prospective, randomized, double blind, controlled clinical study of adjuvant effect of fentanyl (1 μg/kg) or clonidine (2µg / kg) to ropivacaine 0.2% 1ml/kg for caudal analgesia in children undergoing lower abdominal surgeries".ABSTRACT: Ropivacaine having better safety profile and less motor blockade than bupivacaine is well suited for caudal analgesia. Since studies done regarding the effect of fentanyl and clonidine as adjuvants to ropivacaine for prolongation of caudal analgesia are scant and have shown conflicting results, the present study was conducted. METHODS: A total of 90 children aged between 3-6yrs belonging to ASA class I and II undergoing surgical procedures below the umbilicus were randomly allocated to one of two groups: Group R received ropivacaine 0.2%, 1 ml/kg with saline 0.02ml/kg and Group RF received ropivacaine 0.2%, 1 ml/kg with fentanyl 1 μg/kg (0.02ml/kg) and Group RC (clonidine) received 1ml/kg of 0.2% Ropivacaine plus clonidine 2µg / kg caudally after induction of general endotracheal anaesthesia. The pain score was evaluated using Hannallah pain scale, motor blockade using modified bromage scale and sedation assessed using 4 point sedation score at 30 minutes after extubation and at 1, 2, 4, 6, 12 and 24 h. The time to awakening, first analgesic requirement time, number of doses of rescue analgesic and side-effects in a 24 hours period were also recorded. The results were evaluated using SPSS 17 statistical method. RESULTS: There were no differences in demographic characteristics between the groups. However, mean duration of caudal analgesia was 659.5 minutes in group R, 784.5 minutes in group RF and 960.5 minutes in group RC which was statistically highly significant (P<0.01).The total dose of rescue analgesic in 24 hours was lower in groups RF and RC. Also the number of children receiving rescue analgesia at 12 hours was higher in placebo group than fentanyl group and clonidine group which was statistically highly significant (P<0.01). Increased incidence of urinary retention and pruritis was noted in group RF which was statistically not significant (P=0.366). CONCLUSION: Addition of inj. Fentanyl 1µg/kg or clonidine 2µg/kg to Ropivacaine 0.2% 1ml/kg prolongs the duration and improves the quality of analgesia post operatively when compared with Ropivacaine alone. However, clonidine is a better adjuvant to Ropivacaine 0.2% 1ml/kg for single shot caudal block in children undergoing infraumbilical surgeries due to more prolonged analgesia and lesser side effects.
Hemodynamic response to Laryngoscopy and Intubation is a well-known problem since long time and there are many studies conducted to attenuate this presser response, the present study is undertaken to study the effect of 10% lignocaine spray for suppressing the cardiovascular responses to tracheal intubation. METHODS: Thirty nine Patients of either sex aged between 20-60years of age, belonging to ASA Grade I and II, undergoing elective surgery requiring General Anesthesia with endotracheal intubation were included for the study. After recording the baseline Heart Rate, Systolic Blood Pressure and Diastolic Blood Pressure lignocane spray 10% meter dose was used to anaesthetise glasoepiglotic fold before premedication. Anaesthesia induced with propofol and succinylcholine to assist direct laryngoscopy and intubation. Heart rate, systolic blood pressure, diastolic blood pressures were recorded after premedication, induction and immediately after intubation. RESULTS: Heart Rate, Systolic blood Pressure, Diastolic Blood Pressure and rate pressure product of 39 patients included in the study were analyzed and compared from baseline parameters to after intubation. CONCLUSION: Study concluded that 10% lignocaine spray is a simple and probably one of the most effective methods in attenuating hemodynamic response to laryngoscopy and intubation. KEYWORDS: Haemodynamic response, Laryngoscopy and intubation, 10% lignocaine spray. INTRODUCTION:Direct laryngoscopy and intubation leads to reflex release of catecholamines resulting in hemodynamic response meaning transient increase in heart rate, systolic blood pressure, diastolic blood pressure, (1)(2) and occasionally cardiac arrhythmias. (3) It is a self-limiting in most of the patients however it can leads to morbidity and mortality in patients having coronary artery disease and raised intracranial tension. (4)(5) Hence many attempts have been made to attenuate this presser response. Although this hemodynamic response is due to sympathetic adrenergic reflex to laryngoscopy and intubation, most of the studies or the approach using different agents are aimed at blocking the effect of the reflex rather than preventing the stimulation starting from inducing agents thiopentone, propfol (6) analgesics, (7) different opioids, (8)(9) beta blockers, (10)(11) calcium channel blockers, (12)(13) sodium channel blocker (14) and of late alpha2 agonists. (15) Some attempts made to reduce the stimulation include different techniques of intubation, Blaind oral intubation, (16) fiber optic intubation. (17) Few attempts by anaesthetizing the posterior part of tongue and valecula are also made by nerve block(glossopharyngial, laryngeal and transtracheal nerve) (18)(19) Lignocaine 2% viscus gargling, (20) topical spray 4% (21) and 10% (22) most of the methods used to attenuate the presser responses are effective. This study with lignocaine 10% aerosol metered dose spray is an attempt to provide simple effective and not very expensive method.
Introduction: Post operative nausea and vomiting (PONV) are often associated with the laparoscopic surgeries under general anesthesia (GA). The PONV guidelines recommended the use of 5-hydroxytryptamine receptor antagonist (5-HT3RA) as the first-line prophylactic agents in patients categorised as high-risk for emesis perioperatively. There are very few studies comparing the efficacies of combinations of newer 5HT3 RA with dexamethasone. Aim: To compare the severity of emetic episodes as well as the complete response rate to antiemetics like dexamethasone or its combination with palonosetron or ramosetron during the first 48 hours after laparoscopic surgeries. Materials and Methods: This randomised clinical double-blind study Department of Anesthesiology at Mysore Medical College and Research Institute, Mysuru, Karnataka, India, from November 2014 to August 2016 among 90 patients, aged between 18 to 60 years belonging to the American Society of Anesthesiology (ASA) grade I and II scheduled for elective laparoscopic surgery under general anesthesia. They were randomly allocated into three equal groups. Group D received dexamethasone 8 mg, group RD received ramosetron 0.3 mg with dexamethasone 8 mg, and group PD received palonosetron 0.075 mg with dexamethasone 8 mg. Postoperative Nausea and Vomiting (PONV), retching were recorded via direct questioning or by the spontaneous complaints from the patients at 2, 6, 24, 48 hours. A scoring system was used to assess PONV. Complete response rate was also noted i.e, percentage of patients in a group with absence of nausea, retching, vomiting and no requirement of rescue antiemetic medications within postoperative 48 hours. Results: The baseline characteristics were similar in all three groups. Early and late PONV were significantly lesser with group-PD compared to group D (p-value=0.01) and group RD (p-value=0.007). The complete response rate in group PD (86.6%) was significantly highest compared to group D (40%) and group RD (76%). Rescue anlgesics required was nil in group PD compared to group D (36.3%), and group RD (10%) over 48 hours. Conclusion: Combination of palonosetron with dexamethasone is a better alternative to combination of ramosetron with dexamethasone in preventing PONV.
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