Introduction: Spinal opioids have gained popularity in recent years as they augment the analgesia produced by local anesthetics. Fentanyl is one of the opioids used for such purpose however the optimal dose has not been described adequately in the literature available so far in our setup. The aim of this study is to find out the effect of adding various doses of Fentanyl to low dose hyperbaric Bupivacaine intrathecally.Materials and methods:Seventy-five parturients scheduled for caesarean delivery were randomly allocated into three groups (Bupivacaine-Fentanyl) BF10, BF20 and BF30 who received intrathecal 0.5% hyperbaric Bupivacaine 1.6 ml with Fentanyl 10µg, 20 µg and 30 µg respectively. Total volume was made to 2.2ml by adding normal saline. The outcomes measured were peak sensory level, degree of motor block, quality of intraoperative anesthesia, duration of effective analgesia, neonatal APGAR score and side effects were noted if any.Results: Peak sensory level and degree of motor block was similar in all the groups. Peak sensory level (Thoracic Dermatome) was 4.52± 0.82, 4.32± 0.62 and 4.32± 0.74 (p=0.540) in BF10, BF20 and BF30 respectively. Degree of motor block was not significantly different (p=1.000). Quality of intraoperative anesthesia improved from BF10 to BF20 (P=0.040) but did not improve significantly from BF20 and BF30 (P=0.189). Duration of effective analgesia prolonged as the dose of Fentanyl increased which was in minutes 173.64±41, 216.80±32 and 273.16±35 (p=0.000) in BF10,BF20 and BF30 respectively. Neonatal APGAR scores were similar in all groups and very little adverse effects in higher doses.Conclusion: The combination of 1.6 ml of 0.5% hyperbaric Bupivacaine and 20 µg of Fentanyl intrathecally provides excellent surgical anesthesia, prolonged postoperative effective analgesia with very few side effects. Increasing the dose of Fentanyl beyond it could prolong the postoperative pain relief but at the cost of increased adverse effects.
Introduction: While most intravenous induction agents decrease arterial blood pressure, laryngoscopy and endotracheal intubation increase the heart rate and blood pressure. Propofol causes a decrease in systemic blood pressure whereas etomidate has minimal effects on the cardiovascular system. This study aims to evaluate and compare the hemodynamic effects of propofol and etomidate during induction and endotracheal intubation. Methods: 62 ASA I and II patients, 20-60 years of age, scheduled for elective surgery were enrolled in this prospective, randomised and double blind comparative study. Group A received inj. Propofol (2 mg/kg) and group B received inj. Etomidate (0.3 mg/kg), as induction agents. Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure were recorded after induction and after intubation at one, three, five and ten minutes and intergroup comparisons were made. Results: After induction the decrease in systolic, diastolic and the mean arterial pressures were more in group A compared to group B (p = 0.003, 0.004 and 0.002). After 1 minute of intubation all haemodynamic parameters increased from the baseline with no significant differences between the two groups (p >0.05). At three minutes the decrease in heart rate, diastolic blood pressure and mean arterial pressure was more in group A than group B with p values of 0.001, 0.002 and 0.05, however systolic blood pressures showed no significant difference (p = 0.144). The decrease in blood pressures showed significant difference between the two groups (p <0.05) at five and ten minutes but the decrease in heart rate remained significant only at five minutes of intubation (p = 0.001). Conclusions: Propofol and etomidate are both effective in preventing the haemodynamic changes due to induction and endotracheal intubation, with etomidate providing more haemodynamic stability.
Introduction: Laryngoscopy and tracheal intubation are two powerful noxious stimuli that can be potentially deleterious specially in hypertensive patients. This study evaluated the efficacy of low dose oral pregabalin used as a premedication for attenuation of this marked sympathetic response of airway instrumentation. Materials and Methods:This was a double blind randomised study done at a tertiary level referral hospital. The trial was registered as UMIN-000037103 (https://www.umin.ac.jp/ctr/). Patients were randomly assigned into two groups. Placebo arm received multivitamin capsule and treatment arm received Cap. Pregabalin (75 mg), 60 minutes before the induction of general anesthesia. The level of preoperative sedation was assessed with the Ramsay Sedation Scale. Heart rate, systolic, diastolic and mean arterial blood pressure were monitored and recorded before and during induction, during laryngoscopy and 1, 3 and 5 minutes of intubation.Results: A total of 50 patients, 25 in each arm were enrolled. The baseline characteristics were comparable. SBP was significantly lower in the Pregabalin group than in Placebo at all the periods of recording, however, DBP and MAP decreased significantly during, after 1 and 3 minutes of laryngoscopy (p=0.001). Sedation was significantly better in the Pregabalin group with 86% in RSS 3 compared to 80% of a placebo arm in RSS2 (P <0.001). Conclusions:Premedication with a single oral dose of Pregabalin (75 mg) is effective for sedation and attenuation of hemodynamic response to direct laryngoscopy and endotracheal intubation in controlled hypertensive patients without any side effects.
Introduction: Exertional heat related illness particularly heat stroke is very common life threatening condition that frequently occur in young military trainee due to high ambient temperature and humidity. Objective: The study was undertaken to identify its outcome in recruits admitted in intensive care units of military tertiary care hospital. Methods: An observational cross-sectional descriptive study was done among those recruits admitted in Intensive Care Unit of military tertiary care hospital with diagnosis of heat related illness from June 2016 to August 2017 A.D. Data based on hospital case records were collected and analyzed using SPSS version 22. Primary outcome studied was mortality. Secondary outcomes studied were length of stay in ICU, hospital and on ventilator. Results: Out of 17 recruits, 12 were diagnosed as heat exhaustion and 5 were diagnosed as heat stroke. SOFA score for heat stroke and heat exhaustion patients ranged from 2-16 and 0- 2 with respective mortality rate 7-95% and 0-7%. APACHE II score for heat stroke and heat exhaustion patients ranged from 5-33 and 0-5 with respective mortality rate 5.80-73% and 0-5.80%. There was no mortality among 12 heat exhaustion patients. Out of 5 heat stroke patients, 3 died with 60% mortality rate. Heat stroke patients had maximum stay of 4 days in ICU, hospital for 5 days and ventilator for 4 days. Conclusion: Exertional heat related illness is common in young military trainee with heat exhaustion and heat stroke being common causes for ICU admission. Heat stroke has higher mortality rate due to multiple organ dysfunction.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.