BACKGROUND Dexmedetomidine is a selective α2 adrenoreceptor agonist, is more potent, and is highly lipid soluble which causes rapid systemic absorption and local anaesthetic effect. It is therefore a suitable choice for intravenous regional analgesia. Studies on peripheral nerves in-vivo have proved that dexmedetomidine may be safely administered for intravenous regional analgesia in combination with local anaesthetics. The present study compared the onset, quality, total duration, and efficacy of analgesia between the two groups and also attempted to study the toxicity between the two groups after the tourniquet is released. METHODS This is an observational study. Institutional Ethics Committee approval and written informed consent were obtained. Fifty patients in the age group 20-60 years belonging to ASA physical status 1 were selected to participate in the study. Both emergency as well as elective patients were included. RESULTS Minimum period of post-operative analgesia in the dexmedetomidine group (study group) was 180 mins. and maximum was 540 mins. with a mean value of 343.2 mins., in the control group it was varied from 5 mins. to 30 mins. with a mean of 17.8 mins. CONCLUSIONS Addition of 0.5 µg/Kg of dexmedetomidine along with 0.5% preservative free lignocaine can be recommended for intravenous regional analgesia of extremity surgeries as it offers a simple, inexpensive and safe means of good quality postoperative analgesia.
BACKGROUND There are extensive variations in central venous pressure during intraoperative period of a major neurosurgical patients. Monitoring of central venous pressure is vital for guiding the administration of fluids, blood and blood products. Central venous pressure (CVP) also measures the intracranial pressure indirectly. Increased intracranial pressure thereby reduces the cerebral blood flow, leading to cerebral ischemia. METHODS This is a prospective study where 25 major neurosurgical cases posted for elective major neurosurgery were selected. Right subclavian vein was selected for cannulation, by blind technique in all these cases. CVP was recorded every 15 minutes. Central venous catheter was connected to a pressure transducer linked to a multichannel monitor; zeroing was done and the CVP reading obtained. RESULTS Central venous pressure reading was done serially and showed the trends in haemodynamics in various stages of surgery. Initial intraoperative periods showed lower values due to intravenous (I / V) induction of anaesthesia, use of mannitol and diuretics. Later on, the trends changed to higher side subsequent to administration of fluids and blood as required. CONCLUSIONS Monitoring of CVP is an important component of haemodynamic monitoring along with non-invasive blood pressure (NIBP), intra-arterial blood pressure (IABP), and urine output. Central venous pressure can be used to aspirate an air embolism occurring during the intraoperative period after employing Durant’s position. KEYWORDS CVP, NIBP , USS – Ultra Sound Scan, IVC – Inferior Vena Cava, IVCCI – Inferior Vena Cave Collapsibility Index, PEEP – Positive End Expiratory Pressure, C / L – Central Line, IABP.
BACKGROUND Day-care procedures have become accepted and popular among the surgeons and anaesthesiologists all over the world in recent times especially for ENT surgeries. The economic and financial implications are making them acceptable among the general population also. Alleviating acute pain during immediate postoperative period plays a crucial role in deciding the fitness for discharge of the patient. We wanted to evaluate the pain intensity and observe the role of analgesia in its alleviation in postoperative period following day-care ENT surgeries. METHODS 96 adult patients undergoing various types of day-care surgeries in the department of ENT were included in this study. The pain scores were measured using Verbal Pain Intensity Score (VPIS) at frequent two hourly intervals. Opioids, and Paracetamol were used as analgesics. Antiemetic Ondansetron was used to combat nausea and vomiting. The effect of analgesics was assessed using mean values and Friedman test for repeated measures. RESULTS Out of 96 patients 55 (57.29 %) were males and 41 (42.70 %) were females with a male to female ratio of 1.4:1. The mean age was 31.50 ± 4.15 years. 32 / 96 (33.33 %) ear surgeries, 26 / 96 (27.08 %) nose surgeries, 22 / 96 (22.91 %) throat surgeries and 16 / 96 (16.66 %) head and neck surgeries were performed. Moderate to extremely intense grade pain was noticed in 75 / 93 (80.64 %) patients. CONCLUSIONS The prevalence of moderate to extremely intense acute postoperative pain in 75 / 93 (80.64 %) patients was high. But the analgesics prescribed were effective to control the pain and the mean pain intensity was less than 2 in 14 hours, hence 85 / 96 (88.54 %) patients could be discharged in time. The associated symptoms were managed with supportive care and required no additional medications and these patients were discharged after overnight stay. KEYWORDS Day-Care Surgery, Analgesia, Opioids, VPIS, Associated Symptoms, Postoperative Pain
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