Manjushree Ray

Effect of clonidine and magnesium sulphate on anaesthetic consumption, haemodynamics and postoperative recovery: A comparative study.

This randomised, placebo-controlled, double-blind study was designed to assess the effect of intravenous clonidine and magnesium sulphate on intraoperative haemodynamics, anaesthetic consumption and postoperative recovery. Seventy five patients undergoing elective upper limb orthopaedic surgery were randomised into three groups. Group C received clonidine 3 μg/kg as a bolus before induction and 1μg/kg/hour by infusion intraopertively. Group M received magnesium sulphate 30 mg/kg as a bolus before induction and 10 mg/kg/hour by infusion. Group P received same volume of isotonic saline. Anaesthesia was induced and maintained with fentanyl citrate and propofol. Muscular relaxation was achieved by vecuronium bromide. Induction time, recovery time and consumption of propofol as well as fentanyl citrate were recorded. Induction of anaesthesia was rapid with both clonidine and magnesium sulphate. Time of bispectral index (BIS) to reach 60 was significantly lower in Group C and Group M (P < 0.0001). Requirements of propofol and fentanyl were significantly less in Group C and Group M (P < 0.001). Postoperative recovery was slower in Group M compared with other two groups (P < 0.001). Perioperative use of both clonidine and magnesium sulphate significantly reduced the consumption of propofol and fentanyl citrate. Magnesium sulphate caused a delayed recovery.

Analgesic efficacy of transversus abdominis plane block in providing effective perioperative analgesia in patients undergoing total abdominal hysterectomy: A randomized controlled trial

Background and Aims: Transversus abdominis plane (TAP) block has been shown to provide postoperative pain relief following various abdominal and inguinal surgeries, but few studies have evaluated its analgesic efficacy for intraoperative analgesia. We evaluated the efficacy of TAP block in providing effective perioperative analgesia in total abdominal hysterectomy in a randomized double-blind controlled clinical trial. Materials and Methods: A total of 90 adult female patients American Society of Anesthesiologists physical status I or II were randomized to Group B (n = 45) receiving TAP block with 0.25% bupivacaine and Group N (n = 45) with normal saline followed by general anesthesia. Hemodynamic responses to surgical incision and intraoperative fentanyl consumption were noted. Visual analog scale (VAS) scores were assessed on the emergence, at 1, 2, 3, 4, 5, 6 and 24 h. Time to first rescue analgesic (when VAS ≥4 cm or on demand), duration of postoperative analgesia, incidence of postoperative nausea-vomiting were also noted. Results: Pulse rate (95.9 ± 11.2 bpm vs. 102.9 ± 8.8 bpm, P = 0.001) systolic and diastolic BP were significantly higher in Group N. Median intraoperative fentanyl requirement was significantly higher in Group N (81 mcg vs. 114 mcg, P = 0.000). VAS scores on emergence at rest (median VAS 3 mm vs 27 mm), with activity (median 8 mm vs. 35 mm) were significantly lower in Group B. Median duration of analgesia was significantly higher in Group B (290 min vs. 16 min, P = 0.000). No complication or opioid related side effect attributed to TAP block were noted in any patient. Conclusion: Preincisional TAP block decreases intraoperative fentanyl requirements, prevents hemodynamic responses to surgical stimuli and provides effective postoperative analgesia.

Changes in intraocular pressure following administration of suxamethonium and endotracheal intubation: Influence of dexmedetomidine premedication

Background: Use of suxamethonium is associated with an increase in intraocular pressure (IOP) and may be harmful for patients with penetrating eye injuries. The purpose of our study was to observe the efficacy of dexmedetomidine for prevention of rise in IOP associated with the administration of suxamethonium and endotracheal intubation. Methods: Sixty-six American Society of Anaesthesiologists I or II patients undergoing general anaesthesia for non-ophthalmic surgery were included in this randomized, prospective, clinical study. Patients were allocated into three groups to receive 0.4 μg/kg dexmedetomidine (group D4), 0.6 μg/kg dexmedetomidine (group D6) or normal saline (group C) over a period of 10 min before induction. IOP, heart rate and mean arterial pressure were recorded before and after the premedication, after induction, after suxamethonium injection and after endotracheal intubation. Results: Fall in IOP was observed following administration of dexmedetomidine. IOP increased in all three groups after suxamethonium injection and endotracheal intubation, but it never crossed the baseline value in group D4 as well as in group D6. Fall in mean arterial pressure was noticed after dexmedetomidine infusion, especially in the D6 group. Conclusion: Dexmedetomidine (0.6 μg/kg as well as 0.4 μg/kg body weight) effectively prevents rise of IOP associated with administration of suxamethonium and endotracheal intubation. However, dexmedetomidine 0.6 μg/kg may cause significant hypotension. Thus, dexmedetomidine 0.4 μg/kg may be preferred for prevention of rise in IOP.

Effects of progressive muscle relaxation on postmenopausal stress

Background: Menopause increases stress level among females and this may be a contributing factor in developing metabolic syndrome. Objectives: The objective of this study is to study the effects of progressive muscle relaxation on cardiorespiratory efficiency and autonomic functions in over weight and obese working stressed postmenopausal females. Materials and Methods: A total of 30 postmenopausal overweight or obese (body mass index [BMI]: 24.97 ± 1.28) females belonging to the age group 50-55 years were included. Stress level in the subjects was assessed according to the presumptive life event stress scale. The perceived stress scale (PSS) of Sheldon Cohen was used for measuring the perception of stress. Fasting blood samples were collected to exclude diabetic subjects and analyze lipid profile. BMI and waist/hip ratio were calculated. Resting pulse rate and blood pressure, respiratory rate were measured. VO 2 max, physical fitness index, breath holding time and 40 mm endurance test time were calculated for estimation of cardiopulmonary efficiency. Autonomic function tests were carried. Subjects were given progressive muscle relaxation training for 3 months and all parameters were reevaluated. Data was analyzed using SPSS version 16 (SPSS Inc., Chicago, USA). Results: PSS in pre-training session was 26.16 ± 1.7 and in post-training session was 14.33 ± 2.01 and the difference was statistically significant. There was a significant decrease in pulse rate, blood pressure, BMI, waist/hip ratio, cholesterol, low-density lipoprotein following preventive medicine residency training. Results of autonomic function tests and cardiopulmonary efficiency test improved significantly following relaxation training. Conclusions: Increased stress levels may increase BMI and waist/hip ratio, dyslipidemia and lead to autonomic dysfunctions and increase incidence of cardiovascular disease in postmenopausal females. Lifestyle modification with relaxation exercises decreases stress levels and improves autonomic functions, cardiopulmonary efficiency, and lipid profile.

To Study Correlation of Body Fat and Blood Lipids with Autonomic Nervous System Activity in Postmenopausal Indian Women

Background: Obesity, physical inactivity, and altered estrogen metabolism play integrated role contributing to the disease risk profiles of postmenopausal women (PMW). Aim: To study the correlation of body fat and blood lipids with autonomic nervous system activity in PM Indian women. Subjects and Methods: A total of 60 PM sedentary women without any gross systemic disease were selected as a control group and 23 PMW, who were regularly doing morning walk for 1-year was selected as a study group. Body mass index (BMI), waist/hip (W/H) ratio were recorded; lipid profile analyzed, and conventional autonomic function tests were carried. Results were analyzed using SPSS version 16. Results: There was a significant difference in BMI, W/H ratio, lipid profile, autonomic function tests between the two groups. Aging and menopausal duration (MD) were positively correlated with pulse rate, systolic blood pressure, total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, orthostatic tolerance test (OTT), and negatively correlated with Valsalva ratio (VR), deep breath test (DBT), 30:15 relative risk (RR) intervals ratio, isometric hand-grip test (HGT), cold pressor test (CPT). BMI and W/H ratio were positively correlated with TC, triglyceride, LDL cholesterol, OTT, and negatively correlated with isometric HGT, CPT. TC and LDL were negatively correlated with VR, deep breath difference test, 30:15 RR interval ratios, isometric HGT, CPT, and positively correlated with OTT. Multiple regression analysis revealed LDL cholesterol as the only significant independent explanatory variable of DBT. LDL cholesterol and age were the significant independent explanatory variables of 30:15 RR interval ratios, CPT. TC, LDL cholesterol, and age were the significant independent explanatory variables of isometric HGT. Conclusions: Aging, MD, BMI, and W/H ratio all contribute significantly to worsening of autonomic functions and lipid profile. Multiple regression analysis revealed LDL cholesterol as the most significant contributor of worsening of autonomic functions in PM females and regular exercise can improve these parameters significantly.

Bedside prediction of airway length by measuring upper incisor manubrio-sternal joint length

Background: Malpositioning of endotracheal tube may lead to serious complications like endobronchial intubation or accidental extubation. Using anatomical measurements for prediction of airway length would be more practical in resource constrained settings. Materials and Methods: One hundred adult patients of American Society of Anesthesiologists (ASA) grade 1 or 2, without any evidence of difficult airway, were randomly allocated to two cohorts — a model cohort of 70 (50 males) and test cohort of 30 (20 males) subjects. Height, the straight length from the upper incisor to manubrio-sternal joint in fully extended head position (IncManustL), the length from upper incisor to the carina in neutral head position (IncCarinaL), and degree of neck extension were measured in all subjects. Relationship between the two lengths in the model cohort was explored by Pearsons coefficient (r). Predictions were made for subjects in the test cohort and actual and predicted values assessed for agreement using intra-class correlation coefficient (ICC). Results: Good agreement was found between IncManustL and IncCarinaL for both male (r = 0.69) and female (r = 0.54) subjects. Multiple regression analysis suggested height to be another significant predictor, unlike age, weight, and neck extension. The gender-specific regression equations were used to predict IncCarinaL for the test cohort. ICC for absolute agreement between the actual and predicted values was 0.723 (95% CI 0.495-0.858). Conclusions: It is possible to predict airway length in adult Indian subjects by making two simple anatomical measurements, namely stature and incisor manubrio-sternal joint length.