Gagandeep Kaur

Comparative evaluation of ropivacaine versus dexmedetomidine and ropivacaine in epidural anesthesia in lower limb orthopedic surgeries

Background: Various adjuvant are being used with local anesthetics for prolongation of intra operative and postoperative analgesia in epidural block for lower limb surgeries. Dexmedetomidine, the highly selective α2 adrenergic agonist is a new neuroaxial adjuvant gaining popularity. The aim of the present study was to compare the hemodynamic, sedative and analgesia potentiating effects of epidurally administered dexmedetomidine when combined with ropivacaine. Materials and Methods: The study was conducted in prospective, randomized double-blind manner in which 100 patients of American Society of Anesthesiologist Grade I and II in the age group of 20-65 years of either sex under going lower limb surgeries were included after taking informed consent. The patients were randomly allocated into two groups of 50 each. Epidural anesthesia was given with 150 mg of 0.75% ropivacaine in Group A (n = 50) and 150 mg of 0.75% ropivacaine with dexmedetomidine (1 μg/kg) in Group B (n = 50). Two groups were compared with respect to hemodynamic changes, block characteristics which included time to onset of analgesia at T10, maximum sensory analgesic level, time to maximum sensory and motor block, time to regression at S1 dermatome and time to the first dose of rescue analgesia for 24 h. At the end of study, data was compiled and analyzed statistically using Chi-square test, Fishers exact test and Student t-test. P < 0.05 was considered to be significant and P < 0.001 as highly significant. Results: Significant difference was observed in relation to the duration of sensory block (375.20 ± 15.97 min in Group A and 535.18 ± 19.85 min in Group B [P - 0.000]), duration of motor block (259.80 ± 15.48 min in Group A and 385.92 ± 17.71 min in Group B [P - 0.000]), duration of post-operative analgesia (312.64 ± 16.21 min in Group A and 496.56 ± 16.08 min in Group B [P < 0.001]) and consequently low doses of rescue analgesia in Group B (1.44 ± 0.501) as compared to Group A (2.56 ± 0.67). Sedation score was significantly more in Group B in the post-operative period. Conclusion: Epidural Dexmedetomidine as an adjuvant to Ropivacaine is associated with prolonged sensory and motor block, hemodynamic stability, prolonged postoperative analgesia and reduced demand for rescue analgesics when compared to plain Ropivacaine.

Basic concepts for sample size calculation: Critical step for any clinical trials!

Quality of clinical trials has improved steadily over last two decades, but certain areas in trial methodology still require special attention like in sample size calculation. The sample size is one of the basic steps in planning any clinical trial and any negligence in its calculation may lead to rejection of true findings and false results may get approval. Although statisticians play a major role in sample size estimation basic knowledge regarding sample size calculation is very sparse among most of the anesthesiologists related to research including under trainee doctors. In this review, we will discuss how important sample size calculation is for research studies and the effects of underestimation or overestimation of sample size on project′s results. We have highlighted the basic concepts regarding various parameters needed to calculate the sample size along with examples.

Psychiatric and anesthetic implications of substance abuse: Present scenario.

Substance abuse has crossed all social, economic, and geographic borders and is spreading its fangs in each and every sphere of society irrespective of age, gender, caste, creed, and religion. These days, we encounter several patients of substance dependence who visit different hospitals for elective surgical procedures or in emergency (e.g., roadside accidents and with various complications associated with substance abuse). These patients at that time may be either addicted to them or are intoxicated by them or on de addiction treatment. Acute or chronic use of these drugs affect the respiratory, cardiovascular, central nervous, renal, hematological, and hepatic system variably in individuals thus due to diverse clinical presentations a complete understanding of the path physiology and anesthetic implications of drug abuse is essential to tailor a safe anesthetic plan for these high-risk group of patients.

Comparative evaluation of 0.75% ropivacaine with clonidine and 0.5% bupivacaine with clonidine in infraclavicular brachial plexus block.

Background: Infraclavicular brachial block with coracoids approach has gained popularity because of consistent bony landmarks and less chances of vascular puncture and pneumothorax. Aim: The aim of this study was to evaluate the effect of adding clonidine to bupivacaine or ropivacaine on the onset and duration of sensory and motor block and duration of analgesia in infraclavicular block. Materials and Methods: In a prospective randomized double-blind study, 60 patients of 18-65 years were randomly divided in to two groups of 30 each. Infraclavicular block was performed with 30 ml of 0.75% ropivacaine + 150 μg clonidine in group R and 30 ml of 0.5% bupivacaine + 150 μg clonidine in group B and were compared for onset and duration of sensory and motor block, postoperative analgesia, side-effects and complications. Results: Significant differences were observed in the time for onset of sensory block (5.80 ± 5.12 min in group R and 4.87 ± 1.46 min in group B, P < 0.05); onset of motor block (11.37 ± 2.66 min in group R and 9.60 ± 1.78 min in group B, P < 0.05); duration of sensory and motor block (10.07 ± 0.91 and 9.03 ± 0.89 h in group R and 12.50 ± 1.14 and 10.67 ± 1.18 h in group B respectively, P < 0.01) and duration of analgesia (15.30 ± 1.39 h in group R and 18.07 ± 1.66 h in group B). No significant difference was observed in hemodynamics, sedation, side-effects and complications. Statistical Analysis: Variables were compared using Chi-square test for nonparametric data and Student′s t-test for parametric data. Conclusion: Addition of clonidine to bupivacaine lead to early onset and prolonged duration of sensory and motor block with prolonged analgesia as compared to the addition of clonidine to ropivacaine.

COMPARISON OF INDUCTION, INTUBATION AND RECOVERY CHARACTERISTICS OF HALOTHANE + PROPOFOL V/S SEVOFLURANE + PROPOFOL IN CHILDREN UNDERGOING ADENOTONSILLECTOMY

Purpose: General anaesthesia for oral surgeries in paediatric patients is always challenging for an anaesthesiologist. Aim was to compare halothane+propofol and sevoflurane+propofol in paediatric patients undergoing adenotonsillectomy without muscle relaxant. Method: In a double blind manner, eighty patients of 3- 10 years were premedicated with inj. Atropine and randomly divided into two groups of forty each. In Group A, priming was done with 50% oxygen+50% nitrous oxide+4% halothane for 1 minute, after loss of eye lash reflex and centralisation of pupil intravenous cannulation done. Inj. midazolom, lignocaine and Propofol were given and trachea was intubated. Maintenance was done with 1-2% halothane+ nitrous oxide+ oxygen and continuous propofol infusion. Similar technique was used in group B except for priming done with sevoflurane 7% and maintenance with 2-3%. Both groups were compared for induction, intubating conditions, haemodynamics and emergence characteristics. Results: Induction was rapid in group B as time for loss of eye lash reflex and centralisation of pupil was less in group B (21.88±12.6 &114.40±28.8 seconds) as compared to group A (33.05±4.0 & 140.05±12.1 sec) p<0.001. Intubating conditions were excellent but mean intubation time was less in group B as compared to group A p<0.001. Heart rate and blood pressure remained on lower side in group A. Emergence was significantly rapid in group B. No side effect or complications were noted. Conclusion: Both groups provided excellent intubating conditions but sevoflurane+propofol group was better as it provided faster induction and rapid recovery from anaesthesia with more stable haemodynamics as compared to Halothane+propofol group.

Anaesthesia provider's perception of law: Focus on preventive measures

Anaesthesiology is a speciality that delivers most prompt and positive results in medical field. This naturally leads to high expectations among the general public. In the past, patients used to subject themselves to surgery after signing a simple willingness form. But in the present scenario, if any catastrophe occurs, it grabs news headlines, negligence is suspected by laymen in such cases, and these cases land up in a court of law. In the courts, decisions are left to judiciary, which can be potentially influenced by the opinon of general public. This leaves a lot of subjectivity in these decisions. There has been a rising trend in medical negligence cases registered in consumer courts after the decision of the Supreme Court, that the services provided by an anaesthesiologist come under the word service of Consumer Protection Act (1986). So the apprehension amongst the anaesthesiologists regarding the legal issues is rising. This article underlines the standard of care, protocols by which anaesthesiologists should abide to avoid legal consequences. Doctors should have legal awareness so that they can defend their cases in courts properly. There is a need to maintain healthy doctor-patient relationship, good record keeping, and to provide a reasonable standard of care. Doctors should keep abreast with the latest development in the medical field.

Comparison of levobupivacaine and levobupivacaine with fentanyl in infraumbilical surgeries under spinal anaesthesia.

Background: Intrathecal opioids added to low dose local anesthetics in spinal anaesthesia intensifies sensory block without affecting sympathetic blockade. Aim was to evaluate the safety and efficacy of intrathecal levobupivacaine plain versus levobupivacaine plus fentanyl in infraumbilical surgeries. Materials and Methods: In a prospective randomized double blind study, 100 patients of American Society of Anesthesiologists grades I and II of either sex, 20-65 years of age were included after approval from the Ethics Committee. Informed consent was taken and patients were randomly divided into two groups of 50 each, to receive either 2 ml of 0.5% isobaric levobupivacaine (group L) or 2 ml of 0.5% isobaric levobupivacaine + 25 μg fentanyl (group LF) intrathecally. Patients were monitored for sensory and motor block characteristics, postoperative analgesia, haemodynamics and side effects and complications for 24 h. Results: Onset of sensory block and time to maximum sensory block was rapid in group LF (4.8 ± 1.50 and 8.46 ± 1.87 min) as compared to group L (7.6 ± 1.46 and 15.80 ± 2.43 min) (P < 0.000). Maximum sensory block was T6 in group LF and T8 in group L. Maximum Bromage score was 2 in both groups but was achieved earlier in group LF (P < 0.000). Duration of sensory and motor block was significantly prolonged in group LF (270.98 ± 28.60 and 188.52 ± 9.81 min) as compared to group L (197.58 ± 11.20 and 152.76 ± 9.79 min). Total duration of analgesia was also prolonged in group LF (265.16 ± 26.18 min) as compared to group L (168.16 ± 11.08 min). Patients remained haemodynamically stable and side effects and complications were comparable in both groups. Data was analyzed using Chi-square test and unpaired t-test. Conclusion: Addition of fentanyl to levobupivacaine leads to early onset and prolonged duration of sensory and motor block as well as postoperative analgesia with stable haemodynamics and minimal side effects.

Comparative evaluation of bupivacaine alone versus bupivacaine and dexmedetomidine for spinal anesthesia in infraumbilical surgeries

Introduction The efficacy of local anesthetics in spinal anesthesia can be enhanced by using adjuvants like opioids and α2 -agonists. Aim The present study was designed to determine the analgesic efficacy and side effects of adding dexmedetomidine to bupivacaine in spinal anesthesia for infraumbilical surgeries. Patients and methods In a prospective, randomized, double-blind study, 100 patients were randomly divided into two groups of 50 each, after taking their informed consent. Spinal anesthesia was achieved with 12.5 mg of 0.5% hyperbaric bupivacaine in group B (n = 50) and with 12.5 mg of 0.5% hyperbaric bupivacaine plus 10 μg of dexmedetomidine in group D (n = 50). The two groups were compared with respect to hemodynamic parameters, onset of sensory block to T10 and regression to S1, time to achieve Bromage 3 and regression to Bromage 0, duration of analgesia, number of doses of rescue analgesia required, and complications occurring in 24 h. Results Significant difference was observed in relation to onset of sensory block [12.7 ± 1.015 min in group B and 6.84 ± 0.792 min in group D (P < 0.001)], total duration of sensory block [177.74 ± 28.573 min in group B and 353.36 ± 12.138 min in group D (P < 0.001)], total duration of motor block [146.94 ± 9.173 min in group B and 318.36 ± 9.374 min in group D (P < 0.001)], duration of analgesia [283.96 ± 11.165 min in group D and 126.34 ± 7.684 min in group B (P < 0.001)], and total number of doses of rescue analgesia required in 24 h [1.44 ± 0.501 in group D and 2.56 ± 0.675 in group B (P < 0.001)]. Conclusion Addition of dexmedetomidine to bupivacaine leads to early onset of sensory and motor block with prolonged duration, and patients remained pain free for a longer period with decreased demand for rescue analgesia in the postoperative period as compared with plain bupivacaine.