The number of patients with uncorrected congenital cyanotic heart disease is less but at times some may present for non-cardiac surgery with a high anesthetic risk. Some of these may even be adults with compromised cardiopulmonary physiology posing greater challenges to the anesthesiologist. The authors have used a combination of dexmedetomidine and ketamine for anesthesia for non cardiac surgery in five patients with cyanotic heart disease and right to left shunt (3-Eisenmenger's syndrome, 2-Tetralogy of Fallot). The sympathoinhibitory effects of dexmedetomidine were balanced with the cardiostimulatory effects of ketamine, thereby maintaining good cardiovascular stability. The analgesia was good and there was no postoperative agitation. This drug combination was effective and safe for patients with cyanotic heart disease for non cardiac surgeries.
Background: In most instances rapid emergence from general anesthesia after intracranial neurosurgery is desirable. The most compelling reason for this is the need for the patient to cooperate with a postoperative neurological examination intended to screen for such potential intracranial disaster as hematoma formation, herniation, and cerebrovascular accidents. Anesthetic techniques were adopted to achieve rapid emergence. In this respect, inhaled anesthetic agents have an important role in influencing the recovery time after anesthesia and surgery. The aim of this study is to compare isoflurane and sevoflurane as regard to speed of recovery from anesthesia and recovery of post-operative cognitive function in Indian populationMethods: The study was carried out as randomized control, blinded study of patients undergoing neurosurgery in tertiary care hospital. Sample sizes of 60 patients were studied. They were divided into two groups. Results: Sevoflurane shows faster emergence, extubation, motor control (in form of hand squeeze) and orientation time as compared to isoflurane. Though clinically the time difference for the various variables studied was 0.8 to 2.7 min only, statistically the results were significant and supported the basis for this difference as the difference in blood gas solubility coefficient between sevoflurane and isofluraneConclusions: Sevoflurane is recommended for use for faster extubation, emergence and post-operative neurological examination. The observation shows good brain relaxation with the use of both volatile anesthetic agents
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