Introduction Functional endoscopic sinus surgery (FESS) is one of the common surgical procedures requiring hypotensive anesthesia; many agents have been tried to reduce the amount of blood loss. This study aims at comparing the efficacy of two agents for providing deliberate hypotension. Objectives The aim of this study was to evaluate the efficacy of esmolol and of dexmedetomidine and compare which one of the two is a better agent to produce induced hypotension during FESS. Materials and methods This was a comparative study conducted in a tertiary care hospital in Odisha, India. There were two study groups with 30 participants each who were given either esmolol or dexmedetomidine (group E and group DEX, respectively). Results Esmolol is an anti-hypertensive agent with better hemodynamic stability. The amount of drug and dose requirement was low in group DEX. The emergence time, sedation score, and time to first analgesic request were found to be highly statistically significant in group DEX. Conclusion Dexmedetomidine was found to be a better agent at controlling intra-operative blood pressure than esmolol and had beneficial effects on recovery from anesthesia and analgesia.
IntroductionAcute pain following laparoscopic surgeries interferes with the rehabilitation of the patient. Knowledge about the pain pathway from a particular area helps in blocking pain transmission at different sites. Ultrasonography (USG)-guided peripheral nerve blocks help in controlling pain better than non-steroidal anti-inflammatory drugs (NSAIDS) and opioids since they directly act by interrupting the pain pathway and interfere less with the physiology of the body. This study was planned with the objectives to evaluate the analgesic efficacy of USG-guided erector spinae plane block (ESPB) and oblique subcostal transversus abdominis plane (OSTAP) block in patients undergoing elective laparoscopic cholecystectomy, to compare the analgesic requirements in both groups, and to compare the VAS scores in both groups. Materials and methodsA total of 138 patients were randomized into two groups, with 69 patients in each group, and received either bilateral ESP (group 'E') or bilateral OSTAP (group 'O'). Those in group E received the block at the T7 level, and those in group O received the block in the subcostal region, with 20 ml of 0.2% ropivacaine and 4 mg of dexamethasone. The procedures were done after securing the airway. The total analgesic requirement and visual analogue scale (VAS) scoring in the first 24 hours post-operatively were observed, along with intraoperative opioid consumption. The opioid requirement, block-related complications, and patient feedback regarding post-operative pain control were also assessed. The results were analyzed using the Statistical Package for the Social Sciences (SPSS) software version 23.0 (IBM Corp., Armonk, NY). Continuous and categorical data were analyzed using appropriate statistical analysis. A p-value <0.05 was considered statistically significant. ResultsThe VAS scores were significantly lower during the first post-operative day in group E than in group O. In group E, VAS scoring was less than 4 for the first 24 hours post-surgery. In group O, VAS scores remained greater than or equal to 4 after four hours post-surgery, thereby indicating that the patients required opioids. Only seven patients in group E received tramadol, compared to 62 patients in group O. The mean tramadol requirement of seven patients in group 'E' was 65.71 ± 26.3 mg, and the mean tramadol requirement of 62 patients was 114.56 ± 36.8 mg (p = 0.0012). The patients in group 'O' demanded tramadol significantly more times than those in group 'E'. ConclusionIt was concluded that USG-guided ESP block provides better pain control and decreases consumption of opioids post-operatively than OSTAP block in patients undergoing laparoscopic cholecystectomy surgeries. The block was found to be safe with no adverse effects, therefore it can be a part of multimodal analgesia.
Background and objectiveThe development of modern anesthetic agents has made it possible to conduct pain-free surgical procedures. The role of the anesthetist in choosing a suitable anesthetic agent to provide a good anesthetic and sedative effect is very important in any surgical procedure. There is always a degree of risk involved as the hemodynamic parameters may be altered. This study aimed to compare the hemodynamic changes and respiratory effects between the use of etomidate and propofol for the induction of general anesthesia (GA) as well as to compare the side effects of both drugs in daycare surgeries. MethodsThe study was a parallel-design, randomized, double-blinded control trial conducted over a period of three years among patients undergoing elective daycare surgeries under GA. The patients were classified into two groups depending on the type of drug received: Group A or the propofol group and Group B or the etomidate group. Randomization was done by computer-generated random number generator software. A total of 174 patients were selected (87 in each group) at a ratio of 1:1. A baseline evaluation of the hemodynamic parameters was done followed by continuous monitoring. ResultsThe age, weight, and gender distribution of the patients in both groups were comparable. Significant hemodynamic changes were observed following induction in Group A. The fall in systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MABP) in Group A following induction was found to be statistically significant (p<0.00). The rise in heart rate was almost similar in both groups, with Group A demonstrating a slightly higher rate. There were fewer signs of respiratory depression in Group B. The major side effects observed after induction were myoclonus, which was more prevalent in Group B patients (21.84%), and pain at the injection site, which was observed more frequently in Group A (17.1%). ConclusionBased on our findings, etomidate is a drug with better hemodynamic stability and less pain at the site of injection compared to propofol. Hence, it may be a better induction agent in daycare surgeries.
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