Background: Supraglottic airway devices (SAD) are becoming increasingly popular for use in patients undergoing laparoscopic surgeries. In this prospective randomised study, we compared three supraglottic airway devices namely, I-gel, Supreme LMA and Ambu Auragain. Aims and Objectives: The study was undertaken to compare three supraglottic airway devices I-gel, Supreme LMA and Ambu Auragain in laparoscopic surgeries under general anaesthesia with controlled ventilation. Materials and Methods: This was a randomized comparative study in which 90 patients undergoing laparoscopic surgeries under general anesthesia were included. In group A Ambu AuraGain was used whereas in group I and Group S I-gel and Supreme LMA was used respectively. Primary outcome measures which were compared amongst the studied groups included time taken for insertion, ease of insertion, attempts required for insertion, ease of insertion of Ryles tube, fiberoptic bronchoscopic grading and Oropharyngeal leak pressure. Results: There was highly significant difference in the time taken for insertion of SAD in Group-A when compared to Group- I (p<0.0001) and Group-S (p<0.0001). Group-A had significantly increased grades of ease of insertion of SAD when compared to Group-I (p=0.04) and Group-S (p=0.004). 16.66% of patients in Group-A required 3 attempts for successful insertion of the SAD, while no patients in Group- I or Group A required more than two attempts for insertion(p<0.05). Conclusion: Ambu AuraGain provides better oropharyngeal seal and has higher leak pressures as compared to I-gel and Supreme LMA with similar hemodynamic stability and post-operative outcome makingit a preferable SAD over I-gel and Supreme LMA.
Background: Lower segment caesarean sections (LSCS) are commonly done under spinal anaesthesia. Although spinal anaesthetic techniques are relatively safe and associated with quick and uneventful recovery, post-operative pain is a major concern after effect of spinal anaesthesia weans off. Other than pain postoperative nausea and vomiting (PONV) is one of the important side effects of spinal anaesthesia. Steroids by virtue of their anti-inflammatory effect is expected to reduce pain consequent upon inflammation and many studies have shown their efficacy in reducing pain as well as PONV in post-operative patients. Aims and Objectives: Primary objective of the study was to evaluate efficacy of single-dose dexamethasone in reducing post-operative pain. The secondary objectives were to analyse effect of single-dose dexamethasone on hemodynamic stability as well as incidence of nausea and vomiting in patients undergoing LSCS under spinal anesthesia. Materials and Methods: This was a double-blind comparative study in which 60 patients undergoing LSCS under spinal anaesthesia were included on the basis of a predefined inclusion and exclusion criteria. Written informed consent was obtained from all patients. The patients were divided into two groups: Group D: 30 patients who received IV dexamethasone 8 mg (2 ml) intravenously just before giving spinal anesthesia. Group N: 30 patients who received Normal saline (2 ml) immediately before spinal anesthesia. In both groups, hemodynamic parameters, respiratory rate, severity of post-operative pain, and incidence of PONV was compared. P value less than 0.05 was taken as statistically significant. Results: Patients in Group D had significantly less severe post-operative pain (as assessed by the Visual analog scale) and incidence of PONV (P<0.05). Significantly less post-operative rescue analgesia was required in patients who received single dose of intravenous dexamethasone (P<0.05). In terms of hemodynamic stability, both groups were found to be comparable with no statistically significant difference. Conclusion: Single-dose dexamethasone is effective in reducing post-operative pain as well as incidence of PONV in patients undergoing LSCS under spinal anesthesia.
Background: Ropivacaine is a relatively recent local anaesthetic agent. Its decreased lipophilicity is associated with decreased incidence of central nervous system toxicity and cardiotoxicity. This study was aimed to evaluate safety,efficacy, effects on haemodynamics and complications of spinal anaesthesia using 0.5% hyperbaric Bupivacaine and 0.75% isobaric Ropivacaine in patients undergoing transurethral resection of prostate. Aim: To study safety, efficacy, effects on haemodynamics and complications of spinal anaesthesia using 0.5% hyperbaric Bupivacaine and 0.75% isobaric Ropivacaine in patients undergoing transurethral resection of prostate. Methods: Ninety patients were included in our case control study and they were randomly divided into two groups, Group A and B. Group A received 3 ml of 0.5% of hyperbaric bupivacaine and group B received 3ml of 0.75% isobaric ropivacaine. The parameters like demographic characteristics, duration of surgery, onset of sensory and motor blockade, haemodynamic stability and complications were compared in both the groups. Results: There was a significantly less time required for sensory as well as motor blockade in Group B than in group A. Patients in group B was found to be haemodynamically more stable with less incidence of hypotension. Moreover incidence of complications during and after surgery was less in Group B as compared to Group A. Conclusion: 0.75% isobaric Ropivacaine is a better choice for spinal anaesthesia in elderly patients undergoing transurethral resection of prostate as compared to 0.5% hyperbaric Bupivacaine.
ABSTRACT:Introduction: Fracture of proximal femur is a common occurrence following road traffic accidents and falls (in relatively older age group). These fractures are associated with considerable pain before surgery and in postoperative period. Effective pain management during positioning and in postoperative period is crucial and fascia Iliaca compartment block can be used effectively for this purpose in these patients. Many adjuvants like epinephrine, clonidine, Opioids, ketamine, dexamethasone and dexmedetomidine were combined with local anaesthetics to prolong the post-operative analgesia. We conducted this prospective study to know duration of post-operative analgesia with Fascia iliaca compartment block (ficb) using Bupivacaine with Dexmedetomidine and Bupivacaine with Dexamethasone in patients with proximal fracture femur. Materials and methods: This was a randomized, prospective, double blinded and controlled study done in the department of anesthesiology of a medical college situated in an urban area. 90 patients of either gender , ASA grade I & II ,the age of whom was between 18-80 years and who were undergoing surgery for proximal fracture femur under spinal anesthesia were enrolled in this study . All these patients received FICB by landmark technique before spinal anesthesia. The patients were divided in 3 groups. Group I -Patient in this group received 0.25% Bupivacaine plus normal saline 0.9%. Group II Patient in this group received 0.25% Bupivacaine plus dexamethasone. Group III Patient in this group received 0.25% Bupivacaine plus dexmedetomidine. Level of analgesia during positioning and in post operative period along with other parameters like sedation scores, VAS scores, hemodynamics and complications in these 3 groups were compared. Results: The study comprised of 90 patients out of which 45 (50%) were males and 45 (50%) were females with a M: F ratio of 1:1. ASA Grades and Mean duration of surgeries in these groups were comparable. For preoperative Pulse Rate, SBP, SpO2 the test used was One-Way ANOVA. p > 0.05 for all three parameters. There was no significant difference in onset of FICB and time required for giving spinal anesthesia in three groups (p>0.05). 27(90%) patients in group I, 25(83%) patients in group II and 26(87%) patients in group III had no sensation to pinprick thirty minutes after FICB. Preoperative pulse rate and pulse rate thirty minutes after FICB were compared .There was significant reduction in pulse rate (p<0.05) in group III 30 minutes after FICB. The analysis of changes in mean pulse rates showed that there was no significant difference in mean pulse rate intraoperatively (p>0.05). the study of postoperative duration of analgesia showed that There was highly significant difference in post-operative duration of analgesia between group I&II ,group I&III and group II&III . Conclusion: Addition of dexamethasone or dexmedetomidine to Bupivacaine for fascia iliaca compartment block in patients with proximal femur fracture further prolongs post-operative analgesia comp...
Background: Tonsillectomy is one of the most common surgical procedures in population and post tonsillectomy pain affects analgesic consumption, hospital stay, oral intake and return to regular activity. Aims and Objectives: The purpose of the study was to compare peritonsillar infiltration and intravenous administration of dexmedetomidine for perioperative analgesia in tonsillectomy. Materials and Methods: This was a placebo-controlled study to compare peritonsillar infiltration and intravenous administration of dexmedetomidine in patients undergoing tonsillectomy. Ninety patients were included in this study on the basis of a predefined inclusion and exclusion criteria. These patients were divided in 3 groups on the basis of whether they received Peritonsillar dexmedetomidine, intravenous dexmedetomidine or intravenous normal saline. The groups were compared for post-operative pain, time to first request of rescue analgesia (duration of analgesia), post-operative sedation, analgesic requirement during first 24 hours and side effects. SSPS 21.0 was used for statistical analysis and p value less than 0.05 was taken as statistically significant. Results: Out of total 90 patients included in this study there was a female preponderance with a M: F ratio of 1:1.5. The mean age and ASA grades and mean duration of surgery of patients in all 3 groups were found to be comparable with no statistically significant difference in any of the groups (P>0.05). Preoperative mean systolic and diastolic blood pressures as well as mean arterial pressure and SPO2 was found to be comparable in all 3 groups. However intraoperative blood pressures (systolic, diastolic as well as mean arterial pressures) and SPO2 showed significant difference amongst the groups (P<0.05). Time to first request of rescue analgesia was found to be more in group - Dpt than group – Div and group – Pb which was highly statistically significant (p <0.0001).There was statistical significant difference in number of diclofenac injections consumed during first 24 hours between group – Dpt & group – Div and highly significant difference between group – Dpt & group – Pb, group – Div & group – Pb. Conclusion: Peritonsillar infiltration of dexmedetomidine is better alternative to intravenous dexmedetomidine in tonsillar surgeries.
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