MedPulse International Journal of Anesthesiology

Journal Information
ISSN / EISSN : 2579-0900 / 2636-4654
Published by: STATPERSON PUBLISHING CORPORATION (10.26611)
Total articles ≅ 481
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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 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.
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.
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