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Intravenous dexmedetomidine versus esmolol for attenuation of haemodynamic response to endotracheal extubation: A randomized double-blind study 静脉注射右美托咪定与艾司洛尔对气管内拔管血流动力学反应的衰减:一项随机双盲研究
Pub Date : 2023-04-01 DOI: 10.33545/26643766.2023.v6.i2b.396
P. Shah, K. Sahare, R. Bhuaarya, Falgudhara Panda
Background and Aim: Tracheal extubation is a crucial step of general anaesthesia which is associated with intense airway and hemodynamic responses secondary to activation of mechanoreceptors in larynx. The present study aims to compare the efficacy of intravenously administered dexmedetomidine and esmolol in attenuating the hemodynamic response to endotracheal extubation. Materials and Method: This prospective, randomized, double-blind study was conducted in 80 ASA I-II patients of 18-60 years undergoing elective surgery under general anaesthesia. They were randomly divided into two groups of forty each. Anticipated ten minutes before the extubation Group D received intravenous dexmedetomidine 0.5 µg/kg diluted in 10 ml normal saline and Group E received 10 ml of normal saline. Two min before extubation Group D received 10 ml normal saline and Group E received esmolol bolus dose 1 mg/kg diluted in 10 ml normal saline. Heart rate, systolic blood pressure, diastolic blood pressure, mean blood pressure, extubation and emergence time, Ramsay sedation score and adverse events were recorded. Results: Mean heart rate was significantly lower in group D from 5 min of drug administration till 20 min post extubation as compared to group E. Mean systolic blood pressure, diastolic blood pressure and mean blood pressure were significantly lower in group D as compared to group E from 8 min after administration of drug till 20 min of post extubation ( p <0.05). Emergence time, extubation time and adverse events were comparable in both the groups ( p >0.05). Delayed emergence was observed in 2 patients in group D. More number of patients in group D were sedated. Conclusion: IV dexmedetomidine is better in attenuating haemodynamic response to endotracheal extubation than esmolol because of comparatively stable haemodynamics, comparable emergence and extubation time, conscious sedation, less postoperative cough and agitation.
背景与目的:气管拔管是全身麻醉的关键步骤,它与喉部机械感受器激活引起的强烈气道和血流动力学反应有关。本研究旨在比较静脉给药右美托咪定和艾斯洛尔对气管内拔管血流动力学反应的减弱效果。材料和方法:本前瞻性、随机、双盲研究对80例18-60岁的ASA I-II型患者进行了全麻下择期手术。他们被随机分成两组,每组40人。拔管前10分钟,D组静脉滴注右美托咪定0.5µg/kg,用生理盐水10 ml稀释,E组静脉滴注生理盐水10 ml。拔管前2 min, D组给予生理盐水10 ml, E组给予艾斯洛尔丸剂1 mg/kg,用生理盐水10 ml稀释。记录患者心率、收缩压、舒张压、平均血压、拔管及急诊时间、Ramsay镇静评分及不良事件。结果:给药后5 min至拔管后20 min, D组平均心率显著低于E组。给药后8 min至拔管后20 min, D组平均收缩压、舒张压及平均血压显著低于E组(p < 0.05)。D组有2例患者出现延迟出现。结论:静脉注射右美托咪定比艾司洛尔更能降低气管内拔管后的血流动力学反应,因其血流动力学相对稳定,出现和拔管时间相当,有清醒镇静作用,术后咳嗽和躁动较少。
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引用次数: 0
Effect of single dose versus continuous infusion of dexmedetomidine for reduction in incidence of emergence agitation in adults following nasal surgeries: A randomized double-blind study 单剂量右美托咪定与持续输注右美托咪定对降低鼻手术后成人出现性激动发生率的影响:一项随机双盲研究
Pub Date : 2023-04-01 DOI: 10.33545/26643766.2023.v6.i2b.405
R. Bhuaarya, P. Shah, Katari Sruthi
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引用次数: 0
to study the Hemodynamic effects of intravenous clonidine as premedication for endotracheal intubation 研究静脉注射可乐定作为气管插管前用药对血流动力学的影响
Pub Date : 2023-04-01 DOI: 10.33545/26643766.2023.v6.i2a.393
Dr. Sherren Joseph Dsouza, Dhanashree H. Dongare, Dr. Kiran Chandrakant Valake
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引用次数: 0
Block characteristics of hyperbaric bupivacaine versus hyperbaric ropivacaine in lower segment cesarean section: A randomized experimental study 高压布比卡因与高压罗哌卡因在下段剖宫产术中的阻滞特征:一项随机实验研究
Pub Date : 2023-04-01 DOI: 10.33545/26643766.2023.v6.i2b.401
P. Shah, R. Bhuaarya, Mohammed F. Sheikh
Introduction: Bupivacaine is used most commonly for spinal anesthesia, however the major concern is longer duration and cardiotoxicity, that led us to find safe alternative with shorter duration. Hence, we compared routinely used hyperbaric bupivacaine with recently available hyperbaric ropivacaine in terms of block characteristics in caesarean section (CS). Objective: To compare the efficacy and safety of hyperbaric ropivacaine and bupivacaine in spinal anesthesia for elective CS with primary outcome as onset of sensory block at T 10 level & secondary outcomes as onset of motor block, grading & duration of sensory and motor block, duration of analgesia, hemodynamic changes & side effects. Methodology: Eighty parturients with ASA grade ІІ undergoing elective CS were allocated into two groups (n=40): group R (2 ml hyperbaric ropivacaine 0.75%) and group B (2 ml hyperbaric bupivacaine 0.5%). Result: Though onset of sensory block (group B 3.40±0.63 min & in group R 4.13±0.79min) & motor block (group B 5.28±0.82 min & group R 7.10±0.84min) (p<0.001) were significantly shorter in group B, but duration of sensory & motor block and duration of analgesia was significantly shorter in group R (p<0.001). Incidence of side effects (i.e. hypotension, nausea & vomiting, shivering) was comparable in both the groups. Conclusion: Ropivacaine can be preferred as an alternative to bupivacaine for spinal anesthesia in cesarean section because of early recovery & lesser side effects.
简介:布比卡因是脊髓麻醉中最常用的药物,但主要的问题是持续时间长和心脏毒性,这促使我们寻找安全、持续时间短的替代药物。因此,我们比较了常规使用的高压布比卡因和最近可用的高压罗哌卡因在剖宫产(CS)中的阻滞特征。目的:比较高压氧罗哌卡因和布比卡因用于选择性脊髓麻醉的疗效和安全性,主要指标为t10级感觉阻滞的发生,次要指标为运动阻滞的发生、感觉和运动阻滞的分级和持续时间、镇痛持续时间、血流动力学变化和副作用。方法:80例ASA级ІІ行选择性CS的产妇分为两组(n=40): R组(2 ml高压罗哌卡因0.75%)和B组(2 ml高压布比卡因0.5%)。结果:B组感觉阻滞(B组3.40±0.63 min, R组4.13±0.79min)和运动阻滞(B组5.28±0.82 min, R组7.10±0.84min)的发作时间(p<0.001)明显短于B组,但R组感觉、运动阻滞持续时间和镇痛持续时间明显短于R组(p<0.001)。两组的副作用发生率(如低血压、恶心呕吐、寒战)相当。结论:罗哌卡因恢复早、副作用小,可替代布比卡因用于剖宫产术中脊髓麻醉。
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引用次数: 0
Comparison of post-operative shivering, nausea and vomiting between pre-intubation and pre-extubation intravenous paracetamol in percutaneous nephrolithotripsy under general anaesthesia 全身麻醉下经皮肾镜碎石术插管前与拔管前静脉注射扑热息痛术后寒颤、恶心、呕吐的比较
Pub Date : 2023-04-01 DOI: 10.33545/26643766.2023.v6.i2b.397
Dr. Shalaka S Nellore, Dr. Ankesh Jhunjhunwala, Dr. Mrunalini Kasod, Dr. Geeta Patkar
Background: Post-operative shivering, nausea and vomiting is frequently observed in patients undergoing percutaneous nephrolithotripsy [PCNL] under general anaesthesia. It is not only distressing to patients but can also be detrimental because of the increased oxygen consumption, coagulopathies, delayed recovery and increased blood pressure. Prophylactic paracetamol administration has shown to be effective in reducing post-operative shivering by decreasing the hypothalamic temperature set point. When paracetamol is administered prior to extubation, it can reduce nausea and vomiting by reducing the post-operative pain. We aimed to compare the effects of prophylactic pre-induction and pre-extubation intravenous paracetamol on post-operative shivering, nausea and vomiting. Correlation of severe post-operative shivering with patient’s age, BMI, and amount o f irrigation fluid used were also evaluated. Methods: This prospective observational study was carried out on 72 patients undergoing PCNL under GA. Patients receiving intravenous 1gm paracetamol 20 minutes prior to intubation were grouped as PI-PCM while those receiving it 20 minutes prior to extubation over 20 minutes were grouped as PE-PCM. We recorded age, BMI, core body temperature (Pre-induction, before giving muscle relaxant and then 30 minutes thereafter, after extubation and just before shifting to the post-operative recovery), duration of PCNL, amount of irrigation fluid, post-operative shivering using Crossley & Mahajan score and PONV using the Afpel score every 10 minutes for 2 hours. Results: Demographic data such were comparable between the PI-PCM and PE-PCM groups. The occurrence of severe post-operative shivering (Crossley-Mahajan grade >II) was significantly higher (p 0.033) in the PE-PCM group as compared to the PI-PCM group. Post-operative shivering had statistically highly significant negative correlation with BMI and positive correlation with the amount of irrigation volume used. Incidence of PONV was statistically higher (p0.023) in the PI-PCM group as compared to the PE-PCM group. Conclusion: Prophylactic intravenous parcetamol administration can significantly reduce post-operative shivering in PCNL patients under GA. Similarly, it’s administration prior to extubating can significantly decrease the post-operative nausea and vomiting.
背景:全麻下经皮肾镜碎石术(PCNL)患者术后经常出现寒颤、恶心和呕吐。它不仅使患者痛苦,而且由于耗氧量增加、凝血功能障碍、恢复延迟和血压升高,也可能是有害的。预防性扑热息痛管理已被证明是有效的减少手术后颤抖通过降低下丘脑温度设定点。拔管前使用扑热息痛可通过减轻术后疼痛来减轻恶心和呕吐。我们的目的是比较预防性诱导前和拔管前静脉注射扑热息痛对术后寒颤、恶心和呕吐的影响。术后严重寒战与患者年龄、BMI和冲洗液用量的相关性也进行了评估。方法:对72例GA下行PCNL的患者进行前瞻性观察研究。插管前20分钟静脉注射1gm扑热息痛组为PI-PCM,拔管前20分钟静脉注射超过20分钟者为PE-PCM。我们记录年龄、BMI、核心体温(诱导前、给予肌肉松弛剂前、之后30分钟、拔管后和刚转到术后恢复前)、PCNL持续时间、灌洗液量、术后颤抖(采用Crossley & Mahajan评分)和PONV(采用Afpel评分),每10分钟一次,持续2小时。结果:PI-PCM组和PE-PCM组之间的人口统计学数据具有可比性。PE-PCM组术后严重寒战发生率(Crossley-Mahajan分级>II级)明显高于PI-PCM组(p 0.033)。术后寒战与BMI呈极显著负相关,与冲洗量呈正相关。与PE-PCM组相比,PI-PCM组PONV的发生率有统计学意义(p0.023)。结论:预防性静脉注射扑热息痛可显著减少GA下PCNL患者术后寒战。同样,拔管前给药可以显著减少术后恶心和呕吐。
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引用次数: 0
The long-term effectiveness of ultrasound guided cervical medial branch radiofrequency ablation in treatment of chronic neck pain of zygapophysial joints origin 超声引导颈内侧支射频消融术治疗关节关节源性慢性颈部疼痛的远期疗效观察
Pub Date : 2023-04-01 DOI: 10.33545/26643766.2023.v6.i2a.394
Mahmoud Gamal Arakeeb, A. A. El-Hafez, H. El-Gendy, Mohamed Ahmed Lofty
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引用次数: 0
Anaesthesia management for aneurysm clipping surgery in patients with severe aortic stenosis with regurgitation: A case report 严重主动脉狭窄伴返流患者动脉瘤夹闭手术的麻醉处理:1例报告
Pub Date : 2023-04-01 DOI: 10.33545/26643766.2023.v6.i2a.386
Dr. Ankhila D Hamand, Dr. Hemangi Karnik
{"title":"Anaesthesia management for aneurysm clipping surgery in patients with severe aortic stenosis with regurgitation: A case report","authors":"Dr. Ankhila D Hamand, Dr. Hemangi Karnik","doi":"10.33545/26643766.2023.v6.i2a.386","DOIUrl":"https://doi.org/10.33545/26643766.2023.v6.i2a.386","url":null,"abstract":"","PeriodicalId":14146,"journal":{"name":"International Journal of Medical Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80477693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
to compare the efficacy of propofol with ketamine versus propofol with fentanyl for procedural sedation for patients undergoing endoscopic retrograde cholangiopancreatography 比较丙泊酚联合氯胺酮与丙泊酚联合芬太尼用于内镜逆行胆管造影患者手术镇静的疗效
Pub Date : 2023-04-01 DOI: 10.33545/26643766.2023.v6.i2a.389
Dr. Keerthichandra Reddy K, D. Kv
Objective: This study was conducted to compare the efficacy of Propofol with Ketamine versus Propofol with Fentanyl for procedural sedation for patients undergoing ERCP to evaluate Propofol consumption, recovery score, patient satisfaction and sedation related adverse events. Materials and Methods: Sixty patients aged 18-60 years, ASA Class I and II were randomly allocated to one of two groups; Propofol/Ketamine (Ketofol) group KP (n=30) and Propofol/Fentanyl group FP (n=30). The level of sedation was adjusted to achieve a Ramsay Sedation Scale (RSS) score of 5. Results: The total amount of Propofol consumed was significantly higher in FP group (109.883±11.3871 mg) compared to KP group (89.867±9.8942 mg). Time to reach acceptable recovery score was slightly longer in KP group compared to FP (Aldrete scores 9.5±0.509, 9.8±0.407 respectively at 30 min). Patient satisfaction was comparable in both the groups and sedation related side effects like hypotension, bradycardia, desaturation was more significant in FP group compared to KP group. Conclusion: Propofol-Ketamine combination provided sedation quality similar to Propofol-Fentanyl combination with better hemodynamic profile and fewer side effects. Hence Propofol-Ketamine combination can be safely used in patients undergoing ERCP.
目的:比较异丙酚联合氯胺酮与异丙酚联合芬太尼用于ERCP患者手术镇静的疗效,评价异丙酚用量、恢复评分、患者满意度及镇静相关不良事件。材料与方法:年龄18 ~ 60岁,ASA I、II级患者60例,随机分为两组;异丙酚/氯胺酮(Ketofol)组KP (n=30)和异丙酚/芬太尼组FP (n=30)。调整镇静水平,使其达到Ramsay镇静量表(RSS) 5分。结果:FP组丙泊酚总用量(109.883±11.3871 mg)显著高于KP组(89.867±9.8942 mg)。与FP相比,KP组达到可接受恢复评分的时间稍长(30 min时Aldrete评分分别为9.5±0.509和9.8±0.407)。两组患者满意度相当,与KP组相比,FP组镇静相关的副作用如低血压、心动过缓、去血饱和度更显著。结论:异丙酚-氯胺酮联用镇静效果与异丙酚-芬太尼联用镇静效果相近,且血流动力学特征更好,副作用更小。因此异丙酚-氯胺酮联合用药可安全用于ERCP患者。
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引用次数: 0
Prospective study of incidence and risk factors of post-operative delirium following hip/femur surgery in elder patients (age > 60years) in tertiary care hospital 三级医院老年患者(60岁以上)髋关节/股骨手术后谵妄发生率及危险因素的前瞻性研究
Pub Date : 2023-04-01 DOI: 10.33545/26643766.2023.v6.i2b.404
Dr. Bhakti Gaude, Dr. Surekha Sudhir Chavan, Dr. Sujit Kshirsagar, Dr. Shital Rathod, Dr. Ankita Kaparboina, Dr. Priya Chavre
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引用次数: 0
Pericapsular Nerve Group block (PENG) and total hip arthroplasty 囊周神经阻滞(PENG)与全髋关节置换术
Pub Date : 2023-04-01 DOI: 10.33545/26643766.2023.v6.i2b.400
Rania Gamal Hegab, T. Mostafa, Rehab Said El Kalla, A. Hamed
A new method of regional anaesthetic called Pericapsular Nerve Group block (PENG) blocks these nerves in order to target the hip's anterior capsule. PENG Block applications include medial thigh lesions, hip fractures, and vascular operations. Only ultrasonic guidance is used when performing the PENG Block, and two methods — out-of-plane method and in-plane method — are used with the low-frequency probe. When employed in a multimodal manner, ultrasound guided peripheral nerve blocks were shown to be more effective and to have less adverse effects. Infection, bleeding, nerve injury, and local anaesthetic toxicity are some of the consequences. PENG is useful in complete hip replacement
一种新的局部麻醉方法被称为囊周神经群阻滞(PENG),阻断这些神经以靶向髋关节前囊。PENG Block的应用包括大腿内侧病变、髋部骨折和血管手术。在执行PENG块时仅使用超声波引导,并且使用两种方法-面外法和面内法-与低频探头一起使用。当以多模式方式使用时,超声引导的周围神经阻滞被证明更有效,副作用更少。感染、出血、神经损伤和局部麻醉毒性是一些后果。PENG在全髋关节置换术中是有用的
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引用次数: 0
期刊
International Journal of Medical Anesthesiology
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