Background and Objectives:Patients on mechanical ventilation in intensive care unit (ICU) are often uncomfortable because of anxiety, pain, and endotracheal intubation; therefore, require sedation. Alpha-2 agonists are known to produce sedation. We compared clonidine and dexmedetomidine as sole agents for sedation.Study Design:Prospective, randomized, controlled open-label study.Materials and Methods:A total of 70 patients requiring a minimum of 12 h of mechanical ventilation with concomitant sedation, were randomly allocated into two groups. Group C (n = 35) received intravenous (IV) clonidine (1 μg/kg/h titrated up to 2 μg/kg/h to attain target sedation), and Group D (n = 35) received IV dexmedetomidine for sedation (loading 0.7 μg/kg and maintenance 0.2 μg/kg/h titrated up to 0.7 μg/kg/h to achieve target sedation). A Ramsay Sedation Score of 3-4 was considered as target sedation. Additional sedation with diazepam was given when required to achieve target sedation. The quality of sedation, hemodynamic changes and adverse effects were noted and compared between the two groups.Results:Target sedation was achieved in 86% observations in Group D and 62% in Group C (P = 0.04). Additional sedation was needed by more patients in Group C compared with Group D (14 and 8 in Groups C and D, respectively, P = 0.034), mainly due to concomitant hypotension on increasing the dose of clonidine. Hypotension was the most common side-effect in Group C, occurring in 11/35 patients of Group C and 3/35 patients of Group D (P = 0.02). Rebound hypertension was seen in four patients receiving clonidine, but none in receiving dexmedetomidine.Conclusion:Both clonidine and dexmedetomidine produced effective sedation; however, the hemodynamic stability provided by dexmedetomidine gives it an edge over clonidine for short-term sedation of ICU patients.
Central venous catheterization is associated with its share of complications. Most of these complications can be avoided and treated by appropriate patient selection, careful insertion technique and vigilance following catheter insertion. We report a patient presenting with unilateral hydrothorax due malposition of central venous catheter in lung parenchyma. Prompt recognition of complication and its treatment remedied the situation.
Background and objective: Providing a spinal block with preferential distribution to operative side is a useful technique. This study aimed to determine the incidence and suitability of unilateral spinal block, hypotension and recovery profile by 7.5 mg of 0.5% hyperbaric bupivacaine alone or with fentanyl/clonidine for knee or below knee orthopaedic surgery of moderate duration. Methods: 120 patients undergoing orthopaedic surgery of lower limb received 7.5 mg of 0.5% hyperbaric bupivacaine intrathecally with 25 µg of fentanyl (Group BF), 25 Regularg of clonidine (Group BC) or 0.5 ml of saline (Group BS). Block characteristics, unilaterality, haemodynamic changes and recovery profile was noted. Results: Unilateral block was seen in more than 70% of patients in all the groups (p=0.057). Time of regression of sensory block to L2 level (133 ± 18, 187 ± 19, 182 ± 18 mins respectively in groups BS, BF and BC) and time of first postoperative analgesia (245 ± 27, 324 ± 24, 318 ± 22 mins respectively in groups BS, BF,BC, p<0.001) was prolonged in groups BF and BC. Motor block was prolonged in group BC only. Cardiovascular parameters were stable throughout, in all the groups. Conclusion: 7.5 mg of hyperbaric bupivacaine alone or with fentanyl or clonidine produced predominantly unilateral spinal anaesthesia in more than 70% patients in the entire group with stable cardiovascular parameters. Addition of fentanyl or clonidine did not influence unilaterality or block characteristics but prolonged postoperative analgesia. Unilateral spinal block is suitable for moderate duration orthopaedic surgery of knee or below knee. J o u rn al of A n e s th es ia & C li n ic a l Resea rc h
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