Objectives To compare the attenuation of pressor responses by intravenous clonidine and preservative-free lignocaine to laryngoscopy and endotracheal intubation. Materials and Methods A randomized, prospective, comparative, double-blinded study was conducted in 80 adult patients who were randomized into two groups of 40 each, group clonidine (Group C) and group lignocaine (Group L). Group C patients were given 2 µg/kg clonidine in 20 ml of normal saline as a slow infusion over 10 min prior to intubation. Group L patients were given 1.5 mg/kg of preservative-free 2% lignocaine in 20 ml of normal saline as a single-dose infusion over 3 min prior to intubation. Baseline vital and hemodynamic parameters were monitored during the perioperative period at 1-, 5-, and 10-min post-intubation. Results The attenuation of heart rate (HR) after intubation was much better with clonidine than lignocaine as there is statistically significant difference in the mean HR between the two groups at 1, 5, and 10 min after intubation with the HR significantly lesser in the Group C than the Group L at all times after intubation. Both clonidine and lignocaine were effective in attenuating systolic blood pressure response after intubation, but clonidine was more effective than lignocaine as systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) in the Group C remained much lower than the Group L and the difference between the two groups was statistically significant at all times after intubation. Conclusion Premedicating with a single slow infusion of 2 µg/kg i.v. clonidine has been proven to be effective in maintaining perioperative hemodynamic stability at 1, 5, and 10 min post-intubation than lignocaine.
Introduction: A multidisciplinary team that includes an endocrinologist, radiologist, anesthesiologist, and surgeon is a prerequisite for adrenal gland surgeries. The prime indications for adrenal gland surgery can include both hormonal and non-hormonal secreting tumors. Adrenal hormone-secreting tumors usually present to the anesthesiologist with a unique set of challenges that require a good preoperative evaluation and hemodynamic control, corrections of all electrolytes and metabolic imbalances, a carefully planned anesthetic strategy, detailed knowledge about the specific diseases, maintaining of postoperative adrenal function, and finally a good collaboration with other involved colleagues. This review will mainly focus on endocrine issues and anesthetic management during the resection of a hormone-secreting adrenal gland tumor. Case Presentation: This is a case report of a 1.5-year-old boy weighing 13.5 kg who was admitted to our hospital with complaints of an increase in height and weight more than appropriate for age, macroglossia, facial oedema, abnormally enlarged genitals and development of pubic hair for 6 months. On examination along with signs of precocious puberty, he had presented raised blood pressure for which he was started on medication. Results: On ultrasonography, a 6*4 cm mass was seen in the right supra renal fossa which was confirmed on the CECT scan. He underwent surgery for the excision of the tumor mass under general anesthesia with a regional blockade (epidural). The histopathological report of the tumor specimen revealed Adrenocortical Carcinoma. The child required post-operative steroid treatment and subsequently was started on chemotherapy as well. Conclusion: The perioperative medical management of active Adreno Cortical Carcinomas is complex enough, but anesthesia causes even more substantial changes in physiology. Treatment with steroids helps to maintain hemodynamics to a great extent.
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