Propofol-dexmedetomidine Versus Propofol-ketamine for Anesthesia of Endoscopic Retrograde Cholangiopancreatography (ERCP)

Abstract Background The ideal method for anesthetic management during ERCP varied between deep sedation and general anesthesia with preference for general anesthesia over sedation. Aim of the study Primary aim: The aim of this study will to compare the effects of propofoldexmedetomidine and propofol-ketamine combinations for anesthesia in patients undergoing ERCP regarding the following outcome measures: Hemodynamic changes. Respiratory parameters changes. Propofol requirements. The recovery criteria. Post-operative pain. Secondary aim: To assess the rate of other anesthetic and procedural complications regarding the following outcome measures: Anesthetic complications: Post-procedural nausea and vomiting. Post-procedural cognitive dysfunction or hallucinations. Procedural complications: Bleeding: may occur by sphincterotomy. Duodenal perforation; it is a serious condition but it has a rare incidence and usually requires surgical intervention. Material and methods Patients ERCP, aged 20-50ys old, ASA І-II-III, were randomly allocated in two groups each of which was 25 by a probability method in the form of sequentially numbered, opaque, sealed envelopes (SNOSE) that will be divided in 2 groups (25 envelopes for each group) with random selection for each patient for an envelope. Group-I received dexmedetomidine loading 1µg/kg slow IV over 15min then infused at a rate of 0.5µg/kg/h by syringe pump. Group II received Ketamine 1mg/kg slow IV over 15min then infused at a rate of 0.5mg/kg/h by syringe pump. Both groups received propofol; 1-2mg/kg induction – then 5mg/kg/h IV infusion, 0.5mg/kg boluses guided by hemodynamic parameters, atracurium 0.5mg/kg intubating dose followed by 0.1mg/kg every 20min. Cuffed ETT was inserted and CMV. By the end of the procedure, patients turned supine and reversed by administration of neostigmine (0.05mg/kg) + atropine (0.01mg/kg). Extubation was performed after fulfillment of the criteria of extubation. Conclusion Dexmedetomidine-propofol combination was better than ketamine-propofol combination as regard; hemodynamic parameters (intra- and post-procedural), PONV, cognitive functions and recovery time. Incidence of pain had no clinical significant value between both groups. Total propofol consumption had no clinical significant difference between both groups. Recommendation Dexmedetomidine - propofol combination as TIVA technique for ERCP requires further studies with recommendation to include; different types of patients; geriatric, critically ill and increasing the sample size of patients.

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A comparative study between i-gel and classical laryngeal mask airway in elective surgery under general anaesthesia

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20163110 ◽

2016 ◽

Vol 2 (9) ◽

pp. 227

Author(s):

Smita R. Engineer ◽

Digant B. Jansari ◽

Saumya Saxena ◽

Rahul D. Patel

Keyword(s):

Laryngeal Mask Airway ◽

General Anesthesia ◽

Elective Surgery ◽

Laryngeal Mask ◽

Supraglottic Airway ◽

Hemodynamic Parameters ◽

Randomized Clinical Study ◽

Group I ◽

Supraglottic Airway Devices ◽

Significant Difference

Background: Supraglottic airway devices have been widely used as an alternative to tracheal intubation during general anesthesia both in adults and children. This study was carried out to compare classical laryngeal mask airway (LMA) and i-gel, regarding ease of insertion, adequate placement of device, ability to maintain ETCO2 and SPO2, perioperative hemodynamic parameters and intra operative and postoperative complication.Methods: This prospective, randomized clinical study was done on 100 patients of either sex, age between 5 to 60 years, ASA grade I-III who underwent different surgical procedures under general anesthesia in supine position. After giving premedication, induction of anesthesia was done with inj. Propofol 2-3 mg/kg and inj. Succnylcoline 1.5-2 mg/kg. In “sniffing air” position, airway was secured with either LMA or i-gel. An effective placement of device was checked by a square wave capnography, normal chest expansion, SPO2 >95%, and absence of audible leak. Patients were observed for time and ease of insertion, number of attempts, perioperative hemodynamic changes and complications.Results: No statistically significant difference was reported between both the groups, regarding heart rate, BP, SPO2 and ETCO2. Duration of insertion was more in group LMA. Insertion was easy and was possible in first attempt in 88% of patients without much manipulation in group i-gel.Conclusions: I-gel is a better alternative supraglottic airway device than LMA in view of ease of insertion with minimal manipulations and minimal complications. Hemodynamic parameters, SPO2 and ETCO2 were maintained in both the groups.

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Effect of drugs used in general anesthesia on oocyte and embryo quality in Iraqi infertile females undergoing intracytoplasmic sperm injection

Iraqi Journal of Embryos and Infertility Researches ◽

10.28969/ijeir.v10.i1.r6 ◽

2020 ◽

Vol 10 (1) ◽

pp. 85-100

Author(s):

Hameedah Abdul Hussein Mohsin ◽

Mufeda Ali Jwad ◽

Raed Ghazi Reshan

Keyword(s):

Adverse Effects ◽

General Anesthesia ◽

Intracytoplasmic Sperm Injection ◽

Embryo Quality ◽

Oocyte Quality ◽

Anesthetic Techniques ◽

Infertile Women ◽

Anesthetic Agents ◽

Group I ◽

Significant Difference

Various types of anesthetic techniques were described for oocyte recovery. Different anesthetic agents have been used with different effects on oocyte quality and embryonic development and studies on the potential toxicity of general anesthesia ended up with conflicting results. Many experiments as well as human studies documented the existence of anesthetic agents in the follicular fluid (FF) with possible adverse effects on the oocyte quality and subsequent embryo development. Ketamine and remifentanil were used for the studied groups to compare oocytes and embryos characteristic of infertile women during oocytes retrieval under general anesthesia: one group receiving ketamine, midazolam, and propofol and the other group receiving remifentanil, midazolam and propofol. 60 infertile females were undergoing intracytoplasmic sperm injection categorized in two groups, group I received midazolam, remifentanil and propofol; whereas, group II received midazolam, ketamine and propofol. There was highly significant difference in mean abnormal oocyte between ketamine and remifentanil groups. Grade III embryos were significantly limited to ketamine group. FF ketamine and remifentanil were not significantly correlated to any of oocyte characteristics or embryo characteristics. Anesthetic agents, ketamine and remifentanil, were detected in the FF of infertile women and within recommended doses. Ketamine resulted in adverse effects on oocyte and embryo quality in comparison with remifentanil represented by greater percentage of abnormal oocytes and that bad quality embryos were limited to ketamine group.

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Continuous versus Intermittent Bolus Epidural Anaesthesia in Elderly Surgical Patients

Journal of Nepal Medical Association ◽

10.31729/jnma.635 ◽

2003 ◽

Vol 42 (148) ◽

Author(s):

XK Yin ◽

ZG Xiang ◽

A Prasai ◽

N Lamichhane

Keyword(s):

Continuous Infusion ◽

Epidural Anaesthesia ◽

Surgical Patients ◽

Hemodynamic Parameters ◽

Hemodynamic Stability ◽

Intermittent Bolus ◽

Group I ◽

Significant Difference ◽

Baseline Values ◽

A Prospective Study

A prospective study of 70 elderly conventionally continuously randomized patients was done to compare thehaemodynamic changes produced during continuous infusion versus intermittent bolus epidural anaesthesia.The hemodynamic parameters (Blood pressure, Heart rate) were slightly changed in continuous infusiongroup but there was no significant difference compared with baseline value (p>0.05). Whereas, In bolusgroup, the hemodynamic parameters differed significantly compared with baseline values and the patientsin group I. So conclusion of better hemodynamic stability in continuous infusion epidural anaesthesia thanthat in intermittent bolus epidural method in elderly is reached.Key Words: Epidural anaesthesia, haemodynamic, intermittent bolus, continuous infusion.

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Analysis of the experience of anesthetic management during endovascular mechanical thrombectomy in ischemic cerebral stroke

Endovascular Neuroradiology ◽

10.26683/2304-9359-2020-4(34)-70-81 ◽

2020 ◽

Vol 34 (4) ◽

pp. 70-81

Author(s):

N.B. Chabanovych ◽

M.Yu. Mamonova ◽

S.V. Konotopchyk ◽

D.V. Shchehlov ◽

M.B. Vyval

Keyword(s):

Ischemic Stroke ◽

Mean Arterial Pressure ◽

Postoperative Complications ◽

Arterial Pressure ◽

General Anesthesia ◽

Mechanical Thrombectomy ◽

Conscious Sedation ◽

Anesthetic Management ◽

Cerebral Vessels ◽

Significant Difference

Objective ‒ to analyze our own experience of anesthetic management during mechanical thrombectomy (MTE) in patients with acute ischemic stroke (AIS) caused by large cerebral vessels occlusion. Materials and methods. Treatment of patients with AIS caused by large cerebral vessels occlusion was carried out in accordance with the recommendations of the European Stroke Organization (ESO). MTE was performed in 63 patients (23 women and 40 men aged 36 to 82 years, mean age ‒ 62.00 ± 16.31 years). The severity of neurological symptoms in the acute period of ischemic stroke was assessed over time using the National Institutes of Health Stroke Scale (NIHSS). The degree of disability due to stroke was assessed using a modified Rankine scale (mSR) before discharge and after 90 days. The results by mRS after 90 days were the most indicative. Early ischemic changes in the brain on computed tomograms were assessed using the Alberta Stroke Program Early CT score (ASPECTS). To reduce the time «onset-to groin time» (puncture of the femoral artery), all patients were immediately sent to the operating room upon hospitalization after neuroimaging. For MTE in 50 (79 %) cases conscious sedation with local anesthesia (sibazon, fentanyl) was used, in 13 (21%) cases ‒ general anesthesia (propofol, fentanyl, atracurium besylate). Regardless of the anesthesia method, vital signs were monitored and postoperative complications were assessed. The assessment of other important indicators related to the expiration of anesthesia was carried out: the time «onset-the the groin time» the time «from groin – to recanalization», the level of saturation, the stability of mean arterial pressure, the use of vasopressors or labetolol, the number of postoperative complications (pneumonia, dislocation with decompression craniotomy, nausea, myocardial infarction). Results. The algorithm for anesthetic management of the perioperative period included the anesthesia during MTE, postoperative anesthetic monitoring and correction of deviations over the next 72 hours. Mandatory components of anesthetic support of MTE were to maintain blood pressure of at least 140/90 mm Hg. before reperfusion and FiO2 0.45‒0.5%. Anesthetic management also included infusion therapy, prevention of vomiting and regurgitation, and symptomatic therapy. Special attention was paid to the control of hemodynamics in the postoperative period. The results of treatment according to mRS after 90 days showed that more than half of the patients ‒ 32 (50.8%) after MTE were independent of outside help (0‒2 points), 24 (38.1 %) ‒ 3‒5 points, 6 points (mortality) ‒ 7 (11.1 %). After general anesthesia during MTE, 2 (15.4 %) deaths were registered, after MTE with conscious sedation using ‒ 5 (10.0%). There more patients with the vasopressors or labetalol using and the number of postoperative pneumonia were identified in the group with general anesthesia. For other indicators, there was no statistically significant difference in the results depending on the type of anesthesia. There was no statistically significant difference in the results in depending on anesthesia method. Conclusions. The choice of the anesthesia method during MTE for large cerebral vessels should be individual. There was no statistically significant difference in the results in treatment of patients with AIS using MTE (in particular, in mortality), depending on the type of anesthetic management. It is also wasn’t found in the time «onset – to groin time» and the time «groin – to recanalization» with various methods of anesthesia. Indications of vital functions, saturation, mean arterial pressure in patients did not have a significant difference. Differences were revealed in terms of the vasopressors or labetolol using and the number of postoperative pneumonia, depending on the anesthesia type. The anesthesia team should be involved in patient management from the moment of hospitalization, regardless of the method of anesthesia. The results of AIS treatment depend on the initial NIHSS and ASPECTS scores, comorbidity, collateral development, perioperative complications, and the degree of reperfusion after surgery. Special attention should be paid to hemodynamics before and after reperfusion recovery after vessel recanalization, taking into account the degree of reperfusion. The influence of the type of anesthesia on the results of the treatment of AIS with the MTE using remains under the further discussion.

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Effect of Intravenous Lignocaine in Attenuating Dexamethasone Induced Perineal Pruritus During Induction of Anesthesia

KYAMC Journal ◽

10.3329/kyamcj.v9i4.40142 ◽

2019 ◽

Vol 9 (4) ◽

pp. 144-147

Author(s):

Muhammad Sazzad Hossain ◽

Md Afzalur Rahman ◽

Mohammad Mamunur Rashid ◽

Mohammad Ifta Khairul Hasan ◽

Muhammad Alamgir Mandal ◽

...

Keyword(s):

Placebo Group ◽

General Anesthesia ◽

Normal Saline ◽

Sodium Phosphate ◽

Demographic Data ◽

Double Blind Study ◽

Analog Scale ◽

Double Blind ◽

Group I ◽

Significant Difference

Background: Intravenous dexamethasone may produce perineal pruritus in some patients when administered as premedicant before induction of anesthesia. Objectives of study: This randomized, double-blind study was done to evaluate the efficacy of pretreatment of lignocaine on the incidence and severity of dexamethasone-induced perineal pruritus. Materials and methods: 100 patients were enrolled in this study and allocated randomly into two equal groups. Then, patients received intravenous medications in the following sequence before induction of anesthesia: in group I, injection lignocaine 1mg/kg diluted in 5 ml normal saline and in group II, 5 ml normal saline (placebo group), then one minute later, intravenous dexamethasone sodium phosphate 10 mg was given in all groups in 3 seconds and was observed the patient's response about perineal pruritus. The severity of perineal pruritus was graded based on the visual analog scale (VAS) as none (VAS 0), mild (VAS 1-3), moderate (VAS 4-6), or severe (VAS 7-10), and recorded the incidence and severity of perineal pruritus. Then general anesthesia was induced and continued as usual. Results: In terms of demographic data, the results of this study showed that there was no significant difference between patients in both groups (P>0.05). Overall incidence and severity of perineal pruritus in lignocaine group was significantly less, when compared with placebo group (P<0.05). Conclusion: It can be concluded that pretreatment with 1mg/kg intravenous lignocaine may effectively reduce the incidence and severity of dexamethasone induced perineal pruritus. KYAMC Journal Vol. 9, No.-4, January 2019, Page 144-147

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Rigid Laryngoscope-assisted Insertion of Transesophageal Echocardiography Probe Reduces Oropharyngeal Mucosal Injury in Anesthetized Patients

Anesthesiology ◽

10.1097/aln.0b013e318190b56e ◽

2009 ◽

Vol 110 (1) ◽

pp. 38-40 ◽

Cited By ~ 30

Author(s):

SungWon Na ◽

Chang Seok Kim ◽

Ji Young Kim ◽

Jin Seon Cho ◽

Ki Jun Kim

Keyword(s):

General Anesthesia ◽

Transesophageal Echocardiography ◽

Cardiac Disease ◽

Mucosal Injury ◽

Conventional Group ◽

Hemodynamic Parameters ◽

Significant Difference ◽

Intraoperative Transesophageal Echocardiography

Background Intraoperative transesophageal echocardiography has become a routine part of monitoring in patients with cardiac disease. However, insertion of a transesophageal echocardiography probe can be associated with oropharyngeal, esophageal, and gastric injuries. The purpose of this study was to determine whether insertion of a transesophageal echocardiography probe under direct laryngoscopic visualization can reduce the incidence of oropharyngeal mucosal injury. Methods Eighty patients undergoing surgery with general anesthesia were randomly allocated to either the conventional group, in which the probe was inserted blindly, or the laryngoscope group, in which a rigid laryngoscope was used to visualize the passage of the probe. The incidence of oropharyngeal mucosal injury, the number of insertion attempts, and odynophagia were assessed. Results There was no significant difference in demographic and hemodynamic parameters between the 2 groups. The incidence of oropharyngeal mucosal injury was higher in the conventional group than in the laryngoscope group (55% vs. 5%, P < 0.05). The incidence of odynophagia was higher in the conventional group than in the laryngoscope group (32.5% vs. 2.5%, P < 0.05). The number of insertion attempts was also higher in the conventional group than in the laryngoscope group. Conclusion Rigid laryngoscope-assisted insertion of the transesophageal echocardiography probe reduces the incidence of oropharyngeal mucosal injury, odynophagia, and the number of insertion attempts.

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Correlation between C-reactive protein, intravenous hydrocortisone, systemic tranexamic acid and post mastectomy seroma

International Surgery Journal ◽

10.18203/2349-2902.isj20213583 ◽

2021 ◽

Vol 8 (9) ◽

pp. 2544

Author(s):

Ayman A. Albatanony ◽

Ahmed M. A. Assar ◽

Mohammed A. E. El Balshy

Keyword(s):

Breast Cancer ◽

Tranexamic Acid ◽

General Anesthesia ◽

Radical Mastectomy ◽

Modified Radical Mastectomy ◽

C Reactive Protein ◽

Reactive Protein ◽

Drain Removal ◽

Group I ◽

Significant Difference

Background: Breast cancer is the second leading cause of death among women worldwide. Formation of a seroma most frequently occurs after mastectomy and axillary surgery. The objective was to find the correlation between the formation of post modified radical mastectomy seroma and C-reactive protein (CRP) and the effect of preoperative intravenous (IV) hydrocortisone, systemic tranexamic acid.Methods: This prospective study was conducted at Menoufia university hospital on female patients with primary operable breast cancer who were divided to two groups; each included 30 patients: group I received general anesthesia with hydrocortisone therapy (Solu-Cortef 100 mg solution once), systemic tranexamic acid (kapron 5 ml once) and group II received general anesthesia without hydrocortisone nor tranexamic acid. CRP serum levels before surgery and 24 hour after the procedure. All patients were followed up postoperatively for registration of the total drainage volume until drain removal, timing of drain removal, incidence of seroma formation and management of seroma.Results: Our results revealed that a significant difference between both groups as regard CRP, the incidence of seroma, time of removing the drain and total collection of the drain in favor to those who received IV hydrocortisone and systemic tranexamic acid.Conclusions: Induction of IV hydrocortisone, systemic tranexamic acid with general anaesthesia during modified radical mastectomy (MRM) are significantly decreasing the level of CRP, the incidence of seroma, time of removing the drain and total collection of the drain.

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Comparative study between sprayed and inhaled nebulized lidocaine for suppression of hemodynamic response to laryngoscopy and oral endotracheal intubation

Journal of University of Shanghai for Science and Technology ◽

10.51201/jusst/21/09599 ◽

2021 ◽

Vol 23 (09) ◽

pp. 772-787

Author(s):

Ahmed Abdulmaged Ahmed ◽

◽

Dr. Hasan Sarhan Haider ◽

Keyword(s):

Heart Rate ◽

Tracheal Intubation ◽

General Anesthesia ◽

Endotracheal Intubation ◽

Outcome Measures ◽

Cardiovascular Response ◽

Hemodynamic Response ◽

Secondary Outcome ◽

Patient Acceptance ◽

Significant Difference

Background: Direct laryngoscopic manipulation and endotracheal intubation are noxious stimuli capable of producing hemodynamic changes characterized by tachycardia, hypertension, and arrhythmias. Which are tolerated in normotensive healthy individuals but had greater impact in patients with cardiovascular and cerebrovascular diseases lead to increased morbidity and mortality. Aim of the study: To compare the efficacy of sprayed and inhaled nebulized lidocaine in suppressing the cardiovascular response to laryngoscopy and tracheal intubation in normotensive patients undergoing general anesthesia. Patient and method: 80 adult patients undergoing elective surgery under general anesthesia with endotracheal intubation were randomly allocated into two equal groups. Patients in nebulized lidocaine (NL) group received pre-induction nebulized (1ml of 10%) lidocaine, while those in sprayed lidocaine (SL) group received pre-induction sprayed (10 puffs of 10%) lidocaine. The general anesthesia technique was standardized for the two groups. The primary outcome measures were hemodynamic response at 1, 3, 6, 9, and 12 min after intubation. The secondary outcome measures were to note down any adverse effects associated with drugs. The statistical package used was SPSS version 25.Results: There was a statistically significant difference (P < 0.05) between nebulizes and sprayed lidocaine in heart rate, systolic, diastolic and mean arterial pressures at different time points after tracheal intubation with nebulized lidocaine being most effective and better toleration. Conclusion: The hemodynamic instability was lesser with nebulized lidocaine as compared to sprayed lidocaine. The effect was on heart rate and blood pressure. Use of nebulized lidocaine is simple, safe, effective and better patient acceptance.

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Administration of I.V. lidocaine before induction of general anesthesia prolong suxamethonium action in caesarian section surgeries. clinical assessment--------

AL-Kindy College Medical Journal ◽

10.47723/kcmj.v13i2.103 ◽

2019 ◽

Vol 13 (2) ◽

pp. 97-100

Author(s):

Layla Khalil

Keyword(s):

General Anesthesia ◽

Clinical Signs ◽

Cross Sectional Study ◽

Caesarian Section ◽

Cross Sectional ◽

Lidocaine Group ◽

General Anesthesia Group ◽

Anesthetic Agents ◽

Group I ◽

Significant Difference

Background: Known as suxamethonium or succinylcholine, is a medication used to cause short-term paralysis as part of general anesthesia. The duration of operation is one of the important factors accounting to the success of the operation. Simple safe available drug can change the plan of anesthesia. Objective: The purpose of this study was to assess adding Lidocaine three minutes intravenously before induction of general anesthesia on the duration of optimum prolongation the action of Suxamethonium . With other group with regular method. Type of the study: a cross-sectional study Methods: A 100 candidate to compare the effect of Lidocaine for unpremeditated patients ,American society of anesthesia( ASA) physical status II .patients were scheduled for caesarian section surgery were randomly assigned to two groups: Group I patients received 1.5 mg/kg Lidocaine 3 minutes before induction of general anesthesia, Group 2 patients received just the anesthetic agents. For assessment of prolongation of action the researcher Deepened on the clinical signs of recovery from Suxamethonium which are: spontaneous breathing, ability to swallow when we open the patient's lower jaw ( observing movement of the tongue ).between the two group Both groups received general anesthesia. Results: The of prolongation of Suxamethonium in elective cases in Group I was a about 7 - 15 minutes, while in Group II the time of Suxamethonium was about 3 - 5 minutes Conclusions : The study concluded that there was a significant difference between the two groups from the side of suxamethonium time in group one( lidocaine group)as there was prolongation of time more than group two .

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Rapid Sequence Spinal Anesthesia Vs General Anesthesia for Category-I Urgency Caesarean Section

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol03-i01/03 ◽

2018 ◽

Vol 3 (01) ◽

Author(s):

Dr. Ravi Gurvani ◽

Dr. Dharam Veer Chandrakar

Keyword(s):

Caesarean Section ◽

General Anesthesia ◽

Spinal Anesthesia ◽

Pregnancy Termination ◽

P Value ◽

Group I ◽

Rapid Sequence ◽

Significant Difference ◽

American Society ◽

American Society Of Anesthesiologists

Aims of study - Rapid Sequence spinal anesthesia Vs general anesthesia for category-I urgency caesarean section. Background - Pregnancy termination by caesarean section (CS) is rapidly increasing all over the world. Hence, it has increasingly become a greater challenge to provide care for the parturient, but this has given obstetric anesthetists a greater opportunity to contribute to obstetric services. While caesarean deliveries were historically performed using general anaesthesia, there is a recent significant move towards regional anaesthesia. Materials and Methods - As per American Society of Anesthesiologists physical status (ASAPS) I 50 patients of category 1 were included in this study and divided into two equal groups, 25 in each group. Group I received GA and group II received RSSA. Result - Time for anesthesia was more in the RSGA group than the RSSA group, which was statistically significant (P < 0.001). The time for surgical readiness was also significantly higher in the RSGA group in comparison to the RSSA group with P value of < 0.001, which was statistically significant but there was no significant difference in Incision to delivery time.

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