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BACKGROUND: Several clinical studies have reported that significant number of patients receiving non depolarizing muscle relaxants during general anesthesia show postoperative residual neuromuscular block when assessed by neuromuscular monitor in the recovery room. The degree of residual neuromuscular block produced by non-depolarizing muscle relaxants can be evaluated by clinical tests as well as by neuromuscular monitoring y neuromuscular monitor in the recovery room. A randomized double blind clinical trial to determine and compare the incidence of postoperative residual neuromuscular block in patients receiving pancuronium and atracurium applying Train of Four ratio using Train of Four-Guard neuromuscular monitor. AIMS AND OBJECTIVES: To compare the incidence of postoperative residual neuromuscular block following pancuronium and atracurium using Train of Four Ratio in the recovery room. MATERIALS AND METHODS: Comparative randomized study done using 100 patients of age between 15-60 years belonging to either sex, ASA grade 1 and 2 with GROUP 'P'-Pancuronium was employed as the muscle relaxant, GROUP 'A'-Atracurium was employed as the muscle relaxant. Statistical analysis done using student "t" test. RESULTS: The mean duration required to attain Train of Four Ratio of 0.80 in patients with initial Train of four ratio <0.80 in group 'P' was 9.65±5.4413 min and in group 'A' was 2.8± 1.4832 min. CONCLUSION: 1. Our study concludes that the incidence of residual neuromuscular block in patients receiving pancuronium and atracurium were 40% and 10% respectively. Thus residual neuromuscular block can be a significant problem in recovery room, during the postoperative period. 2. The use of intermediate acting non depolarizing muscle relaxant like atracurium lowers the incidence of residual neuromuscular block but does not eliminate it.

BACKGROUNDLaryngoscopy and tracheal intubation in adults cause stress response manifested by a rise in heart rate and blood pressure. Intravenous Esmolol has been used to suppress this stress response. A highly selective α2 adrenoreceptor agonist, Dexmedetomidine is being increasingly used to attenuate this response. In this clinical comparative study, we compared these two drugs in attenuating the stress response to laryngoscopy and intubation. MATERIALS AND METHODS100 patients belonging to ASA1 and ASA2 posted for surgeries under general anaesthesia were randomly divided into 2 groups of 50 each. Both the groups were pre-medicated with Inj. Glycopyrrolate 0.005 mg/kg and Inj. Fentanyl 1.5 μg/kg was given. Group D received 0.5 μg/kg Dexmedetomidine IV in 100 mL 0.9% normal saline for 15 minutes prior to induction and Group E received 1 mg/kg bolus dose of Esmolol 90 seconds prior to intubation. Both groups were induced with 2.5% Thiopentone 5 mg/kg and Inj. Vecuronium 0.1 mg/kg. Laryngoscopy was done and intubation accomplished within 20 seconds. Heart rate, blood pressure, mean arterial pressure were recorded before induction (baseline) and at every minute for the first 5 minutes and at 10, 15, 30 and 45 mins. after intubation. Sedation scoring as per modified Ramsay sedation scale was noted after extubation in both the groups. Statistical analysis was done using Chi-square (χ2) test of significance and Student "t" test and P value obtained. RESULTSBoth groups showed attenuation of stress response. Esmolol and Dexmedetomidine affected heart rate to same extent upto 5 minutes (p > 0.05). Unlike Esmolol group, heart rate remained lower in Dexmedetomidine group even after 10 minutes. In Dexmedetomidine group there was increase in SBP, DBP and MBP upto 3 minutes, after that it was maintained below the baseline. In Esmolol group there was no rise in systolic and diastolic blood pressure, mean arterial blood pressure and rate pressure product compared to the baseline from the 1st minute of intubation which is statistically significant (p < 0.0001). Post extubation Dexmedetomidine group patients were more sedated than those in Esmolol group. CONCLUSIONBoth Esmolol and Dexmedetomidine attenuate the stress response to laryngoscopy and intubation. When both these drugs were compared, Esmolol attenuated the stress response to laryngoscopy and intubation better than Dexmedetomidine and afforded a good haemodynamic stability. Post extubation Dexmedetomidine group patients were more sedated than those in Esmolol group. KEYWORDSAnaesthesia, Haemodynamic, Esmolol, Dexmedetomidine, Laryngoscopy, Intubation. HOW TO CITE THIS ARTICLE:Reddy MM, Nagaraja AS. Attenuation of haemodynamic responses to laryngoscopy and intubationa comparative study between IV esmolol and IV dexmedetomidine. J. Evolution Med. Dent. Sci. 2016;5(85):6313-6317, DOI: 10.14260/jemds/2016/1426 BACKGROUND Laryngoscopy and endotracheal intubation are associated with physical trauma to the oral cavity and elicit physiological response in the form of sy...

BACKGROUND: The maintenance of intraocular pressure forms the mainstay of anesthetic management of intraocular surgery. It is desirable to achieve a normal or reduced intraocular pressure before the eye is opened to avoid expulsive hemorrhage and ocular disruption at the time of incision. Therefore the ideal anesthetic technique for intraocular surgery should produce a moderate reduction in intraocular pressure, or maintain intraocular pressure at near normal values and avoid marked fluctuations during surgery (George et al, 1979). The use of suxamethonium is associated with significant rise in intraocular pressure with a peak increase between 2 and 4 minutes following administration and return to base line value after 6 minutes. The outcome of eye surgery, particularly when there is globe injury depends to a large extent on good control of intraocular pressure not only during maintenance, but also at induction of anesthesia. This is usually achieved by use of non-depolarizing muscle relaxant. Pancuronium when used in relatively larger doses is known to have a faster onset of action and also the block may be prolonged. Vecuronium is intermediate acting and free of cardiovascular and other side effects even when used in larger doses. AIMS AND OBJECTIVES: To study the effect of vecuronium bromide an intermediate acting nondepolarising muscle relaxant on intraocular pressure compared with pancuronium bromide, a long acting nondepolarising muscle relaxant. MATERIALS AND METHODS: Study Design: Comparative randomized study. Sample Size: 60 adult patients between 16-60 years subjected for elective nonophthalmological surgical procedure. Sampling Method: Randomized double blind study. Study groups: Group I: 30 patients received pancuronium bromide 0.08 mg/Kg of body weight. Group II: 30 patients received vecuronium bromide 0.1 mg/Kg of body weight. RESULTS: The total number of patients studied is 60. 30 patients in Group I and 30 patients in Group II. I.O.P Changes: Fall of intraocular pressure in all 30 patients is seen in Group 2. Pulse rate changes: The mean resting pulse rate was 81±6.7 in Group I and 81±6 in Group II. After administration of pancuronium pulse rate was 22.22% more than resting value but after administration of vecuronium there was no change in pulse rate. The pulse rate gradually came down but remained 8.64% more than resting value 10 minutes following intubation in Group I when as it remained 2.47% more than the resting value in Group II. Systolic Blood Pressure Changes: In Group I the mean systolic blood pressure fell by 1.66% and in group II by 1.65% below the resting value. Diastolic Blood Pressure Changes: In Group I on induction with thiopentone, the mean diastolic blood pressure fell by 1.23% below the resting value and in group II by 1.65% below the resting value. CONCLUSION: Hence it is further concluded that pancuronium bromide is the relaxant of choice in patients for ocular surgery where there is need for prolonged anesthesia or when hypotension is undesirable and vecuronium bromide is go...