Background: Adjuvants to local anesthetics (LA) have proven to prolong the analgesic efficacy of Adductor canal block (ACB). The ACB when administered with lower dose of LA produces analgesia without loss of motor control of the thigh. Hence we studied the efficacy of two different doses of dexmedetomidine in ACB to prolong postoperative analgesia when used as adjuvant to ropivacaine. Methods: Total of 90 patients between 18-65years undergoing arthroscopic ligament reconstructions surgeries of knee were randomized into three groups and given Ultrasound guided (USG) ACB. Group A - 0.2% Ropivacaine, Group B – 0.2% Ropivacaine plus Dexmedetomidine 0.50 mcg.kg-1 and Group C- 0.2% Ropivacaine plus Dexmedetomidine 1 mcg.kg-1. Primary aim of our intervention was to study the duration of post-operative analgesia and Secondary aim was to study the total dose of rescue analgesic required in 24hrs, success of early ambulation, level of patient satisfaction and any adverse effects. Results: The duration of analgesia was found highest in Group C (1166 ±200mins) than Group A (420±100mins) and Group B (702± 150mins). The total dose of tramadol consumption in 24 hours was highest in Group A. The number of steps walked postoperatively after 24 hours and level of patient satisfaction was maximum with Group C. Conclusion: Use of 1mcg.kg-1 of dexmedetomidine as adjuvant to 0.2% ropivacaine in ACB after arthroscopic knee surgeries significantly prolongs the duration of postoperative analgesia, reducing the total requirement of rescue analgesic without causing any untoward effects and preserving quadriceps strength aiding in early ambulation and recovery.
Background Intraoperative neuromuscular monitoring (IONM) is used to reduce the risk of postoperative neurological deficit in patients undergoing kyphoscoliosis correction surgery. Somatosensory evoked potentials (SSEPs) are among the several techniques developed by neurophysiologists to increase the sensitivity of intraoperative monitoring. We administered total intravenous anesthesia (TIVA) to 20 patients undergoing kyphoscoliosis deformity correction surgeries: group A: propofol and dexmedetomidine and group B: propofol and fentanyl. The primary objective of our study was to compare the effect of dexmedetomidine and fentanyl on intraoperative hemodynamic parameters and their interference with SSEP’s readings. The secondary objective was to assess the total intraoperative requirement of inhalational anesthetic agents, quality of surgical field, and the cost-effectiveness of either regimen. Results Intraoperative hemodynamic stability, analgesia, surgical field, and cost-effectiveness (due to reduced requirement of sevoflurane) were better with dexmedetomidine than fentanyl. SSEPs were successfully recorded with both the drugs while the requirement of inhalation anesthetic agents was significantly reduced in the dexmedetomidine group than in the fentanyl group. There were no injuries while recording SSEPs. The latency and amplitude of SSEPs were maintained throughout either group. No intraoperative awakening or awareness was noted (bispectral index was maintained in the range of 40 to 60). No postoperative neurological deficit was noted in any patient. Conclusions Both dexmedetomidine and fentanyl can be successfully used in propofol-based TIVA for SSEP monitoring in kyphoscoliosis correction surgeries, but the better analgesic profile, ease of maintaining stable hemodynamics with a significant reduction in inhalational agent requirement, and opioid-sparing effect by dexmedetomidine make it a more desirable agent to be used in propofol-based TIVA.
Lower limb long bone fractures are vulnerable for venous thromboembolism leading to pulmonary thromboembolism. Here, we present a case of preexisting pulmonary thromboembolism with pulmonary artery hypertension posted for bipolar hemiarthroplasty.In hemodynamically stable patients it is better to operate the underlying fracture early to avoid recurrence and worsening of pulmonary thromboembolism. This case was successfully managed under general anesthesia.
Chondrosarcoma is the tumor which affects bone and soft tissue with only 2% spinal involvement. Anesthetic management becomes challenging in patients with cervical chondrosarcoma. Here, we are presenting a case of huge neck mass due to cervical spine chondrosarcoma in 70 year old male hypertensive patient. The patient has distorted anatomy with mucosal edema with left tracheal deviation and compression from right side. Awake Nasal Fiberoptic intubation was done with cuffed ETT no 8. The neck mass was removed and Anterior Cervical Discectomy and Fusion (ACDF) with bone grafting. The case was managed with adequate analgesia, replacement of fluids and Blood and Blood products. Considering complex cervical spine surgery and airway edema the patient was shifted to Surgical Intensive Care Unit (ICU) for elective ventilation and advanced monitoring. After serial ABG and proper weaning the patient was extubated next morning smoothly. Extensive preoperative evaluation, planning, clinical judgement and skilled experienced personale are essential for proper execution of difficult airway cases.
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