Refine Search

New Search

Results in Journal MedPulse International Journal of Anesthesiology: 511

(searched for: journal_id:(4179839))
Page of 11
Articles per Page
by
Show export options
  Select all
MedPulse International Journal of Anesthesiology, Volume 20, pp 01-06; https://doi.org/10.26611/10152011

Abstract:
Background: Laryngeal mask airway (LMA) does not provide definitive airway protection from pulmonary aspiration of potential regurgitated gastric contents. LMA supreme, a recent supraglottic (extraglottic) airway device, shows promising results. Thus, aim of study to evaluate the role of supreme laryngeal mask airway (SLMA) in airway management of patients operated with laparoscopic procedures under general Anaesthesia. Methods: The prospective observational study comprised of 274 patients of ASA grade 1 and 2 scheduled for short elective laparoscopic procedures (<1hr.30min) who provided consent. Patients were anaesthetised according to standard protocol, appropriate size of SLMA was chosen and inserted; and complications were noted. Post SLMA removal, recovery and trauma of throat were noted. Postoperative complications such as nausea, vomiting, and throat pain were noted. Binary logistic regression model and Chi-square test of association was performed to analyse data (P<0.05). Results: Most participants were female (n=260) with mean age of 31.42±7.24 years. Mean duration of surgery and recovery time was 37.3±5.84 min and 5.85±1.93 min respectively. SLMA size 3 was commonly used (n=245) and majority of insertions were successful in the first attempt (n=244). Post insertion, SLMA had adequate length (n=208) Throat pain (n=37) and vomiting (n=38) were common post-operative complications observed in the patients. A significant association was observed between operative procedure and complication (P=0.0004) and number of attempts (P=0.0004) with trauma being significant (P=0.0039). Trauma was associated with gender (P=0.08) and body weight (P=0.006). Conclusion: SLMA can be used as a standalone supraglottic (extraglottic) airway device for airway management in laparoscopic surgeries.
MedPulse International Journal of Anesthesiology, Volume 20, pp 07-09; https://doi.org/10.26611/10152012

Abstract:
Background: Post-operative pain relief after caeserean section is challenging to both anesthetista and obstetricians. Injection buprenorphine can be used intrathecally for post operative analgesia. Aim: the aim of the study was to compare the efficacy of two different doses(30ug and 60ug) of buprenorphine intrathecally with hyperbaric bupivacaine for post operative pain relief in caserean section. Methods and Materials: A prospective randomised controlled study was done on 60 subjects undergoing elective casarean section where in two groups were made, Group A (n=30) and Group B (n=30) who received inj bupivacaine 0.5% hyperbaric 2ml plus inj buprenorphine 30ug and inj bupivacaine 0.5% hyperbric plus inj buprinorphine 60ug intrathecally respectively. Following parameters were observed, onset and duration of sensory block, postopertive pain measured on VAS(visual analogue scale),rescue analgesia requirement, maternal side effects. Results: Unpaired t test and Chi square test were used for statistical analysis. Duration of analgesia was longer significantly in group A compared to group B. rescue analgesia requirement and VAS were significantly lower in group A as compared to group B.No major side effects were seen. Conclusion: Increasing the dosage of buprenorphine intrathecally increased the duration and quality of post operative analgesia. with no major adverse effects.
Neha Sharma
MedPulse International Journal of Anesthesiology, Volume 19, pp 21-26; https://doi.org/10.26611/10151915

Abstract:
Background: Etomidate a commonly used induction agent in anesthesia is associated with pain and episodes of myoclonus post induction. This study was designed to evaluate and compare Midazolam and low dose of Etomidate in prevention of these symptoms on injection. Methods: This prospective randomized controlled study was conducted on 90 patients allocated to three study groups. Group 1 patients received 0.015 mg/kg of Midazolam i/v diluted to 5 ml in normal saline, Group II received 0.03 mg/kg of Etomidate i/v diluted to 5 ml in normal saline and Group III received 5 ml normal saline intravenously as premedication. Five minutes after receiving the study drugs, patient was preoxygenated with 100% oxygen for 3 min along with anesthesia induction with 0.3 mg/kg etomidate injected intravenously over the period of 20-30 sec. The patients were observed for etomidate induced myoclonus and pain. Results: The incidence of myoclonus in Group II was least with 46.67% having no myoclonus as compared to group I and III where Majority of patients had grade 3 myoclonus (50%; Group I) and (46.67%; Group III). There was statistical difference between the groups in terms of myoclonus grading. Further, there was statistical difference between the groups in pain score with majority of group 1 patients having grade 3 (severe pain = 46.67%) pain and group 3 patients with 43.3% having severe pain. Group 2 on the contrary majorly reported no pain (46.6%). Conclusions: The current study indicated pre induction of etomidate in low dose as an effective strategy in prevention of EIM as compared to Midazolam.
MedPulse International Journal of Anesthesiology, Volume 17, pp 141-145; https://doi.org/10.26611/101517310

Abstract:
Background: The LMA Supreme is a supraglottic airway device made of medical grade PVC and is latex-free. The I-Gel is a new supraglottic airway device with a non-inflatable cuff, composed of soft gel like, transparent thermoplastic elastomer. The main aim of present study was to compare the LMA Supreme with the I-Gel LMA in terms of the success of insertion of the device, hemodynamic changes and postoperative device related complications. Material and Methods: Present study was a prospective, randomized, comparative, observational study conducted in patients admitted for various elective surgeries, were randomly divided (by envelope selection) as I-Gel LMA and Supreme LMA insertion for general anaesthesia. Results: The mean age in group I and S were 41.26 ± 10.22 and 44.86 ± 10.1 years respectively. The mean body weight in Group I was 55.51 ± 9.61 kgs and in Group S it was 53.12 ± 9.65 kgs. There was no significant difference in the age, gender, body weight, ASA Grades of the patients between Group 1 and Group 2 .Statistically there was no significant difference in the SAD Sizes, Surgical Procedures, ease of insertion in both the groups. The basal heart rate was, mean SBP, mean basal DBP, mean basal MAP and mean SpO2 were comparable in both groups. Blood Tinged SAD was noted in 6 patients in both group I (I-Gel) and group S (SLMA). None of the patients in group I (I-Gel) out of 43 patients had Lip or Dental Injury, whereas 2 patients in group S (SLMA) out of 43 patients had Lip or Dental Injury. Only 4 of the patients in group I (I-Gel) out of 43 patients had Sore Throat within 24 hours post removal of SAD, whereas 6 patients in group S (SLMA) out of 43 patients had Sore Throat within 24 hours post removal of SAD. Conclusion: Both LMA Supreme and I-Gel can be used effectively and comfortably in selected adult patients during general anaesthesia. Both LMA Supreme and I-Gel are easy to insert, both are almost inserted in first attempt, no significant difference in hemodynamic changes during usage is noted.
Karri Laxmi Priyanka,
MedPulse International Journal of Anesthesiology, Volume 19, pp 07-11; https://doi.org/10.26611/10151912

Abstract:
Background: Total knee replacement (TKR) patients experience severe pain during the early postoperative period1 as it involves extensive bone resection and soft tissue manipulation. The objective of this prospective, randomized, comparative study is therefore to compare the adductor canal block (ACB) with femoral nerve block (FNB) on quadriceps muscle strength preservation and analgesic efficacy in the patients undergoing TKR. Material and Methods: Present study conducted in ppatients of age group 35-70 years, ASA physical status class I, II and III patients posted for unilateral TKR. 50 ppatients were randomized equally by block randomization technique. Group 1 received Adductor Canal Block (15 ml bolus of 0.18% ropivacaine followed by infusion at the rate of 8-10ml/hr), Group 2 received Femoral Nerve Block (15 ml bolus of 0.18% ropivacaine followed by infusion at the rate of 8-10ml/hr) with electromechanical infusion pump for 24 Hours. Results: Gender, BMI distribution between two groups doesn’t have significant difference. Out of 50 patients in our study 19.6% (9) patients were ASA I, 75% (39) were ASA II and 5.4% (2) patients were ASA III. Heart rate, systolic blood pressure and diastolic blood pressure were measured preoperatively, post-operative at 6-8 hrs, at 12 hrs. and at 24 hrs. The difference in those parameters at any given time was not statistically significant. ACB is similar to FNB with respect to quadriceps muscle strength measured by MRC grading at 6 hours. However ACB is very effective in preserving the quadriceps muscle strength measured by MRC grading at 12 and 24 hours with a statistically significant ‘P’ value of 0.0001. Conclusion Adductor canal block makes early rehabilitation after total knee replacement without the risk of inpatient falls.
Raghu K C
MedPulse International Journal of Anesthesiology, Volume 19, pp 27-30; https://doi.org/10.26611/10151921

Abstract:
Background: Use of thoracic epidurals for intra‑ and post‑operative analgesia for open abdominal surgeries has exponentially increased over the last decade. Spinal anaesthesia is used a landmark – guided midline approach, in these absent, indistinct or distorted in the presence of obesity, previous spinal surgeries, deformities, or degenerative changes associated with ageing. In the present study evaluates the efficacy of real‑time ultrasound (RUS)‑guided paramedian approach, and pre‑procedure ultrasound (PUS) landmark‑guided paramedian approach in obese persons. Methods: This is a Prospective Randomized Double-Blind Study conducted in Akash Institute of Medical Sciences and Research centre. Total 50 subjects (Group A – 25, Group A – 25). All the subjects included after informed consent, Along with Chest X- ray and ECG-for patients over 40 years of age. The primary end point was to attain a successful lumbar puncture. Variables like the number of attempts, the number of passes, the time taken for identifying landmark(s), and time for a successful lumbar puncture(s) were secondary end points and were recorded in both the groups. Results: This study was evaluated In real‑time ultrasound (RUS)‑guided paramedian approach, and pre‑procedure ultrasound (PUS) landmark‑guided paramedian approach in obese patients. There is a statistically high significant difference in PUS group than RUS Group. A P value < 0.002 is the statistically in between 2 groups. Conclusion: the space identification and number of attempts, passes and time consuming in pre procedure ultrasound when compared to real time ultrasound. This study suggest real time ultrasound is good for identification of space.
, Robina Mirza
MedPulse International Journal of Anesthesiology, Volume 19, pp 31-34; https://doi.org/10.26611/10151922

Abstract:
Background: The most striking change in adolescent girls is the onset of menstruation. After menarche, common menstrual abnormalities that the female adolescent may encounter include premenstrual syndrome, dysmenorrhea, prolonged menstrual bleeding, and emotional disturbances, In present study, we evaluated gynaecological problems of adolescent girls attending outpatient gynaecology department at tertiary care centre. Material and Methods: Present study was prospective, observational study, conducted in adolescent girls (10-19 years age) attending to the outpatient department of Obstetrics and gynaecology suffering from various gynaecological problems, willing to participate. Results: During study period, total 396 adolescent girls visited gynaecology outpatient department were considered for present study. Most cases belonged to 17-19 years age (52.8 %) followed by 14-16 years age (37.4 %) In study cases, menstrual complaints (67.7 %) were most common indication to visit OPD, followed by complaints like irregular cycles (48.5 %), pain in abdomen (29.8 %), abnormal vaginal discharge (13.9 %), acne and hirsutism (13.6 %) and obesity (11.4 %). Other less common complaints were delayed puberty (4.5 %), Bartholin cyst/abscess (3.3 %), breast diseases (2.8 %), mass per abdomen (0.8 %) and urogenital malformations (0.8 %). On basis of history and relevant investigations, menstrual cycle related gynaecological problems such as dysmenorrhea (24.7 %), oligomenorrhoea (19.7 %), menorrhagia (16.9 %), metrorrhagia (14.9 %) and hypomenorrhea (11.4 %) were noted. Amenorrhea was noted in 9.8 % cases, 1.5 % had primary amenorrhea while 8.3 % cases had secondary amenorrhea. Other problems were anaemia (28.8 %), urinary tract infection (19.7 %), PID (12.4 %), teenage pregnancy (2.3 %) and ovarian cyst (1.0 %). Conclusion: In present study menstrual cycle related gynaecological problems (dysmenorrhea, oligomenorrhoea, menorrhagia, hypomenorrhea, amenorrhea), anemia, urinary tract infection and PID were common in adolescent girls attending gynaecology OPD.
Jinal Manek
MedPulse International Journal of Anesthesiology, Volume 19, pp 44-48; https://doi.org/10.26611/10151925

Abstract:
Background: To evaluate and compare the efficacy and hemodynamic stability of ketamine / fentanyl along with propofol and also assess recovery profile, post-operative analgesia and complications in patients undergoing Dilatation and Curettage (DandC). Method: Total 100 patients of ASA grade I and II, age between 18-55 years were enrolled and divided into two equal groups with adjuvant drugs in group PK- ketamine (0.75mg/kg IV) and in group PF-fentanyl (2ug/kg IV). Both groups received induction dose of Propofol- 2-2.5 mg/kg. Depth of sedation maintained with 0.5 mg/kg boluses of Inj.Propofol and assessed with Ramsay Sedation Score (RSS). The total dose of propofol was noted in both the groups. Intraoperative and postop vital parameters and complications were compared. Visual Analog Scale(VAS) was recorded and if VAS Score >6, then patients received Inj.Paracetamol 15mg/kg IV as rescue analgesia. The recovery was assessed by Modified Aldrete Score (MAS). The time from completion of procedure to reach MAS of 9-10 was noted. Results: The hemodynamics was better with ketamine than fentanyl group. The total dose of propofol requirement, intraoperative and postop complications, and VAS scores were higher in group PF than in group PK, thus more patients required rescue analgesia in fentanyl group as compared to ketamine group. The recovery was delayed in ketamine group as compared to fentanyl (higher MAS and prolonged time to reach MAS>9). Conclusion: Ketamine (0.75 mg/kg) provides better perioperative hemodynamic stability with good analgesia and fewer complications as compared to Fentanyl (2ug/kg) in patients undergoing DandC.
MedPulse International Journal of Anesthesiology, Volume 16, pp 144-147; https://doi.org/10.26611/101516318

Abstract:
Background: Postdural puncture headache (PDPH) is a known complication of spinal anaesthesia. It is an iatrogenic cause,results after either intentional or accidental dural puncture.It begins typically within 2 days but regresses spontaneously in a few days. Present comparative study was conducted in patients who underwent elective lower abdominal surgery under spinal anaesthesia by midline or paramedian approach to evaluate incidence of postdural puncture headache at our tertiary hospital. Material and Methods: This prospective and comparative study was conducted 120 patients undergoing elective lower abdominal surgery under spinal anaesthesia were considered for present study. Patients were randomly divided in double‑blind fashion (patient and observer were blind to procedure) into two groups of 60 each. Numeric visual analog pain score was used to assess the postdural puncture headache in both the groups. Any case of persistent postdural puncture backache after discharge was followed up to 7 days through telephonic communication with the patient. The data collected was analysed statistically. Quantitative variables were expressed as Mean ± SD (standard deviation) while qualitative variables were expressed as relative frequency and percentage. The PDPH was analysed using Chi square test. P-value <0.05 was considered as statistically significant. Results:120 patients undergoing elective lower abdominal surgery under spinal anaesthesia were randomly divided in double‑blind fashion (patient and observer were blind to procedure) into two groups as Group M (median approach) and Group P (paramedian approach) of 60 patients each. General characteristics such as age, weight, gender and ASA status were comparable in both groups. Intra-operative hypotension was noted in 10% patients of group M and 8% patients of group P, difference was not statistically significant. 3 % patients of group M and group P required medications (tramadol / paracetamol) to treat PDPH.In present study postdural puncture headache was mild in 8 % and moderate in 3% patients in group M. While 7% patients had mild and 3% patients had moderate postdural puncture headache in group P. Incidence of postdural puncture headache was 10% in group M and 8% in group P, difference was not statistically significant. Conclusion: There was no difference regarding the incidence of PDPH in median and paramedian approach for spinal anaesthesia.
MedPulse International Journal of Anesthesiology, Volume 18, pp 83-87; https://doi.org/10.26611/10151825

Abstract:
Background: Local anesthetic drugs like bupivacaine are commonly used in spinal anesthesia for lower limb surgeries but the duration of spinal anaesthesia is very short. However, the duration of action of bupivacaine in spinal anaesthesia can be prolonged by using adjuvants such as midazolam, opioids, neostigmine, dexmedetomidine and clonidine. The present study is being undertaken to evaluate and compare the effects of clonidine and fentanyl as intrathecal adjuvants to hyperbaric bupivacaine in patients undergoing lower limb orthopaedic surgery. Material and Methods: Present study was conducted in the Department of Anaesthesiology and Intensive Care, Government Medical College, Jammu in patients of either sex ranging in age from 20-60 years belonging to ASA I/ II scheduled for lower limb orthopaedic surgeries. 90 patients were randomly allocated in three groups of 30 each in order to compare the duration and quality of analgesia of clonidine and fentanyl used as adjuvants to intrathecal bupivacaine. Results: All the three groups were comparable in age, gender, height, weight, ASA grade distribution and the difference between them was not statistically significant. The difference between the time to reach the T10 block, mean time taken for first request for analgesia and duration of motor block in all three groups were found out to be statistically significant (p<0.0001). It was found that group with clonidine had better results than fentanyl and bupivacaine alone. In our study 1 patient in bupivacaine (15mg) with fentanyl (25µg) group and 2 patients in clonidine(37.5ugm) group had hypotension but the difference was statistically insignificant. Only 1 patient in each fentanyl and clonidine group had 1 episode of bradycardia but no patient in bupivacaine alone group had bradycardia and the difference was also insignificant. Postoperative vomiting was experienced by 3.33% of patients receiving Bupivacaine (15mg) with fentanyl (25µg) and it was treated by giving injection Ondansetron 4 mg i/v whereas no case was reported in clonidine group. This difference was statistically insignificant. 2 patients in bupivacaine (15mg) with fentanyl (25µg) group had itching but no such case was reported in clonidine group and the difference was also statistically insignificant. No respiratory depression, nausea was noted in study patients. Conclusion: It can be concluded that intrathecal clonidine (37.5ugm) provides quicker onset and prolonged duration of sensory and motor blocks simultaneously increasing the duration of analgesia when compared to fentanyl (25ugm).
MedPulse International Journal of Anesthesiology, Volume 19, pp 54-59; https://doi.org/10.26611/10151932

Abstract:
Background: Inhaled anesthetics used for general anaesthesia have a rapid onset and offset of action. The Induction and recovery depends on anaesthetic drug solubility, cardiac output and minute ventilation. Sevoflurane and desflurane have low blood gas partition coefficients, and therefore share the advantage of faster onset and recovery from anaesthesia when compared to other inhaled anesthetics. Hence, we designed this prospective randomized study to compare the intraoperative haemodynamic parameters and recovery characteristics of desflurane and sevoflurane. Methods: Sixty patients aged between 18-50 years belonging to ASA I and II scheduled for elective general anaesthesia were enrolled in the study and randomly divided into two groups to receive desflurane(group D) and sevoflurane(group S) for the maintenance of anaesthesia. Both groups were premedicated, pre oxygenated and induced with propofol. Muscle relaxation maintained with vecuronium. Desflurane and sevoflurane concentrations were adjusted according to entropy parameters and clinical variables like HR, NIBP, MAP and SPO2. Neuromuscular blockade reversed with neostigmine and glycopyrrolate. Recovery characteristics assessed using modified Aldrete scoring. Results: The intraoperative haemodynamics was similar with both desflurane and sevoflurane, and was maintained within 20% of baseline values. However, early recovery characteristics were significantly better in group D. Time to eye opening was 6.63 + 2.17 min in group S versus 4.77 + 1.41 min in group D (P< 0.001). Time to Extubation was 8.03 + 2.54 min in group S and 5.93 + 1.44 min in group D (P < 0.001). Response to verbal commands was 8.77 + 3.01 min in group S and 6.97 + 1.67 min in group D (P < 0.001). Modified Aldrete score were significantly better in group D than group S at 1st min, 2nd min and 3rd min. Thereafter, modified Aldrete score assessed at 5, 10, 15, 30 and 60 min were similar in both groups. Conclusion: Both desflurane and sevoflurane produce similar stable haemodynamic profile. Despite the faster early recovery with desflurane, no significant differences were found between the two volatile anaesthetics after 5 minutes during intermediate recovery period.
MedPulse International Journal of Anesthesiology, Volume 19, pp 65-70; https://doi.org/10.26611/10151934

Abstract:
Background: The major perioperative goal is to provide adequate depth of anaesthesia along with optimum perioperative analgesia. One of the IV adjuvant that has been shown potential in pre-emptive analgesia is magnesium sulphate. This study was designed to assess the effect of perioperatively administered IV magnesium sulphate on anaesthetic and analgesic requirements. Materials And Methods: Sixty patients of ASA class 1, 2, 18-65 years of age scheduled for neck surgeries were randomly divided in to two groups. Group M received 40 mg/kg, magnesium sulphate in 100ml normal saline as loading dose over 20min followed by 8 mg/kg/hour as infusion till the end of the surgery during total intravenous anaesthesia with propofol, fentanyl and atracurium in neck surgeries. Group C received 100 ml normal saline as loading dose over 20min and thereafter continuous infusion of same volume of normal saline as received by group M. We observed total requirement of inj.propofol and inj.atracurium intraoperatively and duration of postoperative analgesia in both the groups. Results: The mean VAS score was consistently high in Group C than group M during first 24 hours which was statistically significant (p<0.05). The mean duration of total analgesia was significantly higher in group M. And total requirement of propofol and atracurium in control group were significantly higher compared to group receiving Mgso4.Conclusion: Perioperative use of magnesium sulphate as preloading and infusion shows reduced analgesic and anaesthetic drugs requirements in neck surgeries.
MedPulse International Journal of Anesthesiology, Volume 19, pp 60-64; https://doi.org/10.26611/10151933

Abstract:
Background: Pain and postoperative nausea and vomiting are the most common postoperative complications in middle ear surgeries. Amongst the beta-blockers, esmolol is ultrashort acting cardio selective β1 receptor antagonist used for management of postoperative pain. It also contributes to the significant decrease in PONV and reduces patient distress and facilitates earlier discharge. Objective: To evaluate the effectiveness of perioperative esmolol infusion on postoperative pain relief and postoperative nausea vomiting after middle ear surgeries. Methods: After obtaining approval from Institution Ethics Committee, 70 patients of age 15 and 65 years of ASA I,II and III were allocated with randomization into two groups of 35 each. Group C: 30 ml normal saline loading dose and thereafter continuous infusion of 1ml/min and Group E:0.5mg/kg esmolol in 30ml NS loading dose and 30ug/kg/min as infusion. Results: Average duration of analgesia was about 535 min in group E as compared to 187 min in group C. For PONV requirement of inj. ondansetron in group E was after 145 min and in group C it was 20 min. Group E patients had significantly less variations in blood pressure and heart rate intraoperatively and the response to intubation was masked as compared to group C. Conclusion: Intraoperative esmolol infusion is a newer justified method to reduce postoperative pain and PONV with advantage of hemodynamic stability.
MedPulse International Journal of Anesthesiology, Volume 19, pp 91-95; https://doi.org/10.26611/10151939

Abstract:
Background: Endotracheal extubation is the translaryngeal removal of a tube from the trachea via the nose or mouth. It is associated with hemodynamic changes because of reflex sympathetic discharge caused by epipharyngeal and laryngopharyngeal stimulation. Various drugs and techniques have been tried to attenuate the airway and stress responses during tracheal extubation. In present study, we have compared the effects of dexmedetomidine and intravenous lignocaine on the hemodynamic and recovery profiles during endotracheal extubation. Material and Methods: Present study was prospective randomised comparative study, conducted in patients from age group of 18-45 years, ASA grade I/II, scheduled for elective abdominal surgeries. The patients were categorised into two different groups using the sealed envelope method as Group D and group L. Results: In present study, patients were divided in following 2 groups with 50 patients in each group as group D (Dexmedetomidine) and group L (Lignocaine). Age, gender, mean BMI were comparable in both groups and difference was not significant statistically. The difference between mean heart rate, systolic BP, diastolic BP and mean arterial BP during extubation, after extubation at 1, 3, 5, 10, 15, 20, 25, 30 minutes in dexmedetomidine group and lignocaine group was statistically significant. In Dexmedetomidine group, 12% of the patients had no cough during extubation, 72% of the patients had smooth extubation with minimal cough while in Lignocaine group, 22% of the patients had smooth extubation with minimal cough, 74 % of the patients had moderate cough during extubation. Statistical analysis of the Emergence agitation score shows better results in group D. Conclusion: Administration of Dexmedetomidine before tracheal extubation was more effective in maintaining the hemodynamic stability, facilitated smooth tracheal extubation and had a better quality of recovery as compared to Lignocaine.
Rama Rao V M
MedPulse International Journal of Anesthesiology, Volume 19, pp 86-90; https://doi.org/10.26611/10151938

Abstract:
Background: Spinal anesthesia is the most common method of the regional block in cesarean section, because it is easy to perform, economical produces rapid onset of anesthesia, and good muscle relaxation, and most importantly, it gives immense pleasure to the conscious mother. To improve the quality of subarachnoid block, intrathecal opioids are used as adjuvants to Bupivacaine. Fentanyl has a rapid onset of action as a lipophilic opioid following intrathecal administration. Because of high lipid solubility, it undergoes rapid uptake by the spinal cord, and hence the chances of delayed respiratory depression are less. Methods: We randomly selected 60 patients belonging to the American Society of Anesthesiologists (ASA) class I and II, who are scheduled for elective LSCS. These patients were divided randomly into two groups of 30 each. Group B received 10mg of 0.5% hyperbaric bupivacaine (2ml). Group BF received 7.5mg of 0.5% hyperbaric bupivacaine (1.5ml) with 25mcg of Fentanyl (0.5ml). Lumbar puncture was performed at the level of L3-L4 with 23 Guage Quincke Babcock's needle with the patient in the right lateral position. The sensory block was assessed with the loss of pin prick sensation, and the motor block was set using the Bromage scale technique. We also recorded the hemodynamic parameters like pulse rate, blood pressure, oxygen saturation. Results: No significant statistical difference was found in demographic data between the two groups. Group BF showed early onset of the sensory block with a P value of 0.001. Time taken to attain peak sensory level was early in the BF group with a P value of 0.001. The total duration of sensory block and duration of effective analgesia was longer in the BF group with a P value of 0.001. The onset of motor blockade was early in the bupivacaine only group with a P value of 0.02. Conclusion: The intrathecal fentanyl 25mcg reduces the dose of 7.5 mg of 0.5% hyperbaric Bupivacaine for spinal anesthesia in cesarean section, thus reducing the incidence of side effects associated with it. By its synergistic effect with 0.5% hyperbaric bupivacaine, it provides better excellent sensory blockade and postoperative analgesia, good hemodynamic stability, less incidence of complications like Nausea, vomiting, and shivering without compromising the safety of mother and fetus in comparison to intrathecal 10mg of 0.5% hyperbaric Bupivacaine alone.
Sheetal K Desai
MedPulse International Journal of Anesthesiology, Volume 19, pp 77-80; https://doi.org/10.26611/10151936

Abstract:
Background: Spinal anesthesia is a commonly employed technique for anesthesia for caesarean section and is associated with hypotension which may cause maternal morbidity. Prediction of hypotension before the procedure can reduce complications. The study aimed to evaluate the role of pulse plethysmograph in the prediction of hypotension in caesarean section patients under spinal anesthesia. Methods: The observational study was conducted on 50 patients who were undergoing emergency or elective caesarean section. Spinal anesthesia was performed by anaesthesiologist using a 25 or 26-gauge spinal needle with bupivacaine at L3-4 interspinous space. Pre and post-anesthesia observations such as the width of pulse plethysmograph, non-invasive blood pressure in another arm, and heart rate were recorded. Paired T-test, Wilcoxon sign rank test, and chi-square test was used to analyse data using R Studio V 1.2.5001 software. Results: Post spinal anesthesia minor fall in systolic blood pressure (SBP) was observed in 11 patients, moderate fall in 21 patients, severe fall in 8 patients and a massive fall in 10 patients. A significant difference was observed between mean pre- and post-spinal anesthesia SBP (P<0.001). Width of pulse plethysmograph (PPG) was maintained in 14 patients whereas, narrowed and significantly narrowed PPGs were observed in 29 and 7 patients, respectively. Significant association was observed between grades of SBP and width of PPG (P<0.05). Receiver operating characteristic curve showed the width of PGG was good for prediction of hypotension in patient (AUC=0.828). Conclusion: Width of PPG can be used to predict SA induced maternal hypotension.
MedPulse International Journal of Anesthesiology, Volume 19, pp 49-53; https://doi.org/10.26611/10151931

Abstract:
Background: Dexmedetomidine (D) is alpha-2 agonist that acts as an anaesthetic and analgesic substitute. The goal of this study was to see how intravenous (I.V.) dexmedetomidine affected the length of sensory and motor block, postoperative analgesia, sedation degree, and side effects. Aims: To assess the effect of Dexmedetomidine infusion on the duration of analgesia with spinal Bupivacaine for adult patients undergoing herniorrhaphy and to assess side effects. Materials and methods: Prospective study was done under the for a period of 11 months. In 80 adults aged 20 to 60 years scheduled for herniorrhaphies were allocated into two study groups, named B and BD using computer generated randomization. The enrolled patients were divided into 2 groups each 40 patients to receive either 0.5 µg/kg dexmedetomidine intravenous bolus over 10 min (Group BD) or saline infusion (Group B) prior to subarachnoid block with 0.5% hyperbaric bupivacaine 12.5 mg Results: Numerical pain rating scale scores were significantly lower in group BD. Total analgesic requirement was significantly less in group BD. Time to request for first analgesic dose was longer in group BD as compared to group B. The duration of analgesia was longest in patients received intravenous dexmedetomidine along with spinal bupivacaine. Hemodynamic parameters and incidence of side effects were similar in both the groups. Conclusion: Premedication with single dose of intravenous dexmedetomidine 0.5 µg/kg prior to subarachnoid blockade with 0.5% hyperbaric bupivacaine hastens the onset and increases duration of sensory and motor block, with maintenance of stable hemodynamics and arousable sedation in Inguinal Herniorrhaphies.
MedPulse International Journal of Anesthesiology, Volume 20, pp 10-14; https://doi.org/10.26611/10152013

Abstract:
Background: With development of safer local anesthetic agents and advances in minimally invasive surgical techniques, the performance of day care surgeries are increasing in prevalence. Many local anesthetic drugs with varying concentrations and physical properties are used in spinal anesthesia to achieve early recovery, mobilization with minimal adverse effects. In the present study we are comparing the efficacy of Isobaric 0.5% Levobupivacaine with isobaric 1% 2-chlorprocaine in patients undergoing ambulatory surgeries under spinal anesthesia. Material and Methods: Sixty patients aged 18 to 60 years belonging to ASA physical status I-II, scheduled for various elective ambulatory surgeries under spinal anesthesia were randomized into two groups. Group A patients received 3ml of 0.5% Levobupivacaine and Group B received 4ml of 1% chlorprocaine. The time of onset, duration of sensory and motor block, hemodynamic changes and adverse effects were studied. Results: The time of onset of sensory block and motor block was significantly shorter (p<0.001) in Group B compared to Group A. Similarly, the duration of sensory and motor block in Group B was shorter (p<0.001). Intraoperative hemodynamic parameters including heart rate, systolic blood pressure and diastolic blood pressure were comparable in both groups. Conclusion: Intrathecal isobaric 1% 2- chloroprocaine has a shorter onset and duration of both Sensory and motor blockade compared to Isobaric 0.5% Levobupivacaine thereby, enabling early recovery and ambulation
S Sakthi Abirami, G R Rajashree
MedPulse International Journal of Anesthesiology, Volume 19, pp 12-16; https://doi.org/10.26611/10151913

Abstract:
Background: The analgesic requirement of patients following laparotomy surgeries could not be met by single method.Pain, if effectively managed in the post operative period will reduce the respiratory complications, decrease the hospital stay and health care cost for the patients. Ultrasound guided rectus sheath catheter allows continuous infiltration of local anaesthetic in the post operative period. Materials and Methods: Randomised controlled trial – 60 patients who underwent Laparotomy surgery were divided into 2 groups. Group A – Bilateral wound catheter was placed subcutaneously at the end of surgery. Group B –Rectus sheath catheter was placed bilaterally under USG guidance. Both patient received bolus of 10ml 0.25% Bupivacaine followed by infusion of 0.25% Bupivacaine at 2ml/hr for 48hrs. The hemodynamic parameters,VAS score, Post operative opioid consumption were recorded for the above mentioned period. Results: The VAS score was significantly low in Group B compared to Group A (2.2, 2.0, 1.67, 1.87, 1.7, 2.17 vs 3.93, 3.86, 3.6,3.97, 4.1, 3.8)(p<0.05) in the observed time intervals. The need for rescue analgesia with opioid was less in Group B (6.7%) compared to patients in Group A (26.7%) (p<0.05). The HR, MAP observed in Group A is increased significantly as compared to Group B at all time intervals (p<0.05). Conclusion: We concluded that USG guided Rectus sheath catheter provides better post operative analgesia in laparotomy surgeries than wound catheter infusion.
Raghu K C, , Viswash G K, Kaveri Hospital Consultant Anaesthesiologist
MedPulse International Journal of Anesthesiology, Volume 19, pp 17-20; https://doi.org/10.26611/10151914

Abstract:
Background: Ankylosing spondylytes is a chronic inflammatory disorder characterized by inflammation in spines and spinal arthritis with a complex polygenic aetiology. The disease is more common in young males and risk factors include both genetic and environmental. Anesthesia management for ankylosing spondylitis is a challenge due to management of difficult airway, respiratory and cardiovascular complications, as well as the medications for disease and pain control. Both airway management and neuraxial access may prove to be difficult. Awake fibreoptic intubation is the safest option (²) in these patients with a potentially difficult airway as it allows continuous neurological monitoring while achieving a difficult airway. Methods: This is a Prospective Randomized Double-Blind Study conducted in Sri Sathya Sai Institute of Higher Medical Sciences; Total 70 Patients (Group A – 35, Group A – 35). All the subjects included after informed consent, blood samples and urine samples are collected from the all the subjects. Hb, RBCs, WBCs and Platelets was measured by laboratory standard methods. Along with Chest X- ray and ECG-for patients over 40 years of age. Results: This study was evaluated that in ankylosing spondylitis cases most of the physicians prefer to give general anaesthesia because to prevent trauma to the spinal cord but in these cases spine and surrounding tissues also it will involve at that time for maintain airway to the patient is challenge to the physicians by using fibreoptic intubation is good way to approach and maintain airway to the ankylosing patients. Conclusion: In this study suggest that in ankylosing spondylitis patients during surgery in place of tracheal intubation fibreoptic intubation is the best way to maintain airway to the patients and also we can prevent spinal cord damage.
S Ch Sai Ramakrishna, Chhavi Agarwal
MedPulse International Journal of Anesthesiology, Volume 19, pp 01-06; https://doi.org/10.26611/10151911

Abstract:
Background: Pre emptive analgesia is multimodal approach where drug is used before surgery and has potential to be more effective than a similar analgesic treatment initiated after surgery. Pregabaline and Gabapentin are GABA analogue used is used as pre-emptive analgesic. Its analgesic action is mediated through α2δ subunit of voltage gated calcium channels on dorsal horn neurons. Material and Method:96 patients satisfying selection criteria were enrolled for this study and divided in to three groups Group P, Group G and Group C each having 32 patients. All patients were explained about visual analogue score. Result: There is significant difference between three groups regarding time of first rescue analgesia and tramadol consumption. The mean time for rescue analgesia was longer in pregabaline group then gabapentin group (482.7±113.5 min vs 343.35±70.74 min). The mean amount of dose of tramadol requirement was also less in pregabaline and gabapentin group (164.32±39.41 vs178.32±48.21 vs 272.82±83.01) in comparison control. Conclusion: The VAS score was significantly higher in control then pregabaline and gabapentin group. Both pregabaline (group P) and gabapentin (group G) are comparable to each other regarding VAS score at different time interval in post operative period. Ramsay sedation score was significantly higher in pregabaline and gabapentin group up 4 hour post operatively but after that there was no significant difference between two groups. Both pregabaline (group P) and gabapentin (group G) are comparable to each other regarding Ramsay sedation score at different time interval in post operative period.
MedPulse International Journal of Anesthesiology, Volume 19, pp 39-43; https://doi.org/10.26611/10151924

Abstract:
Background: Rocuronium is fastest among non-depolarizing muscle relaxants ,but still it produces appropriate intubating conditions comparable to succinylcholine, in >90 seconds on administering 2 × ED95 dose as a bolus dose. In present study we compared the effect of inj. Rocuronium with priming dose and inj. Rocuronium without priming on intubating conditions and onset time of intubation with respect to rocuronium as bolus. Material and Methods: Present study was single-center, prospective, randomized study, conducted in patients of age groups from 18-60 years of either sex , 40-60 kgs weight, ASA grades I and II, undergoing surgeries under general anaesthesia and given valid written consent for participation. The patients were randomly allocated into 2 groups of 30 patients each as Group C (control group) and Group P (priming group). Results: Overall, 60 patients were studied in age group of 18 to 60 years, 30 patients in each group C and group P. we compared mean age, weight, gender and ASA grade between group C and group P and difference was statistically not significant (p value >0.05). We compared mean HR, mean MAP and mean SPO2 preoperatively baseline, at induction, at intubation, mean HR at 1 minute after intubation and mean HR at 5 minute after intubation between group C and group P, the difference between two groups was statistically insignificant. (P value >.05) In group C, out of 30 patients ,17 patients were having score 9 while 12 patients were having score 8, while 1 patient had score 7 which was comparable with the group P in which out of 30 patients ,18 were having score 9,while 11 patients were having score 8 and 1 patient was of score 7,so in both groups most of the patients (96.67% in each group) had excellent intubating condition, and the groups were comparable as statistically no significant difference was noted. In group C mean Onset Time of Intubation was 92.33± 6.26 seconds, while in group P it was 56± 6.75 seconds, so the difference between the groups on the basis of OTI was statistically highly significant. (P value 0.0001) Conclusion: Rocuronium with priming would be an excellent alternative to succinylcholine, whenever fast induction will be needed. Intubating conditions were good to excellent and comparable in both rocuronium with priming and without priming. NMT monitoring is a useful tool for indicating the clinically acceptable paralysis.
MedPulse International Journal of Anesthesiology, Volume 19, pp 96-99; https://doi.org/10.26611/101519310

Abstract:
Background: Shivering is a common problem during the perioperative period, in surgeries done under regional anesthesia. Shivering is a potentially serious complication, resulting in increased metabolic rate; increased oxygen consumption along with raised carbon dioxide production; ventilation and cardiac output; adverse postoperative outcomes, such as wound infection; increased surgical bleeding; and morbid cardiac events.4,5 Present study aimed to compare the efficacy of butorphanol versus clonidine for control of shivering in patients undergoing surgeries under spinal anaesthesia. Material and Methods: Present study was conducted patients aged between 18-60 years, of either sex, ASA physical status I/II, scheduled for elective lower abdominal surgeries under subarachnoid block. 60 Patients were randomly allocated using a computer generated table of random numbers. Group B (n= 30) received intravenous bolus butorphanol 1 mg while group C (n= 30) received an intravenous bolus of 150 μg (1 mL) clonidine. Results: In present study, 60 patients were randomly allocated into group B (n= 30, received butorphanol) and group C (n= 30, received clonidine). Age (years), weight (Kg), BMI(Kg/m2), Gender (Male/Female), ASA grade, duration of surgery (min) and baseline axillary temperature were comparable between both groups and no statistically significant difference was noted among them. In butorphanol group an earlier onset of sensory as well as motor block and prolonged duration of sensory as well as motor block was noted as compared to clonidine group and difference was statistically significant. In present study, higher incidence of shivering was noted in clonidine group as compared to butorphanol group and difference was statistically significant. Side effects, such as hypotension, nausea and vomiting werer more in clonidine group as compared to butorphanol group and difference was statistically significant. Bradycardia was noted in both groups in 3 patients. Conclusion: Intravenous butorphanol is a safe and effective for prevention of shivering as well as had early onset and prolonged duration of sensory/motor block.
MedPulse International Journal of Anesthesiology, Volume 19, pp 81-85; https://doi.org/10.26611/10151937

Abstract:
Background: Gold standard surgical treatment for gallstone disease is Laparoscopic cholecystectomy. Over the years surgical skills have been improved and also there is better understanding of pneumoperitoneum3 Pneumoperitoneum stimulate a neuro-hormonal stress response which lead to increases heart rate, mean arterial blood pressure and systemic vascular resistance. Present study was designed to study the effect of pneumoperitoneum on hemodynamic parameters and cardiac function in patients undergoing laparoscopic cholecystectomy with and without cardiac disease. Material and Methods: Present study was prospective, comparative study, conducted in department of anaesthesiology. Study group was patients 18-65 years age, with echocardiographic findings consistent with presence of moderate to severe left ventricular systolic dysfunction, planned for laparoscopic cholecystectomy, Consented for participation, while control group was patients 18-65 years age, with normal echocardiographic finding, planned for laparoscopic cholecystectomy, Consented for participation. Results: Total 30 patients were enrolled in this prospective trial; 15 in each group. (Study and control group). The mean age of patients are 55.6 years and 36.6 years in study and control group, respectively and difference was statistically significant. Sex distribution: In control group, male: female distribution is 1:1.2; while in the study group, male: female distribution is 1:4, and difference was statistically significant. On intragroup statistical analysis, in the control group a statistically significant fall in HR is noticed at T2 and T4 from T1. Conclusion: Present study showed that laparoscopic cholecystectomy may be safely done in cardiac patients with moderate to severe left ventricular systolic dysfunction patients under the supervision of an experienced consultant anaesthesiologist.
Page of 11
Articles per Page
by
Show export options
  Select all
Back to Top Top