Background: Compromised ventricular function complicates the postoperative course after open heart surgery. Incidence of low-output syndrome (LOS) after cardiopulmonary bypass(CPB) is 30%. Vaso active therapy is required for weaning from bypass. Levosimendan is one of the new class of inodilator useful in refractory cardiac failure. Objective: The aim of this randomized control trial is to detect whether prophylactic levosimendan infusion is superior to milrinone in preserving better tissue perfusion, in decreasing complications related to low output syndromes and better hemodynamic control and to evaluate the efficacy of intravenous levosimendan infusion in decreasing the use of high dose of conventional inotropes and consequent prolonged hospitalization in open heart surgery patients with preoperative compromised ventricular function. Methods: Thirty consecutive patients with compromised cardiac function belongs to American Society of Anesthesiologists(ASA) physical status III who underwent open-heart surgery with CBP were randomly divided into two groups. Gr-L received levosimendan (loading dose of 12 μg/kg over 10 mins followed by infusion dose of (0.1 μg/kg /min ) and Gr-M received milrinone loading dose of 50 μg/kg over 10 mins followed by infusion dose of (0.5 μg/kg/ min )after anesthesia induction. Hemodynamic profile, mixed or central venous oxygen saturation (SVO2, SCVO2) which are surrogate markers for cardiac output, tissue perfusion were recorded, and blood obtained for troponin level. Results: SVO2 and SCVO2 were significantly higher in Gr L versus Gr M. Postoperative troponin-I concentrations, need of other inotropes incidence of arrhythmia, re-intubation, Intensive care unit(ICU) stay and hospital stay were significantly decreased in Gr L. Conclusion: Prophylactic levosimendan infusion maintains better hemodynamic control, tissue perfusion, myocardial protection and lesser complications in patients with compromised ventricular function.
Background: Rocuronium provides good intubating conditions but large doses causes prolongation of its duration of action, making it unsuitable for short surgical procedures. Aims: This study was designed to compare the effects of rocuronium with 3min priming interval and 2% sevoflurane on the time of intubation and intubating conditions. Methods: the study design is that of randomized, prospective double-blind trial. Forty five adult patients were randomly allocated into three equal groups: Group R received 0.8 mg/kg rocuronium, Group RS received 0.8 mg/kg of rocuronium with 2% sevoflurane andGroup RP patients received a priming dose of 0.08 mg/kg of rocuronium followed by 0.72 mg/kg rocuronium 3 min later. Onset time of intubation, intubating conditions and time for loss of thumb adduction were assessed. Analysis of variance (ANOVA) test was used to compare the demographic data and intubating conditions among the groups.Intergroup comparison between R and RS,R and RP,RS and RP of the time for intubation and time for the loss of thumb adduction were done using student t test. A P value <0.05 was considered significant. Results: The onset time of intubation (loss of T1 of TOF) was 100.53+2.03s in group 62.9+1.9 s in-group RS, and 61.88+1.9s in group RP. The time for the loss of thumb adduction in R,RS,RP were 98.53+2.03, 60.93+1.9, 60+2.12 respectively. There is statistical significance p=0.001 between R and RS ,R and RP group while comparing the onset time for intubation and time for the loss of thumb adduction. Mean intubating scores were excellent in all the three groups.Conclusion: Both rocuronium (0.08mg/kg) along with 2% sevoflurane and priming principle for rocuronium provide excellent intubating conditions within 60-66 sec in neurosurgical patients.
Background: To compare controlled induced hypotension for facilitating surgical exposure and reducing intraoperative blood loss, using diltiazem and nitroglycerin in total hip arthroplasty under general anesthesia. Methods: 60 adults of American Society of Anesthesiologists (ASA) grade I and II posted for total hip arthroplasty in the department of orthopaedics were selected for prospective, randomized study and allocated randomly into three groups: Group A (control group), group B (diltiazem-controlled hypotension), and group C (nitroglycerin-controlled hypotension).Statistical analysis done using SPSS 20 software. Analysis of variance (ANOVA) test was used to compare the demographic data. Intergroup comparison between A and B,B and C,A and C of the heart rate (HR) and mean arterial pressure (MAP)were done using student t test. A P value <0.05 was considered significant. Results: The mean HR of group B showed a statistically significant decrement which continued 30 min after stoppage of infusion compared to group A (p=0.001)and C(p=0.001).The mean HR of group C showed a statistically significant increase upto the stoppage of infusion compared to group A(P=0.001) and group B(P=0.001). MAP of group C (59.9+4.28)is decreased to the target MAP between 15 and 45min after starting infusion whereas group B (71.2+4.65)remained above target MAP even after 45min. Group B showed a significant decrease in mean MAP (64.43+4.34)continuing upto 30 min after stoppage of infusion(p=0.001) compared to group A(105.8+3.86) and group C(106.4+4.9). Conclusion: Diltiazem is a poor agent for the management of controlled hypotension.
Management of a premature infant with PDA poses a significant challenge in the perioperative period for the anaesthesiologist. The risk is multiplied when it is associated with other congenital respiratory anomalies. In our case a premature child at 5 month of age presented with PDA and tracheomalacia. There was a risk of airway collapse during sedation or induction of anaesthesia along with an anticipated difficult intubation. We have managed the case by inducing and intubating the patient in the lateral position without using muscle relaxants. We have used Sevoflurane as the sole anaesthetic agent for inducing and intubating the patient. Postoperatively patient was extubated in lateral position and succesfully discharged from ICU.
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