Faisal Sheikh, Mubasher Ahmed, Mohamad Ommid, S. Gurcoo, N. Shakoor, Sheeba Nazir, Gousia Nisa
Neuraxial administration of opioid’s along with local anesthetics improve the quality of intraoperative analgesia and also provides postoperative pain relief for longer duration. The present study was conducted to study and compare the effects of bupivacaine alone and its combination with fentanyl used intrathecally in parturients with PIH. 50 ASA grade II patients with PIH defined as blood pressure between 140-160/ 90-110 mmHg without proteinuria were selected and divided into 2 groups as Group (I)-Bupivacaine and Group (II)BupivacaineFentanyl group. Haemodynamic variables like systolic and diastolic blood pressure, heart rate were recorded every 2 minutes upto delivery of baby and then every 5 minutes until end of surgery. Sensory block and motor block alongwith side effects were recorded. Pain was evaluated using visual analogue scale and neonatal outcome assessed using APGAR scoring. The highest sensory level achieved in bupivacaine-fentanyl group was higher than in the group receiving plain bupivacaine. The time taken for sensory regression to T12 and duration of analgesia was longer in the Bupivacaine-Fentanyl group. We conclude the combination group prolongs the duration of sensory spinal block, increases the duration of analgesia without increasing the duration of motor block, does not cause any significant side effects and provides stable haemodynamic conditions without fetal or maternal compromise.
{"title":"Comparative Evaluation Of Low Dose Hyperbaric Bupivacaine With Or Without Fentanyl In Spinal Anaesthesia For Caesarean Section In Patients With Pregnancy Induced Hypertension","authors":"Faisal Sheikh, Mubasher Ahmed, Mohamad Ommid, S. Gurcoo, N. Shakoor, Sheeba Nazir, Gousia Nisa","doi":"10.5580/2cca","DOIUrl":"https://doi.org/10.5580/2cca","url":null,"abstract":"Neuraxial administration of opioid’s along with local anesthetics improve the quality of intraoperative analgesia and also provides postoperative pain relief for longer duration. The present study was conducted to study and compare the effects of bupivacaine alone and its combination with fentanyl used intrathecally in parturients with PIH. 50 ASA grade II patients with PIH defined as blood pressure between 140-160/ 90-110 mmHg without proteinuria were selected and divided into 2 groups as Group (I)-Bupivacaine and Group (II)BupivacaineFentanyl group. Haemodynamic variables like systolic and diastolic blood pressure, heart rate were recorded every 2 minutes upto delivery of baby and then every 5 minutes until end of surgery. Sensory block and motor block alongwith side effects were recorded. Pain was evaluated using visual analogue scale and neonatal outcome assessed using APGAR scoring. The highest sensory level achieved in bupivacaine-fentanyl group was higher than in the group receiving plain bupivacaine. The time taken for sensory regression to T12 and duration of analgesia was longer in the Bupivacaine-Fentanyl group. We conclude the combination group prolongs the duration of sensory spinal block, increases the duration of analgesia without increasing the duration of motor block, does not cause any significant side effects and provides stable haemodynamic conditions without fetal or maternal compromise.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134325925","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: Epidural anesthesia after abdominal surgery results in improved postoperative pain relief but has up to a 30% failure rate. Hemodynamic changes after epidural administration of local anesthetics may provide parameters to predict dermatomal blockade and effective pain control in the postoperative period. The Endotracheal Cardiac Output Monitor (ECOM) provides continuous measurements of stroke volume (SV), cardiac output (CO) cardiac index (CI) and systemic vascular resistance (SVR). We hypothesized that the changes in hemodynamic parameters measured by the ECOM monitor along with changes in systolic (SBP), diastolic (DBP) and mean arterial pressure (MAP) would predict effective epidural anesthesia. Methods: 19 patients undergoing intra-abdominal surgery were enrolled. After placement of an epidural catheter and establishment of general anesthesia hemodynamics were recorded in 15-minute intervals using the ECOM monitor. At the start of abdominal closure epidural catheters were loaded with two 5 ml boluses of 0.25% bupivacaine in ten-minute intervals. Hemodynamic parameters where then recorded at five-minute intervals until conclusion of surgery. The number of dermatomes blocked, post anesthesia care unit (PACU) pain scores, average 24-hour pain scores, and patient satisfaction were recorded.Results: Significant reduction was observed in SBP, DBP, MAP and in SVR, and increases were seen in CO and CI after starting epidural anesthesia. From the parameters measured, only a significant reduction of SVR accompanied with higher level of dermatomes blocked, and lower average 24-hour pain scores. At the sane time patients without significant SVR change had relatively low pain scores, high patient satisfaction and required the same amount of pain medications. Conclusion: Changes in SVR detected by the ECOM monitor might help to predict an effective epidural system but its clinical relevance needs to be further evaluated.
{"title":"Prediction of Effective Post-Operative Epidural Anesthesia Using Hemodynamic Changes Detected by Endotracheal Cardiac Output Monitor (ECOM)","authors":"Bryan Ahlgren, F. Puskas, C. Dingmann, T. Seres","doi":"10.5580/2c77","DOIUrl":"https://doi.org/10.5580/2c77","url":null,"abstract":"Background: Epidural anesthesia after abdominal surgery results in improved postoperative pain relief but has up to a 30% failure rate. Hemodynamic changes after epidural administration of local anesthetics may provide parameters to predict dermatomal blockade and effective pain control in the postoperative period. The Endotracheal Cardiac Output Monitor (ECOM) provides continuous measurements of stroke volume (SV), cardiac output (CO) cardiac index (CI) and systemic vascular resistance (SVR). We hypothesized that the changes in hemodynamic parameters measured by the ECOM monitor along with changes in systolic (SBP), diastolic (DBP) and mean arterial pressure (MAP) would predict effective epidural anesthesia. Methods: 19 patients undergoing intra-abdominal surgery were enrolled. After placement of an epidural catheter and establishment of general anesthesia hemodynamics were recorded in 15-minute intervals using the ECOM monitor. At the start of abdominal closure epidural catheters were loaded with two 5 ml boluses of 0.25% bupivacaine in ten-minute intervals. Hemodynamic parameters where then recorded at five-minute intervals until conclusion of surgery. The number of dermatomes blocked, post anesthesia care unit (PACU) pain scores, average 24-hour pain scores, and patient satisfaction were recorded.Results: Significant reduction was observed in SBP, DBP, MAP and in SVR, and increases were seen in CO and CI after starting epidural anesthesia. From the parameters measured, only a significant reduction of SVR accompanied with higher level of dermatomes blocked, and lower average 24-hour pain scores. At the sane time patients without significant SVR change had relatively low pain scores, high patient satisfaction and required the same amount of pain medications. Conclusion: Changes in SVR detected by the ECOM monitor might help to predict an effective epidural system but its clinical relevance needs to be further evaluated.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"164 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124743706","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}
Difficult airway management is a dilemma for any anaesthesiologist. In the following case we encountered an acutely enlarging thyroid mass that was compromising the airway. Due to the huge neck mass which caused airway compression leading to breathlessness and difficulty in breathing in supine position. This 70 years old male was being investigated for a swelling in the anterior neck region and had sudden increase in the size of swelling. He became breathless and could not breathe in supine posture. Biopsy revealed the swelling to be follicular carcinoma of the thyroid with bilateral lung metastasis. His breathing difficulty compelled us to contemplate emergency tracheostomy because of decreased in saturation and severe respiratory distress.
{"title":"Compromised Airway Secondary to Thyroid Carcinoma – a Case Report","authors":"Arshi Taj, K. Bhat","doi":"10.5580/2ca6","DOIUrl":"https://doi.org/10.5580/2ca6","url":null,"abstract":"Difficult airway management is a dilemma for any anaesthesiologist. In the following case we encountered an acutely enlarging thyroid mass that was compromising the airway. Due to the huge neck mass which caused airway compression leading to breathlessness and difficulty in breathing in supine position. This 70 years old male was being investigated for a swelling in the anterior neck region and had sudden increase in the size of swelling. He became breathless and could not breathe in supine posture. Biopsy revealed the swelling to be follicular carcinoma of the thyroid with bilateral lung metastasis. His breathing difficulty compelled us to contemplate emergency tracheostomy because of decreased in saturation and severe respiratory distress.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"202 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116169327","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}
U. Srivastava, K. Joshi, Amrita Gupta, Yogita Dwivedi, H. Anand, A. Kannaujia, Sathiyanarayanam Pilendram
Background: Ropivacaine a recently introduced local anaesthetic with lesser cardiotoxicity and shorter duration of anaesthesia may be of value in obstetrics. Aim of this study was to evaluate efficacy of spinal anaesthesia with 0.5% hyperbaric ropivacaine during caesarean section and to compare with that of hyperbaric bupivacaine. Methods: In this double blind prospective randomized study, block characteristics of hyperbaric ropivacaine were compared with that of hyperbaric bupivacaine in patients receiving single shot spinal anaesthesia for caesarean delivery. Eighty parturients were randomly allocated to two groups. Group R (n=39) received 15 mg of 0.5% hyperbaric ropivacaine in 8.3% dextrose and group B (n=41) received 11 mg of 0.5% hyperbaric bupivacaine (commercially available preparation).Result: Onset of sensory block was slightly slower in group R but the speed of onset of motor block was similar in both groups. Regression of sensory and motor block was faster in group R. The incidence of hypotension and other side effects was similar in the two groups. Quality of surgical anaesthesia in group R was indistinguishable from that of group B. Conclusion: It was concluded that 15 mg of ropivacaine in 8.3% dextrose provided satisfactory anaesthesia for caesarean delivery similar to that with 11 mg of 0.5% hyperbaric bupivacaine.
{"title":"Comparison Of Intrathecal Hyperbaric Ropivacaine And Bupivacaine For Caesarean Delivery","authors":"U. Srivastava, K. Joshi, Amrita Gupta, Yogita Dwivedi, H. Anand, A. Kannaujia, Sathiyanarayanam Pilendram","doi":"10.5580/2cbc","DOIUrl":"https://doi.org/10.5580/2cbc","url":null,"abstract":"Background: Ropivacaine a recently introduced local anaesthetic with lesser cardiotoxicity and shorter duration of anaesthesia may be of value in obstetrics. Aim of this study was to evaluate efficacy of spinal anaesthesia with 0.5% hyperbaric ropivacaine during caesarean section and to compare with that of hyperbaric bupivacaine. Methods: In this double blind prospective randomized study, block characteristics of hyperbaric ropivacaine were compared with that of hyperbaric bupivacaine in patients receiving single shot spinal anaesthesia for caesarean delivery. Eighty parturients were randomly allocated to two groups. Group R (n=39) received 15 mg of 0.5% hyperbaric ropivacaine in 8.3% dextrose and group B (n=41) received 11 mg of 0.5% hyperbaric bupivacaine (commercially available preparation).Result: Onset of sensory block was slightly slower in group R but the speed of onset of motor block was similar in both groups. Regression of sensory and motor block was faster in group R. The incidence of hypotension and other side effects was similar in the two groups. Quality of surgical anaesthesia in group R was indistinguishable from that of group B. Conclusion: It was concluded that 15 mg of ropivacaine in 8.3% dextrose provided satisfactory anaesthesia for caesarean delivery similar to that with 11 mg of 0.5% hyperbaric bupivacaine.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130412614","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}
A 32 year old female with pre-eclampsia presented for cesarean delivery and was found to have leg weakness reported after spinal attempts. MRI revealed lumbosacral subdural and subarachnoid blood felt to be unrelated to the neuraxial anesthesia attempts. The main cause of spinal subarachnoid/subdural hemorrhage in pregnancy is generally a result of neuraxial anesthesia. However, in this case, the lower extremity symptoms preceded the spinal anesthesia attempts. The subarachnoid blood was felt to have an alternative etiology, prompting a thorough review of the differential diagnosis of subarachnoid hemorrhage in the parturient.
{"title":"Lumbar subarachnoid hemorrhage in a parturient with HELLP Syndrome revealed by but unrelated to spinal anesthesia; A review of differential diagnosis of spinal subarachnoid hemorrhage in pregnancy","authors":"A. Adler, P. Manikantan","doi":"10.5580/2c7a","DOIUrl":"https://doi.org/10.5580/2c7a","url":null,"abstract":"A 32 year old female with pre-eclampsia presented for cesarean delivery and was found to have leg weakness reported after spinal attempts. MRI revealed lumbosacral subdural and subarachnoid blood felt to be unrelated to the neuraxial anesthesia attempts. The main cause of spinal subarachnoid/subdural hemorrhage in pregnancy is generally a result of neuraxial anesthesia. However, in this case, the lower extremity symptoms preceded the spinal anesthesia attempts. The subarachnoid blood was felt to have an alternative etiology, prompting a thorough review of the differential diagnosis of subarachnoid hemorrhage in the parturient.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"265 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121209017","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}
D. C. Tripathi, Komal S Shah, C. Shah, Samir M. Shah, Emon K Das
Background: Ropivacaine is recently introduced in Indian market and needs to be evaluated for its clinical efficacy and safety profile in regional anesthesia. We evaluated ropivacaine for its anesthetic and safety profile in brachial plexus block for upper limb orthopedic surgery and its clinical comparison with bupivacaine.Patients and method: This prospective, randomized, double blind clinical study was carried out in 60 consenting adults of either sex, aged 20-40 yrs, scheduled for elective upper limb orthopedic surgery. Patients were randomly allocated to one of the two groups of 30 patients each. Group B received 30 ml of 0.5% bupivacaine and Group R received 30ml of 0.75% ropivacaine in Supraclavicular brachial plexus block after confirming the proximity of brachial plexus with nerve locator. Patients were observed for onset, peak and duration of sensory and motor blockade, post-operative analgesia using visual analogue scale and complications if any.ResultsIn comparison to equal volume of 0.5% bupivacaine, 0.75% ropivacaine provides earlier onset and peak of sensory blockade (p 0.05). Though, it provides earlier onset of motor blockade (p<0.05), there is statistically significant delay in achieving peak effect as compared to bupivacaine (p<0.05). Haemodynamic remained stable and no complications were encountered in both the groups.Conclusion – We conclude that 30ml of 0.75% ropivacaine has effective anaesthetic and safety profile in Supraclavicalar brachial plexus block with excellent post operative analgesia. We recommend this dose of ropivacaine against equal volume of 0.5% bupivacaine for achieving earlier onset of sensory and motor blockade.
{"title":"Supraclavicalar Brachial Plexus Block for Upper Limb Orthopedic Surgery: A Randomized , Double Blinded Comparison Between Ropivacaine And Bupivacaine","authors":"D. C. Tripathi, Komal S Shah, C. Shah, Samir M. Shah, Emon K Das","doi":"10.5580/2ca4","DOIUrl":"https://doi.org/10.5580/2ca4","url":null,"abstract":"Background: Ropivacaine is recently introduced in Indian market and needs to be evaluated for its clinical efficacy and safety profile in regional anesthesia. We evaluated ropivacaine for its anesthetic and safety profile in brachial plexus block for upper limb orthopedic surgery and its clinical comparison with bupivacaine.Patients and method: This prospective, randomized, double blind clinical study was carried out in 60 consenting adults of either sex, aged 20-40 yrs, scheduled for elective upper limb orthopedic surgery. Patients were randomly allocated to one of the two groups of 30 patients each. Group B received 30 ml of 0.5% bupivacaine and Group R received 30ml of 0.75% ropivacaine in Supraclavicular brachial plexus block after confirming the proximity of brachial plexus with nerve locator. Patients were observed for onset, peak and duration of sensory and motor blockade, post-operative analgesia using visual analogue scale and complications if any.ResultsIn comparison to equal volume of 0.5% bupivacaine, 0.75% ropivacaine provides earlier onset and peak of sensory blockade (p 0.05). Though, it provides earlier onset of motor blockade (p<0.05), there is statistically significant delay in achieving peak effect as compared to bupivacaine (p<0.05). Haemodynamic remained stable and no complications were encountered in both the groups.Conclusion – We conclude that 30ml of 0.75% ropivacaine has effective anaesthetic and safety profile in Supraclavicalar brachial plexus block with excellent post operative analgesia. We recommend this dose of ropivacaine against equal volume of 0.5% bupivacaine for achieving earlier onset of sensory and motor blockade.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"74 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127363604","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 – Oral Clonidine premedication for attenuation of haemodynamic response to laryngoscopy and intubation.Methods : 50 Patients of ASA I & II in age group of 20-50 years undergoing elective surgery were included. Patients were randomly categorized to two groups. Group A receiving tab clonidine 4 ug/Kg 90 minutes prior to induction and Group B receiving placebo. .Heart rate and blood pressure were measured and recorded before, immediately after 1 min and then every 5 minutes after intubation until 15 minutes.Results and conclusion – Clonidine decreases anxiety, systolic blood pressure, diastolic blood pressure, mean blood pressure and heart rate at 90 minutes. Clonidine group showed a significant superiority over placebo in the prevention of increase in systolic blood pressure as well as heart rate over the intubation. Clonidine blunts the stress response to laryngoscopy. Preoperative clonidine is also an effective anxiolysis and hence this study suggest that orally administered clonidine in preanaesthetic period provides more haemodynamic stability and attenuates the stress response to laryngoscopy and intubation.
{"title":"Effectiveness Of Oral Clonidine As Anxiolytic And For Attenuation Of Haemodynamic Responses To Laryngoscopy And Intubation.","authors":"Arshi, Khairat, Mehnaz, Zafar, I. Naqash","doi":"10.5580/2ca5","DOIUrl":"https://doi.org/10.5580/2ca5","url":null,"abstract":"Background – Oral Clonidine premedication for attenuation of haemodynamic response to laryngoscopy and intubation.Methods : 50 Patients of ASA I & II in age group of 20-50 years undergoing elective surgery were included. Patients were randomly categorized to two groups. Group A receiving tab clonidine 4 ug/Kg 90 minutes prior to induction and Group B receiving placebo. .Heart rate and blood pressure were measured and recorded before, immediately after 1 min and then every 5 minutes after intubation until 15 minutes.Results and conclusion – Clonidine decreases anxiety, systolic blood pressure, diastolic blood pressure, mean blood pressure and heart rate at 90 minutes. Clonidine group showed a significant superiority over placebo in the prevention of increase in systolic blood pressure as well as heart rate over the intubation. Clonidine blunts the stress response to laryngoscopy. Preoperative clonidine is also an effective anxiolysis and hence this study suggest that orally administered clonidine in preanaesthetic period provides more haemodynamic stability and attenuates the stress response to laryngoscopy and intubation.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"56 7","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114060493","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}
E. Abraham, Jesus S. Apuya, M. S. Siddiqui, Taranjit S. Sangari, Tariq Parray, D. Harrison
Background There are wide array of methods in providing deep sedation or general anesthesia to pediatric patients having esophagogastroduodenoscopy (EGDs). It can range from intravenous sedation, insufflation, propofol sedation, and endotracheal intubation with general anesthesia. Some studies found that not intubating pediatric patients for EGDs were associated with more complications than intubating them. There is still controversy whether intubating is safer than not intubating EGD pediatric patients. Thus, we compared intubating versus not intubating pediatric patients undergoing EGDs. MethodsAfter getting IRB approval, a retrospective chart review was performed on EGDs performed during a one year time period. Patients included had EGDs, were between 2 and 18 years old, ASA I or II, and had a BMI less than 30. We included 200 subjects who were intubated during EGDs and 200 subjects who were not intubated during EGDs. Comparisons between the groups included adverse events such as nausea or vomiting, aspiration, laryngospasm, sore throat, dysphagia, and respiratory depression. Total surgical time, anesthesia time before turnover to surgeon, time to recovery, and time to discharge was also compared. ResultsThere was no significant difference in adverse outcomes between the two groups. The only variable that was statistically significant (p< .05) was the anesthesia time before turnover to surgeon (TOTS), with the time to recovery being shorter in the not intubated group compared to the intubated group.ConclusionsThere was not a higher incidence of complication in patients who were not intubating compared to the patients intubated.
{"title":"Comparison Between Intubating and Not Intubating Pediatric Patients for Esophagogastroduodenoscopy","authors":"E. Abraham, Jesus S. Apuya, M. S. Siddiqui, Taranjit S. Sangari, Tariq Parray, D. Harrison","doi":"10.5580/2cbd","DOIUrl":"https://doi.org/10.5580/2cbd","url":null,"abstract":"Background There are wide array of methods in providing deep sedation or general anesthesia to pediatric patients having esophagogastroduodenoscopy (EGDs). It can range from intravenous sedation, insufflation, propofol sedation, and endotracheal intubation with general anesthesia. Some studies found that not intubating pediatric patients for EGDs were associated with more complications than intubating them. There is still controversy whether intubating is safer than not intubating EGD pediatric patients. Thus, we compared intubating versus not intubating pediatric patients undergoing EGDs. MethodsAfter getting IRB approval, a retrospective chart review was performed on EGDs performed during a one year time period. Patients included had EGDs, were between 2 and 18 years old, ASA I or II, and had a BMI less than 30. We included 200 subjects who were intubated during EGDs and 200 subjects who were not intubated during EGDs. Comparisons between the groups included adverse events such as nausea or vomiting, aspiration, laryngospasm, sore throat, dysphagia, and respiratory depression. Total surgical time, anesthesia time before turnover to surgeon, time to recovery, and time to discharge was also compared. ResultsThere was no significant difference in adverse outcomes between the two groups. The only variable that was statistically significant (p< .05) was the anesthesia time before turnover to surgeon (TOTS), with the time to recovery being shorter in the not intubated group compared to the intubated group.ConclusionsThere was not a higher incidence of complication in patients who were not intubating compared to the patients intubated.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127688447","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}
Sarita Sharma, R. Angral, Anju Jamwal, Kewal Bhanotra
Background: The aim of our study was to compare the relative effectiveness of gabapentin and clonidine in attenuation of pressor response to direct laryngoscopy and intubation, and to evaluate the synergistic effect of combination of both drugs.Materials and methods: 120 patients of either sex of age between 20-60 years of American Society of Anaesthesiologist (ASA) grade I and II admitted 24 hours before elective surgery requiring general anaesthesia (GA) were included in the study. Patients were randomly allocated into four groups of 30 patients each: patients received oral 800 mg of gabapentin (group A), 300 μg of clonidine (group B), 400 mg of gabapentin and 150μg of clonidine (group C) and placebo (group D); 60 minutes (min.) prior to induction of anaesthesia. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure (MAP) were measured before induction, intubation and at 0,1,3,5 and 10 minutes after intubation.Results: Analysis revealed that there was significant rise in HR at 0 minute in all the groups (p<0.05) except in group B. It remained to significant levels in group C and D up to 10 minutes (p<0.001 and p<0.01) but in group A it returned to insignificant level at 3 minutes. There was statistically highly significant rise in SBP, DBP and MAP (p<0.001,p<0.001 and p<0.01) in all the groups except in group A. In group A statistically significant (p<0.001) fall in SBP, DBP and MAP continued up to 10 minutes.Conclusion: Given 60 minutes before induction of GA, oral gabapentin and clonidine in the dose of 800mg and 300μg attenuate the pressor response but gabapentin blunts the increase in arterial blood pressure better than clonidine. The combination of these two drugs in the studied dosage was not effective in attenuating the pressor response to laryngoscopy and intubation.
{"title":"Comparative Evaluation Of Gabapentin, Clonidine And Combination Of Both The Drugs To Attenuate The Pressor Response To Direct Laryngoscopy And Intubation.","authors":"Sarita Sharma, R. Angral, Anju Jamwal, Kewal Bhanotra","doi":"10.5580/2c79","DOIUrl":"https://doi.org/10.5580/2c79","url":null,"abstract":"Background: The aim of our study was to compare the relative effectiveness of gabapentin and clonidine in attenuation of pressor response to direct laryngoscopy and intubation, and to evaluate the synergistic effect of combination of both drugs.Materials and methods: 120 patients of either sex of age between 20-60 years of American Society of Anaesthesiologist (ASA) grade I and II admitted 24 hours before elective surgery requiring general anaesthesia (GA) were included in the study. Patients were randomly allocated into four groups of 30 patients each: patients received oral 800 mg of gabapentin (group A), 300 μg of clonidine (group B), 400 mg of gabapentin and 150μg of clonidine (group C) and placebo (group D); 60 minutes (min.) prior to induction of anaesthesia. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure (MAP) were measured before induction, intubation and at 0,1,3,5 and 10 minutes after intubation.Results: Analysis revealed that there was significant rise in HR at 0 minute in all the groups (p<0.05) except in group B. It remained to significant levels in group C and D up to 10 minutes (p<0.001 and p<0.01) but in group A it returned to insignificant level at 3 minutes. There was statistically highly significant rise in SBP, DBP and MAP (p<0.001,p<0.001 and p<0.01) in all the groups except in group A. In group A statistically significant (p<0.001) fall in SBP, DBP and MAP continued up to 10 minutes.Conclusion: Given 60 minutes before induction of GA, oral gabapentin and clonidine in the dose of 800mg and 300μg attenuate the pressor response but gabapentin blunts the increase in arterial blood pressure better than clonidine. The combination of these two drugs in the studied dosage was not effective in attenuating the pressor response to laryngoscopy and intubation.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"8 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131592799","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}
A 76-year-old woman with a left femur neck fracture was admitted for urgent hip bipolar hemiarthroplasty. The patient was prescribed angiotensin-converting-enzyme inhibitor, beta blocker and clopidogrel daily for hypertension and angina. The preoperative echocardiogram showed left ventricular hypertrophy and a severely calcified and thickened aortic valve with stenosis. A single-shot spinal anesthesia was planned. After dural puncture, 9 mg of 0.5 % hyperbaric bupivacaine plus fentanyl 12.5 mcg were injected. At the same time, we started infusion of norepinephrine (50 ng/kg/min) to prevent expected perioperative hypotension. Invasive blood pressure declined during the initial 5 min after intrathecal injection, but recovered quickly. Vital signs were hemodynamically stable and the patient did not need any treatment for surgery. The norepinephrine infusion was safely tapered down over 15 min while skin incision was closed. We found that prophylactic short-term norepinephrine infusion can be safely used for expected hypotension induced by a single-shot spinal block in an elderly patient with aortic stenosis.
{"title":"Prophylactic Norepinephrine for Spinal Anesthesia in anElderly Patient with Aortic Stenosis.","authors":"Daeseok Oh, Hyae-Jin Kim","doi":"10.5580/2c78","DOIUrl":"https://doi.org/10.5580/2c78","url":null,"abstract":"A 76-year-old woman with a left femur neck fracture was admitted for urgent hip bipolar hemiarthroplasty. The patient was prescribed angiotensin-converting-enzyme inhibitor, beta blocker and clopidogrel daily for hypertension and angina. The preoperative echocardiogram showed left ventricular hypertrophy and a severely calcified and thickened aortic valve with stenosis. A single-shot spinal anesthesia was planned. After dural puncture, 9 mg of 0.5 % hyperbaric bupivacaine plus fentanyl 12.5 mcg were injected. At the same time, we started infusion of norepinephrine (50 ng/kg/min) to prevent expected perioperative hypotension. Invasive blood pressure declined during the initial 5 min after intrathecal injection, but recovered quickly. Vital signs were hemodynamically stable and the patient did not need any treatment for surgery. The norepinephrine infusion was safely tapered down over 15 min while skin incision was closed. We found that prophylactic short-term norepinephrine infusion can be safely used for expected hypotension induced by a single-shot spinal block in an elderly patient with aortic stenosis.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133073831","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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