Objective: The aim of this study was to compare the effect of dexmedetomidine with midazolam for intranasal premedication in children posted for elective surgery. Trial design: This was a prospective, randomised, double-blinded clinical study. Method: 60 children, 3 to 10 years of age, with American Society of Anaesthesiologists (ASA) physical status I, scheduled for elective surgery, were randomly divided into two groups, group D (dexmedetomidine) and group M (midazolam). Group D patients received intranasal dexmedetomidine 1 μg/kg and group M patients intranasal midazolam 0.2 mg/kg, approximately 30 minutes before induction of anaesthesia, in the form of a spray. Outcome: Preoperative effects on heart rate, blood pressure, sedation and anxiety including parental separation and mask acceptance were assessed. Results: Intranasal dexmedetomidine (1 μg/kg) premedication resulted in statistically significant but clinically unimportant lower heart rate and blood pressure at 10, 20, and 30 minutes following administration compared with intranasal midazolam (0.2 mg/kg). There were no episodes of hypotension or bradycardia. Children in group D achieved better parental separation and mask acceptance scores compared with group M. Conclusion: Dexmedetomidine resulted in better parental separation and mask acceptance scores than intranasal midazolam. Thus it would seem to offer some advantage compared with midazolam.
Background:Clonidine is added to intrathecal local anesthetics to improve intraoperative analgesia and to increase the duration of sensory and motor block. Aim of this study was to evaluate and compare the effects of addition of two different doses of clonidine (15 and 30 mcg) to 11 mg hyperbaric bupivacaine in patients undergoing inguinal herniorrhaphy surgery under spinal anesthesia.Materials and Methods:Seventy-five patients enrolled in the study were randomly divided into three groups of 25 each. Group I patients received 11 mg hyperbaric bupivacaine, whereas groups II and III received 15 mcg and 30 mcg clonidine, respectively, as an adjuvant to 11 mg hyperbaric bupivacaine. The volume of solution was kept constant to 2.4 ml by adding saline wherever needed.Results:Highest level of sensory block, time to achieve this level, and highest Bromage scale recorded were comparable among the groups. The mean time to two-segment regression, regression of sensory block to L3 dermatome, and mean duration of motor block were the greatest in group III followed by group II and group I. There was significant fall in mean arterial pressure (MAP) in groups II and III as compared to group I (P = 0.04). Episodes of hypotension were more in group III than in group II.Conclusion:30 mcg clonidine was associated with more incidence and duration of hypotension than 15 μg of clonidine. 15 mcg clonidine added to 11 mg hyperbaric bupivacaine provides better sensory and motor blockade for inguinal herniorrhaphy.
Background and Aims:Infraclavicular (IC) approach of subclavian vein (SCV) catheterisation is widely used as compared to supraclavicular (SC) approach. The aim of the study was to compare the ease of catheterisation of SCV using SC versus IC approach and also record the incidence of complications related to either approach, if any.Methods:In the study, 60 patients enrolled were randomly divided into two groups of 30 patients each. In Gp. SC right SCV catheterisation was performed using SC approach and in Gp. IC catheterisation was performed using IC approach. Access time, success rate of cannulation, number of attempts to cannulate vein, ease of guidewire and catheter insertion and length of catheter inserted and any associated complications were recorded.Results:The mean access time in group SC for SCV catheterisation was 4.30 ± 1.02 min compared to 6.07 ± 2.14 min in group IC. The overall success rate in catheterisation of the right SCV using SC approach (29 out of 30) was better as compared with group IC (27 out of 30) using IC approach. First attempt success in the SC group was 75.6% as compared with 59.25% in the IC group. All successful subclavian vein catheterisations in SC group and IC group were associated with smooth insertion of guidewire following subclavian venipuncture.Conclusion:The SC approach of SCV catheterisation is comparable to IC approach in terms of landmarks accessibility, success rate and rate of complications.
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