Objective: To compare the frequency of tourniquet induced hypertension in patients undergoing limb surgeries under general anesthesia with intravenous infusion of ketamine and placebo (saline infusion). Study Design: Comparative prospective study. Place and Duration of Study: Anaesthesia Department, Combined Military Hospital, Rawalpindi Pakistan, from May to Nov 2018. Methodology: Total 80 patients undergoing upper and lower limb surgeries with tourniquet application under general anesthesia were randomly assigned into two equivalent groups. Group A (n=40) received intravenous ketamine 0.1 mg/kg bolus followed by infusion at a rate of 2ug/kg/min while Group B (n=40) received intravenous bolus of normal saline followed by its infusion via infusion pump. Systolic blood pressures were recorded by non-invasive method 30 seconds prior to tourniquet inflation and at 60 mins interval after its inflation. Results were characterized using the descriptive statistics. Mean and standard deviation (SD) were used for quantitative variables while frequency and percentages for qualitative variables. The p-value <0.05 was considered as significant. Results: Tourniquet induced hypertension was found in 2 (5.0%) group A patients and 11 (27.50%) group B patients with statistically significant p-value of <0.05. Visual analogue scale score was slightly higher in the Saline group, but the result was statistically not significant (p=0.32). Conclusion: Ketamine infusion reduces the occurrence of tourniquet induced hypertension in patients undergoing surgeries with tourniquet application.
Objective: To determine the efficacy of granisetron versus placebo (saline) for reducing shivering in patients undergoing lower segment caeserian section under spinal anaesthesia. Study Design: Comparative cross - sectional study. Place and Duration of Study: Department of Anaesthesia, Combined Military Hospital Rawalpindi, from Apr to Sep 2019. Methodology: Total 178 patients undergoing lower segment ceaserian section under spinal anaesthesia with age ranges from 18-40 years of American Society of Anaesthesiologists status I & II with full term pregnancy scheduled for elective caesarean section under spinal anaesthesia. Group A (n=92) received an intravenous bolus of 1 mg granisetron in a 10ml syringe and Group B (n=86) received intravenous bolus of normal saline in a 10ml syringe, drugs were administered immediately before spinal anaesthesia by anaesthetist as coded syringes. Heart rate, blood pressure, core body temperature and shivering scores were measured at 0 minutes, 30 minutes and 60 minutes, average surgery time recorded to be 60 minutes. Results: None of the patients in group A (drug group) exhibited appreciable post spinal shivering whereas 25 (29%) in group B (placebo) had clinically significant shivering necessitated administration of other established pharmacological agents to abort shivering in order to ensure patient comfort and satisfaction with statistically significant p-value of <0.05. Conclusion: Prophylactic injection granisetron was efficacious against post spinal shivering, moreover provides worth while relief of nausea and vomiting which is dilemma with most of the drugs employed for control of post spinal shivering.
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