Introduction: Airway manipulation during endotracheal intubation is associated with hemodynamic and cardiovascular responses. Different agents have been used to obtund the pressure response. Objectives: To evaluate the place of Dexmedetomidine for routine use during induction of anesthesia to blunt pressure response to laryngoscopy and intubation. Methodology: One hundred patients of ASA I and II were randomly divided into two groups. Group A received Midazolam (0.05 mg/kg) a n d Fentanyl (2 mcg/Kg) and group B received Dexmedetomidine (0.6 mcg/kg) 10 minutes before induction of anesthesia. Both groups were induced with Propofol (1.5 mg/Kg). In all patients after induction (loss of eye lashes reflex) tracheal intubation was facilitated using Rocuronium 1mg/kg. Baseline heart rate was noted and hemodynamic response to intubation was observed 3, 6 and 9 minutes after intubation. Results: In group A, time for loss of eyelashes reflex was 17.45±2.19 seconds and in group B it was 11.33±2.64 seconds. In group A, after intubation heart rate increased by 11.22±2.37, 5.71±1.68, 2.34±1.73 in3, 6 and 9 minutes respectively. In group A, after intubation MAP increased by 6.49±1.37, 3.30±1.15, and 1.24±1.50 from baseline in 3,6, and 9 minutes respectively. In group B after intubation heart rate increased by 2.49±0.89 from baseline at third minutes, however decreased by 2.85±1.58 and 4.73±1.86 at sixth and ninth minute respectively. In group B, MAP increased from baseline by 3.44±1.06 in third minute however decreased by 2.22±1.38 and 4.24±3.40 at sixth and ninth minutes respectively. Conclusion: Both the agents were observed to obtund pressure response to laryngoscopy and intubation however Dexmedetomidine proved to be better option compared to Fentanyl.
Emergency medicine is an emerging specialty worldwide and is taking a leading role in caring for critically ill and undifferentiated patients. Nepal is one of the South Asian countries that have recently started an emergency medicine training program. Medical toxicology services are currently provided by emergency physicians and other doctors working in the emergency department (ED). However, the lack of trained specialists in medical toxicology means acutely poisoned patients may not receive the same level of care offered in developed nations. Demand for healthcare and patient expectations are high in the poisoned patients and families in Nepal. Currently, there are no formal training programs or educational opportunities in medical toxicology in Nepal.Poisoning is a frequent method of deliberate self-harm in Nepal, of which organophosphate poisoning is the most common [1]. The 10-20 % case fatality rate found with selfpoisoning in the developing world differs markedly from the 0.5 % found in the west [2]. The lack of knowledge and experience has contributed significantly to mortality in young poisoned patients in Pakistan [3]. A study done in Pakistan showed that a short period of clinical training in medical toxicology improved emergency physicians' knowledge about the management of poisoned patients [4]. Education is essential to improving care in these regions. For example, first aid training has had a huge impact on changing the knowledge and practice of the medical staff in the management of snake bite and has decreased mortality [5].New emergency physicians and doctors working in EDs need to receive continual education in medical toxicology to improve patient care. This could be made possible through either online distance courses or onsite teaching. Online teaching by GETUP (Global Educational Toxicology Uniting Project) is one of the solutions for the resource poor setting [6]. GETUP is an initiative supported by the American College of Medical Toxicology to facilitate education in medical toxicology using the Internet to connect healthcare providers in developed and developing countries. Potential barriers to this include electricity shortages, poor Internet connectivity, and lack of familiarity with the computer conferencing software.The creation of a medical toxicology center and development of a curriculum relevant to the local setting would be a long-term solution; however, this will likely require ongoing on-site expertise and hospital resources. GETUP may be instrumental in providing this expertise and knowledge to a resource poor setting like Nepal, and may help to train current healthcare providers caring for poisoned patients. In the future, this model may be able to be applied to other medical specialties.
Introduction: Different pharmacological approach for preemptive analgesia have been tried with varying degree of success. Preemptive analgesia results in decrease in postoperative opioid requirement and hence decreases opioid related complication. Objectives: This study aims to evaluate pregabalin as preemptive analgesic in scheduled cases. Methodology: Fourty ASA I and II patients posted for elective laparoscopic cholecystectomy under general anesthesia were divided into two groups of twenty. Group A received pregabalin 300 mg, two hours before induction of anesthesia but group B were not given any medication. Postoperative VAS Score, Ramsay Sedation Score, postoperative nausea and vomiting and postoperative opioid requirement in two groups were observed over 48 hours and noted.Results: The mean VAS scores were higher in control group whereas the mean Ramsay score was higher in group pregabalin in the first six hours in the post operative period which was statistically significant. The mean Ramsay sedation score was same (2) in both the group after twelve post operative period. Postoperative nausea and vomiting was lower in the pregabalin group. Requirement of post operative analgesia was higher in the control group. Conclusion: Preemptive use of Pregabalindecreasespostoperateive pain, postoperative opioid requirement and increases postoperative sedation.
Introduction: To study about the efficacy of Peritonsillar infiltration of Ropivacaine and pain control in immediate postoperative period following tonsillectomy surgery in adult patients. Methods: 80 patients were included in the study of age 18 to 50 years. After informed consent, patients were divided into two groups. In Group R 0.5%Ropivacaine with 1:100000 Adrenaline and in Group C 0.9%normal saline with 1:100000 Adrenaline was injected into the tonsillar fossa following tonsillectomy. Surgery duration, blood loss, time to demand for 1st analgesia, analgesic consumption in 24 hours, and VAS score in 1hr, 2hr, 4hr, 6hr, 12hr, 24hr were noted. Results: We observed significant pain control during first 4 post-operative hours with Value of <0.01, <0.01 and 0.019 respectively in first, second and fourth post-operative score. We also observed significant difference in the time for first analgesia request in two groups with the study group requesting for first analgesic at 518±175 postoperative minutes and control group at 132±47.95 postoperative minutes (P value <0.01). Total analgesia requirement was 61±22.48 in the study group and 102±27.84 in control group (P value < 0.01). Conclusions: It is concluded that intraoperative Peritonsillar infiltration of Ropivacaine causes analgesia in the immediate postoperative hours with the decrease in the requirement of analgesia in the first 24 postoperative hours. It is therefore recommended to use it in adult patient undergoing Tonsillectomy.
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