No abstract

Background and Aims:Middle ear surgery requires bloodless surgical field for better operating conditions, deep level of anaesthesia and rapid emergence. Recent studies suggest that α2 agonists could provide desired surgical field, sedation and analgesia. The present study was aimed to evaluate the clinical effects of dexmedetomidine infusion as anaesthetic adjuvant during middle ear surgery using operating microscope.Methods:Sixty four adult patients aged 18-58 years, American Society of Anaesthesiologists Grades I and II, of both gender were randomised into two comparable equal groups of 32 patients each for middle ear surgery under general anaesthesia with standard anaesthetic technique. After induction of general anaesthesia, patients of Group I were given dexmedetomidine infusion of 0.5 μg/kg/h and patients of Group II were given placebo infusion of normal saline. Isoflurane concentration was titrated to achieve a systolic blood pressure 30% below the baseline value. All patients were assessed intra-operatively for bleeding at surgical field, haemodynamic changes, awakening time and post-operative recovery.Results:Statistically significant reduction was observed in the required percentage of isoflurane (0.8 ± 0.6%) to maintain the systolic blood pressure 30% below the baseline values in patients receiving dexmedetomidine infusion when compared to those receiving placebo infusion (1.6 ± 0.7%). Patients receiving dexmedetomidine infusion had statistically significant lesser bleeding at surgical field (P < 0.05). The mean awakening time and recovery from anaesthesia did not show any significant difference between the groups.Conclusion:Dexmedetomidine infusion can be safely used to provide oligaemic surgical field for better visualization using operating microscope for middle ear surgery.

No abstract

Background: Regional anesthesia techniques for gynaecological procedures are on increasing trends due to their advantage of postoperative analgesia owing to intrathecal adjuvants. The present study was aimed to comparatively evaluate the clinical efficacy of clonidine with nalbuphine when co-administered intrathecally with 0.5% hyperbaric bupivacaine for gynaecological procedures.Methods: Regional anesthesia techniques for gynaecological procedures are on increasing trends due to their advantage of postoperative analgesia owing to intrathecal adjuvants. The present study was aimed to comparatively evaluate the clinical efficacy of clonidine with nalbuphine when co-administered intrathecally with 0.5% hyperbaric bupivacaine for gynaecological procedures.Results: The onset of sensory block was earlier in patients of Group BN (3.91±2.25 min vs 4.30±0.87 min, p=0.039). The onset of motor block was also earlier in patients of Group BN (p=0.042). The time to first rescue analgesia in patients receiving intrathecal clonidine was significantly delayed (283±14.18 min vs 231.50±26.18 min, p=0.001). Intraoperative hemodynamic changes were comparable and none of the patient suffered from respiratory depression, shivering, nausea or vomiting.Conclusions: Intrathecal clonidine as adjuvant to bupivacaine provided was clinically more effective than nalbuphine for prolonging the duration of analgesia for gynaecological procedures.

Background: Laparoscopic surgery under general anaesthesia activates the neurohumoral stress responses thereby causing release of significant amount of catecholamines into the tissue. We hypothesized that intraoperative dexmedetomidine infusion would attenuate the metabolic and hemodynamic changes during laparoscopic surgery which could be assessed by estimating the serial blood sugar level. Subjects and Methods: Sixty adult consenting patients undergoing laparoscopic surgery were enrolled. Patients were randomized into two equal groups of 30 patients each. Patients of Group D received loading dose of dexmedetomidine 1µg/kg over 10 min, followed by dexmedetomidine infusion at rate of 0.5µg/kg/h while patients of Group C received equal volume of normal saline. Primary end points were changes in heart rate, blood pressure, electrocardiogram, emergence time and serial blood glucose levels. Any adverse effects related to dexmedetomidine or anesthetic technique, were noted as secondary outcome. Results: Patients of Group D showed comparatively lower intraoperative heart rate and mean arterial blood pressure with no significant changes in cardiac rhythm. The blood glucose concentration showed 20% increase after surgery in patients of Group D versus 35% increase in patients of Group C, with statistically significant difference. The emergence time in patients of Group C was significantly lower when compared to patients of Group D. Conclusion: Dexmedetomidine infusion has effectively attenuated the metabolic and hemodynamic changes during laparoscopic surgery with inherent advantages of analgesia, sedation and anaesthetic sparing effects.

No abstract

No abstract

Background: Day care knee arthroscopy can be performed with general anesthesia, central neuraxial blockade and peripheral nerve blocks. The adjuvants to local anaesthetic may be used to enhance the duration of analgesia without increasing the duration of motor blockade. The present study compared the clinical efficacy of clonidine with fentanyl as adjuvants to epidural ropivacaine (0.75%) for day care knee arthroscopy.Methods: Sixty adult patients of both gender of ASA physical status I and II scheduled for day care knee arthroscopy under epidural anaesthesia, were randomized into two groups of 30 patients each to receive either 15 ml of 0.75% ropivacaine with 1 ml of clonidine 50 µg (Group RC) or with 1 ml of fentanyl 50 µg (Group RF). Groups were compared for onset and duration of sensory and motor blockade and post-anesthesia discharge score (PADS) as primary end points. Intraoperative hemodynamic changes, time taken to void, total duration of hospital stay and any adverse effects were evaluated as secondary end points.Results: The onset of complete sensory block to T10 (15.4±4.7 versus 17.5±3.8 minutes) and time to achieve complete motor block (23.7±3.3 versus 26.9±1.4 minutes) was earlier in patients of Group RC. Intraoperative hemodynamic changes were comparable. Time to achieve PADS was earlier in patients of Group RF (6.37±1.08 versus 7.11±0.49 hour) with no statistical significant difference. Total duration of hospital stays (7.81±1.31 versus 8.27± 1.18 hour) was also comparable.Conclusions: Clonidine and fentanyl, both can be used as epidural adjuvant to 0.75% ropivacaine for day care knee arthroscopy as they could enhance the duration of analgesia without affecting the hospital stay.