INTRODUCTIONLaryngoscopy and tracheal intubation are mandatory for most patients undergoing operations under general anaesthesia, which invariably is associated with certain cardiovascular changes such as tachycardia, rise in blood pressure and a wide variety of cardiac arrhythmias.1 The hemodynamic response to laryngoscopy and intubation was first described by Reid and Brace in 1940. A typical pressor response can leads to an average increase in blood pressure by 40-50% and heart rate by 20% and an elevation of both epinephrine and norepinephrine levels.These effects are generally well tolerated by overall healthy patients but can be lethal to patients with preexisting conditions such as coronary artery disease, recent myocardial infarction, hypertension, geriatric population pre-eclampsia, and cerebrovascular pathology such as tumours, aneurysms or increased intracranial pressure etc., and are at increased risk of morbidity and mortality. 2Geriatric and elderly patients which make up an increasingly large percentage of both the inpatient and outpatient hospital population, have an increased ABSTRACT Background: Laryngoscopy and tracheal intubation is invariably associated with certain cardiovascular changes such as tachycardia, rise in blood pressure and a wide variety of cardiac arrhythmias. 1 Such complications are highly detrimental in patients with limited cardiovascular reserve specially in geriatric and elderly population. Various pharmacological agents have been used to attenuate these stress responses but none has yet been considered ideal. Therefore, purpose of this study is to investigate the efficacy of sublingual Nitroglycerine spray alone and sublingual Nitroglycerine spray with intravenous Fentanyl to attenuate the pressor response to laryngoscopy and intubation in normotensive patients. Methods: A total of 120 ASA I and II patients of age group 18-60 years scheduled for elective surgical procedure under general anesthesia were randomly divided into 3 groups of 40 in each group. Group 1 control group, Group 2, received NTG sub-lingual spray (0.4mg/spray) two min. before induction, and Group 3 received inj. Fentanyl (2µg/kg) 5min before + NTG sublingual spray (0.4 mg/spray) 2min before induction. Vital parameters before and after induction and thereafter at specified time interval following laryngoscopy and intubation were recorded for comparison. Results: Demographic characteristics and baseline vital parameters in both the groups were comparable. Significant differences in mean arterial pressure (MAP) and heart rate (HR) were observed in between the groups during postintubation period. Conclusions: Combination of intravenous Fentanyl plus Nitroglycerin spray is more effective than NTG alone in attenuating the stress response following laryngoscopy and intubation.
Background: Induction and endotracheal intubation are invariably associated with certain cardiovascular changes during anaesthesia practice and can lead to sudden swings of blood pressure, arrhythmias, MI and cardiovascular collapse especially in geriatric and haemodynamically unstable patients. Therefore it is desirable to use a safer agent with fewer adverse effects to minimise these complications. Present prospective randomized study is designed to compare the haemodynamic alterations and various adverse effects following induction with etomidate and midazolam.Methods: Hundred ASA I and II patients of age group 18-60 years scheduled for elective surgical procedure under general anesthesia were randomly divided into two groups of 50 each receiving etomidate (0.3mg/kg) and midazolam (0.15mgk/kg) as an induction agent. Vital parameters before and after induction and thereafter at specified time interval following laryngoscopy and intubation were recorded for comparison. Adverse effect viz. pain on injection, apnea and myoclonic activity were also carefully watched.Results: Demographic variables in both the groups were comparable. Patients in both the groups showed little change in mean arterial pressure (MAP) and heart rate (HR) from baseline value (p >0.05). Pain on injection and myoclonic activity were seen in etomidate group while delayed awakening was seen with Midazolam group.Conclusions: This study concludes that both etomidate and midazolam provides haemodynamic stability but Midazolam can be preferred as an induction agent in view of fewer side effects.
BACKGROUNDIn the present study, we compared the analgesic effect between buprenorphine hydrochloride and tramadol hydrochloride administered through epidural route for the purpose of postoperative analgesia in patients undergoing lower abdominal surgica l procedures.The aim of this study is to evaluate and compare the efficacy between epidurally administered buprenorphine and tramadol in providing post-operative analgesia, along with their onset and duration of analgesia, side effects.
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