Raj Bahadur Singh

A comparative study between intrathecal dexmedetomidine and fentanyl as adjuvant to intrathecal bupivacaine in lower abdominal surgeries: A randomized trial.

Context: Spinal anesthesia is preferred choice of anesthesia in lower abdominal surgeries since long time. However problem with this is limited duration of action, so for long duration surgeries alternative are required. Dexmedetomidine is a highly selective alpha-2-adrenergic agonist has property to potentiate the action of local anesthetic used in spinal anesthesia. Fentanyl is an opioid and it has also the same property. Aims: To compare the efficacy, analgesic effects, and side-effects of dexmedetomidine and fentanyl as adjuvant to bupivacaine for lower abdominal surgery. Settings and Design : The type of this study was double-blind randomized trial. Subjects and Methods: A total of 80 patients were randomly allocated in two Group D and Group F. Group D were injected injection bupivacaine 0.5% heavy × 3.0 ml + 0.5 ml of preservative free normal saline containing 5 μg dexmedetomidine. Group F were received injection bupivacaine 0.5% heavy × 3.0 ml + 0.5 ml fentanyl equivalent to 25 μg. Statistical Analysis Used: The statistical analysis was performed using SPSS (Statistical Package for Social Sciences) version 15.0 statistical analysis software. Results: The results show that highest sensitivity level of T6 and T8 was achieved by higher proportion of subjects from Group D when compared to Group F and sensitivity level T7 was achieved by higher proportion of subjects of Group F when compared to Group D. Duration of analgesic properties was significantly higher in Group D when compared to Group F. Conclusion: The findings in the present study suggested that intrathecal adjuvant use of dexmedetomidine as compared to fentanyl provides a longer sensory and motor blockade and also prolongs the postoperative analgesic effect.

Comparision between bupivacaine and ropivacaine in patients undergoing forearm surgeries under axillary brachial plexus block: a prospective randomized study.

CONTEXT Brachial plexus block is a suitable alternative to general anaesthesia for patient undergoing upper extremity surgery. Ropivacaine the S-enantiomer emerged as a possible replacement of Bupivacaine without undesirable toxic effects. It provides similar duration of sensory analgesia with early recovery of motor block. AIMS Comparision of onset, duration of sensory- motor block and any adverse effects between 0.5% Bupivacaine and 0.5% Ropivacaine in axillary brachial plexus block. SETTINGS AND DESIGN Prospective randomized study. MATERIALS AND METHODS This study was carried out in 50 patients between 18-55 y, comparable in demographic variables was randomly allocated to two groups of 25 each. Group I received 30ml 0.5% Bupivacaine, Group II received 30 ml 0.5% Ropivacaine in axillary brachial plexus block for forearm surgeries. Onset, Duration of sensory-motor block, Heart rate, Blood pressure, Oxygen saturation and Respiratory rate were recorded. STATISTICAL ANALYSIS Statistical analysis used was Statistical Package for Social Sciences version 15.0, Chi-square test was used to evaluate the proportional data. Odds ratio/risk ratios have been calculated wherever necessary. Parametric data has been evaluated using Student t-test while non-parametric data has been evaluated using Mann-Whitney U-test. RESULTS Onset of motor blockade was earlier in ropivacaine group (5 min) as compared to bupivacaine group (20 min), Higher levels of motor blockade, Mean onset time for motor block was significantly shorter in ropivacaine group (14.88±3.35 min) as compared to bupivacaine group (22.92±3.79 min), Mean duration of block was significantly longer in bupivacaine group (408.40±50.39 min) as compared to ropivacaine group (365.60±34.29 min) (p=0.001), Onset of sensory block was observed from 5 min itself in ropivacaine group as compared to bupivacaine group (10 min), Duration of sensory block was significantly longer in bupivacaine group (450.40±54.50 min) as compared to ropivacaine group (421.20±38.33 min) . CONCLUSION On the basis of present study, conclusions were drawn that onset of action of sensory, motor block was early in Ropivacaine group with faster recovery of motor functions as compared to Bupivacaine group. No adverse effects were noted in either groups. This study suggests that Ropivacaine is a suitable alternative to Bupivacaine for forearm surgeries under Brachial Plexus Block.

Role of Clonidine as adjuvant to intrathecal bupivacaine in patients undergoing lower abdominal surgery: A randomized control study.

Background: Neuraxial anesthesia greatly expands the anesthesiologist armamentarium, providing alternatives to general anesthesia, especially in the lower abdominal surgeries. Clonidine, an alpha-2 adrenergic agonist, has a variety of actions, including potentiation of effects of local anesthetics. This study was undertaken to assess the degree of sensory and motor block and postoperative analgesia provided by low dose (50 mcg) intrathecal clonidine admixed with bupivacaine. Aims: The aim of this study is to establish efficacy and safety of intrathecal clonidine as adjuvant to bupivacaine. Settings and Design: The type of the study was double-blind randomized trial. Materials and Methods: Hundred patients were randomly allocated in two groups, A and B. Group A received bupivacaine 0.5%, 3 ml with placebo (normal saline 0.33 ml) and Group B, bupivacaine 0.5%, 3 ml with clonidine 50 μg (0.33 ml). Statistical Analysis Used: Statistical Package for Social Sciences version 15.0 statistical analysis software. Results: Mean duration of motor block was significantly higher in Group B (280.80 ± 66.88 min) as compared with Group A (183.60 ± 77.06 min). Significant difference in duration of sensory block was noted between Group B (295.20 ± 81.17 min) and Group A (190.80 ± 86.94 min). Duration of postoperative analgesia was significantly higher in Group B as compared to Group A (551.06 ± 133.64 min and 254.80 ± 84.19 min respectively). Mean visual analog scale scores at different time intervals were significantly lower in the study group (except for 4-h time interval), but the control group had better hemodynamic stability as compared with study group. Conclusion: The findings in this study suggested that use of clonidine 50 μg added to bupivacaine for spinal anesthesia effectively increased the duration of sensory block, duration of motor block, and duration of analgesia.

A comparison between nitroprusside and nitroglycerine for hypotensive anesthesia in ear, nose, and throat surgeries: A double-blind randomized study

Context: Blood obscures the operative field and makes precise technique difficult, and to the anesthetist, when the volume of blood lost is large. Practice of induced hypotension in the otolaryngology is a common practice owing to its benefits in providing a better visibility and preventing blood loss. Aims: The aim was to compare controlled induced hypotension for facilitating surgical exposure, and reducing intraoperative blood loss using sodium nitroprusside and nitroglycerin in ear, nose, and throat surgeries under general anesthesia. Settings and Design: A prospective, randomized, double-blind study. Materials and Methods: The study was carried out in 60 adults, American Society of Anesthesiologists grade I and II patients, allocated randomly in to three groups: group A was control group, group B patients received nitroprusside (0.5-10 μg/kg/min) and group C patients received nitroglycerine (1-10 μg/kg/min). Mean arterial pressure was maintained in the range of 50-60 mmHg. Statistical Analysis Used: Statistical Package for Social Sciences version 17.0 (ANOVA) followed by independent samples t-test and Chi-square test. Results: The results of the present study indicate that the use of controlled hypotension provides a better surgical field and reduces the blood loss. Of the two modalities under question, use of sodium nitroprusside gives the desired results in a significantly, shorter time as compared to nitroglycerin; however, the use of sodium nitroprusside must be carried out with caution as it has toxic effects. Conclusions: (1) The achievement of target level was quicker in sodium nitroprusside group as compared to nitroglycerin group. (2) Reflex tachycardia was the main side effect of the nitroglycerin group. (3) Rebound hypertension was the associated side effect of the sodium nitroprusside group.

Effects of different types of pharyngeal packing in patients undergoing nasal surgery: A comparative study.

Context: Postoperative throat complaints such as postoperative sore throat (POST), dysphagia, and hoarseness frequently arises after tracheal intubation and throat packing for patient undergoing general anesthesia. This condition is very disturbing to patient. Avoiding POST is a major priority for these patients because preventing postoperative complications contributes to patient satisfaction. Aims: To describe and analyze the postoperative throat effects of nasopharyngeal packing and oropharyngeal packing in patients undergoing nasal surgery. Settings and Design: A randomized comparative study. Subjects and Methods: After obtaining approval of Ethical Committee 40 patients were included in study. After this patient were randomly allocated into two groups of 20 each. Group A - in which the oropharynx was packed and Group B - inwhich the nasopharynx was packed. General anesthesia were given and throat packing was done and patients were interviewed postoperatively for any throat complications such as sore throat, difficulty in swallowing (dysphagia), hoarseness of voice, throat irritation, and any other symptom pertaining to the study were noted and data were analyzed. Statistical Analysis Used: T-test to compare the age, while Chi-square test and Fisher′s exact test were used to compare sex distribution, sore throat, dysphagia, hoarseness, and throat irritation. Results: Results showed statistically significant difference in incidence and severity of POST in Group A patients when compared to Group B patients to be more. Patients in Group A had a higher incidence of dysphagia when compared to their Group B counterparts. With respect to the incidence of hoarseness and throat irritation, there was no statistical significance between the groups. Conclusion: We concluded that the site of pharyngeal packing influences the incidence and severity of POST and as well as the incidence of dysphagia after general anesthesia. The use of nasopharyngeal packing in the patients undergoing nasal surgeries might lead to a reduction of the same.

Preemptive epidural analgesia for postoperative pain relief revisited: Comparison of combination of buprenorphine and neostigmine with combination of buprenorphine and ketamine in lower abdominal surgeries, a double-blind randomized trial

Context: Postoperative pain relief provides subjective comfort to patient in addition to blunting of autonomic and somatic reflex responses to pain, subsequently enhancing restoration of function by allowing the patient to breathe, cough, and move easily. Aims: The aim is to evaluate and compare the effects of neostigmine + buprenorphine and ketamine + buprenorphine for preemptive epidural analgesia for postoperative pain relief in patients undergoing abdominal surgeries under general anesthesia (GA). Settings and Design: A double-blind randomized trial. Subjects and Methods: A total of 60 American Society of Anesthesiologists physical status Classes I and II patients undergoing abdominal surgeries under GA were taken up for the study. They were randomly allocated into two groups, Group A and Group B of thirty patients each. Preemptive epidural analgesia for postoperative pain relief was provided by a combination of neostigmine 1 μg/kg + buprenorphine 2 μg/kg in Group A patients and ketamine 1 mg/kg + buprenorphine 2 μg/kg in Group B patients after induction of GA but before surgical incision. Postoperatively, vital parameters, pain score, requirement of top up doses, and side effects in the two groups were observed and recorded at 2, 4, 6, 10, 18, and 22 h. Statistical Analysis Used: Mean values within each of the Group A and Group B were compared using one-way analysis of variance (one-way ANOVA). Mean values between Group A and Group B were compared using double analysis of variance (two-way ANOVA). Results: Group A patients had a significant analgesia (visual analog scale [VAS] pain scores reduced significantly from 54.6 ± 6.3 at 2 h to 8.1 ± 8.9 at 22 h postoperatively). Group B patients had significant analgesia too (VAS pain scores reduced significantly from 36 ± 12.5 at 2 h to 5.3 ± 10.9 at 22 h postoperatively). There was however no significant difference between the two groups with respect to the degree of postoperative analgesia on comparison of VAS scores, effect on vital parameters, and incidence of side effects. Conclusions: Either of the two combinations, neostigmine 1 μg/kg + buprenorphine μg/kg or ketamine 1 mg/kg + buprenorphine 2 μg/kg can be safely used for preemptive epidural analgesia for postoperative pain relief in patients undergoing abdominal surgeries under GA.

A rare and deceptive venous anomaly, sinus pericranii.

to widen the skin and subcutaneous tissue, but frequently inserted unnecessarily far.[3,4] Other possible mechanisms of injury include kinking of guidewire resulting in misdirection of the dilator and insertion of wire outside the vessel. However, this had not happened in this case as the guidewire was still in the vein, and it was not bent when removed. Dilators provided in the pediatric central venous catheterization (CVC) sets are thin and sharp-tipped and can henceforth present as such a complication. Several reports suggest the advantages of ultrasonography for risk reduction and improved cannulation success for all access sites in adults and children in different settings. However, a recent survey of the Society of Cardiovascular Anesthesiologists members revealed that 67% never or almost never used ultrasound when performing CVC, with only 15% always or almost always using ultrasound. The dilator position if doubtful can be checked using ultrasound or by a pressure manometry.

To evaluate the efficacy of intravenous infusion of dexmedetomidine as premedication in attenuating the rise of intraocular pressure caused by succinylcholine in patients undergoing rapid sequence induction for general anesthesia: A randomized study

Context: Laryngoscopy and intubation performed during RSI lead to choroidal blood volume increase and an eventual rise in intraocular pressure (IOP). Use of succinylcholine (SCh) causes an undesirable rise in IOP which is further aggravated by laryngoscopy and endotracheal intubation. Dexmedetomidine is a highly selective centrally acting α2adrenergic agonist that has IOP lowering properties. Aims: This study aims to evaluate the efficacy of intravenous (i.v.) infusion of dexmedetomidine (0.5 μg/kg) as premedication in attenuating the rise of IOP and adverse effect if any caused by SCh in patients undergoing RSI for general anesthesia. Settings and Design: This was a double-blind, randomized trial. Subjects and Methods: Sixty adult patients in the age group of 20–50 years scheduled for elective surgeries under general anesthesia. Group I (dexmedetomidine group) (n = 30) received i.v. infusion of dexmedetomidine (0.5 μg/kg) and Group II (control group) (n = 30) received i.v. infusion of 50 ml normal saline as premedication Statistical Analysis Used: The analysis was done using Statistical Package for Social Sciences Version 15.0 statistical Analysis Software. Results: It was observed that Group I (dexmedetomidine group) had a better attenuating effect over the increases in IOP in patients undergoing RSI for general anesthesia using SCh. An increase in IOP was seen in Group II (control group) patients with RSI. Conclusions: The findings in the present study indicate that i.v. dexmedetomidine effectively attenuates the increases in IOP with an additional advantage of control on hemodynamic responses following RSI.

Efficacy of oral transmucosal fentanyl citrate for premedication in patients for surgery under general anesthesia

Background: Oral transmucosal fentanyl citrate (OTFC), a water soluble salt when mixed in saliva is 80% nonionized; making it the only opioid suitable for transmucosal absorption. OTFC has rapid onset of action (3–5 min) with peak effect at 20–40 min and total duration of activity is 2–3 h. Aims: This study aims to determine the efficacy of OTFC as premedicant in patients scheduled for surgery under general anesthesia (GA) and to assess the effects of OTFC on anxiety, sedation. Settings and Design: A prospective randomized study. Subjects and Methods: Patients between 21 and 60 years of age in American Society of Anesthesiologists physical status Classes I and II scheduled for elective surgery under GA were randomly assigned to three groups of 30 each: OTFC, placebo, and control. Mean arterial blood pressure (MAP), heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO2) along with anxiety and sedation scores were recorded as baseline and upon entering the operation theater. Adverse effects were also recorded. Statistical Analysis Used: Statistical analysis was done using Statistical Package for Social Sciences Version 15.0 Statistical Analysis Software. Results: No significant differences were found in MAP, HR, RR, or SpO2among the groups. OTFC group demonstrated significantly higher levels of anxiolysis than the control group (P < 0.05). No significant difference in sedation score was found. No remarkable adverse effects were observed. Conclusions: OTFC is an effective anxiolytic in adult with minimal risks and side effects. It is readily acceptable by the patients in its given form.

Comparison of ropivacaine with levobupivacaine under epidural anesthesia in the lower limb orthopedic surgeries: A randomized study

Context: Epidural anesthesia is nowadays considered as the gold standard anesthetic technique for lower limb orthopedic surgeries, and the present study was conducted to evaluate the efficacy of levobupivacaine and ropivacaine in terms of onset, duration of sensory and motor block with duration of postoperative analgesia in patients undergoing lower limb orthopedic surgeries under epidural anesthesia. Aims: To compare the efficacy of 15 mL of levobupivacaine 0.5% with that of 15 mL of ropivacaine 0.75% in patients undergoing lower limb orthopedic surgeries under epidural anesthesia and to determine the better of the two agents with respect to onset, duration of sensory and motor blockade, postoperative analgesia, and adverse effects; if any. Settings and Design: A double-blind randomized study. Subjects and Methods: A total of seventy patients planned to undergo elective lower limb orthopedic surgeries fulfilling the criteria were enrolled in the study. Group I (n = 35): Received 15 mL 0.5% levobupivacaine epidurally. Group II (n = 35): Received 15 mL 0.75% ropivacaine epidurally. Statistical Analysis: Statistical Analysis was done by Statistical Package for Social Sciences (SPSS Version 15.0) statistical analysis software. The values were represented in number (%) and mean ± standard deviation. Results: Time to achieve sensory onset and motor onset were significantly lower in Group II (17.86 ± 2.51 and 23.14 ± 2.73) as compared to Group I (26.14 ± 2.45 and 31.43 ± 2.59) while the duration of sensory block was significantly higher in Group II (173.29 ± 6.29 min) as compared to Group I (156.71 ± 6.96 min). Although motor block duration of Group I (142.43 ± 8.43 min) was higher than that of Group II (141.43 ± 12.81 min), but this difference was not found to be statistically significant. Conclusions: The inference drawn from this discussion, in general, indicated that both the drugs are comparable for block onset, quality, and duration along with similar hemodynamic profile when given in same concentration. However, relatively better response of ropivacaine for block onset and duration as obtained in the present study coupled with higher but statistically.