Aim:To evaluate the effect of intravenous (IV) clonidine premedication for the bloodless surgical field in patients undergoing middle ear or nasal surgery comparing three different doses.Subjects and Methods:This prospective randomized, clinical trial was performed on 90 normotensive patients belonging to American Society of Anesthesiologists grade I/II, aged 18–60 years, of either sex, undergoing routine middle ear or nasal surgery. These patients were divided into three Groups A, B, and C with 30 patients in each according to the dose of IV clonidine used as premedicant that is 3, 4, and 5 µg/kg, respectively. The hypotensive period commenced 10 min after the start of surgery till the surgeon's request for no hypotension required any longer. The target mean blood pressure for producing bloodless surgical field was 60–70 mmHg. During the hypotensive period, the surgeons were asked to rate the bleeding severity score on a six-point scale from 0 (no bleeding) to 5 (severe bleeding).Statistical Analysis Used:ANOVA, Chi-square test, Z-test, standard deviation and P value.Results:IV clonidine premedication in a dose of 4 and 5 µg/kg reduces bleeding and provides a clear field for surgery. It also reduces the requirement of isoflurane, fentanyl, and metoprolol for controlled hypotension. However, clonidine 5 µg/kg was not more effective than clonidine 4 µg/kg in producing these effects rather was associated with some side effects.Conclusion:IV clonidine premedication in a dose of 4 µg/kg is safe and effective for producing a bloodless surgical field in the middle ear and nasal surgery.
Epidural anesthesia is a safe and inexpensive technique with the advantage of providing surgical anesthesia and prolonged postoperative pain relief. To address the problems of limited duration of action and to improve the quality of analgesia intra-operatively and postoperatively, various adjuvants have been added to bupivacaine. The present study is designed to evaluate the effect of magnesium sulphate vs clonidine as an adjunct to 0.5% Bupivacaine in epidural anesthesia for patients undergoing lower limb surgeries in terms of onset, duration and degree of sensory and motor block, sedation and pain. 90 patients of age group 18-60 years of ASA grade I & II of either sex undergoing lower limb surgeries were included in this prospective study who were randomly allocated into three groups. Group A received bupivacaine 0.5%(19ml) +normal saline 0.9% (1.0ml), Group B received bupivacaine 0.5%(19ml)+magnesium sulphate 50mg dissolved in 0.9% normal saline (1.0ml) and Group C received bupivacaine 0.5%(19ml) +clonidine 150µgm(1.0ml). Assessments of sensory block were performed at 5, 10, 15, 20, 25, 30 min and then every 10 min until the return of normal sensation.). Assessment of motor block were performed immediately after the assessment of sensory block until the return of normal motor function. The onset and end of all degrees of motor blocks were assessed bilaterally according to the Modified Bromage scale. Duration of analgesia, patient's satisfaction, duration of motor block and adverse effects were assessed and recorded. We concluded that co-administration of epidural magnesium sulphate 50MG with bupivacaine 0.5% produces predictable rapid onset of surgical anesthesia without any side-effects, and addition of clonidine 150µgmto epidural bupivacaine 0.5% produces prolonged duration of anesthesia with sedation. The results of our study suggest that magnesium may be a useful alternative as an adjuvant to epidural bupivacaine as clonidine.
Background: Aim: To compare the effectiveness of the diclofenac and paracetamol infusion for post operative pain relief in Hysterectomy patient under subarachnoid block in 24 hours. Subjects and Methods: This prospective randomized, clinical study was performed on 100 female patients belonging to American Society of Anesthesiologists grade I/II, aged 40-60 years of age undergoing hysterectomy under Subarachnoid block. These patients were divided in to two Groups A and B with 50 patients in each according to drug given for postoperative analgesia that is diclofenac 75mg and paracetamol 1000mg respectively. Pain was assessed by VAS at the completion of infusion for effective analgesia (VAS<3). If patient did not achieve effective analgesia than rescue analgesia was provided with fentanly 20 mcg. Results: IV diclofenac 75 mg 12 hourly and paracetamol 1000 mg 6 hourly provides effective post operative pain relief. Paracetamol regimen shows better effect than diclofenac in 24 hours post operative period. Rescue analgesia with fentanyl 20mcg provides quick and effective pain relief in moderate to severe breakthrough pain in post hysterectomy patients. Conclusion: IV Paracetamol is superior in terms of effectiveness of pain relief and rescue analgesia required. Common side effect comprising of nausea, vomiting, pruritis were observed in few no of cases. No patients required special treatment. No serious side effect like hypotension, respiratory depression, bleeding, allergic reactions were observed.
Objective(s): To compare the intubating conditions, onset and duration of action, side effects and complications with rocuronium bromide and atracurium besylate. Material and Method: This prospective, randomized double blind study was conducted with a sample size of 100 patients. After standard general anaesthesia technique group I received IV. rocuronium bromide 0.6 mg/kg and group II received iv. atracurium besylate 0.5 mg/kg. Laryngoscopy was attempted60 sec after administration of NMBA and thereafter every 30 sec till good or excellent intubating conditions were achieved. Intubating condition was scored on fourpoint scale (0-3). Intubating conditions, onset and duration, side effects and complications were observed and recorded. Result: Overall intubating condition was acceptable (excellent + good) in 50(100%) patients in group I and 47(94%) patients in group II. It was excellent in 45(90%) and 16(32%) patients in group I and II respectively. Good intubating condition was found in 5(10%) and 31(62%) patients in group I and II respectively. Fair intubating condition was found in 3(6%) patients in group II. None of the patients had poor intubating condition in either group. Cutaneous flushing was found in 4% cases in group II. No other side effects and complications were observed. Conclusion: Rocuronium with its faster initial response and possibly early laryngeal muscle paralysis provides better intubating conditions in shorter duration of time than atracurium.
Nasotracheal intubation is a skill greatly appreciated by anaesthetists and surgeons in head and neck specialities. The introduction of fibreoptic intubation has revolutionized the anaesthetic management of difficult airway and its increasing use in clinical anaesthesia has drawn attention to the circulatory responses during fibreoptic intubation. The aim of this study was to compare changes in Heart rate, Systolic and Diastolic blood pressures, SpO2 and EtCO2 levels, associated complications and time required to achieve successful nasotracheal intubation with fibreoptic and laryngoscopic technique. 100 patients of ASA grade I & II between 18-50 yrs of age undergoing elective surgeries requiring nasotracheal intubation were allocated into two groups. Group I was intubated in the conventional manner using a Macintosh laryngoscope and Group II was intubated using a fibreoptic bronchoscope. Vital parameters like heart rate, blood pressure (Systolic and diastolic), ECG, oxygen saturation, EtCO2 and N2O/Isoflurane% with O2 were continuously monitored and recorded preoperatively, immediately after induction, at intubation and every 1min for further 5 min. Intubation time was also recorded. Incidence of epistaxis and post-operative sore throat were noted. Nasotracheal intubation was accompanied by significant increases in blood pressure and heart rate compared to post induction values in both groups but there was no significant difference between the two groups. SpO2 and EtCO2 were maintained within normal range during both of intubation procedures, although the time required for intubation was longer in fibreoptic bronchoscope group. There was no significant difference in the incidence of epistaxis between the two groups. It was concluded that stress response to fibreoptic nasotracheal intubation in similar to nasotracheal intubation facilitated by Macintosh laryngoscope.
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