Introduction:There is increasing evidence to include sedation as an integral part of regional anesthesia to ensure patient comfort. This may compromise patient cooperation, an important component of regional anesthesia. We decided to determine the efficacy of dexmedetomidine (0.3 μg/kg/h and 0.5 μg/kg/h) for allaying procedural discomfort and ensuring their cooperation in patients undergoing surgery with subarachnoid block.Setting:Tertiary care center.Materials and Methods:Sixty patients with the American Society of Anesthesiologists physical status Class I and II posted for surgeries under subarachnoid block were randomized into two groups of 30 each to receive dexmedetomidine in a loading dose of 1 μg/kg in both groups followed by continuous infusion of 0.3 μg/kg/h in Group D 0.3 and 0.5 μg/kg/h in Group D 0.5. Observer assessment sedation score, ease of positioning score, response to spinal needle insertion, hemodynamic parameters, patient satisfaction (PS) score, and surgeon satisfaction (SS) score were evaluated.Results:Median observer Assessment Sedation Score ranged between four and three at all times during dexmedetomidine infusion in Group D 0.3. In Group D 0.5, median Observer assessment of alertness/sedation scale ranged between three and two. Ease of positioning (P = 1.000) and response to spinal needle insertion (P = 0.521) were comparable in both groups. PS was higher in Group D 0.5 as compared to Group D 0.3. SS score was comparable in both the groups.Conclusion:Intravenous dexmedetomidine infusion 0.3 μg/kg/h produces effective sedation in patients undergoing surgery with spinal anesthesia while ensuring patient cooperation for positioning and without any recall of the procedure in postoperative period.
Background: Procedural discomfort is experienced by patients during the establishment of subarachnoid block even after good preoperative counseling and adequate premedication. The fear of needle prick, back pain during and after subarachnoid injection are becoming the leading causes for patient refusal to spinal anaesthesia. To enhance comfort and to overcome the denial, procedural sedation that would provide good analgesia, faster recovery and amnesia is inevitable. Materials and methods: Patients with ASA status I and II posted for elective surgeries under subarachnoid block were premedicated with midazolam 0.05mg/kg and pre-loaded with 10 ml/kg ringer lactate solution. They were randomized into 2 groups of 30 each. Group D received dexmedetomidine 1mcg/kg bolus over 10 min, group K received ketamine 0.3mg/kg intravenously. University of Michigan sedation score, ease of positioning, prick response, verbal response, hallucinations, recall of procedure and patient satisfaction were evaluated. Results: Both the drugs produced adequate sedation for performing subarachnoid block, UMSS score response to needle prick was comparable between them. Significant difference was observed during positioning the patient for subarachnoid block. Patients sedated with dexmedetomidine were able to position themselves without any help whereas patients sedated with ketamine required one or two persons help. In maintaining verbal response during the procedure both the drugs showed significant difference between them. In group D, most of the patients maintained the verbal response from immediately after bolus to throughout the study. Whereas in group K, no patient responded to verbal command after bolus up till 3min and majority of them (40%) regained verbal response only at 4min after bolus injection. There were no hallucinations and no recall of events in both groups. Except one patient in group D, all the patients were satisfied and willing to undergo subarachnoid block if need arises. Conclusion: We conclude that both ketamine and dexmedetomidine provided adequate sedoanalgesia for performing subarachnoid block. Dexmedetomidine was advantageous in terms of maintaining verbal response and ability to positioning themselves.
Background & Aim: The temperature of a local anaesthetic solution influences its pKa and molecular kinetic activity, thereby affecting baricity. We evaluated the effects of 0.5% Levobupivacaine preheated at 37ºC on sensory and motor block characteristics and haemodynamic in patients undergoing infra-umbilical surgeries. Methods: This was a prospective, randomised, double blinded study, in which 70 patients were allocated into two groups [Group A (n=35) and Group B (n=35)]. In Group A, patients were administered 3 mL of levobupivacaine 0.5% solution at room temperature (24 -28ºC) and patients in Group B were administered with 3 mL of levobupivacaine 0.5% solution at 37°C (Thermostatically controlled digitalized hot bath machine) into the subarachnoid space. Our primary objective was to determine the time of onset of sensory blockade at T10. Time of onset and duration of motor blockade, duration of analgesia, time to two segment regression and other adverse events after spinal anaesthesia were secondary objectives. Results:The time to reach a sensory block of T10 was significantly shorter in group B (Mean ±SD 2.7±2.9 min, P 0.005) compared to that in group A (Mean ±SD 4.8±4.5 min). The mean duration of sensory block was longer in group B (Mean ±SD 155.5±25.9 min, P 0.048). Time to onset of motor block, duration of motor block and time to regression of two dermatomal level were not found statistically significant among the two groups. Conclusion: Spinal anaesthesia with 0.5% levobupivacaine heated to 37ºC shortens sensory block onset time and provides longer block duration.
Skillful airway management is an essential prerequisite for orotracheal intubation both in emergencies and elective surgeries requiring general anesthesia. Both Miller and Macintosh blades are very commonly and widely used for intubations in all patient age groups, though the Macintosh blade is more commonly recommended in the adult population and the Miller blade in the pediatric population as evidenced in the existing literature. A better view of the glottis is obtained with the adult straight Miller blade as it has a narrow tip and hence gives a wider working space to negotiate an endotracheal tube that leads to an improved line of sight to the glottis. A review of the literature was conducted to summarize existing evidence of the adult Miller on ease of orotracheal intubation, glottic view, time taken for intubation, and hemodynamic changes, and there is very little literature comparing the Miller blade and Macintosh blade use in the adult population.
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