Background: Nebulized dexmedetomidine has been used for procedural sedation and allaying separation anxiety in children. Literature regarding its use in the attenuation of laryngoscopy and intubation response via the nebulized route is scarce. We evaluated preoperative dexmedetomidine nebulization on the hemodynamic response arising from laryngoscopy/intubation, hemodynamics, analgesic consumption, and postoperative sore throat. Objectives: The primary objective was to evaluate/compare the hemodynamic effects of preoperative intravenous and nebulized dexmedetomidine on laryngoscopy/intubation and compare the efficacy of the two routes in blunting the sympathoadrenal response. The secondary objective was to evaluate their effects on intraoperative analgesic consumption and incidence and sore throat postoperatively. Methods: 120 ASA I & II adult patients undergoing elective surgeries requiring tracheal intubation were randomized to receive intravenous dexmedetomidine (1 µg/kg over 10 minutes) and nebulized dexmedetomidine (1 µg/kg in 3 - 4 mL of 0.9% saline), 30 min before anesthesia induction. Heart rate and non-invasive blood pressure were monitored for 10 min following laryngoscopy and then throughout the surgery. Intraoperative analgesic consumption, postoperative sore throat, and recovery from anesthesia were assessed. Results: No significant hemodynamic difference was found between the two groups till three minutes. Then, the difference turned significant owing to a greater fall in the heart rate and mean arterial pressure in the intravenous group. Nebulized dexmedetomidine exhibited a lesser tendency of hypo/hypertension and brady/tachycardia, while hemodynamics was more stable. There was lesser sore throat and sedation in the nebulized group. Intraoperative analgesic and propofol consumption was comparable between the two groups. Conclusions: Nebulized dexmedetomidine attenuated laryngoscopy and intubation response, although to a lesser extent than the intravenous group in equivalent doses. However, the nebulized route provided greater hemodynamic stability in the intraoperative period and lesser sedation/sore throat postoperatively without an increase in adverse effects. Nebulized dexmedetomidine may provide a more holistic and viable alternative in patients who poorly tolerate hypotension, bradycardia, and sedation.
Background: The relationship between hyperuricemia and diabetes mellitus is proved to be associated with the risk of cardiovascular diseases, but it is unclear whether hyperuricemia is actually related to diabetes.Methods: A 50 patients with newly diagnosed diabetes according to ADA guidelines were selected. Uric acid level and HbA1C levels were measured. Results were calculated with the reference range of uric acid >7.0 mg/dl.Results: The mean serum uric acid level was higher in 72% of the newly diagnosed diabetic patients (36/50).Conclusions: Hyperuricemia seems to be associated with newly diagnosed diabetics. It can be used as a biomarker of deterioration of glucose metabolism.
Background: Dexmedetomidine has increasingly been used in regional anesthesia as an adjuvant, but there is still no consensus on the optimum dose when it is used intrathecally. We conducted this study to elucidate the dose-response relation between three different doses of intrathecal dexmedetomidine (2.5, 5, or 10 µg) as an adjuvant to 0.5% hyperbaric bupivacaine in patients undergoing elective lower abdominal and lower limb surgeries. Methodology: 90 patients, aged 18-60 y, were randomized into three groups of 30 patients each. Group A received 0.5% hyperbaric bupivacaine 12.5 mg (2.5 ml) with 2.5 µg dexmedetomidine, Group B received 5 µg dexmedetomidine with bupivacaine, and Group C received 10 µg dexmedetomidine with bupivacaine. Duration of the spinal sensory blockade (primary outcome), onset of the blockade, time to rescue analgesia, level of sedation, duration of motor blockade, comparison of hemodynamic variables and complications, if any were assessed. Results: There was a significant dose dependent prolongation of sensory block; Group A - 250.67 ± 51.39, Group B - 286 ± 52.76, and Group C - 351.00 ± 47.00 min; (p < 0.001), motor block; Group A - 255.53 ± 44.25, Group B - 312 ± 29.64, and Group C - 361.4 ± 16.14 min (p < 0.001). Time to two segment regression was 132.33 ± 48.29, 148.77 ± 48.89, 171.57 ± 25.46 min (p = 0.002) and time for rescue analgesia was 351.33 ± 101.19, 472.00 ± 24.41, 738.00 ± 67.79 min (p < 0.001). VAS was significantly low in Group C (p < 0.05). Intergroup hemodynamic parameters were comparable (p > 0.05) without any appreciable side effects. Conclusion: Spinal dexmedetomidine increases the sensory and motor block durations as well as time to first analgesic use, and decreases analgesic consumption in a dose-dependent manner, when used with hyperbaric bupivacaine. Abbreviations: IT - Intrathecal; ITD - Intrathecal Dexmedetomidine; SAB - Subarachnoid Block; VAS - Visual Analogue Scale; BMI - Body Mass Index; NIBP - Non-Invasive Blood Pressure; RSS - Ramsay Sedation Score; TSSR - Two segment sensory regression; ANOVA - Analysis of Variance; OSB - Onset of sensory block, TSSRT - Two segment sensory regression time; Duration of sensory blockade; OMB - Onset of motor block; DMB - Duration of motor blockade Key words: Dexmedetomidine; Bupivacaine; Anesthesia, Spinal; Dexmedetomidine; Post-operative analgesia Citation: Mowar A, Singh V, Pahade A, Karki G. Effect of three different doses of intrathecal dexmedetomidine on subarachnoid block: a prospective randomized double-blind trial. Anaesth. pain intensive care 2021;26(1):8–13; DOI: 10.35975/apic.v26i1.1759 Received: July 24, 2021, Reviewed: November 18, 2021, Accepted: November 28, 2021
An endotracheal tube is an integral part of general anaesthesia especially in long duration head and neck surgeries. Often, in such surgeries, the airway is shared by the surgeon and the anaesthetist. Any damage to the Endotracheal tube cuff may cause improper ventilation and airway contamination. We propose an algorithm through this case to prevent such complications and correct them if they happen.
Background: Perioperative pain management is a major challenge for anaesthesiologists. IV lidocaine and dexmedetomidine have been utilised for peri-operative pain management. Aims and Objectives: To analyse the effects of intraoperative intravenous lignocaine/dexmedetomidine on pain relief, opioid consumption, peri-operative hemodynamic and side-effect profiles/unique interactions in patients undergoing laparoscopic surgeries. Materials and Methods: Prospective, interventional, single-centric, double-blind, randomised, active-controlled, Helsinki protocol-compliant clinical study was conducted on 90 ASA I/II class patients aged 18-60 yrs. This Patients were block-randomised to Group-L (2% Lignocaine), Group-D (dexmedetomidine) and Group C (Control/Placebo/0.9% normal saline). Hemodynamic were noted at pre-defined time frames intra-/post-operatively. Post-operative VAS score and Richmond Agitation Sedation Score monitoring was done. Results: Demographic parameters of were comparable. Mean intra-operative fentanyl consumption amongst the three groups were 20.5 ± 20.05 mcg, 26.5 ± 17.57 mcg and 46.83 + 21.31 mcg (Group-L, Group-D, Group-C; P value Group-L vs Group-D:0.22, Group L/D vs Group C: <0.0001). Group-D exhibited the lower heart rates and MAP ( P < 0.05). Extubation- First rescue analgesic phase was comparable for the Group-C and Group-L (59.17 ± 46.224 min vs 61.64 ± 53.819 min) and significantly greater in Group-D (136.07 + 55.350 min; P < 0.0001). Conclusion: Both Dexmedetomidine and lignocaine can be useful intra-operative pain relief adjuncts. Dexmedetomidine delayed First rescue analgesic and total analgesic consumption more than lignocaine. Dexmedetomidine patients exhibited bradycardia intraoperatively more than the other groups. we recommend, Dexmedetomidine in the intra-operative phase and lignocaine in the post-operative phase can be an alternative in patients who are poor candidates for post-operative opioids/sedation/contraindicated regional anaesthesia regimes.
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