Background: Compromised ventricular function complicates the postoperative course after open heart surgery. Incidence of low-output syndrome (LOS) after cardiopulmonary bypass(CPB) is 30%. Vaso active therapy is required for weaning from bypass. Levosimendan is one of the new class of inodilator useful in refractory cardiac failure. Objective: The aim of this randomized control trial is to detect whether prophylactic levosimendan infusion is superior to milrinone in preserving better tissue perfusion, in decreasing complications related to low output syndromes and better hemodynamic control and to evaluate the efficacy of intravenous levosimendan infusion in decreasing the use of high dose of conventional inotropes and consequent prolonged hospitalization in open heart surgery patients with preoperative compromised ventricular function. Methods: Thirty consecutive patients with compromised cardiac function belongs to American Society of Anesthesiologists(ASA) physical status III who underwent open-heart surgery with CBP were randomly divided into two groups. Gr-L received levosimendan (loading dose of 12 μg/kg over 10 mins followed by infusion dose of (0.1 μg/kg /min ) and Gr-M received milrinone loading dose of 50 μg/kg over 10 mins followed by infusion dose of (0.5 μg/kg/ min )after anesthesia induction. Hemodynamic profile, mixed or central venous oxygen saturation (SVO2, SCVO2) which are surrogate markers for cardiac output, tissue perfusion were recorded, and blood obtained for troponin level. Results: SVO2 and SCVO2 were significantly higher in Gr L versus Gr M. Postoperative troponin-I concentrations, need of other inotropes incidence of arrhythmia, re-intubation, Intensive care unit(ICU) stay and hospital stay were significantly decreased in Gr L. Conclusion: Prophylactic levosimendan infusion maintains better hemodynamic control, tissue perfusion, myocardial protection and lesser complications in patients with compromised ventricular function.
Background: Longer duration of analgesia, ceiling effect on respiratory depression, and the antihyperalgesia property make buprenorphine a good adjuvant for managing moderate-to-severe postoperative pain. Aims: The aim of this study is to evaluate the onset and duration of postoperative analgesia of three different doses of buprenorphine of 60, 100, and 150 μg given intrathecally along with hyperbaric bupivacaine in patients undergoing lower limb surgeries. Setting and Design: This prospective observational study was carried out in the anesthesia department of a tertiary care hospital. Materials and Methods: The study included 90 patients of either sex, aged 18–60 years, scheduled for elective lower limb surgery under subarachnoid block. Patients were randomly allocated into three groups (30 each) receiving different doses of buprenorphine. In addition, all patients received 3 mL of 0.5% hyperbaric bupivacaine. Statistical Analysis Used: The Chi-square test or Fisher's exact test was used to find out the association between the categorical variables. The association of quantitative variables between the groups was assessed by Kruskal–Wallis test while within the groups was assessed by repeated-measures analysis of variance test. Results: Baseline characteristics such as age, gender, and American Society of Anesthesiologist physical status classification were comparable among the three groups. Sensory block, motor block, and total duration of analgesia were significantly higher with higher doses of buprenorphine. The mean difference in the duration of analgesia was comparable in patients receiving 100 μg (720 min) and 150 μg (825 min) of buprenorphine. Bradycardia as a side effect was only in patients receiving 150 μg of buprenorphine. Conclusion: Risk–benefit of different doses of buprenorphine suggests that 100 μg may be the ideal dose for a better quality of spinal block and maintaining hemodynamic stability.
Objective: We administered intraoperative pectoral nerve block after tissue resection was over and assessed its analgesic efficacy with conventional post-operative intravenous opioids in patients undergoing modified radical mastectomy. Methods: Sixty patients undergoing modified radical mastectomy surgery were enrolled in this prospective, randomized, and doubleblinded study. After general anesthesia and surgical resection in both groups, Group P received pectoralis (PECS) block under vision with ropivacaine at two points: 20 ml in the fascia over serratus anterior and 10 ml in the fascia between pectoral major and minor at the level of the third rib and Group T received tramadol (75 mg) in thrice daily frequency and 2% lignocaine infiltration at suture site. Primary objectives were to assess visual analog scale (VAS) scores over 24 h, time to first request for rescue analgesia (ketorolac) and total dose of analgesics needed, and secondary outcome was adverse effects and patient satisfaction score. “Mann–Whitney U test” and “Chi-square/Fischer exact test” were used for quantitative and categorical variables, respectively. Results: The mean time to the first rescue analgesia was 1175±120.21 and 1175±77.35 min and total analgesia requirement was equal (30.00±0.00 mg) in Group P and Group T, respectively. The mean VAS score over 24 h was comparable in both the groups. PECS block group had significantly less adverse effects and better satisfaction score. Conclusion: PECS block has similar analgesic efficacy as opioids but with better ability to mobilize the respective arm, better patient satisfaction score, and lesser adverse effects.
Objectives: Septic shock is associated with refractory hypotension and organ dysfunction and remains an important cause of mortality in intensive care units (ICUs). Vasopressors are the first-line treatment. The present study aims to compare vasopressin and phenylephrine in the management of dopamine-resistant septic shock in the ICU setting. Methods: The study is a prospective, open-labeled, and randomized study comparing the effects of vasopressin (Group I) and phenylephrine (Group II) in the management of dopamine resistant septic shock in intensive care set up. The parameters recorded from 0 to 6 h after persistent hypotension despite maximum dose of dopamine were: Heart rate (HR) (beats/min), systemic blood pressure (mmHg), cardiac output (L/min), cardiac index (CI) (L/min/m2), stroke volume (ml), systemic vascular resistance index (dynes/cm5/m2), oxygen delivery index (IDO) (ml O2/min/m2), urine output (ml), and serum lactate (mg/dl). Results: There was a significant difference in HR, systolic blood pressure, cardiac output, and CI in both groups from 1 h to 6 h. The IDO had a significant rise in Group II. The serum lactate level also decreased in Group II at 6 h. Conclusion: From our study, we concluded that as organ perfusion and oxygenation are more important for the treatment of septic shock and to keep the vital organs functioning rather than to increase the systemic vascular resistance and blood pressure, phenylephrine showed a better result than vasopressin in the treatment of septic shock.
Objective: Our aim is comparison of hemodynamic status and complications between two different doses of intramyometrial vasopressin during laparoscopic myomectomy. Methods: We did a retrospective analysis of hemodynamic status and its anesthetic concerns in patients who received two different doses of intramyometrial vasopressin. Eighty patients undergoing laparoscopic myomectomy under general anesthesia were divided into two groups of 40 patients in each group. In Group A (n=40), 10 units of intramyometrial vasopressin in 200 ml of normal saline were given and, in Group B, 20 units of intramyometrial vasopressin in 200 ml of NS were given intraoperatively by surgeon. Results: 20 units intramyometrial vasopressin used dogmatically by surgeons drops blood loss but it is connected with cardiovascular impediments. Hence, 10 units of intramyometrial vasopressin as compared to 20 units which are used by some surgeons are associated with similar blood loss and lesser side effects such as bradycardia, pulmonary edema, hypotension, blood loss, and increased airway pressure. Conclusion: Hence, anesthesiologists and gynecologists must take the precautions to escape and minimize the frequency of impediments with intramyometrial vasopressin by selecting the appropriate dosage of vasopressin.
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