Background:Awake fiberoptic intubation (AFOI) is a recommended technique for anticipated difficult airway. An ideal regime should provide patient comfort, cooperation, amnesia, hemodynamic stability, and blunt airway reflexes and maintain a patent airway with spontaneous ventilation. The aim of our study was to compare intubation conditions between dexmedetomidine and fentanyl–midazolam combination during AFOI.Methods:This prospective, randomized study was conducted on a total of sixty patients of the American Society of Anesthesiologists physical status I and II of either sex, in the age group of 18–60 years having predicted difficult intubation undergoing elective surgeries and the patients were allocated to two groups of thirty patients each. After premedication and topicalization of airways, dexmedetomidine group (Group I, n = 30) received dexmedetomidine 1 μg/kg over 10 min and midazolam–fentanyl group (Group II, n = 30) received fentanyl 2 μg/kg plus midazolam 0.02 mg/kg over 10 min. Adequacy of intubation condition was evaluated by cough score and postintubation score. Incidence of desaturation, hemodynamic changes, and sedation using Ramsay sedation scale were noted and compared between two groups.Results:The demographic characteristics were comparable in the two groups (P > 0.05). The mean Ramsay sedation score in Group I was 3.13 ± 0.937 and Group II was 3.16 ± 0.949, and the comparison between two groups was statistically insignificant (P = 0.891). Cough scores and postintubation scores were favorable in dexmedetomidine group than midazolam–fentanyl group and were statistically significant with P < 0.001 and 0.0001, respectively. Group I also showed better hemodynamics and less episodes of desaturation than Group II.Conclusions:Dexmedetomidine is more effective than midazolam–fentanyl during AFOI, as it provides better intubation condition, hemodynamic stability, and preservation of airway and spontaneous ventilation.
Background: Endotracheal intubation is associated with postoperative sore throat. The aim was to evaluate the efficacy of intravenous magnesium sulphate versus dexamethasone for prevention of postoperative sore throat in patients undergoing lumbar surgery in prone position.Methods: 150 patients of ASA physical status I and II in the age group of 18 to 70 years were divided into three groups of 50 each. group I (magnesium sulphate) received intravenous magnesium sulphate 30 mg. kg-1 in a total of 50 ml of normal saline for 10 minutes after intubation, group II (dexamethasone group) received intravenous dexamethasone 8 mg in 50 mL normal saline for 10 minutes after intubation and group III (placebo group) received 50 ml of normal saline for 10 minutes after intubation. The incidence and severity of postoperative sore throat and hoarseness was assessed by an anesthesiologist unaware of the group allocation, on arrival in the post anesthesia care unit at 0 h, and at 1 h, 6 h, 12 h, and 24 h thereafter.Results: Both incidence and severity of sore throat and incidence of hoarseness was more in placebo group than magnesium sulphate group and dexamethasone group and was statistically significant (p<0.05) and was comparable between magnesium sulphate and dexamethasone groups.Conclusions: Endotracheal intubation is associated with sore throat and hoarseness of voice. Magnesium sulphate and dexamethasone given intravenously reduce the incidence and severity of sore throat and hoarseness associated with endotracheal intubation.
Background: Propofol is a popular induction agent, especially for short cases, day care surgeries and when a laryngeal mask is to be used. It produces a good quality of anaesthesia and rapid recovery. Pain on injection of propofol has been reported and is an important limitation of its use. A multitude of interventions: pharmacological as well as non-pharmacological, have been tried for the attenuation of pain caused due to propofol injection. In our study, we evaluated and compared the efficacy of lidocaine, ramosetron and tramadol in attenuating pain on propofol injection. Methods: A total of 180 patients belonging to American Society of Anesthesiologists (ASA) grade I and II, of either sex, aged between 21 to 50 years undergoing elective surgery under general anaesthesia, were taken up for the study and were divided into group A, B and C. Group A received 2ml of 2% (40mg) lidocaine, Group B received 2ml of ramosetron (0.3mg) and Group C received 1mg/kg of tramadol in 0.9% normal saline to make a total solution of 2ml. Venous occlusion was done by compressing forearm with tourniquet to increase the local concentration of drug after establishing an intravenous access. The study drug was injected over 10 seconds and then occlusion was removed after 60 seconds, followed by giving 25% of the total calculated dose (2.5mg/kg) of propofol (1% w/v in lipid base) injected over 20 seconds. This was followed by asking the patient about the severity of pain felt. The intensity of pain was graded using verbal rating scale (McCrirrick and Hunter) and was assessed at 0, 5, 10, 15 and 20 seconds, as after 20 seconds, the patient would be under the influence of propofol. Results: Lidocaine showed the best efficacy in attenuating propofol injection pain amongst the 3 groups recorded at 5 (95%), 10 (91.7%) and 15 seconds (98.3%). In addition to reducing the incidence of pain, it also reduced its severity, with majority of patients experiencing only mild pain. Ramosetron ranked 2 nd in the overall reduction of propofol pain, with lowest incidence of propofol pain amongst 3 groups, recorded at 0 (98.3%) and 20 seconds (95%) of propofol injection. However, ramosetron failed in reducing severity of pain, with a significant number of patients experiencing moderate and severe pain. Tramadol ranked 3 rd in the overall attenuation of propofol pain and showed lowest incidence of pain at 0 seconds (93%) of propofol injection. Conclusions: All the three study drugs viz lidocaine, ramosetron and tramadol cause a significant decrease in propofol injection pain with lidocaine as the most efficacious drug amongst the 3 drugs followed by ramosetron and tramadol. Lidocaine has an added advantage of decreasing incidence and severity of pain associated with propofol and ramosetron prevents postoperative nausea and vomiting.
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