Background: Etomidate a commonly used induction agent in anesthesia is associated with pain and episodes of myoclonus post induction. This study was designed to evaluate and compare Midazolam and low dose of Etomidate in prevention of these symptoms on injection. Methods: This prospective randomized controlled study was conducted on 90 patients allocated to three study groups. Group 1 patients received 0.015 mg/kg of Midazolam i/v diluted to 5 ml in normal saline, Group II received 0.03 mg/kg of Etomidate i/v diluted to 5 ml in normal saline and Group III received 5 ml normal saline intravenously as premedication. Five minutes after receiving the study drugs, patient was preoxygenated with 100% oxygen for 3 min along with anesthesia induction with 0.3 mg/kg etomidate injected intravenously over the period of 20-30 sec. The patients were observed for etomidate induced myoclonus and pain. Results: The incidence of myoclonus in Group II was least with 46.67% having no myoclonus as compared to group I and III where Majority of patients had grade 3 myoclonus (50%; Group I) and (46.67%; Group III). There was statistical difference between the groups in terms of myoclonus grading. Further, there was statistical difference between the groups in pain score with majority of group 1 patients having grade 3 (severe pain = 46.67%) pain and group 3 patients with 43.3% having severe pain. Group 2 on the contrary majorly reported no pain (46.6%). Conclusions: The current study indicated pre induction of etomidate in low dose as an effective strategy in prevention of EIM as compared to Midazolam.
{"title":"Comparison of pre-treatment with low -dose midazolam versus low- dose etomidate for prevention of etomidate induced myoclonus and pain at intubation - A randomized controlled study","authors":"N. Sharma","doi":"10.26611/10151915","DOIUrl":"https://doi.org/10.26611/10151915","url":null,"abstract":"Background: Etomidate a commonly used induction agent in anesthesia is associated with pain and episodes of myoclonus post induction. This study was designed to evaluate and compare Midazolam and low dose of Etomidate in prevention of these symptoms on injection. Methods: This prospective randomized controlled study was conducted on 90 patients allocated to three study groups. Group 1 patients received 0.015 mg/kg of Midazolam i/v diluted to 5 ml in normal saline, Group II received 0.03 mg/kg of Etomidate i/v diluted to 5 ml in normal saline and Group III received 5 ml normal saline intravenously as premedication. Five minutes after receiving the study drugs, patient was preoxygenated with 100% oxygen for 3 min along with anesthesia induction with 0.3 mg/kg etomidate injected intravenously over the period of 20-30 sec. The patients were observed for etomidate induced myoclonus and pain. Results: The incidence of myoclonus in Group II was least with 46.67% having no myoclonus as compared to group I and III where Majority of patients had grade 3 myoclonus (50%; Group I) and (46.67%; Group III). There was statistical difference between the groups in terms of myoclonus grading. Further, there was statistical difference between the groups in pain score with majority of group 1 patients having grade 3 (severe pain = 46.67%) pain and group 3 patients with 43.3% having severe pain. Group 2 on the contrary majorly reported no pain (46.6%). Conclusions: The current study indicated pre induction of etomidate in low dose as an effective strategy in prevention of EIM as compared to Midazolam.","PeriodicalId":18595,"journal":{"name":"MedPulse International Journal of Anesthesiology","volume":"69 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88584620","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}
Background: Local anesthetic drugs like bupivacaine are commonly used in spinal anesthesia for lower limb surgeries but the duration of spinal anaesthesia is very short. However, the duration of action of bupivacaine in spinal anaesthesia can be prolonged by using adjuvants such as midazolam, opioids, neostigmine, dexmedetomidine and clonidine. The present study is being undertaken to evaluate and compare the effects of clonidine and fentanyl as intrathecal adjuvants to hyperbaric bupivacaine in patients undergoing lower limb orthopaedic surgery. Material and Methods: Present study was conducted in the Department of Anaesthesiology and Intensive Care, Government Medical College, Jammu in patients of either sex ranging in age from 20-60 years belonging to ASA I/ II scheduled for lower limb orthopaedic surgeries. 90 patients were randomly allocated in three groups of 30 each in order to compare the duration and quality of analgesia of clonidine and fentanyl used as adjuvants to intrathecal bupivacaine. Results: All the three groups were comparable in age, gender, height, weight, ASA grade distribution and the difference between them was not statistically significant. The difference between the time to reach the T10 block, mean time taken for first request for analgesia and duration of motor block in all three groups were found out to be statistically significant (p<0.0001). It was found that group with clonidine had better results than fentanyl and bupivacaine alone. In our study 1 patient in bupivacaine (15mg) with fentanyl (25µg) group and 2 patients in clonidine(37.5ugm) group had hypotension but the difference was statistically insignificant. Only 1 patient in each fentanyl and clonidine group had 1 episode of bradycardia but no patient in bupivacaine alone group had bradycardia and the difference was also insignificant. Postoperative vomiting was experienced by 3.33% of patients receiving Bupivacaine (15mg) with fentanyl (25µg) and it was treated by giving injection Ondansetron 4 mg i/v whereas no case was reported in clonidine group. This difference was statistically insignificant. 2 patients in bupivacaine (15mg) with fentanyl (25µg) group had itching but no such case was reported in clonidine group and the difference was also statistically insignificant. No respiratory depression, nausea was noted in study patients. Conclusion: It can be concluded that intrathecal clonidine (37.5ugm) provides quicker onset and prolonged duration of sensory and motor blocks simultaneously increasing the duration of analgesia when compared to fentanyl (25ugm).
{"title":"Comparative study of postoperative analgesia intrathecal addition of fentanyl versus clonidine in lower limb surgeries","authors":"Palak Gupta","doi":"10.26611/10151825","DOIUrl":"https://doi.org/10.26611/10151825","url":null,"abstract":"Background: Local anesthetic drugs like bupivacaine are commonly used in spinal anesthesia for lower limb surgeries but the duration of spinal anaesthesia is very short. However, the duration of action of bupivacaine in spinal anaesthesia can be prolonged by using adjuvants such as midazolam, opioids, neostigmine, dexmedetomidine and clonidine. The present study is being undertaken to evaluate and compare the effects of clonidine and fentanyl as intrathecal adjuvants to hyperbaric bupivacaine in patients undergoing lower limb orthopaedic surgery. Material and Methods: Present study was conducted in the Department of Anaesthesiology and Intensive Care, Government Medical College, Jammu in patients of either sex ranging in age from 20-60 years belonging to ASA I/ II scheduled for lower limb orthopaedic surgeries. 90 patients were randomly allocated in three groups of 30 each in order to compare the duration and quality of analgesia of clonidine and fentanyl used as adjuvants to intrathecal bupivacaine. Results: All the three groups were comparable in age, gender, height, weight, ASA grade distribution and the difference between them was not statistically significant. The difference between the time to reach the T10 block, mean time taken for first request for analgesia and duration of motor block in all three groups were found out to be statistically significant (p<0.0001). It was found that group with clonidine had better results than fentanyl and bupivacaine alone. In our study 1 patient in bupivacaine (15mg) with fentanyl (25µg) group and 2 patients in clonidine(37.5ugm) group had hypotension but the difference was statistically insignificant. Only 1 patient in each fentanyl and clonidine group had 1 episode of bradycardia but no patient in bupivacaine alone group had bradycardia and the difference was also insignificant. Postoperative vomiting was experienced by 3.33% of patients receiving Bupivacaine (15mg) with fentanyl (25µg) and it was treated by giving injection Ondansetron 4 mg i/v whereas no case was reported in clonidine group. This difference was statistically insignificant. 2 patients in bupivacaine (15mg) with fentanyl (25µg) group had itching but no such case was reported in clonidine group and the difference was also statistically insignificant. No respiratory depression, nausea was noted in study patients. Conclusion: It can be concluded that intrathecal clonidine (37.5ugm) provides quicker onset and prolonged duration of sensory and motor blocks simultaneously increasing the duration of analgesia when compared to fentanyl (25ugm).","PeriodicalId":18595,"journal":{"name":"MedPulse International Journal of Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90801075","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}
{"title":"Effect of intravenous paracetamol for post-operative pain relief after tonsillectomy - A study of 70 cases","authors":"Kawin Kumar M","doi":"10.26611/10151415","DOIUrl":"https://doi.org/10.26611/10151415","url":null,"abstract":"","PeriodicalId":18595,"journal":{"name":"MedPulse International Journal of Anesthesiology","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84114468","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}
{"title":"Comparative study of intrathecal bupivacaine plus midazolam vs bupivacaine alone for duration of postoperative analgesia in the patients of caesarean delivery","authors":"Vinaysingh Kishansingh Rajput","doi":"10.26611/101516316","DOIUrl":"https://doi.org/10.26611/101516316","url":null,"abstract":"","PeriodicalId":18595,"journal":{"name":"MedPulse International Journal of Anesthesiology","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83177837","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}
{"title":"Comparative effects of intravenous diclofenac versus intramuscular diclofenac on postoperative surgical pain management","authors":"Richa V Patel","doi":"10.26611/10151514","DOIUrl":"https://doi.org/10.26611/10151514","url":null,"abstract":"","PeriodicalId":18595,"journal":{"name":"MedPulse International Journal of Anesthesiology","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88142700","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}
INTRODUCTION: Tonsillectomy is one of the commonest surgical procedures performed in the field of otorhinolaryngology. The most common and distressing symptoms, which follow anaesthesia and surgery, are pain and emesis. The provision of adequate analgesia after tonsillectomy presents the anaesthesiologist with difficulties, as this is a painful procedure and may be associated with significant bleeding into the airway. As evidence continues to accumulate concerning the role of central sensitisation in post operative pain, many researchers have followed methods to prevent central neuropathic changes from occurring, through the utilization of pre-emptive analgesic techniques. Effective preventive analgesic technique may not only be useful in reducing the acute pain, but also chronic post surgical pain and disabilities. Paracetamol is an effective analgesic and an antipyretic agent. The efficiency and tolerability for intravenous Paracetamol are well established. It has a favourable safety profile and it is the most commonly prescribed drug for the treatment of mild to moderate pain. The objective of the present study is to evaluate the post operative analgesia, the haemodynamic profile and the side effects of IV Paracetamol. AIM OF THE STUDY: 1. To evaluate the efficacy of Intravenous Paracetamol as a pre-emptive analgesic in relieving the post operative pain. 2. To study the hemodynamic variables during the post-operative period. 3. To establish the safety of Intravenous paracetamol in patients. MATERIALS AND METHODS: Study Design: Prospective, randomized, double blinded, comparative study. Double blinding was done by taking appropriate dose of intravenous paracetamol calculated in mg/kg and was added to a solution of normal saline to make a volume of 100 ml. This was labelled as drug A. Plain 100 ml of normal saline was labelled as drug B. Neither the person administering the drug nor the person observing the patient in the post operative period did not know the drug. Study Population: After obtaining the institutional ethical committee approval and written informed consent from the parent/guardian, 70 ASA I physical status patients undergoing tonsillectomy were selected between the age group of 6-16 years and weighing between 10-30 kg. Sample Size: 35 patients in the paracetamol group (P group) and 35 in the control group (N group). Probability sampling: All the70 patients were randomised in two groups and the entire patients stood an equal chance of getting into any group. Data collection: 1. Age, Sex, Weight, 2. Pre operative and intra operative pulse rate and blood pressure, Spo2, 3. Duration of surgery, 4. Sedation score using Ramsays Sedation Scale, 5. Visual analogue pain scale at the end of surgery, 1h 2h, 3h, 4h, 5h, 6h. 6. Post operative complications such as: • Drug intolerance, • Nausea and vomiting, • Epigastric pain, • Bleeding, Exclusion Criteria: 1. Upper and lower respiratory tract infections, 2. Card
{"title":"Effect of intravenous paracetamol for post-operative pain relief after tonsillectomy - A study of 70 cases","authors":"M. KawinKumar","doi":"10.26611/10151411","DOIUrl":"https://doi.org/10.26611/10151411","url":null,"abstract":"INTRODUCTION: Tonsillectomy is one of the commonest surgical procedures performed in the field of otorhinolaryngology. The most common and distressing symptoms, which follow anaesthesia and surgery, are pain and emesis. The provision of adequate analgesia after tonsillectomy presents the anaesthesiologist with difficulties, as this is a painful procedure and may be associated with significant bleeding into the airway. As evidence continues to accumulate concerning the role of central sensitisation in post operative pain, many researchers have followed methods to prevent central neuropathic changes from occurring, through the utilization of pre-emptive analgesic techniques. Effective preventive analgesic technique may not only be useful in reducing the acute pain, but also chronic post surgical pain and disabilities. Paracetamol is an effective analgesic and an antipyretic agent. The efficiency and tolerability for intravenous Paracetamol are well established. It has a favourable safety profile and it is the most commonly prescribed drug for the treatment of mild to moderate pain. The objective of the present study is to evaluate the post operative analgesia, the haemodynamic profile and the side effects of IV Paracetamol. AIM OF THE STUDY: 1. To evaluate the efficacy of Intravenous Paracetamol as a pre-emptive analgesic in relieving the post operative pain. 2. To study the hemodynamic variables during the post-operative period. 3. To establish the safety of Intravenous paracetamol in patients. MATERIALS AND METHODS: Study Design: Prospective, randomized, double blinded, comparative study. Double blinding was done by taking appropriate dose of intravenous paracetamol calculated in mg/kg and was added to a solution of normal saline to make a volume of 100 ml. This was labelled as drug A. Plain 100 ml of normal saline was labelled as drug B. Neither the person administering the drug nor the person observing the patient in the post operative period did not know the drug. Study Population: After obtaining the institutional ethical committee approval and written informed consent from the parent/guardian, 70 ASA I physical status patients undergoing tonsillectomy were selected between the age group of 6-16 years and weighing between 10-30 kg. Sample Size: 35 patients in the paracetamol group (P group) and 35 in the control group (N group). Probability sampling: All the70 patients were randomised in two groups and the entire patients stood an equal chance of getting into any group. Data collection: 1. Age, Sex, Weight, 2. Pre operative and intra operative pulse rate and blood pressure, Spo2, 3. Duration of surgery, 4. Sedation score using Ramsays Sedation Scale, 5. Visual analogue pain scale at the end of surgery, 1h 2h, 3h, 4h, 5h, 6h. 6. Post operative complications such as: • Drug intolerance, • Nausea and vomiting, • Epigastric pain, • Bleeding, Exclusion Criteria: 1. Upper and lower respiratory tract infections, 2. Card","PeriodicalId":18595,"journal":{"name":"MedPulse International Journal of Anesthesiology","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82270213","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}
{"title":"A prospective randomised comparative study of epidural bupivacaine and levobupivacaine after single dose of intrathecal fentanyl for combined spinal epidural labour analgesia","authors":"Bhavya Reddy H A","doi":"10.26611/10151539","DOIUrl":"https://doi.org/10.26611/10151539","url":null,"abstract":"","PeriodicalId":18595,"journal":{"name":"MedPulse International Journal of Anesthesiology","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90543639","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}
{"title":"Efficiency of fascia iliaca compartment block as a part of multimodal analgesia for post- operative analgesia after femoral bone surgeries","authors":"Prr Kamal","doi":"10.26611/10151717","DOIUrl":"https://doi.org/10.26611/10151717","url":null,"abstract":"","PeriodicalId":18595,"journal":{"name":"MedPulse International Journal of Anesthesiology","volume":"86 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78156646","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}
{"title":"Study of post-operative analgesic effect of intraperitoneal ropivacaine with or without tramadol in laparoscopic cholecystectomy","authors":"P. Sharma","doi":"10.26611/101517210","DOIUrl":"https://doi.org/10.26611/101517210","url":null,"abstract":"","PeriodicalId":18595,"journal":{"name":"MedPulse International Journal of Anesthesiology","volume":"75 3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72688551","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}
{"title":"Evaluation of supraclavicular brachial plexus block using a nerve stimulator versus ultrasound guidance","authors":"A. .","doi":"10.26611/10151531","DOIUrl":"https://doi.org/10.26611/10151531","url":null,"abstract":"","PeriodicalId":18595,"journal":{"name":"MedPulse International Journal of Anesthesiology","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85573506","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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