Objective
Recent meta-analysis comparing the success rates of various methods of arterial cannulation in adult patients found heterogeneity in the available data. Hence, we did this study to evaluate and compare the success rate of palpatory method with that of ultrasound guided methods of radial artery cannulation. The aim is to compare the first-attempt success rate of the palpatory method with that of ultrasound-guided radial artery cannulation techniques, namely, the short-axis out-of-plane and the long-axis in-plane methods.
Methods
This is a prospective, randomized, parallel-arm study. Ninety patients aged from 18 to 50 years (presenting for various surgeries requiring radial artery cannulation for invasive blood pressure monitoring or frequent arterial blood gas analysis) were divided into 3 groups. Each group had one of the 3 techniques of radial arterial cannulation, namely palpatory, short-axis ultrasound method, and long-axis ultrasound method. The parameters analyzed were first-attempt success rate, number of attempts needed, cannulation time, need for crossover of technique, and incidence of complications. Multivariate analysis was done with one-way ANOVA, with Tukey's post hoc test. For categorical data, the chi-square test was used. The probability value of .05 was considered as a significant level.
Results
The first-attempt success rate was 76.7% in the long-axis method, 86.7% in the short-axis method, and 56.7% in the palpatory method. The short-axis method has been shown to have a shorter cannulation time, fewer attempts needed for successful cannulation, and lower need for crossover of techniques when the first 2 attempts fail.
Conclusions
: We conclude that the ultrasound-guided short-axis method of radial artery cannulation is associated with higher first-attempt success rate compared to the traditional palpatory method.
Objective: Airway manipulation during endotracheal intubation is a potential stimulus and it is associated with untoward hemodynamic changes. The aim of this study was to compare the efficacy of intravenous dexmedetomidine and oral pregabalin premedication for attenuation of hemodynamic pressor response to laryngoscopy and intubation. Methods: A total of 60 patients of age group of 18-60 years scheduled for elective surgeries under general anesthesia with ASA physical status I were randomized into two groups. Group D received intravenous dexmedetomidine at a dose of 1 µg kg-1 over 10 minutes before induction and group P received oral pregabalin 150 mg one hour prior to intubation. The primary outcomes, heart rate and mean arterial pressure noted at serial intervals during intubation were compared between the groups. Sedation score was assessed as secondary outcome using Richmond Agitation Sedation Scale Scores (RAAS). Results: Group D and P were comparable with distribution of age, sex and duration of laryngoscopy. The mean heart rates and mean arterial pressures assessed at serial measurements at 0, 1, 3, 5, 10 minutes post-intubation were statistically significant (p=0.005) in dexmedetomidine group when compared to pregabalin group. The RASS scores assessed at 15, 30 and 60 minutes post-extubation were statistically significant (p<0.05) in pregabalin group when compared to dexmedetomidine group. Conclusion: Intravenous dexmedetomidine at a dose of 1 µg kg-1 is more effective than oral pregabalin 150 mg in attenuating hemodynamic response to laryngoscopy and orotracheal intubation. Post-procedural sedation was better achieved with oral pregabalin compared to intravenous dexmedetomidine.
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