INTRODUCTIONCisatracurium besilate is a cis-cis isomer (51W89:1R-cis 1'R-cis atracurium), one of the 10 stereoisomers of atracurium that constitutes 15% of the atracurium mixture, an intermediate duration non-depolarising neuromuscular blocking drug. It is about three to four times more potent than atracurium and devoid of cardiovascular side effects in doses of upto 8 times of ED95. The ED95 of cisatracurium is 0.05mg/kg. 1-5The rate limiting step in the degradation of cisatracurium is Hoffmann degradation.(organ independent elimination) to form laudanosine and monoquaternary alcohol. 77% of drug is cleared via Hoffmann degradation which is a ph and temperature dependent process, rest 23% of drug get cleared through organ dependent means, and renal elimination accounts for 16% of this. Hydrolysis by non-specific esterases is not an important pathway for cisatracurium degradation. It is not associated with histamine release in humans. Although the liver and kidneys play only a small role in the excretion of cisatracurium besilate, urinary and hepatic elimination pathways are important for the metabolites of laudanosine. 5-8The total body clearance (CL), steady-state Vd and elimination half-life of cisatracurium besilate in patients with normal organ function are approximately 0.27 to 0.34 L/h/kg (4.7 ml/min/kg), 0.11 to 0.16 L/kg and 22 to 35 minutes, respectively. The volume of distribution (Vd) ABSTRACT Background: Cisatracurium is one of the cis-cis isomer of atracurium (51W89:1R-cis 1'R-cis atracurium) an intermediate duration non-depolarising neuromuscular blocking drug and is devoid of histamine release. However, 2× ED95 dose of cisatracurium does not provide satisfactory intubating condition. The recommended intubating dose of cisatracurium is 3 ×ED95. The objective of this study was to evaluate and compare duration of action, hemodynamic effects and any adverse effects for different doses of cisatracurium. Methods: After Institutional Ethical Committee approval and informed patient consent, 80 patients of ASA I and II in the age group of 20-60 years were selected and included in the study. Patients were divided in two groups of 40 each, group A received intravenously 3×ED95 (0.15 mg/kg) loading dose of cisatracurium and group B received intravenously 4×ED95 (0.2 mg/kg) loading dose of cisatracurium. Results: After induction, MAP and HR shows decrease in both groups but neither statistically nor clinically significant. Better hemodynamic stability and longer duration of action was found in group B compared to group A. No adverse effects noted in both groups. Conclusions: 4×ED95 dose of cisatracurium provides longer duration of action and more stable hemodynamic status than 3×ED95. No associated signs of histamine release were detected clinically.
A study was conducted to assess the severity of COVID-19 pneumonia by ultrasonography compared to computed tomography. 50 patients, older than 18 years, referred to a major territory care centre in India between June and December 2021 with any two of the three criteria: fever, Spo2<94% on room air, and shortness of breath were studied. Patients proven to have COVID-19 pneumonia with either RT-PCR/RAT or Computed tomography scan were excluded from the study. Lung ultrasound was performed by two experienced physicians using a portable ultrasound device. A modied Lung Ultrasound Score for COVID-19 was compared with a computed tomography scan performed using a single inspiratory phase in a commercial multi-detector computed tomography scanner. Results: The correlation coefcient between the lung ultrasound score and the computed tomography severity score (r) was 0.79 (strong correlation) with a p value <0.00001 (signicant as p value <0.05). In patients with moderate to severe disease, the correlation was stronger. Conclusions: Our study showed that there is a good correlation between the lung ultrasound score and Computed tomography severity score. Lung ultrasound may help as an alternative method for diagnosing and isolating COVID-19 pneumonia patients during the peaks of the pandemic. Lung ultrasound score exhibited similar accuracy compared with chest computed tomography in the detection of lung abnormalities in COVID-19 patients.
Background: The study was designed to compare the efficacy of 0.75% isobaric Ropivacaine (3ml) with 0.5 % Hyperbaric Bupivacaine (3ml) in lower limb orthopaedic surgeries. Subjects and Methods: 100 patients between 18-60 years of age, of either sex, weighing 50-90 kgs, ASA-I and ASA-II, undergoing elective lower limb orthopaedic surgeries were randomly assigned into two groups-Group B-intrathecal hyperbaric 0.5% Bupivacaine (3ml=15mg) and Group R-intrathecal isobaric 0.75% Ropivacaine (3ml=22.5mg).The time of onset of sensory and motor block, time of peak sensory and motor block, two segment sensory regression, motor block duration, duration of analgesia, the maximum sensory dermatomal level and side-effects were observed. Results: The time of onset of sensory and motor block was earlier in group B compared to Group R(p<0.001). The time of peak sensory and motor block was earlier in group B compared to group R (p<0.001). The heart rate, SBP and DBP were statistically insignificant between the two groups (p>0.05). The two dermatomal sensory regression of B group was significantly prolonged compared to group R (p=0.0206). The total duration of motor block and sensory was significantly prolonged (p<0.001) in group B. 30 patients (60%) of B group and 36 patients (72%) of R group showed a maximal sensory dermatomal level of T6. 8 patients (16%) of group B and 10 patients (20%) of group R showed a maximal sensory dermatomal level of T4. Five patients in group B had bradycardia (p<0.05). Add this new sentence in between. Seven patients in group B and one in group R had hypotension (p<0.05). Three patients in group B had vomiting (p>0.05). Conclusion: Ropivacaine produced satisfactory anaesthesia. Ropivacaine took a longer time to 'fix' to cause sensory and motor blockage. The lessor duration of the motor block of ropivacaine is desirable. Patient in Ropicaine group showed higher proportion of maximum level of sensory analgesia and lesser incidences of hypotension and bradycardia.
BACKGROUNDDexmedetomidine, an α2 agonist is an approved drug for sedation and co-analgesia, but may cause hypotension and bradycardia. Ketamine, which provides profound analgesia and dissociative anaesthesia when used with dexmedetomidine may counteract the adverse haemodynamic effects as both have opposing actions on the cardiovascular system apart from providing satisfactory sedation and analgesia during minor surgical procedures.
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