INTRODUCTIONCisatracurium besilate is a cis-cis isomer (51W89:1R-cis 1'R-cis atracurium), one of the 10 stereoisomers of atracurium that constitutes 15% of the atracurium mixture, an intermediate duration non-depolarising neuromuscular blocking drug. It is about three to four times more potent than atracurium and devoid of cardiovascular side effects in doses of upto 8 times of ED95. The ED95 of cisatracurium is 0.05mg/kg. 1-5The rate limiting step in the degradation of cisatracurium is Hoffmann degradation.(organ independent elimination) to form laudanosine and monoquaternary alcohol. 77% of drug is cleared via Hoffmann degradation which is a ph and temperature dependent process, rest 23% of drug get cleared through organ dependent means, and renal elimination accounts for 16% of this. Hydrolysis by non-specific esterases is not an important pathway for cisatracurium degradation. It is not associated with histamine release in humans. Although the liver and kidneys play only a small role in the excretion of cisatracurium besilate, urinary and hepatic elimination pathways are important for the metabolites of laudanosine. 5-8The total body clearance (CL), steady-state Vd and elimination half-life of cisatracurium besilate in patients with normal organ function are approximately 0.27 to 0.34 L/h/kg (4.7 ml/min/kg), 0.11 to 0.16 L/kg and 22 to 35 minutes, respectively. The volume of distribution (Vd) ABSTRACT Background: Cisatracurium is one of the cis-cis isomer of atracurium (51W89:1R-cis 1'R-cis atracurium) an intermediate duration non-depolarising neuromuscular blocking drug and is devoid of histamine release. However, 2× ED95 dose of cisatracurium does not provide satisfactory intubating condition. The recommended intubating dose of cisatracurium is 3 ×ED95. The objective of this study was to evaluate and compare duration of action, hemodynamic effects and any adverse effects for different doses of cisatracurium. Methods: After Institutional Ethical Committee approval and informed patient consent, 80 patients of ASA I and II in the age group of 20-60 years were selected and included in the study. Patients were divided in two groups of 40 each, group A received intravenously 3×ED95 (0.15 mg/kg) loading dose of cisatracurium and group B received intravenously 4×ED95 (0.2 mg/kg) loading dose of cisatracurium. Results: After induction, MAP and HR shows decrease in both groups but neither statistically nor clinically significant. Better hemodynamic stability and longer duration of action was found in group B compared to group A. No adverse effects noted in both groups. Conclusions: 4×ED95 dose of cisatracurium provides longer duration of action and more stable hemodynamic status than 3×ED95. No associated signs of histamine release were detected clinically.
Background and Aims:Although LMA insertion is less invasive than endotracheal intubation,it also requires adequate mouth opening and blunting of minimal airway reflexes. Propofol is considered an appropriate IV agent for LMA insertion owing to its prompt induction and suppression of airway reflexes but induction doses required are often associated with hypotension,pain and apnea.Sevoflurane on the other hand,has minimal respiratory irritability,better hemodynamic stability and less apnea, but is associated with delayed jaw relaxation. Our hypothesis is that the combination of sevoflurane and propofol may be of better outcome whereby the insertion conditions of the LMA may be optimized adequately,at the same time the potential side-effects of individual drugs are effectively curtailed. Methods: 90 patients aged 20-60yrs of ASA I and II, 30 in each group were induced with Propofol (2mg/kg) in Group P, 8% Sevoflurane in N O: O (67%:33%) TVB technique in Group S and Group SP with additional propofol (1mg/kg) in 2 2 Group SP after loss of eyelash reflex. Induction characteristics, hemodynamic parameters and complications were observed. Results: 87% of the patients of Group SP had successful LMA insertion at first attempt, compared to 53% and 40% in Group P and Group S respectively, which was statistically significant. Less apnea was seen in Group SP(20%) as compared to Group P(60%),which was statistically significant. Conclusion: Our study showed that the combination group stood out to be the best with highest successful LMA insertion at first attempt and less incidence of apnea.
Laryngoscopy and intubation violates the patient's protective airway reflexes and lead to physiological changes involving various systems of the body. Reflex changes in the cardiovascular system are most marked after laryngoscopy and intubation and leads to average increase in blood pressure by 40-50% and 20% increase in heart rate (Indian J. Anaest 2002) 45(2):104-106. The present study compare the safe and clinically effective intravenous bolus dose of labetalol and lignocaine for controlling the cardiovascular response to laryngoscopy and intubation. METHODSA total of 90 normotensive adult consented patients aged 20-50 years, ASA grade I and grade II of both gender were randomized into three treatment groups of 30 patients each. Group I received normal saline 10 mL as infusion. Group II received 1.5 mg/kg body wt. of lignocaine hydrochloride one minute before intubation. Group III received 0.4 mg/kg body wt. of labetalol hydrochloride 5 minutes before intubation respectively. Anaesthetic technique was standardized and all groups were assessed for haemodynamic changes after the premedication before and after intubation, at the 1 st , 3 rd , 5 th and 10 th minute after intubation along with intraoperative haemodynamic stability and post-operative side effects. RESULTSSignificant increase in heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were observed in group I after laryngoscopy and intubation. Statistically significant alteration of heart rate, systolic blood pressure and mean arterial pressure but no significant effect in the rise of diastolic blood pressure was observed respectively in group II, whereas statistically highly significant alternation of heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were recorded in Group III. CONCLUSIONIntravenous bolus dose of labetalol is superior to lignocaine in attenuating the cardiovascular response to laryngoscopy and intubation. The study patients were haemodynamically stable perioperatively without prolongation of recovery time and side effects. KEYWORDSLabetalol, Lignocaine, Laryngoscopy, Intubation. HOW TO CITE THIS ARTICLE:Tayung RP, Laha AK, Talukdar TK, et al. Effect of intravenous labetalol in controlling the cardiovascular response to laryngoscopy and intubation: a comparison with intravenous lignocaine.
Background: Intrathecal neostigmine and magnesium sulfate (MgSO4) produce substantial antinociception, potentiate analgesia of bupivacaine without neurotoxicity. The aim of the study was to investigate the effect of neostigmineAims: and MgSO4 on characteristics of spinal anesthesia (SA), hemodynamic stability and postoperative analgesia when added to 0.5% hyperbaric bupivacaine for SA. In this prospective, randomized, single-blindSubjects and Methods: study 90 American Society of Anesthesiologist status I and II adult males and females posted for major lower abdominal surgery were assigned to one of the three groups (n = 25). Group N received Neostigmine 50
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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