Introduction:The aim of the present study was to evaluate and compare the effect of clonidine 200 μg and gabapentin 900 mg and pregabalin 150 mg in attenuation of the hemodynamic response to laryngoscopy and intubation in normotensive patients undergoing elective surgery.Methods:Ninety adult patients between 18 and 60 years are enrolled in the study. Patients with American Society of Anesthesiologists Grade-I and Grade-II are included which are posted for elective surgery under general anesthesia. Patients were divided into three groups: A, B, and C and received oral drugs 90 min before induction of general anesthesia, pregabalin 150, gabapentin 900mg, and clonidine 200 μg, respectively. Hemodynamic parameters such as heart rate and blood pressure were noted just before the (basal) administration of the drug, and in operation room, readings were recorded before intubation (T0) and after intubation at 1, 3, 5, and 10 min. Sedation and anxiety score were noted after 1 h of oral administration of the drug.Results:Mean arterial pressure was well attenuated by pregabalin than others, and mean heart rate following laryngoscopy and intubation was attenuated by clonidine group significantly.Conclusion:We conclude that oral pregabalin and gabapentin attenuate blood pressure response fairly well and heart rate significantly attenuated by clonidine. All three drugs are very effective for relieving anxiety and improving sedation.
To find the ideal drug combinations which can be used during day care surgeries and procedures. AIMS: This study was conducted. To evaluate and compare the efficacy, and haemodynamic stability of ketamine and fentanyl combination with propofol. To compare the incidence of side effects. To compare the time of awakening and recovery time. To compare the discharge criteria in both groups. METHODS: The study was conducted in 50 patients of age group 18-50 years of either gender belonging to ASA grade I and II, were divided into two groups of 25 each. They underwent elective surgery of approximately 1 hour duration. Group I received Propofolketamine while group II received Propofol-fentanyl for induction and maintenance of anaesthesia. Postoperatively, time for awakening, recovery time '(by modified Aldrete scoring system) and discharge status (by modified post anaesthetic discharge scoring system) were recorded and compared in two groups. RESULTS: Profol-fentanyl combination produced a significantly greater fall in pulse rate and in both systolic and diastolic blood pressure as compared to Propofol-ketamine during induction and maintenance of anaesthesia. Fall in respiratory rate was greater in Propofolfentanyl group as compared to Propofol-ketamine group. The recovery time in group I was longer than group II. Discharge criteria is significantly earlier in group II. CONCLUSION: Both Profolketamine and Propofol-fentanyl combination reduce rapid, pleasant and safe anesthesia with only a few untoward side effects and propofol-ketamine produces better haemodynamic statistic, during anaesthesia.
BACKGROUNDThe social stigma of chronic empyema thoracis treated with open window thoracostomy (OWT) has significant negative impact on psychosocial well-being, especially in early young age group patients. So, evaluation of better alternative of dead space reduction closed thoracoplasty method was done by the author. Aims and Objectives-To evaluate standard easily reproducible surgical method to cure and control chronic empyema thoracis other than open window thoracostomy in early young age group patients in central India. MATERIALS AND METHODSDead space reduction closed thoracoplasty was performed in 44 patients of chronic empyema thoracis between the age group of 13 and 25 years by conventional thoracoplasty (Alexander type), tailoring thoracoplasty and Schede thoracoplasty. Patients were evaluated in terms of weight gain, chest x-ray, air leak and column movement in ICD and pus culture sensitivity at regular intervals. Targeted dead space reduction is achieved excellently when column movement is less than 5 cm and acceptable when between 5 and 10 cm. Absence of air leak even on coughing (excellent) and only on coughing (acceptable) in patent intercostal drainage tube. Statistical Analysis-By student's t-test, repeated measure ANOVA test for difference of mean, confidence interval with standard error estimation, 'p' value and percentage also. Setting and Design-A hospital-based prospective longitudinal study as all the enrolled patients are followed up at designed time. RESULTSChronic empyema thoracis of 40 patients was cured and controlled with dead space reduction thoracoplasty, whereas 4 patients with multi-drug resistance tuberculosis (MDR TB) did not cure, so they further required other modalities. CONCLUSIONPatients with persistent infection and poor weight gain have high failure rate in dead space reduction closed thoracoplasty.
BACKGROUND: Addition of lipophilic opioids like Fentanyl and Sufentanil to local anaesthetic for spinal anaesthesia has shown to prolong the duration of analgesia. This study was carried out to study (a) Comparison of effect of Fentanyl and Sufentanil added to Bupivacaine on onset and duration of anaesthesia in Cesarean Section. (b) To compare the quality and duration of analgesia between the two opioids and (c) To compare the effect on neonatal outcome. METHODS: 50 parturients of ASA grade 1 and 2 undergoing Cesarean Section were randomized into two groups of 25 each. Group F received 2.5 ml 0.5% Bupivacaine heavy + inj. Fentanyl 0.25 ml (12.5 mcg) and Group S received 2.5 ml 0.5% Bupivacaine heavy + inj. Sufentanil 0.1 ml (5 mcg) intrathecally. Onset of sensory and motor blockade was noted in all the patients. Haemodynamic parameters were recorded every 5 minutes for first 30 minutes and then every 15 minutes till the completion of surgery. Duration of sensory and motor sensory blockade was observed post operatively. RESULT: Both the groups were stable haemodynamically. Both the groups were comparable regarding the duration of sensory and motor block, but the total duration of effective analgesia was significantly longer in Sufentanil group. Pruritus was significant side effect in Sufentanil group. Neither the mother nor the neonate had respiratory depression. CONCLUSION: Addition of Sufentanyl to intrathecal bupivacaine provides longer duration of analgesia as compared to intrathecal fentanyl-bupivacaine. However, the incidence of pruritus was greater in Sufentanyl group.
AIMAim of our study was to assess effect of 0.5% bupivacaine, 0.5% levobupivacaine and 0.5% ropivacaine in axillary brachial plexus block. OBJECTIVETo compare the onset time and duration of sensory and motor blockade of 0.5% bupivacaine, 0.5% levobupivacaine and 0.5% ropivacaine in axillary brachial plexus. MATERIAL AND METHODNinety patients of ASA I and II of age group 20yrs-60yrs of either sex were included in our study undergoing upper limb surgeries in Gandhi Medical College and Hamidia Hospital, Bhopal (MP). The patients were randomly divided into three groups:-Group I (n= 30) : Bupivacaine 0.5%-5mg/ml-30ml, Group II (n= 30) : Levobupivacaine 0.5%-5mg/ml --30ml, Group III (n=30) : Ropivacaine 0.5%-5mg/ml --30ml onset time of sensory and motor block, duration of sensory and motor block and duration of pain relief were recorded. RESULTAnalysis revealed that Ropivacaine provided fast onset of action and better quality of anaesthesia and analgesia than bupivacaine and levobupivacaine when used in axillary brachial plexus blockade. There was no significant difference in duration of sensory blockade between three groups. But Ropivacaine showed lesser duration of motor blockade when compared to bupivacaine and levobupivacaine. CONCLUSIONWe conclude that 0.5% 30ml of ropivacaine in axillary brachial plexus block is a safe dose, allowing practitioner to produce a fast onset of sensory block and long duration of peripheral nerve block with excellent postoperative analgesia and stable hemodynamics. So ropivacaine is a better option for forearm surgeries in axillary brachial plexus block when compared with bupivacaine and levobupivacaine.
BACKGROUND Emergency surgeries for penetrating eye trauma may be complicated by elevation in intraocular pressure (IOP) caused by succinylcholine administration and endotracheal intubation. Hence, it is critical to attenuate the rise in IOP for better outcome. This study was conducted to evaluate the effect of dexmedetomidine premedication in attenuating the rise in IOP due to succinylcholine and endotracheal intubation. MATERIALS AND METHODS This non-randomised controlled trial was conducted on 70 American Society of Anesthesiologists (ASA) grade I-II patients, aged 18-60 years undergoing non-ophthalmic surgeries under general anaesthesia (GA). The patients were divided into two groups of 35 each. Group 'C' (control) received 10 mL normal saline, while Group 'D' (study group) received dexmedetomidine (0.5 µg/kg) with normal saline added to make a total volume of 10 mL. IOP, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded before and after premedication, after induction of anaesthesia, after succinylcholine administration immediately and 5 minutes post-intubation. RESULTS Data were compared using independent student 't' test and chi-square test in Statistical Package for Social Sciences (SPSS) software version 22. P-value < 0.05 was considered significant. The rise in IOP, mean HR and MAP were significantly reduced after premedication in Group 'D.' The incidence of side effects between the groups was not significantly different. CONCLUSION The study led to the conclusion that dexmedetomidine premedication significantly attenuates the rise in IOP in response to succinylcholine administration and endotracheal intubation without any additional side-effects and can be used in emergency ophthalmic surgeries for this purpose.
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