Background: To compare propofol and etomidate as anaesthetic agents for elective non-cardiac surgery with respect to stability of haemodynamic parameters, systemic side effects and quality of induction.Methods: Randomised, blinded study of 100 patients posted for elective non-cardia surgery under general anaesthesia, divided in to two group. In group P(n=50) induction was achieved with injection Propofol 1mg/kg, whereas in group E(n=50), it was achieved with injection etomidate 0.3mg/kg after premedication with injection midazolam 0.04mg/kg and fentanyl 2µg/kg in both the group. Hemodynamic parameters like, heart rate, systolic BP, diastolic BP, Mean BP and induction time in seconds, pain on injection, myoclonus, post-operative nausea, vomiting were recorded at different time intervals (base line, at induction, immediately after intubation and 1,3,5 and 15 min after intubation).Results: There was no statistically difference was found in demographic profile and baseline hemodynamic parameters but significant different was found in intraoperative mean HR, SBP, DBP, MBP at various time intervals, and our result was more in favour of E group as compare to P, in which above recorded vital parameters were decreased more than E and induction time was also faster in E as compare to P. Pain on injection and post-operative nausea, vomiting was more in group P as compare to E, however the myoclonus movements was more in E group as compare to P but statistically not significant.Conclusions: Etomidate is a better intravenous induction agent of anaesthesia than Propofol in hemodynamically unstable patient also as it has faster onset of action with less pain and post-operative nausea, vomiting with good hemodynamic stability.
Introduction: Supraclavicular brachial plexus block is used for providing pain relief in upper limb surgeries and has many advantages over general anaesthesia. Alpha-2-adrenergic agonists are chosen with local anaesthetics for their sedative, analgesic and antihypertensive properties. Aim: To compare the efficacy of clonidine and dexmedetomidine when added to 0.5% ropivacaine in nerve stimulator guided supraclavicular block when performed for upper limb surgeries. Materials and Methods: This randomised clinical study was conducted in the Department of Anaesthesia Mata Chanan Devi Hospital, New Delhi, India (tertiary care center), from September 2015 to September 2016. Total 90 patients were randomly allocated into three groups. Group A {Inj. ropivacaine 0.5% (29 mL)+ normal saline 1 mL to make 30 mL}, group B {Inj. ropivacaine 0.5% (29 mL)+ clonidine 1 μg kg-1 to make 30 mL) and group C {Inj. ropivacaine 0.5% (29 mL)+ dexmedetomidine 1 μg kg-1 to make 30 mL}. Parameters observed included onset of sensory and motor block, total motor duration, postoperative analgesia as primary outcome; and intraoperative haemodynamic parameters and side effects as secondary outcome. Results: All the three groups were found to be similar with demographic profile. Patients in dexmedetomidine group showed faster onset and longer duration of sensory and motor blocks (p-value<0.01). The mean onset of sensory block in minutes was 12.03±2.20, 8.20±1.40, 6.80±1.35 in groups A, B and C, respectively (p-value<0.001). The mean onset of motor block in minutes was 18.47±2.78, 13.37±2.86 and 11.30±2.04 in group A, group B and C, respectively (p-value<0.001). The mean duration of analgesia in group A, B and C was 555.17±65.36, 710.00±73.58 and 902.67±116.65 minutes, respectively (p-value<0.001). The mean duration of motor block in group A, group B and group C were 330.00±51.78, 418.17±38.29 and 516.83±50.33 minutes, respectively (p<0.0001). The duration of postoperative analgesia and total motor duration were significantly prolonged in dexmedetomidine group than group A and B. Conclusion: It can be concluded that both clonidine and dexmedetomidine increases the total motor duration and postoperative analgesia when added to ropivacaine, but dexmedetomidine is a better choice when used in supraclavicular block, without any significant side-effects.
Objective This prospective randomised double-blind study was conducted to compare the effect of intravenous (IV) with intraperitoneal (IP) administration of clonidine with respect to analgesic efficacy and side effects. Methods A total of 60 American Society of Anaesthesiologists (ASA) physical status class I and II patients, aged 35–60 years, undergoing total abdominal hysterectomy, were randomly divided into 2 groups. Standard general anaesthesia technique was used. All the patients in group IV received 3 μg kg −1 of IV clonidine after resection of the uterus along with 0.25% bupivacaine (20 mL intraperitoneally and 10 mL as wound infiltration), whereas patients in group IP received 10 mL of normal saline intravenously and 3 μg kg −1 of clonidine mixed with 0.25% bupivacaine (20 mL intraperitoneally and 10 mL as wound infiltration). Postoperative analgesia was provided with IV diclofenac every 8 hours and IV fentanyl (1 μg kg −1 ) on demand. Pain at rest, opioid consumption, level of sedation and severity of nausea were recorded for 24 hours. The heart rate (HR) and blood pressure (BP) were recorded at an interval of 15 minutes for 2 hours followed by routine hourly monitoring. Results Both the groups were found to be similar with respect to demography and ASA physical status. The maximum pain was felt at 6 hours in both the groups. The mean visual analogue scale score at 6 hours (p=0.47) was comparable. However, patients in group IV had significantly higher sedation (p<0.001) and nausea (p=0.013) scores on arrival at post-anaesthesia care unit along with a significant reduction in HR (p=0.001) and BP (p=0001) for the first 2 hours postoperatively. Conclusion Although IP clonidine is comparable with IV clonidine with respect to postoperative pain scores and supplementary opioid requirement, the side effects are significantly less with IP clonidine.
Background: Onset of hemodynamic changes is often associated with procedures such as laryngoscopy and tracheal intubation. This poses an increased risk of fatality in high-risk patients with diseases such as cardiovascular diseases. Several attempts utilizing singular parameters have been used to combat this clinical manifestation. In this study, we have used a holistic approach, in combination with the pre-recommended parameters, to attenuate the pressor responses during the procedure. Subjects and Methods: Sixty adult patients were randomized into two groups, receiving two different doses of dexmedetomidine (0.5 µg or 1 µg) per kilogram of the bodyweight. In addition, the quality of the intubation was also assessed using the scoring system adapted from McNeil et al., 2000. Longitudinal monitoring of various physiological parameters such as systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) and O2 saturation (SpO2) was performed at four different time points during the procedure. Results: Our results revealed that dexmedetomidine administration results in a transient decrease in these parameters in the patients from both the groups, with more prominent effects in the Group I patients, received 1 µg/kg of dexmedetomidine. Moreover, at time-point T3 (60 sec after intubation), a transient increase was observed in almost all the tested parameters. The assessment of the intubating conditions revealed no significant differences among the groups. Conclusion: A higher dosage of dexmedetomidine (1 µg/kg) showed better management of hemodynamic responses during laryngoscopy and intubation.
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