Pregnancy with underlying heart disease is a unique challenge both to the obstetrician and the anesthesiologist. Asymptomatic women with mild to moderate single lesions can successfully carry a pregnancy to term and undergo vaginal delivery. However, pregnancy can result in rapid clinical deterioration, which may lead to maternal and/or foetal mortality in symptomatic patients with complex heart diseases, like Shone's syndrome. A thorough understanding of the impact of pregnancy on the haemodynamic response to the patient's cardiac lesion is required for the management of labour and delivery. A meticulous approach is needed when planning anaesthesia for Caesarean section in such a case as the associated haemodynamic effects of both regional and general anaesthesia can have a serious deleterious effect on both the mother and infant. We report on the successful management of a parturient known to have Shone's syndrome undergoing Caesarean section under graded epidural anaesthesia.
Objective: Intravenous regional anesthesia (IVRA) is an effective anesthetic technique for surgical procedures of short duration involving the distal parts of the limbs. Intraoperative tourniquet pain is the major restraint of this technique, and to overcome this limitation, various adjuvants to local anesthetics have been used. This study investigated the effect of a fixed low dose of dexmedetomidine as an adjuvant to lignocaine on intraoperative tourniquet pain, onset of block, duration of block, and patient satisfaction. Methods: A total of 100 adult patients with ASA grade I and II who were scheduled for upper limb surgery of approximately 1 hour in duration were randomly divided into two groups (n=50 in each group). Group A received 35 mL of preservative-free lignocaine alone and Group B received 35 mL of preservative-free lignocaine along with 30 μg of dexmedetomidine. The incidence of tourniquet pain, intraoperative fentanyl consumption, duration of onset and recovery of sensory and motor block after tourniquet deflation, postoperative numeric pain rating scale (NPRS) scores, duration of analgesia, and overall patient satisfaction were noted. Result: The incidence of tourniquet pain and intraoperative fentanyl consumption were significantly lower in Group B. The onset and duration of sensory and motor blocks were faster and longer, respectively, in Group B. Postoperative NPRS scores were lower, duration of analgesia was longer, and overall patient satisfaction was better in the dexmedetomidine group. Conclusion: Dexmedetomidine at a dose of 30 μg as a lignocaine adjuvant significantly reduces tourniquet pain and intraoperative fentanyl consumption in IVRA. Dexmedetomidine shortens the onset of block, prolongs the duration of block, and provides a more satisfactory anesthesia than lignocaine alone.
This study aims to compare the efficacy of intranasal midazolam and ketamine as premedication before anaesthesia in paediatric patients. Materials and Methods: Sixty pediatric patients scheduled for surgery between the age group of 2-8 years and belonging to the American Society of Anesthesiologists (ASA) grade I and II were selected for the study. Group A received midazolam (0.2 mg/kg) and Group B received ketamine (5 mg/kg), intranasally 30 minutes before surgery with monitored anesthesia care. Sedation score, parenteral separation reaction, intravenous cannula acceptance, mask acceptance, and hemodynamic parameters were measured. Results: Patients of both the groups were calm and tranquil, but sedation scores were higher in the ketamine group (3.37±0.67) in comparison to midazolam group (2.60±0.67) at 30 minutes. Parenteral separation was easier in ketamine group compared to midazolam group with a significantly higher separation reaction scores (p<0.05). Venous cannulation and face mask acceptance was also better in the ketamine group with a significantly higher percentage of patients with satisfactory venous cannulation and face mask acceptance (p<0.05). Non-invasive blood pressure, oxygen saturation, and respiratory rate were maintained in both the groups throughout the study period, however tachycardia was observed in the ketamine group. Conclusion: Administration of the drug through the nasal route is an effective way for paediatric premedication. Both midazolam and ketamine gave a good level of sedation, however, level of sedation, venipuncture acceptance, and face mask acceptance were significantly better in the ketamine group. No adverse effects of the premedication drugs were observed in any of the groups.
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