Pub Date : 2023-10-01Epub Date: 2023-02-02DOI: 10.4103/joacp.joacp_167_22
Sunil Rajan, Niranjan K Sasikumar, Ramya Anand, Jerry Paul
{"title":"Airway management of a patient with extensive upper airway hemangioma for total thyroidectomy.","authors":"Sunil Rajan, Niranjan K Sasikumar, Ramya Anand, Jerry Paul","doi":"10.4103/joacp.joacp_167_22","DOIUrl":"10.4103/joacp.joacp_167_22","url":null,"abstract":"","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10805187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44665967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01Epub Date: 2022-10-04DOI: 10.4103/joacp.joacp_104_22
Sonali Gupta, Mamta Dubey
Background and aims: Cancer chemotherapeutic agents cause alteration in the response to neuromuscular blocking drugs, which can have serious perioperative implications. Magnesium, commonly found to be deficient in these patients, plays an indispensable role in neuromuscular transmission. This study aimed to understand the effect of neoadjuvant chemotherapy on the neuromuscular blocking properties of cisatracurium.
Material and methods: One hundred female patients scheduled for breast cancer surgery were divided into two groups (n = 50 each). Group B received neoadjuvant chemotherapy with taxane, adriamycin, and cyclophosphamide, and Group A did not receive neoadjuvant chemotherapy. Neuromuscular block following cisatracurium 0.15 mg/kg was measured using peripheral nerve stimulator at the ulnar nerve. Onset time, duration of intense block, clinical duration of action, time to TOF4 after the last dose of cisatracurium, along with preoperative serum magnesium concentration were measured. Correlation and multiple regression were run to analyze the relationship between history of neoadjuvant chemotherapy, preoperative magnesium, and the abovementioned time points. Mediation analysis was done to ascertain if magnesium was mediating the observed effects.
Results: Onset time was prolonged by nearly 18% in Group B compared to Group A (P = 0.001). The duration of intense block was 35.27 ± 8.9 min in Group B and 42.07 ± 10.99 min in Group A (P < 0.001). The clinical duration of action of cisatracurium was significantly shorter in Group B (46.06 ± 8.68 min) compared to Group A (55.87 ± 11.04 min, P < 0.001). The time to TOF4 was 32.86 ± 5.66 min in Group B and 36.57 ± 8.49 min in Group A (P < 0.05). Preoperative serum magnesium levels were significantly lower in Group B (P < 0.001).
Conclusion: Patients who had received neoadjuvant chemotherapy had a delayed onset, shorter duration of action, and faster recovery for cisatracurium. Although preoperative magnesium levels were lower in Group B, it was found to be an independent predictor rather than a mediator of these effects.
{"title":"Neuromuscular blockade characteristics of cisatracurium in patients receiving chemotherapy: A preliminary study in breast cancer patients.","authors":"Sonali Gupta, Mamta Dubey","doi":"10.4103/joacp.joacp_104_22","DOIUrl":"10.4103/joacp.joacp_104_22","url":null,"abstract":"<p><strong>Background and aims: </strong>Cancer chemotherapeutic agents cause alteration in the response to neuromuscular blocking drugs, which can have serious perioperative implications. Magnesium, commonly found to be deficient in these patients, plays an indispensable role in neuromuscular transmission. This study aimed to understand the effect of neoadjuvant chemotherapy on the neuromuscular blocking properties of cisatracurium.</p><p><strong>Material and methods: </strong>One hundred female patients scheduled for breast cancer surgery were divided into two groups (<i>n</i> = 50 each). Group B received neoadjuvant chemotherapy with taxane, adriamycin, and cyclophosphamide, and Group A did not receive neoadjuvant chemotherapy. Neuromuscular block following cisatracurium 0.15 mg/kg was measured using peripheral nerve stimulator at the ulnar nerve. Onset time, duration of intense block, clinical duration of action, time to TOF4 after the last dose of cisatracurium, along with preoperative serum magnesium concentration were measured. Correlation and multiple regression were run to analyze the relationship between history of neoadjuvant chemotherapy, preoperative magnesium, and the abovementioned time points. Mediation analysis was done to ascertain if magnesium was mediating the observed effects.</p><p><strong>Results: </strong>Onset time was prolonged by nearly 18% in Group B compared to Group A (<i>P</i> = 0.001). The duration of intense block was 35.27 ± 8.9 min in Group B and 42.07 ± 10.99 min in Group A (<i>P</i> < 0.001). The clinical duration of action of cisatracurium was significantly shorter in Group B (46.06 ± 8.68 min) compared to Group A (55.87 ± 11.04 min, <i>P</i> < 0.001). The time to TOF4 was 32.86 ± 5.66 min in Group B and 36.57 ± 8.49 min in Group A (<i>P</i> < 0.05). Preoperative serum magnesium levels were significantly lower in Group B (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Patients who had received neoadjuvant chemotherapy had a delayed onset, shorter duration of action, and faster recovery for cisatracurium. Although preoperative magnesium levels were lower in Group B, it was found to be an independent predictor rather than a mediator of these effects.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10805208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45149464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and aims: Surgical procedure commonly performed in the advanced pediatric age group includes urogenital surgery, adenotonsillectomy, etc., Aim: The aim of this study is to determine the effect of single-dose gabapentin 15 mg/kg on acute pain in the immediate postoperative period in patients aged 8-14 years undergoing surgeries under general anesthesia.
Material and methods: After the approval from the institutional ethical committee, 60 American Society of Anesthesiologists (ASA) I and II patients aged 8-14 years undergoing urogenital surgeries (orchidopexy/urethroplasty) under general anesthesia were included in this study. The patients were assigned into one of the two treatment groups. Patients in group I received oral gabapentin 15 mg/kg dissolved in 5 mL of honey 2 h before surgery, while patients in group II received 5 mL honey orally 2 h before surgery.
Results: A total of 60 patients participated. Patients in group I had lower consumption of fentanyl perioperatively (intraoperatively: 1.36 ± 0.70 mcg/kg; postoperatively: 2.36 ± 0.795 mcg/kg) than group II (intraoperatively: 1.8 ± 0.6 mcg/kg; postoperatively: 2.9 ± 0.47 mcg/kg). The differences in the two groups were significant. The time to first rescue analgesia was greater in group I (3.03 ± 0.60 h) than in group II (2.26 ± 0.57 h). There was an increase in sedation score in the treatment group.
Conclusion: Our clinical study demonstrates that a 15 mg/kg single preemptive oral dose of gabapentin might reduce the requirement of analgesics perioperatively in pediatric urogenital surgery but might also be associated with undesirable effects such as increased sedation.
背景和目的：目的：本研究旨在确定单剂量加巴喷丁15 mg/kg对8-14岁全身麻醉下手术患者术后即刻急性疼痛的影响：经机构伦理委员会批准后，60 名年龄在 8-14 岁、在全身麻醉下接受泌尿生殖系统手术（睾丸切除术/尿道成形术）的美国麻醉医师协会（ASA）I 级和 II 级患者被纳入本研究。患者被分配到两个治疗组中的一组。I 组患者在手术前 2 小时口服溶于 5 mL 蜂蜜的加巴喷丁 15 mg/kg，II 组患者在手术前 2 小时口服 5 mL 蜂蜜：结果：共有 60 名患者参与。I 组患者围手术期的芬太尼消耗量（术中：1.36 ± 0.70 微克/千克；术后：2.36 ± 0.795 微克/千克）低于 II 组（术中：1.8 ± 0.6 微克/千克；术后：2.9 ± 0.47 微克/千克）。两组差异显著。I 组首次镇痛抢救时间（3.03 ± 0.60 小时）比 II 组（2.26 ± 0.57 小时）长。治疗组的镇静评分有所增加：我们的临床研究表明，在小儿泌尿生殖系统手术中，15 毫克/千克的单次抢先口服剂量加巴喷丁可能会减少围手术期的镇痛药需求，但也可能会带来不良反应，如镇静增加。
{"title":"Perioperative role of oral gabapentin as an analgesic in paediatric patients: A randomised controlled trial.","authors":"Chandni Sinha, Amarjeet Kumar, Ajeet Kumar, Poonam Kumari, Abhyuday Kumar, Bindey Kumar","doi":"10.4103/joacp.joacp_503_21","DOIUrl":"10.4103/joacp.joacp_503_21","url":null,"abstract":"<p><strong>Background and aims: </strong>Surgical procedure commonly performed in the advanced pediatric age group includes urogenital surgery, adenotonsillectomy, etc., Aim: The aim of this study is to determine the effect of single-dose gabapentin 15 mg/kg on acute pain in the immediate postoperative period in patients aged 8-14 years undergoing surgeries under general anesthesia.</p><p><strong>Material and methods: </strong>After the approval from the institutional ethical committee, 60 American Society of Anesthesiologists (ASA) I and II patients aged 8-14 years undergoing urogenital surgeries (orchidopexy/urethroplasty) under general anesthesia were included in this study. The patients were assigned into one of the two treatment groups. Patients in group I received oral gabapentin 15 mg/kg dissolved in 5 mL of honey 2 h before surgery, while patients in group II received 5 mL honey orally 2 h before surgery.</p><p><strong>Results: </strong>A total of 60 patients participated. Patients in group I had lower consumption of fentanyl perioperatively (intraoperatively: 1.36 ± 0.70 mcg/kg; postoperatively: 2.36 ± 0.795 mcg/kg) than group II (intraoperatively: 1.8 ± 0.6 mcg/kg; postoperatively: 2.9 ± 0.47 mcg/kg). The differences in the two groups were significant. The time to first rescue analgesia was greater in group I (3.03 ± 0.60 h) than in group II (2.26 ± 0.57 h). There was an increase in sedation score in the treatment group.</p><p><strong>Conclusion: </strong>Our clinical study demonstrates that a 15 mg/kg single preemptive oral dose of gabapentin might reduce the requirement of analgesics perioperatively in pediatric urogenital surgery but might also be associated with undesirable effects such as increased sedation.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10805194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45368395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01Epub Date: 2023-12-20DOI: 10.4103/joacp.joacp_515_23
Ghansham Biyani, Rajasekhar Metta
{"title":"Green anesthesia: How green is our practice?","authors":"Ghansham Biyani, Rajasekhar Metta","doi":"10.4103/joacp.joacp_515_23","DOIUrl":"10.4103/joacp.joacp_515_23","url":null,"abstract":"","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10805192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139546538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-18DOI: 10.4103/joacp.joacp_132_22
Sunil Rajan, Aishwarya P. Suresh, Madhumita Ramakrishnan, Jerry Paul
Dear Editor, Securing endotracheal tubes (ETT) during facial cosmetic surgeries can be challenging.[1] We are reporting how ETT was secured in two patients who underwent cosmetic facial surgeries which demanded bilateral cheeks, chin, and nose to be free. Flexometallic ETTs were used and were secured to incisors. In case 1, a 25-year-old female was posted for rhinoplasty, chin implant placement, and liposuction of the cheeks. After intubation, ETT was brought to the midline and a firm knot was made around ETT using size 1.0 silk (Centisilk, Centenial Surgical Suture Ltd, India) that was tied twice around ETT, and the knot was kept near the inner aspect of the upper incisors. Threads were then slipped down to gum through either side of one upper incisor, like performing dental flossing, and tied firmly on the buccal aspect of the incisor [Figure 1a].Figure 1: (a) ETT secured with thread to the upper incisor, (b) ETT secured with stainless steel wire to lower incisorsIn case 2, a 55-year-old female was posted for a chin implant, neck lift, lip lift, and liposuction of nasolabial folds. As incisors were closely placed, we failed to slip the thread between teeth down to the gum. Therefore, we decided to use a pre-stretched 26 G stainless steel wire (Ortho Max Mfg Co Pvt Ltd, India) which is commonly used by dental surgeons for arch bar fixation. The wire was wound twice around ETT and twisted repeatedly by holding both wires at a short distance from ETT using a needle holder. Once the wire was tightly wound around ETT, both the free ends of the wire were brought out to the buccal aspect through the lateral part of the first two lower incisors close to the gum. Both the ends were held together and twisted repeatedly till it was secured tightly around the incisors. The extra length of twisted wire was then cut short, the free end turned away from the lip, and covered with a piece of transparent incision drape to avoid lip trauma [Figure 1b]. Fixing ETT using adhesive tapes to cheeks or chin was not practical in both patients as surgeries involved the chin and both cheeks and frequent assessment of facial symmetry intraoperatively was required. Preformed tube (oral/nasal) was avoided as surgeries involved the nose, chin, and neck. The use of a flexometallic tube prevented kinking of ETT and gave surgeons freedom to move the proximal part of ETT with an attached breathing circuit (covered in sterile plastic sheet) away from the surgical field with no distortion of facial anatomy. These requirements could have been met with submental intubation as in panfacial trauma,[2-4] but not considered as our patients were undergoing cosmetic procedures. Though tying ETT with silk to incisors is totally atraumatic, dental wires may cause minimal gum injury. As tips of incisors are always broader than root, the chance of suture slipping out intraoperatively is rare, if the knot is tied firmly close to the root of incisors. ETT should not be tied to loose or partly br
亲爱的编辑，在面部整容手术中固定气管内管(ETT)是很有挑战性的。[1]我们报告了两名接受面部美容手术的患者是如何获得ETT的，该手术要求双侧脸颊，下巴和鼻子自由。使用柔性金属假体并将其固定在门牙上。在病例1中，一名25岁的女性接受了鼻整形、下巴植入和脸颊吸脂手术。插管后，将ETT带至中线，用1.0号丝(Centisilk, Centenial Surgical Suture Ltd, India)在ETT周围打结，在ETT周围打结两次，结保持在上门牙内侧附近。然后将牙线从一个上门牙的两侧滑落到牙龈上，就像使用牙线一样，并牢固地系在门牙的颊面上[图1a]。图1:(a)上门牙螺纹固定ETT， (b)下门牙不锈钢丝固定ETT。病例2，一名55岁女性，行下巴种植、颈部提升、唇部提升和鼻唇沟吸脂术。由于门牙的位置很近，我们没能把牙间的线滑到牙龈上。因此，我们决定使用预拉伸的26g不锈钢丝(Ortho Max Mfg Co Pvt Ltd, India)，这是牙科医生常用的弓杆固定。将金属丝绕ETT两圈，并用夹针器将两根金属丝握在离ETT近的地方反复扭转。一旦金属丝紧紧缠绕在ETT上，金属丝的自由两端通过靠近牙龈的前两个下门牙的外侧部分被带到颊面。两端被固定在一起，反复扭曲，直到它被牢牢地固定在门牙周围。将多余的绞丝剪短，游离端远离唇部，并覆盖一层透明切口悬垂，避免唇部外伤[图1b]。由于手术涉及到下巴和双颊，且术中需要频繁评估面部对称性，因此使用胶带将ETT固定在两名患者的脸颊或下巴上并不实际。由于手术涉及鼻子、下巴和颈部，因此避免使用预成形管(口/鼻)。柔性金属管的使用防止了ETT的扭结，并使外科医生可以自由地将ETT的近端部分与附加的呼吸回路(覆盖在无菌塑料片上)移离手术场，而不会扭曲面部解剖结构。这些要求可以在全面外伤中通过颏下插管来满足[2-4]，但由于我们的患者正在接受美容手术，因此不被考虑。虽然将ETT用丝系在门牙上是完全无伤大雅的，但牙丝可能会对牙龈造成最小的伤害。由于切牙的尖端总是比牙根宽，如果结系紧靠近切牙的根部，术中缝线滑落的机会很少。ETT不应绑在松动或部分断裂的门牙上。1.0码的丝绸很厚，不容易断裂。如果可能的话，可以使用双线。然而，在任何面部手术中意外拔管的罕见可能性应牢记在心。即使长时间使用，牙间导线也是一种安全的技术。[5]我们建议在面部整形手术中考虑这两种确保ETT的技术。患者同意声明作者证明他们已经获得了所有适当的患者同意表格。以患者同意在期刊上报道其图像和其他临床信息的形式。患者明白他们的姓名和首字母缩写不会被公布，我们会尽力隐藏他们的身份，但不能保证匿名。财政支持及赞助无。利益冲突没有利益冲突。
{"title":"Techniques of securing endotracheal tube during cosmetic facial surgeries involving nose, cheeks, and chin","authors":"Sunil Rajan, Aishwarya P. Suresh, Madhumita Ramakrishnan, Jerry Paul","doi":"10.4103/joacp.joacp_132_22","DOIUrl":"https://doi.org/10.4103/joacp.joacp_132_22","url":null,"abstract":"Dear Editor, Securing endotracheal tubes (ETT) during facial cosmetic surgeries can be challenging.[1] We are reporting how ETT was secured in two patients who underwent cosmetic facial surgeries which demanded bilateral cheeks, chin, and nose to be free. Flexometallic ETTs were used and were secured to incisors. In case 1, a 25-year-old female was posted for rhinoplasty, chin implant placement, and liposuction of the cheeks. After intubation, ETT was brought to the midline and a firm knot was made around ETT using size 1.0 silk (Centisilk, Centenial Surgical Suture Ltd, India) that was tied twice around ETT, and the knot was kept near the inner aspect of the upper incisors. Threads were then slipped down to gum through either side of one upper incisor, like performing dental flossing, and tied firmly on the buccal aspect of the incisor [Figure 1a].Figure 1: (a) ETT secured with thread to the upper incisor, (b) ETT secured with stainless steel wire to lower incisorsIn case 2, a 55-year-old female was posted for a chin implant, neck lift, lip lift, and liposuction of nasolabial folds. As incisors were closely placed, we failed to slip the thread between teeth down to the gum. Therefore, we decided to use a pre-stretched 26 G stainless steel wire (Ortho Max Mfg Co Pvt Ltd, India) which is commonly used by dental surgeons for arch bar fixation. The wire was wound twice around ETT and twisted repeatedly by holding both wires at a short distance from ETT using a needle holder. Once the wire was tightly wound around ETT, both the free ends of the wire were brought out to the buccal aspect through the lateral part of the first two lower incisors close to the gum. Both the ends were held together and twisted repeatedly till it was secured tightly around the incisors. The extra length of twisted wire was then cut short, the free end turned away from the lip, and covered with a piece of transparent incision drape to avoid lip trauma [Figure 1b]. Fixing ETT using adhesive tapes to cheeks or chin was not practical in both patients as surgeries involved the chin and both cheeks and frequent assessment of facial symmetry intraoperatively was required. Preformed tube (oral/nasal) was avoided as surgeries involved the nose, chin, and neck. The use of a flexometallic tube prevented kinking of ETT and gave surgeons freedom to move the proximal part of ETT with an attached breathing circuit (covered in sterile plastic sheet) away from the surgical field with no distortion of facial anatomy. These requirements could have been met with submental intubation as in panfacial trauma,[2-4] but not considered as our patients were undergoing cosmetic procedures. Though tying ETT with silk to incisors is totally atraumatic, dental wires may cause minimal gum injury. As tips of incisors are always broader than root, the chance of suture slipping out intraoperatively is rare, if the knot is tied firmly close to the root of incisors. ETT should not be tied to loose or partly br","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135207765","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}
Abstract Background and Aims: Sedative effects of melatonin may have an additive effect on general anesthesia (GA). We compared hemodynamic response to intubation following oral premedication with melatonin versus placebo. Induction dose of propofol, isoflurane and fentanyl consumption were also compared. Material and Methods: This prospective, double-blinded study was conducted in fifty patients randomized into two equal groups. Group M received oral melatonin 6 mg and group P a placebo two hours before surgery. All patients were induced with intravenous propofol of 1.5–2.5mg/kg till loss of response to verbal commands, three minutes after vecuronium, laryngoscopy was done and trachea was intubated. Heart rate (HR) and mean arterial pressures (MAP) were recorded before premedication, before induction, immediately after induction and then at 1,3,5 and 10 minutes after intubation. Results: Mean HR was comparable in both groups throughout the study period. Group M had significantly lower MAP before induction and immediately after induction ( P < 0.05). At all other time points MAP remained comparable in both groups. Mean isoflurane consumption was significantly lower in group M compared to group P (14.8 ± 4.2 vs 19.7 ± 3.2 mL). Propofol requirement for induction was also significantly lower in group M (102.4 ± 19.6 vs 122.4 ± 26.3mg). Intraoperative fentanyl consumption was comparable. Conclusion: Oral premedication with melatonin 6mg administered two hours before surgery significantly reduced MAP before and after induction of GA with a significant reduction in dose of propofol requirement.Titrating induction dose of propofol till loss of response to verbal commands did not effectively attenuate responses to laryngoscopy and intubation following melatonin oral premedication.
背景与目的:褪黑激素的镇静作用可能对全身麻醉(GA)有附加作用。我们比较了口服褪黑激素和安慰剂治疗前插管后的血流动力学反应。并比较了异丙酚、异氟醚和芬太尼的诱导剂量。材料和方法:本前瞻性双盲研究将50例患者随机分为两组。M组术前2小时口服褪黑素6毫克，P组术前2小时口服安慰剂。所有患者均静脉注射异丙酚1.5 ~ 2.5mg/kg诱导至对口头命令失去反应，维库溴铵给药3分钟后行喉镜检查并插管。分别记录用药前、诱导前、诱导后及插管后1、3、5、10分钟的心率(HR)和平均动脉压(MAP)。结果:在整个研究期间，两组的平均HR具有可比性。M组诱导前和诱导后即刻MAP显著降低(P <0.05)。在所有其他时间点，两组的MAP保持可比性。与P组相比，M组的平均异氟醚消耗量显著降低(14.8±4.2 mL vs 19.7±3.2 mL)。诱导丙泊酚需用量M组显著低于对照组(102.4±19.6 mg vs 122.4±26.3mg)。术中芬太尼用量具有可比性。结论:术前2小时口服褪黑素6mg可显著降低GA诱导前后的MAP，异丙酚需用量显著降低。滴定异丙酚诱导剂量，直到对口头命令失去反应，并不能有效地减弱口服褪黑素预用药后对喉镜检查和插管的反应。
{"title":"Effects of oral melatonin premedication on hemodynamic responses to intubation, anesthetic requirements and postoperative sedation: A randomized trial","authors":"Sunil Rajan, Reema Abubaker, Revathy Ajayachandran Kala, Niranjan Kumar Sasikumar, Mani Vignesh Kannan, Lakshmi Kumar","doi":"10.4103/joacp.joacp_159_22","DOIUrl":"https://doi.org/10.4103/joacp.joacp_159_22","url":null,"abstract":"Abstract Background and Aims: Sedative effects of melatonin may have an additive effect on general anesthesia (GA). We compared hemodynamic response to intubation following oral premedication with melatonin versus placebo. Induction dose of propofol, isoflurane and fentanyl consumption were also compared. Material and Methods: This prospective, double-blinded study was conducted in fifty patients randomized into two equal groups. Group M received oral melatonin 6 mg and group P a placebo two hours before surgery. All patients were induced with intravenous propofol of 1.5–2.5mg/kg till loss of response to verbal commands, three minutes after vecuronium, laryngoscopy was done and trachea was intubated. Heart rate (HR) and mean arterial pressures (MAP) were recorded before premedication, before induction, immediately after induction and then at 1,3,5 and 10 minutes after intubation. Results: Mean HR was comparable in both groups throughout the study period. Group M had significantly lower MAP before induction and immediately after induction ( P < 0.05). At all other time points MAP remained comparable in both groups. Mean isoflurane consumption was significantly lower in group M compared to group P (14.8 ± 4.2 vs 19.7 ± 3.2 mL). Propofol requirement for induction was also significantly lower in group M (102.4 ± 19.6 vs 122.4 ± 26.3mg). Intraoperative fentanyl consumption was comparable. Conclusion: Oral premedication with melatonin 6mg administered two hours before surgery significantly reduced MAP before and after induction of GA with a significant reduction in dose of propofol requirement.Titrating induction dose of propofol till loss of response to verbal commands did not effectively attenuate responses to laryngoscopy and intubation following melatonin oral premedication.","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135207768","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}
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