(p<0.05). Conclusion: Addition of fentanyl to bupivacaine resulted in faster onset of action and effective spinal anaesthesia with a lower dose of bupivacaine.
A Comparison Of Oral Clonidine Versus Oral Diazepam Premedication For Maintaining Haemodynamic Stability During Craniotomy
Author:R Brindha, K Jayanthi, R Shankar
Volume: 3 | Issue no: 3-2016 | Pagination: 446-450
Background: Clonidine is an alpha-2 adrenergic agonist, which is a centrally acting antihypertensive drug. The recent reviews had shown that clonidine has sedative, anxiolytic, analgesic, and anesthetic-sparing properties which would stabilises the circulatory system and maintains the perioperative stress response at a lower level. Aim: To compare the efficacy between oral clonidine and oral diazepam as a premedication in maintaining the hemodynamic stability during craniotomy surgeries. Materials and Methods: Fifty patients with various types of intracranial tumours who were planned for elective surgical excision were included for the study. Group 1 patients (n=25) received 0.2mg/kg of diazepam and the Group 2 patients received 3.5mcg/kg body weight of clonidine orally 90mts before induction. Recordings of systolic, diastolic, mean blood pressure and heart rate was done from the arterial tracing, the transducer kept at the level of the external auditory meatus. It was made every 10mts for the first 2hours from the time of dural opening. Results: Of all the various hemodynamic parameters the heart rate alone had shown a statistically significant reduction over the period of 2 hours in patients among the clonidine group. The blood pressure parameters in both the groups had also shown reduction from base line in the first 60minutes and later on over the period of 2 hours the values had come back to that of the base line values and no statistically significant difference had occurred between the two groups and also the antisialagogue activity is more with clonidine than diazepam. Conclusion: The hemodynamic response during craniotomy was better controlled with clonidine which has shown a better response in controlling tachycardia and maintaining the systolic, diastolic and mean arterial pressures than diazepam. So clonidine can be considered as a good drug for premedication in craniotomy surgeries in comparison with diazepam.
Comparative Study On The Clinical Profile Of Different Doses Of Dexmedetomidine With Levobupivacaine In Supraclavicular Brachial Plexus Block
Author:Sangeetha Balakrishnan, Shamjith Kunikkakath, Kevin Koshy Jacob, Mangesh Shenoy
Volume: 3 | Issue no: 3-2016 | Pagination: 436-442
Background and aims: Many studies have been conducted using dexmedetomidine as adjuvant to local anaesthetics in peripheral nerve blocks, but few studies compare the effect of different doses of dexmedetomidine. We aimed at comparing the clinical profile of different doses of dexmedetomidine as adjuvant to levobupivacaine in supraclavicular brachial plexus block and finding out the dose which provides maximum improvement in block parameters with minimum undesirable effects. Material and Methods: This double blinded comparative study was conducted in 120 patients belonging to American Society of Anaesthesiologist Physical Status (ASA PS) I or II, undergoing elective upper limb orthopaedic procedures. The subjects were randomly allocated into four groups of 30 each. Supraclavicular brachial plexus blocks were performed in each group. While group LS received plain levobupivacaine, group LD30, LD60 and LD100 received 30 microgram(mcg), 60mcg and 100mcg dexmedetomidine along with levobupivacaine. The primary outcomes studied were block parameters and the secondary outcomes were hemodynamic profile, oxygen saturation and sedation scores. Statistical analysis was done using ANOVA test, chi-square test and Scheffe?s multiple comparison tests. Results: The demographic profile and hemodynamic variables were comparable in all four groups. Increasing doses of dexmedetomidine showed statistically significant improvement in block parameters and increase in sedation score, while significant decrease was found in heart rate and blood pressure. Conclusions: A dose of 60mcg of dexmedetomidine showed clinically significant improvement in block characteristics with minimum undesirable effects like bradycardia, sedation and prolonged motor blockade.
Impact Of Dexmedetomidine On Hemodynamic Parameters And Anaesthetic Requirement During Induction Of Anaesthesia In Coronary Artery Bypass Surgery Patients
Author:Sambhunath Das, Suruchi Ladha
Volume: 3 | Issue no: 3-2016 | Pagination: 431-435
Introduction: Laryngoscopy and tracheal intubation is associated with profound adverse hemodynamic changes. Coronary artery disease patients have compromised myocardial blood flow and usually have associated hypertension. If the stress response to tracheal intubation is not controlled, it may lead to severe hypertension, arrhythmias and myocardial ischemia. Dexmedetomidine is a new alpha agonist with high potency to control the stress response, pain and tachyarrhythmia. Hence, impact of dexmedetomidine on hemodynamic parameters during tracheal intubation in coronary artery bypass grafting (CABG) surgery patients was evaluated in the study. Methods: Sixty patients undergoing CABG were enrolled in the study. They were divided into 3 groups. Group 1 received thiopentone 3-5mg/kg, group 2 received thiopentone plus lignocaine 1mg/kg and group 3 received thiopentone plus dexmedetomidine 0.5µg/kg prior to laryngoscopy and tracheal intubation. Heart rate (HR), mean arterial pressure (MAP) and cardiac index (CI) were measured before induction, after anaesthetic induction, at laryngoscopy, and 1min, 3min, 6min and 10min after tracheal intubation. The extra amount of fentanyl and thiopentone required controlling hypertension to laryngoscopy and intubation was noted. The values were analyzed with SPSS 20 software with a P value of <0.05 considered as significant difference. Result: Demography variables of patients were similar among the groups. The values of MAP, HR and cardiac index were similar at base line in all three groups. The increase in the heart rate and cardiac index was less in dexmedetomidine group compared to thiopentone only group (p<0.05) at all-time points. Dexmedetomidine group also had lower rise in MAP after base line in comparison to group 1 and significantly less at laryngoscopy (p< 0.0001). Lignocaine group had better control on hemodynamic changes during intubation compared to group 1, but less attenuation compared to dexmedetomidine group. Group 3 patients required less thiopentone (23.2±27mg vs 52.5±29.1mg vs 107.5±53.8mg, p=0.0001) and fentanyl (26.2±30.8µg vs 58.7±39.9µg vs 108.7±35.6µg, p=0.0001) in comparison to group 1 and group 2. Conclusion: Dexmedetomidine is an effective drug in attenuating the hemodynamic response to tracheal intubation in patients undergoing CABG. Dexmedetomidine reduced the requirement of rescue doses of thiopentone and fentanyl.
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