High levels of testosterone seen in CAIS can stimulate Wolffian duct development/differentiation. Gonadectomy is advisable in such patients to avoid future neoplastic changes.
BACKGROUND Supraclavicular block provides anaesthesia for upper extremity in the most consistent andf efficient manner of any brachial plexus technique. Adjuvants when added to local anaesthetics enhance the onset and prolongs the duration of block. α2 agonists produce analgesia, sympatholysis and sedation, hence considered as effective adjuvant. The aim of this study is to compare the efficacy and safety of two α2 agonists, i.e. clonidine and dexmedetomidine as an adjuvant for brachial plexus block. MATERIALS AND METHODS It was a prospective, randomised and double-blind study. Sixty patients of ASA grades I and II undergoing forearm surgeries were randomly divided into two groups of 30 patients each. Group C patients received Inj. Bupivacaine (0.5%) 2 mg/kg + Inj. Lignocaine (2%) 5 mg/kg with adrenaline + Inj. Clonidine 1 μg/kg. Group D patients received Inj. Bupivacaine (0.5%) 2 mg/kg + Inj. Lignocaine (2%) 5 mg/kg with adrenaline + Inj. Dexmedetomidine 1 μg/kg. Parameters noted were onset, completion and duration of sensory and motor block, duration of analgesia, Ramsay sedation score, vital parameters and complications if any. Results were analysed by student's unpaired 't' test and chi-square test. RESULTS Onset and time for complete sensory and motor block was significantly faster in the dexmedetomidine group when compared to the clonidine group. The total duration of sensory and motor block and duration of analgesia was also significantly longer in Group D. Both the groups had stable haemodynamics. No complications or side effects were observed in both the groups. CONCLUSION Dexmedetomidine can be used as an adjuvant, alternative to clonidine in supraclavicular brachial plexus block with prolongation of both sensory and motor block, and without any haemodynamic instability and systemic side effects.
BACKGROUND Middle ear surgeries done under local anaesthesia require adequate patient sedation and analgesia to prevent patient anxiety and movement during surgical procedures. This study was undertaken to compare dexmedetomidine and propofol for their sedative and analgesic properties, safety profile, adverse events and recovery profile in patients undergoing middle ear surgery under monitored anaesthesia care. METHODS This is a prospective observational study. 96 patients of both sexes, of American society of anaesthesiologist (ASA) grade I or II, between 18 - 60 years of age were randomly divided into two groups; group D and group P consisting of 48 patients each. Patients in group D received a loading dose of injection dexmedetomidine 1 µg / kg I.V. over 10 minutes followed by an infusion at a rate of 0.5 µg / kg / hr. Patients in group P received a loading dose of injection propofol 75 µg / kg / min. I.V. over 10 min followed by an infusion at a rate of 50 µg / kg / min. Time taken to achieve the modified Aldrete score of 10 was compared between both the groups. Before discharge from post anaesthesia care unit (PACU), patient’s satisfaction with sedation & surgeon satisfaction was recorded on Likert scale. Time to rescue analgesia was compared. RESULTS The Bi-Spectral Index values in intra-operative period were on the lower side in the group D as compared to the corresponding values in the group P, but P values were statistically insignificant suggesting that both dexmedetomidine and propofol produced similar sedation. Time to rescue analgesia was greater for group D. CONCLUSIONS Having similar sedation effect, dexmedetomidine was better than propofol for sedation in patients undergoing middle ear surgery under monitored anaesthesia care. KEYWORDS Dexmedetomidine, Propofol, Monitored Anaesthesia Care, Bi-spectral Index
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