Background and Aims:Episure™ AutoDetect™ syringe (EAS), a spring-loaded syringe, is a new loss-of-resistance syringe used to identify epidural space. It has an advantage of subjective and objective confirmation in identifying epidural space over glass syringe (GS) for beginners. We compared the performance of EAS with that of GS for identifying epidural space in lower thoracic epidurals.Methods:A total of 120 American Society of Anesthesiolgists I-II patients aged 18–60 years requiring lower thoracic epidural analgesia for surgery were randomised into Group I (EAS): Epidural identified using EAS and Group II (GS) epidural identified with GS. Patient demographic data, depth to epidural space (cm), number of attempts, time to locate epidural space (s), inadvertent dural puncture and failed epidural analgesia were the parameters noted.Results:There were no differences in patient demographics or depth to the epidural space between the two groups. There were five failed blocks in the GS group and none in the EAS group (P = 0.0287). Similarly, there were five inadvertent dural punctures in the GS group and none in the EAS group (P = 0.0287). When epidural was identified in fewer attempts, the time needed to identify epidural space was quicker with EAS (P = 0.0012).Conclusion:Using EAS allowed reliable and quick identification of the epidural space in lower thoracic epidural technique as compared to use of glass syringe. There was no incidence of inadvertent dural puncture or failed blocks with the EAS.
BACKGROUNDThe epidural technique became popular as it has some specific advantages over spinal anaesthesia. The feasibility of extended duration and differential blockade extended its application into other fields like post-operative analgesia, chronic pain relief and obstetric pain relief. But some inherent negative points of epidural technique like delayed onset and patchy analgesia persist. Various attempts have been made to rectify these negative points. Analgesic effects of magnesium sulphate on peripheral nerves may be due to the antagonism of NMDA receptors, thus preventing central sensitisation from peripheral nociceptive stimulation. Also, magnesium competitively blocks calcium influx into presynaptic endings leading to reduced acetylcholine release. The aim of the study is to add magnesium sulphate as an adjunct to epidural Bupivacaine and evaluate the impact of magnesium sulphate on the quality of the block using the following parameters; Onset of sensory blockade, Motor blockade quality, two segment regression time, Post-operative analgesia and Impact of magnesium sulphate on haemodynamic changes.
BACKGROUNDIntranasal route of drug administration is a practical option as a non-invasive alternative to intravenous route especially for children. We conducted a study to compare the effects of Dexmedetomidine and Midazolam administered as premedication agents through intranasal route. The primary outcome measures were assessing the sedation status upon parental separation and behaviour level during induction. The secondary outcome measures were assessing the acceptance of intravenous cannulation and acceptance of facemask during induction.
BACKGROUNDChildren undergoing Tonsillectomy have significant pain. Various modalities of treatment have been used to treat pain. Our aim is to compare the duration of analgesia and comfort of child with paracetamol administered through intravenous and rectal route. MATERIALS AND METHODS40 children undergoing tonsillectomy surgeries were randomised into two groups receiving either intravenous paracetamol (Group I) or rectal paracetamol (Group R) as suppositories. After induction and intubation, children were randomised to one of the groups. Haemodynamic parameters were recorded preop; intraop and post-operatively along with assessment of post-operative pain using Wong-Baker face pain scale for period of 10 hours. Kruskal-Wallis chi-square test was used to test the significance of difference between quantitative variables and Yate's chi square test for qualitative variables. RESULTSThus, duration of analgesia was significantly (p= 0.0029) higher in rectal group than in IV group. Comfort scores were not statistically significant. CONCLUSIONThe post-operative pain scores were significantly higher in the intravenous group as compared to the rectal group. There was no difference in post-operative comfort.
BACKGROUND Tracheal intubation is performed routinely during general anaesthesia to secure the airway, to facilitate ventilation of the lungs, for control of partial pressures of oxygen and carbon dioxide in arterial blood. Laryngoscopy and intubation are associated with tachycardia, hypertension and arrhythmias. Placement of LMA is effective in securing the airway. Its insertion does not require Laryngoscopy and its placement is less stimulating and produces less catecholamine release; hence, there is no tachycardia, hypertension and arrhythmias. The aim of the study is to analyse the cardiovascular response to LMA and ETT insertion. MATERIALS AND METHODS This study was done to evaluate the cardiovascular response to intubation following insertion of LMA and ETT. This is a prospective, non-randomised, clinical study of 110 patients admitted to KAP Viswanatham Medical College Hospital, Trichy, during 2002-04 to undergo elective surgical procedures. Overall, 110 patients were found to have the satisfying criteria and they were all included in the study and alternatively allotted to each group, hence the sample size is 110. The patients were in the age group of 14-70 years. RESULTS Two sample student's 't' test and standard error of mean test were used for statistical analysis of the parameters obtained in the study. The following are the results obtained in our study. The heart increased by 15.54% following endotracheal intubation and by 9.91% following laryngeal mask insertion. The systolic blood pressure showed an increase of 14.13% in endotracheal group and 4.88% in laryngeal mask group. The diastolic blood pressure increased by 17.73% in endotracheal group and 27.27% in laryngeal mask group. The rate pressure product increased by 31.26% following endotracheal intubation and 14.20% following laryngeal mask insertion. The incidence of premature ventricular contraction is 9.09% following endotracheal intubation and 3.64% following laryngeal mask airway insertion. CONCLUSION This study shows that a considerably less cardiovascular response is produced by insertion of the laryngeal mask airway compared with direct Laryngoscopy and Endotracheal intubation. The laryngeal mask airway may be useful in situations where the pressor response to endotracheal intubation should be avoided, for example during induction of anaesthesia in an hypertensive patient.
BACKGROUNDPremedication traditionally has several goals; Reduction of anxiety and fear, secretion and provision of basal or background sedation. The primary purpose of prescribing drugs in the immediate preoperative period is to allay patient anxiety. In this study ketamine was evaluated as an oral premedication agent. The effect of different dosages of ketamine and its advantages and disadvantages were studied. MATERIALS AND METHODSIn this prospective, randomized and double blind study, hundred children posted for lower abdominal and perineum surgeries. The patients were randomly divided into two Groups. Group I received 4 mg/Kg and Group II received 6 mg/Kg 30-40 min before surgery. All children were evaluated the onset and level of sedation, emotional state, reaction to separation from parents and mask application for induction of anaesthesia, side effects. The observation was analysed using student's T test and Chi-square test used to compare the data between two groups. RESULTSThe oral ketamine can be used as a better premedication drug to produce optimal sedation and emotional state. CONCLUSIONOral ketamine 6 mg/Kg has been shown to be an effective and safe agent for premedication of children undergoing elective surgeries.
BACKGROUNDInduction involves the transition from an awake conscious state with intact productive reflexes to an unconscious state. Induction is accomplished when there is no response to oral commands and loss of eyelash reflexes. The Induction of general anaesthesia is characterised by rapid loss of consciousness which is an indicator of light surgical plane of anaesthesia. Midazolam is a water soluble short-acting benzodiazepine. Midazolam possesses some of the properties of an ideal intravenous anaesthetic agent and hence has been evaluated as an induction agent for an ideal dosage.The aim of the study was to find out a minimum effective dose of midazolam by comparing 0.25 mg/kg and 0.30 mg/kg body weight as an induction agent in general anaesthesia and study about its responses namely smoothness of induction, haemodynamic changes and respiratory status during induction. MATERIALS AND METHODSIn this prospective randomised and double-blind study, sixty cases posted for abdominal surgeries were enrolled. Patients received the study drugs in a randomised manner. Group I patients received midazolam 0.25 mg/kg while group II patients received midazolam 0.3 mg/kg for induction of anaesthesia. The observations were analysed using student's test and Chi-square test to compare the data between groups. RESULTSMidazolam can be used as an induction agent in patients undergoing major surgical procedures without any systemic complications. CONCLUSIONThis study showed that Midazolam in a dose of 0.3 mg/kg was more ideal to induce clinically acceptable anaesthesia since induction and recovery were smooth and pleasant.
BACKGROUND Epidural is a central neuraxial blockade with various applications. The epidural space was first described by Corning in 1901. And Fidel Pages first used epidural analgesia in humans in 1921. Fidel Pages described the interspinous approach to the epidural space and reported satisfactory anaesthesia for abdominal procedures. Improvements in equipment, drugs and technique have made it a popular and versatile anaesthetic technique, with applications in Surgery, Obstetrics and Pain relief. Both single injection and catheter techniques can be used. Its versatility means it can be used as an anaesthetic, an adjuvant to general anaesthesia and for postoperative analgesia in procedures involving the lower limbs, perineum, pelvis, abdomen and thorax. This study compares the median and paramedian epidural techniques to identify the lower thoracic epidural space and catheter insertion for upper abdominal surgeries. METHODS AND MATERIALSThis is a comparative, randomised, double-blinded prospective study comparing median and paramedian approaches to identify the lower thoracic epidural space and catheter insertion for upper abdominal surgeries in two groups of patients comprising of fi fty patients each. The observations were analysed using Epi info software and ANOVA measure for students' test and Chi-square test to compare the data between the two groups. RESULTSThis study shows paramedian approach of identification lower thoracic epidural space has less number of attempts, less incidence of dural tap, easy insertion of catheter, less incidence of pain, less time taken to identify the epidural space and less resistance to catheter insertion than the median approach. CONCLUSIONThe location of epidural space in patients posted for upper abdominal surgeries was found to be easier and has lesser complication by paramedian approach when compared to median epidural approach.
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