Background: Epidural anesthesia is the most commonly used technique for inducing surgical anesthesia and postoperative analgesia in patients undergoing lower limb surgeries. Fentanyl as an adjuvant to epidural local anesthetic has been used for a long time. Dexmedetomidine is a potent and highly selective á-2-adrenoceptor agonist with analgesic potency. Aim: The aim of the present study was to compare the effect of dexmedetomidine and fentanyl as an adjuvant to epidural bupivacaine in lower limb surgeries. Materials And Methods: Sixty patients belonging to the American Society of Anesthesiologists' Grade I or II who were undergoing lower limb surgery were randomly divided into two groups. Group BD: received epidural study solution of 38 ml of 0.25% bupivacaine hydrochloride + 1 ml of 100 ìg dexmedetomidine + 1 ml of normal saline. Group BF: received epidural study solution of 38 ml of 0.25% bupivacaine hydrochloride + 2 ml of 100 ìg fentanyl. Onset and maximum level of sensory blockade, time to attain maximum sensory level, time to complete motor blockade, time for two-segment regression, duration of analgesia and motor block, heart rate, and blood pressure were observed. Pain and sedation were assessed by numerical rating scale and Ramsay Sedation Scale, respectively. Data were recorded and statistically analyzed. Results: The onset of sensory blockade and time to attain maximum sensory level in Group BD were earlier than that of Group BF (P < 0.001). Duration of analgesia and motor blockade in Group BD were signicantly more than that of Group BF (P < 0.001). Postoperative visual analog scale was reduced statistically signicantly in Group BD (P < 0.001). Conclusion: Dexmedetomidine as an adjuvant to epidural bupivacaine is a better alternative to fentanyl with higher analgesic property
Introduction: Most of the lower abdominal surgeries are conducted under spinal or epidural anaesthesia. The purpose of this study is to evaluate combined spinal epidural anesthesia and epidural block in terms of efficacy, surgical analgesia and muscle relaxation in patients undergoing lower abdominal surgeries. Material and methods: This prospective randomised study was conducted at SKMCH, Muzaffarpur, Bihar where 60 patients of ASA I and II, aged 20-60 years of both sexes scheduled for elective lower abdominal surgeries were randomized into two groups. Group A – receiving epidural anaesthesia. 20ml of 0.5% plain bupivacaine was injected epidurally.1.5-2ml of 0.5% Bupivacaine was injected epidurally for every unblocked segment after the maximum height of block is reached so as to get the required T6 level. Group B – receiving combined spinal epidural anaesthesia. (2.5 ml) of 0.5% Bupivacaine (heavy) was deposited in the subarachnoid space.1.5-2ml of 0.5% bupivacaine was injected epidurally for every unblocked segment after 10 minutes to get required T6 height of block. Results: The changes in hemodynamic parameters observed between the two groups are statistically not significant. The time to achieve T6 sensory block was significantly shorter in CSE group when compared to epidural group. CSEA provided more degree of motor blockade and significantly good quality of analgesia compared to epidural anesthesia alone. The amount of bupivacaine required to produce the desired level of T6 blockade is 2.5 times less in CSEA compared to epidural anesthesia. Conclusion: Combined spinal epidural technique is effective, safe, with stable hemodynamics and superior to epidural anaesthesia in patients undergoing lower abdominal surgeries.
Introduction: Airway management is a crucial skill for the clinical anaesthesiologist. It is an integral part of general anesthesia, allowing ventilation and oxygenation as well as a mode for anesthetic gas delivery. The laryngeal mask airways (LMA) have become popular in airway management as a missing link between facemask and tracheal tube in terms of both anatomical position and degree of invasiveness. Haemodynamic stability is an important aspect to the anaesthesiologist for the benet of the patients especially during intubations, laryngeal mask insertion. Laryngoscopy and endotracheal intubation can cause striking changes in Haemodynamics as result of intense stimulation of sympathetic nervous system. The aim of this study was to evaluate the hemodynamic changes between endotracheal intubation and laryngeal mask airway insertion. Material And Methods: This was a prospective observational study on 46 patients of ASA I-II status divided into 2 groups of 23 each. In the ETT (Endotracheal tube) group endotracheal intubation was done using Macintosh laryngoscope by using portex cuffed endotracheal while in LMA (Laryngeal mask airway) group laryngeal mask airway was inserted according to the standard recommendation. Heart rate, Systolic, Diastolic and Mean arterial pressure and dysrhythmias were monitored. Results: The two groups were comparable in terms of demographic data as there were no signicant differences between the 2 groups in terms of age, sex, duration of surgery, ASA grades and MPC classication. Heart rate (HR), Systolic blood pressure (SBP), Diastolic blood pressure(DBP), Mean arterial pressure (MAP) remains on higher side in ETT group than LMA group which was statistically signicant. P<0.05. Dysrhythmias were noted in 2 patients of ETT group while LMA group did not notice any dysrhythmias. Conclusion: This study demonstrated that there is a haemodynamic response consisting of an increase in Heart rate, SBP, DBP and MAP that comes with ETT insertion as well as with LMA insertion. However, the response caused by ETT insertion is signicantly greater than that caused by LMA insertion.
Background And Aims: Both dexmedetomidine and dexamethasone have individually been shown to be benecial as an adjuvant to ropivacaine. We compared the efcacy of combination of ropivacaine with dexmedetomidine and ropivacaine with dexamethasone in ultrasound guided supraclavicular brachial plexus (SCBP) block. Material And Methods: In this prospective randomised double blind controlled trial, 60 ASA physical status I/II patients undergoing elective upper limb surgery under ultrasound guided SCBP block with 30 ml of 0.5% ropivacaine were randomised into three groups. Group 1 (n = 20) received 1 μg/kg of dexmedetomidine, and group 2 (n = 20) received 8 mg of dexamethasone in addition to ropivacaine, while group 3 (n = 20) received only ropivacaine. The primary outcomes studied were onset and duration of sensory and motor block. Secondary outcomes included duration of analgesia, total analgesic consumption in 24 h postoperatively and quality of block. ANOVA and Chi-square test were used to compare results on continuous measurements and categorical measurements, respectively. Results: Onset of sensory and motor block was faster in group 1 (13.5 ± 4.1 and 17.0 ± 4.1 min) and group 2 (15.6 ± 3.6 and 18.5 ± 3.7 min) as compared to group 3 (20.1 ± 5.3 and 24.9 ± 5.6 min; P < 0.001). Block duration was signicantly longer in group 1 and group 2 than in group 3. Duration of analgesia was prolonged in group 1 and 2 (1218.0 ± 224.6 and 1128.0 ± 207.5 min, respectively) as compared to group 3 (768.0 ± 273.7 min; P < 0.001). Twenty four hours analgesic consumption postoperatively was reduced in the two study groups. Conclusion: Both dexmedetomidine and dexamethasone when used as adjuvants to ropivacaine for SCBP block, block onset time, and prolong' block duration
Background: Thermoregulatory system coordinates defenses against environmental temperature to maintain internal core temperature within a narrow range, thus optimizing normal body function and homeostasis in humans. Anaesthetic induced thermoregulatory impairment and hence hypothermia in cold environments. Shivering is an important complication of hypothermia. Shivering is an involuntary, oscillatory muscular activity that augments metabolic heat production upto 600% above basal level to increase temperature. It is associated with substantial adrenergic activation, discomfort and can double or even triple oxygen consumption and carbon dioxide production. Potent anti-shivering properties have been attributed to numerous drugs including biogenic monoamines, cholinomimetics, cations, endogenous peptides and possibly N-methyl-D- aspartate (NMDA) receptor antagonists like ketamine, tramadol and clonidine. Aim: To evaluate the effectiveness of prophylactic use of intravenous ketamine, clonidine and tramadol in control of shivering and to note any side-effects of the drugs used. Methods: A total number of 120 ASA I and 2 patients of either sex belonging to age group 18-60 years posted for Lower Abdomen and Lower Limb surgeries under subarachnoid block were divided into four groups of 30 each. Group P (control group): Patients received 10mL of normal saline IV as placebo. Group K: Patients received Inj. Ketamine 0.5mg/kg BW IV diluted to 10ml in Normal Saline. Group C: Patients received Inj. Clonidine 75mcg IV diluted to 10ml in Normal Saline. Group T: patients received Inj. Tramadol 0.5mg/kg BW IV diluted to 10ml in normal saline. Results: We conclude that giving Ketamine 0.5mg/kg,Clonidine 75mcg or tramadol 0.5mg/kg i.v. prophylactically just before subarachnoid block significantly decreased the incidence of shivering without causing any major side effects. Conclusion: Ketamine, Tramadol or Clonidine decrease shivering during spinal anesthesia.
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