Background:The α2-adrenoreceptor agonist, dexmedetomidine, provides excellent sedation with minimal cardiovascular instability or respiratory depression and may be a useful adjunct to facilitate smooth tracheal extubation.Materials and Methods:Fifty American Society of Anesthesiologists grade I-II patients, aged 20-45 years, scheduled for elective general surgical, urological and gynecological surgeries were studied after randomization into two groups. Group A and B, received an intravenous infusion of dexmedetomidine 0.75 mcg/kg or placebo respectively, over 15 minutes before anticipated time of end of surgery, in a double blind manner. Anesthesia techniques were standardized. Heart rate, systolic, diastolic, mean arterial pressures were recorded while starting injection, at 1, 3, 5, 10, 15 minutes after starting injection, during extubation, at 1, 3, 5 minutes after extubation, and thereafter every 5 minutes for 30 minutes. Quality of extubation was evaluated on a 5 point scale and postoperative sedation on a 6 point scale. Any event of laryngospasm, bronchospasm, desaturation, respiratory depression, vomiting, hypotension, undue sedation was noted.Results:Heart rate, systolic, diastolic, mean arterial pressures were significantly higher in group B (P < 0.05). Extubation quality score of majority of patients was 2 in group A and 3 in group B. Sedation score of most patients was 3 in group A and 2 in group B. Bradycardia and hypotension incidences were higher in group A. One patient in group A, two patients in group B had vomiting. No patient had any other side effects.Conclusion:Dexmedetomidine 0.75 mcg/kg administered 15 minutes before extubation, stabilizes hemodynamics and facilitates smooth extubation.

Context:Hormonal and mechanical factors make obstetric patients need strict dose calculations of local anesthetics intrathecally for spinal anesthesia. Any greater dose of local anesthetics can cause hemodynamic instability, maternal morbidity and any lesser dose can produce inadequate block. Hence, we hypothesized in our study that by using low dose of bupivacaine with fentanyl can maintain stable hemodynamics and provide better analgesia.Aim:The aim was to compare the hemodynamics and duration of analgesia using a low dose (7.5 mg) bupivacaine fentanyl mixture to a conventional dose (10 mg) of hyperbaric bupivacaine for cesarean section.Settings and Design:Double-blinded, randomized, controlled prospective study was conducted at a tertiary academic hospital from 2008 to 2011.Materials and Methods:Fifty singleton parturient, scheduled for elective caesarean section were randomly allocated into two groups. Study group (group-S) received a combination of 25 μg fentanyl and 7.5 mg of hyperbaric bupivacaine, whereas the control group (group-C) received 10 mg of hyperbaric bupivacaine. Maternal hemodynamics, sensory and motor block, duration of analgesia and the Apgar score of the newborn were compared between the groups.Statistical Analysis Used:Observational descriptive statistics, statistical package for social sciences (SPSS Inc. Released 2006, SPSS for Windows, Version 15.0. Chicago), paired t-test was used as applicable.Results:The blood pressure significantly decreased with >25% fall from the baseline in group-C (98.76 ± 8.36) than in group-S (117.32 ± 12.21) with P < 0.001. The duration of effective analgesia was significantly prolonged in the study group than in the control group (P < 0.001).Conclusion:The combination of low dose bupivacaine and fentanyl in comparison to bupivacaine alone is hemodynamically stable and prolonged duration of analgesia in caesarean section.

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This study was undertaken to evaluate the effect of a bolus dose of dexmedetomidine on haemodynamic, recovery responses and airway reflexes during extubation. MATERIAL AND METHODSSixty patients aged 20-45 yrs. of either sex of ASA grade I/II scheduled for elective general surgical, ENT, orthopaedics and gynaecological surgeries were studied after randomisation into two groups; 5 minutes before anticipated end of surgery, group A and B received either dexmedetomidine 0.5 µg/kg or placebo (Saline) respectively intravenously over 2 minutes. Anaesthesia technique was standardised for both groups. Heart rate, systolic, diastolic, mean arterial pressures were recorded at the start of a bolus drug injection and thereafter 1, 2 and 3 minutes after injection during extubation; at 1, 3, 5 minutes after extubation for 15 minutes. Quality of extubation was evaluated immediately after extubation based on cough using a 5-point rating score. Postoperative sedation was evaluated on a 6-point scale (Ramsay sedation scale). Side effects like laryngospasm, bronchospasm, respiratory depression, desaturation, vomiting, hypotension, bradycardia and undue sedation were noted. RESULTSHeart rate, systolic, diastolic, mean arterial pressure were significantly lower in study group. Extubation quality score in majority of cases was score 1 in study group and score 3 in control group. Sedation score in most of the cases was 3 in study group and 2 in control group. Bradycardia and hypotension were more in study group. Vomiting incidence was comparable in both the groups. CONCLUSIONOur study concludes that single dose of dexmedetomidine 0.5 µg/kg administered 5 minutes before extubation attenuates the haemodynamic and airway reflexes during emergence from anaesthesia without causing undue sedation. KEYWORDSDexmedetomidine, Haemodynamic Responses, Airway Reflexes, Extubation. HOW TO CITE THIS ARTICLE:Vankayalapati SD, Ramsali MV, Dumpala S, et al. Effect of dexmedetomidine on haemodynamic and recovery responses during tracheal extubation: a randomized comparative study.

Results indicate that cataract surgery can be safe in patients with Mooren's ulcer and visually significant cataract. Performing surgery in a quiet, noninflamed eye improves the prognosis in these cases.

Electro convulsive therapy (ECT) induced status epilepticus is known to occur in patients undergoing ECT. Its recognition and management under general anesthesia are of paramount importance; otherwise it may endanger the life of the individual.

A 36-year-old male from an urban middleclass family with strained relationship among family members was referred from a corporate hospital for further management of psychological problem. As he was attempting suicide repeatedly, Electroconvulsive Therapy (ECT) was planned. After preoperative assessment and preparation, modified ECT was done with thiopentone and 0.5 mg/kg of suxamethonium. Apnea following suxamethonium was prolonged for 2 hours. Subsequent enquiry revealed that patient was treated for organophosphate poisoning and was on ventilator support for 15 days. This was concealed by the relatives. On searching patient previous records, Butyrylcholinesterase levels were very low, i.e., 350 u/l (normal reference range is 5 500 – 12 500 u/l). Prolonged suxamethonium apnea should be anticipated in patients with recent history of organophosphate poisoning; it is advisable to estimate the levels of butyrylcholinesterase and avoid suxamethonium in patients with low enzyme levels.

Intravenous induction is smooth, fast and pleasant. In search for alternative to thiopentone, various agents such as propofol, etomidate are introduced. AIM OF STUDYPresent study is undertaken to evaluate induction characteristics and haemodynamic responses and side effects of etomidate as an intravenous induction agent in comparison with thiopentone and propofol. MATERIAL AND METHODSSeventy five ASA I and II patients between 18 -50 years undergoing elective surgical procedures were randomly divided in to 3 groups of 25 patients each. Each group received either etomidate or propofol or thiopentone as an induction agent. Time taken for induction, heart rate, blood pressure, pain on injection of drug and severity of myoclonus were recorded. BP and HR recorded at preinduction, after induction at one minute intervals till 5 minutes, thereafter at 5-minute intervals. RESULTSTime taken for induction was almost same in all groups. Heart rate was increased in thiopentone and etomidate groups. Blood pressure was decreased significantly in propofol group whereas blood pressure was well maintained in etomidate group. Pain on injection with etomidate lipuro was much less than propofol. Myoclonic movements were much higher in etomidate group. CONCLUSIONEtomidate is more cardio stable agent.