Introduction: Shivering is an unpleasant experience after spinal anesthesia. We conducted this study to evaluate the efficacy of ondansetron, ketamine and tramadol for prevention of shivering. Methods: In this prospective, randomized controlled study, 120 patients aged 18-65 years of American Society of Anesthesiologist (ASA) physical status I&II undergoing various surgical procedures were included and allocated alternately to one of the 4 groups; Normal saline (Group1), Ondansetron 4mg (Group2), Ketamine 0.25mg/kg (Group3) and Tramadol 0.5mg/kg (Group4). Incidence of shivering, effect on hemodynamics, nausea, vomiting, sedation and emergence reactions were recorded. Data was analyzed using SPSS (The Statistical Package for Social Sciences) version 20.0 software. Results: The patients were comparable in terms of demographic variables, baseline temperature, type of surgery, median level of sensory blockade, duration of surgery and anesthesia. Shivering was present in 17 (56.7%), 5 (16.7%), 3 (10%) and 3 (10%) patients respectively in Group 1, 2, 3 and 4 which was statistically significant when compared to Group 1 (P=0.00) The odds of NS and ondansetron, NS and ketamine, NS and tramadol was 6.53, 11.76 and 11.76 respectively which showed that study drugs were effective in preventing shivering. None of the patients were sedated in Group 1 and 2. Mild to moderate sedation was present in Group 3 and 4 (P=0.00). None of the patients had drug related adverse reactions. Conclusions: Prophylactic use of ondansetron, low doses of ketamine and tramadol is effective in preventing shivering post spinal anesthesia without untoward effects. Keywords: Anesthesia spinal; Ketamine; Ondansetron; Shivering; Tramadol.
Introduction:The clavicle has dual nerve supply from the brachial plexus and cervical plexus. The interscalene brachial plexus block combined with superior cervical plexus block is frequently used for the clavicle surgery. This study was conducted to compare ineterscalene approach with the supraclavicular approach for brachial plexus block used for clavicle surgery Methodology:This was prospective comparative study conducted for two years in tertiary care hospital. Sixty patients with clavicle fracture with ASA I and II were randomly divided into two equal groups; ISBPB (interscalene approach) and SCBPB (supraclavicular approach). Both of these blocks were combined with superior cervical plexus block. Ultrasound was used to perform all the blocks. Primary outcome for the comparison was block characteristics, which included sensory and motor block onset, duration, and block satisfaction. The secondary variables used for comparison were analgesic properties and complications. Results: Supraclavicular brachial plexus had rapid onset of sensory and motor block and was statistically significant (P<0.05) as compared to interscalene approach. Similarly, SCBPB had significantly longer duration of sensory block (P=0.003). The duration of motor block was comparable between the blocks. The intraoperative pain score (VAS), requirement of rescue analgesia with in 24 hours of surgery and complications related with the procedures were comparable between the two groups. Majority of the patients were satisfied with either of the approach for brachial plexus block. Conclusion: Supraclavicular brachial plexus block combined with superior cervical plexus block provided equally effective and adequate anesthesia and analgesia for clavicle surgery with comparable complications as compared to interscalene approach.
Introduction: The aim of the study was to carry out the comparative study of variations in blood glucose levels intra operatively in patients undergoing surgical procedures in Spinal Anesthesia and General Anesthesia by capillary blood glucose level.Objective: To compare intra operative blood glucose level in Spinal and General Anesthesia.Methodology: Sixty non diabetic patients (30 in each group) aged between 20 – 60 years belonging to ASA I and ASA II status were enrolled for this prospective comparative study. Capillary blood glucose was measured preoperatively and thereafter at 15 minutes interval after incision in Spinal Anesthesia and after induction of General Anesthesia till one hour of surgery. For statistical analysis paired sample t – test was used for comparing mean of quantitative data. Difference was considered statistically significant if p < 0.05.Results: Blood sugar level was well controlled in patients receiving spinal anesthesia. General anesthesia produced more increase in blood sugar level compared to base line value which was statistically significant (P<0.05). Similarly, Glycaemia was significantly higher in the General anesthesia group (p < 0.05) when compared with Spinal Anesthesia group suggesting poor control of stress response during general anesthesia.Conclusion: Based on capillary blood glucose level, spinal anesthesia proved more effective in suppressing stress response as compared to general anesthesia in elective surgical patients. BJHS 2018;3(2)6: 458-462
Introduction: Dexmedetomidine and midazolam are frequently used to maintain sedation in mechanically ventilated patient in intensive care unit. The study compared dexmedetomidine and midazolam infusion in mechanically ventilated patient in terms providing effective sedation. Methods: This was one year prospective comparative study conducted in 130 mechanically ventilated patients who were randomly divided in two groups receiving either dexmedetomidine or midazolam infusion for sedation. Sedation level was assessed by Riker Sedation-Agitation Scale with the aim of maintaining target sedation score of 3 to 4. The two drugs were compared in terms of sedation level in first 24 hours, time required to achieve target sedation level, hemodynamic changes and adverse effects including ICU delirium. The outcome was measured in terms of duration of mechanical ventilation, length of ICU stays and ICU mortality. Results: Both dexmedetomidine and midazolam achieved target sedation level in a comparable time duration. The median sedation level for both the drugs was 4 and 3 in initial 4 and 24 hours respectively. Dexmedetomidne produced significant decrease in blood pressure and heart rate (P=0.044 and P=0.007 respectively). Patients treated with dexmedetomidine had less incidence of ICU delirium (odds ratio=2.669, P=0.029).Dexmedetomidine infusion had significantly shorter duration mechanical ventilation (4.10 ± 2.05 vs. 5.15 ± 2.44, P=0.011), early discharge from ICU (6.05 ± 2.02 vs. 7.48 ± 2.42, p=0.001). ICU mortality was comparable between the groups. Conclusion: Dexmedetomidine and midazolam both were equally effective in maintaining sedation in Critically ill patient. Compared to midazolam, dexmedetomidine could be a preferred sedative in ICU in terms of early removal from mechanical ventilation, early discharge from ICU and less incidence of delirium.
Introduction: Electrolyte and hemoglobin measurement are the integral part of management of critically ill patient. There can be a wide variation in the electrolyte and hemoglobin measurement in critically ill patient between arterial blood gas analyzer and central laboratory auto analyzer. Objective: To compare the electrolytes (sodium, potassium and chloride) and hemoglobin level measured by arterial blood gas analyzer and laboratory analyzer. Methodology: This was a prospective cross-sectional comparative study comparing the electrolytes (sodium, potassium and chloride) and hemoglobin measurement between arterial blood gas analyzer and laboratory auto analyzer. The study included 124 paired blood samples from the patient admitted in intensive care unit of Birat Medical College Teaching Hospital in two months duration. The arterial sample and venous sample for electrolytes and hemoglobin measurement were taken simultaneously or not more than one hour apart and analysis was done by arterial blood gas analyzer and central laboratory auto analyzer accordingly. The values of electrolytes and hemoglobin measured by two different analyzers were finally compared for variation. Result: The mean difference calculated for sodium potassium and chloride in ABG machine and Auto-analyzers were 0.57 mmol/l.-0.04mmol/l and 1.71mmol/l respectively. These data were within the acceptable range of United States Clinical Laboratory Improvement Amendments(USCLIA). The mean difference derived for hemoglobin in ABG and Auto-analyzers was 0.16g/dl which was not consistent with the range of United States Clinical Laboratory Improvement Amendments (USCLIA) Conclusion: The measurement of electrolyte namely sodium, potassium and chloride in ABG machines and Auto-analyzers of central lab were comparable while hemoglobin was not comparable under the USCLIA guidelines.
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