Background:In patients with penetrating eye injury and a full stomach, suxamethonium is still used for rapid sequence induction of anesthesia. But its use is associated with the rise in intraocular pressure (IOP) and this can result in permanent vision loss in these patients. Dexmedetomidine and clonidine are two alpha-2 adrenergic agonist drugs which prevent the rise in IOP. The aim of this study is to compare the efficacy of intravenous (i.v.) dexmedetomidine and clonidine in preventing an increase in IOP after administration of suxamethonium and tracheal intubation.Materials and Methods:Sixty patients undergoing elective nonophthalmic surgery under general anesthesia were included in this clinical study. Patients were randomly assigned into three groups to receive 0.5 mcg/kg dexmedetomidine (Group D), 2 mcg/kg clonidine (Group C) or normal saline (Group S) as premedication i.v. over a period of 10 min before induction. IOP, heart rate, and mean arterial pressure were recorded before and after premedication, after suxamethonium, after intubation and then after 5 min.Results:Following administration of dexmedetomidine and clonidine IOP decreased in both groups. After suxamethonium IOP increased in all three groups but it never crossed the baseline in Group D and C. After laryngoscopy and intubation IOP again increased in all three groups but in dexmedetomidine group it never crossed the baseline whereas in clonidine group it was significantly higher than the baseline.Conclusion:Single i.v. dose of dexmedetomidine premedication (0.5 mcg/kg) blunt the IOP and hemodynamic response to suxamethonium injection and tracheal intubation more effectively than single i.v. dose of clonidine premedication (2 mcg/kg).
We report a case of pentazocine induced multiple contractures leading to residual deformities in a young female presenting for emergency caesarean section. During preoperative assessment, severe disabling abduction deformities of both lower limbs at hip as well as knee and restricted movements of right upper limb were noted. History revealed intramuscular abuse of pentazocine and promethazine for 6 years, from an early age. She was presently de-addicted for last 3 years. Despite difficult positioning, we were able to perform the subarachnoid block successfully.
Propofol is a widely used intravenous agent for general anesthesia and sedation. Propofol is associated with a variety of neuroexcitatory events including: opisthotonus, muscle rigidity, myoclonus, and seizures collectively termed as seizure-like phenomenon (SLP). We report a rare case of propofol induced severe neuroexcitatory symptoms at the time of induction in a young male presenting for emergency laparotomy. He developed generalized tonic- clonic seizures which resulted in dislodgement of intravenous cannula. Immediately a new intravenous cannula was inserted with difficulty during convulsions and injection thiopentone 200 mg bolus was given. Convulsions subsided within a minute. Patient remained hemodynamically stable and surgery was uneventful. He developed emergence agitation which was treated with injection midazolam. Patient recovered with no neurologic sequelae. [Int J Basic Clin Pharmacol 2013; 2(5.000): 645-646
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