Anxiety is common amongst patients awaiting general anaesthesia. Incidence of anxiety has been found variable in different studies. Overall rate of anxiety was observed in 72.7% (112/154) patients scheduled for elective caesarian section. 2 Around 23.4% patients were found to be anxious regarding GA and females showed a higher ABSTRACT Background: The main aims of pre-anaesthetic medication are anxiolysis, analgesia, anti-emesis and reducing perioperative patient risk. Producing a state of amnesia for pre and post-operative events is desired by all. This study has been undertaken to evaluate the role of three of the benzodiazepines i.e. diazepam, lorazepam and midazolam during general anaesthesia, in providing anxiolysis, sedation and amnesia. Methods: The study included patients with ASA grade I and ASA grade II physical status of both sexes, age ranging between 18-60 years. Patients were divided into three groups of thirty patients each, every group receiving intramuscular injections of diazepam 0.1 mg/kg body weight, lorazepam 0.07 mg/kg body weight and midazolam 0.08 mg/kg body weight respectively; 45 minutes prior to induction of general anaesthesia. Anxiety assessment before premedication along with assessment of sedation after premedication was done. Results: Before premedication the mean values of pulse rate, blood pressure and respiratory rate were not significantly different among the three groups (p>0.05). Maximum changes in these parameters were observed with Midazolam followed by lorazepam and diazepam. The dose of thiopentone used as inducing agent was also lowered significantly in case of midazolam (p<0.05). One patient in midazolam group showed respiratory depression whereas four patients receiving lorazepam and diazepam showed delayed recovery and prolonged sedation, but the effects were self-limiting. Conclusions: Midazolam offers the maximum advantage in allaying anxiety and providing excellent sedation and amnesia during general anaesthesia and proves to be the most suitable premedicant before general anaesthesia.
Introduction: Adjuvants like intravenous (i.v.) Magnesium Sulphate (MgSO4 ) are used to improve the efficacy and duration of spinal anaesthesia and postoperative analgesia. But it is unclear, whether this prolongation of duration of analgesia is an independent effect of MgSO4 or it is because of increased duration of spinal anaesthesia itself. Aim: To evaluate the effect of intraoperative i.v. low dose MgSO4 on two-segment regression time of sensory block, regression time up to L2 dermatome from the highest level of sensory block and postoperative analgesic requirement. Materials and Methods: This randomised placebo-controlled blinded study was conducted in the Department of Anaesthesia, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam, India from September 2020 to August 2021. A total of 60 patients, satisfying American Society of Anaesthesiology (ASA) physical status I and status II, aged between 40-70 years, patients undergoing femur fracture surgery under spinal anaesthesia were enrolled in the present study. Patients in the magnesium group (Group M, n=30) received MgSO4 5 mg/kg infusion, and control group (Group C, n=30) received at the same volume of saline during operation. Unpaired t-test was used to test the significance in normally distributed continuous variable and Mann-Whitney U test was used to test the significance of the difference between the quantitative variables. The software Predictive Analytics Software (PASW) 18.0 was used for statistical analysis and the graphs have been generated using the Microsoft Excel 2007. A p-value of less than 0.05 has been considered to be significant. Results: There were no significant differences between the two groups with respect to patient characteristics (age, weight, and height).The mean time for two segment regression in the group M was prolonged by around 13 minutes, as compared to group C (104.96±11.37 minutes versus 91.2±11.86 minutes, respectively, p<0.001). The mean regression time up to L2 dermatome in the group M was prolonged by 15 minutes as compared to the group C. (171.23 minutes versus 156.43 minutes, respectively, p=0.0003). The total consumption of tramadol in the group M was significantly lesser than the control group (192.5±58.03 mg and 245.0±43.74 mg, respectively, p=0.0002). Conclusion: An i.v. infusion of 5 mg/kg MgSO4 prolongs two segment regression time upto L2 dermatome and reduces postoperative opioid consumption without any complication in patients undergoing femur fracture surgery under spinal anaesthesia
BACKGROUND A vasopressor drug is often required to control hypotension. Many authors have compared ephedrine and phenylephrine as vasopressor in patients undergoing elective cesarean section with conflicting conclusions, but none have evaluated these two agents in patients from the NorthEastern part of India. As a secondary objective, we intended to evaluate the side effects and umbilical artery blood pH (UApH). MATERIALS AND METHODS Term parturients of ASA-I and ASA-II category, in the age group of 20-30 years, with weight of 50-70 kg and height of 150-170 cms posted for elective caesarean section under spinal anaesthesia were selected for the study. After dural puncture with a 23G spinal needle, 2.5 ml of 0.5% bupivacaine heavy was injected. Systolic and diastolic blood pressures (SBP and DBP) were recorded after subarachnoid block, and then every 2 mins for next 20 mins and thereafter every 5 mins till 30 minutes. Whenever the SBP falls below 20% of the baseline value, the study drug was given. Rescue atropine sulphate (0.3 mg IV) was given when the heart rate became less than 50. RESULTS The number of boluses of phenylephrine(Group-P) required to maintain maternal blood pressure were less as compared to Ephedrine(Group-E) in the first 6 minutes. In Group-P, 23.33% patients required single dose of Atropine to treat bradycardia and 76.67% patients did not require any atropine dose. In Group-E, no patients required any rescue dose of Atropine. Higher UApH in Group-P (Mean 7.37±0.023) as compared to Group-E (7.319±0.021) was noticed. CONCLUSION The maternal blood pressure was better maintained with phenylephrine as compared to ephedrine. There was less maternal heart rate along with statistically significant higher UApH in the patients receiving phenylephrine.
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