Background: Various anaesthetic agents have been tried to attenuate pressor response to laryngoscopy and intubation. Among the recommended groups intravenous nalbuphine satisfies without much undesired effects. The objective was to study efficacy of two different doses of nalbuphine to attenuate pressor response to laryngoscopy and intubation.Methods: This was hospital based comparative study was carried out at Karnataka institute of Medical Sciences Hospital, Hubli, India. Patients were divided into two groups of 50 each randomly. First group was named as N1 and the second group was named as N2. Patients in N1 were given 0.1mg/kg Nalbuphine in 10ml of normal saline and patients in N2 were given 0.2-0.1mg/kg Nalbuphine in 10ml of normal saline. Appropriated statistical tests were applied like t test, ANOVA. P value if found less than 0.05 was recorded as statistically significant.Results: There was marked increase in HR, SBP, DBP and MAP immediately following laryngoscopy and intubation in the both the groups. Intravenous Nalbuphine given 5 minutes before intubation in the dose of 0.2mgkg-1 body weight effectively attenuated the hemodynamic response after laryngoscopy and intubation. However, there was a rise in HR, SBP, DBP and MAP immediately following intubation in group N2 which was clinically not significant though statistically significant. Side effects like nausea, vomiting, respiratory depression and sedation was not observed in both study groups.Conclusions: Authors concluded that 0.2mg/kg body weight dose of Nalbuphine was found to be more effective than 0.1mg/kg body weight dose of nalbuphine in maintaining the haemodynamics of the patients.
Introduction:Spinal anesthesia with bupivacaine is associated with hypotension and inadequate postoperative analgesia. The addition of clonidine as an adjuvant to intrathecal bupivacaine is beneficial in reducing the dose of the local anesthetic and also provides prolonged postoperative analgesia.Methodology:One hundred and five American Society of Anesthesiologists physical status Classes 1 and 2 parturient women undergoing elective cesarean section were randomly divided into three groups. Patients in Group C (control) received 2 ml of 0.5% of heavy bupivacaine (10 mg) with 0.5 ml of 0.9% saline to a total volume of 2.5 ml, those in Group H (high dose of bupivacaine) received 2 ml of 0.5% of heavy bupivacaine (10 mg) with 1 μg/kg of clonidine and 0.9% saline to make a total volume of 2.5 ml, and those in Group L (low dose of bupivacaine) received 1.5 ml of 0.5% of heavy bupivacaine (7.5 mg) with 1 μg/kg clonidine and 0.9% saline to make a total volume of 2.5 ml. Patients were observed for onset and duration of sensory and motor block and for postoperative analgesia.Results:Patients who received clonidine as adjuvant had effective prolonged postoperative analgesia (Group H – 480 ± 40 min, Group L – 480 ± 34 min) as compared to control group (180 ± 19 min).Conclusion:The dose of intrathecal bupivacaine 0.5% was effectively reduced to 7.5 mg by adding 1 μg/kg of clonidine as adjuvant in patients undergoing elective cesarean section.
Background: Studies comparing the efficacy of dexmedetomidine and clonidine as adjuvants to ropivacaine 0.75% in spinal anesthesia are few. The objective was to study the safety and efficacy of dexmedetomidine in comparison to clonidine as an adjuvant to ropivacaine in subarachnoid block.Methods: Patients were randomly allotted into 3 groups. Group R (n=30) patients received 3ml of 0.75% isobaric ropivacaine +0.5ml of 0.9% normal saline to a total volume of 3.5ml. Group RD (n=30) patients received 3ml of 0.75% isobaric ropivacaine +5μg of dexmedetomidine +0.9% normal saline to a total volume of 3.5ml. Group RC (n=30) patients received 3ml of 0.75% isobaric ropivacaine +30μg of clonidine +0.9% normal saline to a total volume of 3.5ml. The patients and the investigator were blinded for the study.Results: Time to reach T10 level of sensory block in group R was 7.6±1.3 min, group RC was 7.8±1.4 min and in group RD it was 7.9±1.4 min which was statistically not significant with p value 0.66. Time to reach motor onset to Bromage scale 4 was 9.8±1.4 min in group R, 10±1.4 min in group RC, 10.5±1.5 min in group RD which was statistically not significant with p value 0.24. Time to reach maximum sensory block in group R was 10.7±1.4 min, 10.6±1.1 min in group RC, 11±1.7 min in group RD which was statistically insignificant with p value 0.51.Conclusions: Intrathecal dexmedetomidine had superior anaesthetic effects with respect to duration of sensory blockade, motor blockade and duration of analgesia compared to intrathecal clonidine.
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