scholarly journals A randomized study of comparison of intravenous dexmedetomidine and intravenous esmolol to attenuate the cardiovascular responses to laryngoscopy and endotracheal intubation

2020 ◽  
Vol 8 (9) ◽  
pp. 3239
Author(s):  
Ninad Deepak Chodankar ◽  
Bhagyashree Shivde
Keyword(s):  
Blood Pressure ◽  
Endotracheal Intubation ◽  
Elective Surgery ◽  
Randomized Study ◽  
Cardiovascular Responses ◽  
Pressor Responses ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Group D ◽  
Dexmedetomidine Infusion

Background: The objective of this study was to compare the efficacy of intravenous dexmedetomidine and esmolol in attenuating the cardiovascular pressor responses to laryngoscopy and endotracheal intubation.Method: Study was done on 60 adults, American society of anesthesiologists (ASA) grade I or II normotensive patients, undergoing elective surgery under general anesthesia and willing to participate. These patients were randomly allocated to either group E (esmolol) or D (dexmedetomidine). Group ‘D’, patients were given intravenous dexmedetomidine infusion 1 mcg/kg over 10 minutes, 3 minutes before start of laryngoscopy. Group ‘E’, patients were given intravenous esmolol 1.5 mg/kg 2 minutes before start of laryngoscopy. All patients were premedicated, induced and intubated using thiopentone and succinyl choline as per the protocol. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded at baseline (taken half an hour prior to anesthesia), before sedation, after induction but before intubation, immediately after endotracheal intubation and thereafter at 1, 2, 3, 4, 5 and 10 minutes.Results: Immediately after intubation, HR was similar in group D and group E, thereafter HR remained higher in group E as compared to group D, and difference was statistically significant. SBP, DBP and MAP recorded was higher in group E as compared to group D, and difference was statistically significant.Conclusion: Authors conclude that intravenous dexmedetomidine 1 ug/kg is better drug to attenuate hemodynamic response to laryngoscopy and intubation as compared to intravenous esmolol 1.5 mg/kg.

scholarly journals A randomized controlled study of intravenous esmolol to attenuate the cardiovascular responses to laryngoscopy and endotracheal intubation

2020 ◽  
Vol 8 (3) ◽  
pp. 1103
Author(s):  
Ninad Deepak Chodankar ◽  
Bhagyashree Shivde
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
General Anaesthesia ◽  
Endotracheal Intubation ◽  
Elective Surgery ◽  
Cardiovascular Responses ◽  
Controlled Study ◽  
Control Group ◽  
Significant Difference ◽  
Control Group Group

Background: Objective is to compare the efficacy of intravenous Esmolol to attenuate the cardiovascular responses to laryngoscopy and endotracheal intubation with control group.Methods: Study was done on 60 adults, ASA grade I or II normotensive patients, undergoing elective surgery under general anaesthesia and willing to participate. These patients where be randomly allocated in to either group C (Control) or E (Esmolol). Group ‘C’ Control group. Group ‘E’, patients were given intravenous Esmolol 1.5 mg/kg 2 minutes before start of laryngoscopy. All patients were premedicated, induced and intubated using Thiopentone and Succinyl Choline as per the protocol. Heart Rate (HR), SBP, DBP and MAP were recorded at baseline (taken half an hour prior to anaesthesia), Before sedation, After induction but before intubation, Immediately after endotracheal intubation and Thereafter at 1, 2, 3, 4, 5 and 10 minutes.Results: Heart rate was lower in Group E as compared to Group C, and there was statistically significant difference immediately after intubation till 4 minutes after intubation. While Blood pressure was lower in Group E as compared to Group C, and there was statistically significant difference only immediately after intubation.Conclusions: In Normotensive patients requiring general anaesthesia with laryngoscopy and intubation, authors conclude that intravenous Esmolol 1.5 mg/kg attenuated Heart rate response but fails to satisfactorily prevent rise in blood pressure.

scholarly journals Comparison of Dexmedetomidine Infusion versus Scalp Block with 0.5% Ropivacaine to Attenuate Hemodynamic Response to Skull Pin Insertion in Craniotomy: A Prospective, Randomized Controlled Trial

2020 ◽  
Author(s):  
Georgene Singh ◽  
Ganesamoorthi Arimanikam ◽  
Karen R. Lionel ◽  
Smita V. ◽  
Bijesh Yadav ◽  
...  
Keyword(s):  
Adverse Events ◽  
Controlled Trial ◽  
Hemodynamic Response ◽  
Prospective Randomized Controlled Trial ◽  
Neurosurgical Patients ◽  
Scalp Block ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Group D ◽  
Dexmedetomidine Infusion

Abstract Background The insertion of the skull pin head holder to stabilize the head during neurosurgery causes significant periosteal stimulation, resulting in hemodynamic responses, which may lead to brain edema, intracranial hypertension, and hemorrhage in patients with intracranial space-occupying lesions and intracranial aneurysms. We compared the efficacy of dexmedetomidine infusion and 0.5% ropivacaine scalp block in attenuating the hemodynamic response to the skull pin application. Methods A total of 65 American Society of Anesthesiologists (ASA) class I and II patients aged between 18 and 65 years with a preoperative Glasgow Coma Scale score of 15 undergoing elective craniotomy were randomized to receive either a bolus of 1mcg/kg of dexmedetomidine followed by an infusion of 1 mcg/kg/hour (group D) or a scalp block with 0.5% ropivacaine (group S) in a single-blinded comparator study. Patients were monitored for the following hemodynamic changes following skull pin insertion: heart rate (HR), mean arterial pressure (MAP), the requirement of additional analgesia/anesthesia, and adverse events. Results HR and MAP were comparable between the groups at baseline, before induction, and before pin insertion. HR and MAP at 1, 2, and 3 minutes after skull pin insertion were significantly higher in group D as compared with group S (p < 0.05) and were comparable between the groups at 5 minutes. The groups were comparable with respect to the requirement of additional analgesia, anesthesia, and incidence of adverse events. Conclusion Scalp block with 0.5% ropivacaine is effective and superior to dexmedetomidine in attenuating the hemodynamic response to skull pin insertion in ASA I and II neurosurgical patients undergoing craniotomy. However, the hemodynamic effects achieved with dexmedetomidine were within the permissible limits.

scholarly journals Efficacy of Oral Gabapentin for Attenuation of Haemodynamic Responses to Laryngoscopy & Endotracheal Intubation

2021 ◽  
Vol 10 (12) ◽  
pp. 905-909
Author(s):  
Bhavitha Venigalla ◽  
Sanjot Sudhir Ninave
Keyword(s):  
Blood Pressure ◽  
Endotracheal Intubation ◽  
Rate Pressure Product ◽  
Marked Rise ◽  
Pressor Responses ◽  
Anaesthesia Practice ◽  
Haemodynamic Changes ◽  
Significant Attenuation ◽  
Random Number Table ◽  
American Society

BACKGROUND Laryngoscopy and endotracheal intubation are basic skills to be acquired by an anaesthesiologist. For many years, laryngoscopy has been used as a conventional way to facilitate endotracheal intubation. These are the most critical events because, they provoke a marked rise in sympathoadrenal response as hypertension and tachycardia. There is an absolute need to decrease these haemodynamic responses, for which various drugs were used, with varying degrees of success. Gabapentin, initially used as an anticonvulsant has extended its role into anaesthesia practice with its multimodal effects. This study was conducted to evaluate the efficacy of oral gabapentin 800 mg in attenuation of haemodynamic responses to laryngoscopy and endotracheal intubation. METHODS After obtaining institutional ethical clearance, a prospective randomised comparative study was undertaken. Written and informed consent was obtained from 80 patients belonging to American Society of Anaesthesiologists (ASA) class I & II scheduled for various elective surgeries under general anaesthesia. They were divided into two groups of 40 each using computer generated random number table. Group G received oral gabapentin 800 mg and group C received empty capsules with sips of water, 2 hours prior to induction. Haemodynamic parameters – heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) were noted and rate pressure product (RPP) was calculated at baseline, at laryngoscopy and then at 1, 3, 5, 10 & 15 minutes after laryngoscopy and endotracheal intubation. RESULTS In Group G there was significant attenuation of HR, SBP, DBP, MAP at 1, 3 and 5 minutes after laryngoscopy and endotracheal intubation as compared to Group C. Hence, in Group G there was significant attenuation of RPP at 1 minute (12673.60 ± 1691.25, 11769.08 ± 1146.02, P = 0.01), 3 minutes (12546.85 ± 1123.78, 11759.98 ± 1358.02, P = 0.01) and 5 minutes (12411.68 ± 1270.04, 11537.03 ± 1230.06, P = 0.002) after laryngoscopy and endotracheal intubation as compared to Group C. No statistical difference was seen at 10 and 15 minutes. CONCLUSIONS Oral gabapentin 800 mg given preoperatively can attenuate haemodynamic responses to laryngoscopy and endotracheal intubation without significant side effects. KEY WORDS Oral Gabapentin, Laryngoscopy, Endotracheal Intubation, Haemodynamic Changes, Attenuation, Pressor Responses

scholarly journals Comparison of Train of Four Measurements with Kinemyography NMT DATEX and Accelerography TOFscan

2021 ◽  
Vol 9 (2) ◽  
pp. 21
Author(s):  
Cyrus Motamed ◽  
Migena Demiri ◽  
Nora Colegrave
Keyword(s):  
Neuromuscular Blockade ◽  
Lower Limit ◽  
Elective Surgery ◽  
Orotracheal Intubation ◽  
Neuromuscular Blocking ◽  
Physical Status Classification ◽  
Train Of Four ◽  
Surgery First ◽  
American Society ◽  
American Society Of Anesthesiologists

Introduction: This study was designed to compare the Datex neuromuscular transmission (NMT) kinemyography (NMTK) device with the TOFscan (TS) accelerometer during the onset and recovery of neuromuscular blockade. Patients and methods: This prospective study included adult patients who were scheduled to undergo elective surgery with general anesthesia and orotracheal intubation. The TS accelerometer was randomly placed at the adductor pollicis on one hand, and the NMTK was placed on the opposite arm. Anesthesia was initiated with remifentanil target-controlled infusion (TCI) and 2.0–3.0 mg/kg of propofol. Thereafter, 0.5 mg/kg of atracurium or 0.6 mg/kg of rocuronium was injected. If needed, additional neuromuscular blocking agents were administered to facilitate surgery. First, we recorded the train of four (TOF) response at the onset of neuromuscular blockade to reach a TOF count of 0. Second, we recorded the TOF response at the recovery of neuromuscular blockade to obtain a T4/T1 90% by both TS and NMTK. Results: There were 32 patients, aged 38–83 years, with the American Society of Anesthesiologists (ASA) Physical Status Classification I–III included and analyzed. Surgery was abdominal, gynecologic, or head and neck. The Bland and Altman analysis for obtaining zero responses during the onset showed a bias (mean) of 2.7 s (delay) of TS in comparison to NMTK, with an upper/lower limit of agreement of [104; −109 s] and a bias of 36 s of TS in comparison to NMTK, with an upper/lower limit of agreement of [−21.8, −23.1 min] during recovery (T4/T1 > 90%). Conclusions: Under the conditions of the present study, the two devices are not interchangeable. Clinical decisions for deep neuromuscular blockade should be made cautiously, as both devices appear less accurate with significant variability.

scholarly journals Hemodynamic Monitoring During Heated Intraoperative Intraperitoneal Chemotherapy Using the FloTrac/Vigileo System

2015 ◽  
Vol 100 (6) ◽  
pp. 1033-1039 ◽  
Author(s):  
Christos Mavroudis ◽  
Leonidas Alevizos ◽  
Konstantinos M. Stamou ◽  
Theodosia Vogiatzaki ◽  
Savvas Eleftheriadis ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Peritoneal Cancer Index ◽  
Venous Pressure ◽  
Term Survival ◽  
Continuous Increase ◽  
Peritoneal Cancer ◽  
American Society ◽  
American Society Of Anesthesiologists

Cytoreductive surgery with HIPEC has provided a chance for long-term survival in selected patients. However, perioperative management remains a challenge for the anesthesiology team. The aim of this study was to evaluate the changes in hemodynamic parameters during hyperthermic intraperitoneal chemotherapy (HIPEC) using the FloTrac/Vigileo system. Forty-one consecutive patients undergoing cytoreductive surgery and HIPEC were enrolled. Heart rate (HR), esophageal temperature, and cardiac output (CO) steadily increased until the end of HIPEC. In the first half of HIPEC, systolic blood pressure (SBP) and central venous pressure (CVP) increased whereas systemic vascular resistance (SVR) decreased; SVR stabilized in the second half. Diastolic blood pressure (DBP), mean arterial pressure (MAP), and stroke volume (SV) showed no significant variation. Male gender was related to increased CVP, CO, and SV, and decreased SVR; age &gt;55 years was related to increased SBP, and peritoneal cancer index (PCI) was correlated with HR, DBP, and SV. PCI &gt;14 was associated with increased HR and decreased DBP and MAP. American Society of Anesthesiologists score &gt;1 was related to decreased CO and SV. Patients undergoing HIPEC develop a hyperdynamic circulatory state because of the increased temperature, characterized by a steady decrease in SVR and continuous increase in HR and CO. FloTrac/Vigileo system may provide an easy-to-handle, noninvasive monitoring tool.

scholarly journals Obtenção de Consentimento Informado para Anestesia em Cirurgia Eletiva num Hospital Terciário: Práticas e Contexto Ético-Legal

2019 ◽  
Vol 32 (1) ◽  
pp. 53
Author(s):  
Luís Guilherme Casimiro ◽  
Sara Marisa Pereira ◽  
Sofia Cardoso Pires ◽  
Joana Mourão
Keyword(s):  
Informed Consent ◽  
Elective Surgery ◽  
University Hospital ◽  
Anesthetic Technique ◽  
Patient Relationship ◽  
Active Process ◽  
Legal Principles ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Written Informed Consent

Introduction: Informed consent is an active process of the doctor-patient relationship, based on ethical and legal principles. The anesthetic act has inherent risks, which should be subject of specific consent. The aim of this study was to evaluate the degree of implementation of written specific informed consent for anesthesia in the context of elective surgery.Material and Methods: An observational prospective study, at a tertiary university hospital, in 230 patients aged 60 years or older, undergoing elective surgery between May and July 2017. Eligible patients who consented to participate were interviewed clinically on the day before surgery. In the postoperative period, the anesthetic technique and the existence of the written informed consent for the anesthetic and surgical procedures were assessed. Patients who were unable to give informed consent or those admitted in the Intensive Care Unit after surgery were excluded. Results: Written informed consent for the surgical procedure was obtained for 225 (97.8%), while it was obtained in just 96 (41.7%) patients for the anesthetic act. There was a higher prevalence of stroke, anemia, and higher Charlson and physical American Society of Anesthesiologists scores in patients without written informed consent for the anesthetic act.Discussion: We identified a low implementation of written informed consent for anesthesia. This situation may have important implications in the context of disciplinary, civil or criminal liability.Conclusion: Despite its importance, the practice of written informed consent for anesthesia in this institution is not yet implemented on a regular basis.

The Combitube in Elective Surgery

2001 ◽  
Vol 94 (1) ◽  
pp. 79-82 ◽  
Author(s):  
Luis A. Gaitini ◽  
Sonia J. Vaida ◽  
Somri Mostafa ◽  
Boris Yanovski ◽  
Milian Croitoru ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Airway Device ◽  
Spontaneous Ventilation ◽  
Mechanically Ventilated ◽  
Entire Duration ◽  
Duration Of Surgery ◽  
American Society ◽  
End Tidal ◽  
American Society Of Anesthesiologists ◽  
Spontaneously Breathing

Background The Combitube has proved to be a valuable device for securing the airway in cases of difficult intubation. This study investigated the effectiveness of the Combitube in elective surgery during both mechanical and spontaneous ventilation. Methods Two hundred patients classified as American Society of Anesthesiologists physical status I and II, with normal airways, scheduled for elective surgery were randomly allocated into two groups: nonparalyzed, spontaneously breathing (n = 100); or paralyzed, mechanically ventilated (n = 100). After induction of general anesthesia and insertion of the Combitube, oxygen saturation, end-tidal carbon dioxide and isoflurane concentration, systolic and diastolic blood pressure and heart rate, as well as breath-by-breath spirometry data were obtained every 5 min. Results In 97% of patients, it was possible to maintain oxygenation, ventilation, and respiratory mechanics, as well as hemodynamic stability during either mechanical or spontaneous ventilation for the entire duration of surgery. The duration of surgery was between 15 and 155 min. Conclusions The results of this study suggest that the Combitube is an effective and safe airway device for continued management of the airway in 97% of elective surgery cases.

scholarly journals Attenuation of extubation responses: Comparison of prior treatment with verapamil and dexmedetomidine

2016 ◽  
Vol 03 (01) ◽  
pp. 033-039 ◽  
Author(s):  
Tuhin Mistry ◽  
Shobha Purohit ◽  
Gunjan Arora ◽  
Nitesh Gill ◽  
Jaya Sharma
Keyword(s):  
Blood Pressure ◽  
Stress Response ◽  
Tracheal Extubation ◽  
Group V ◽  
Airway Response ◽  
Significant Attenuation ◽  
American Society ◽  
Airway Responses ◽  
Group D

Abstract Background: Tracheal extubation is almost always associated with stress response, airway response, and arrhythmias. There are many ways to attenuate this stress response. We have compared verapamil and dexmedetomidine on attenuation of these responses. Materials and Methods: Thirty patients (American Society of Anaesthesiologists Grade I, II) scheduled for spinal surgeries under general anaesthesia were randomly divided into two groups. At the end of surgery, after return of spontaneous efforts (bispectral index >80), in “Group V” verapamil 0.1 mg/kg and in “Group D” dexmedetomidine 0.3 mcg/kg were administered as bolus intravenously over one minute. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded just before (T0) and 2 min after intravenous administration of study medications (TM), just after oral suction (TS), immediately after extubation (TE) and 1, 3, 5 and 10 min postextubation (E1, E3, E5, E10). Duration of emergence and extubation, quality of extubation, Richmond Agitation Sedation Scale (RASS) score and time to reach modified Aldrete score ≥9 were compared. Results: HR, SBP, DBP, MAP were higher in Group V than Group D, but statistically insignificant (P > 0.05). Extubation quality scores was 1 for 20%, 2 for 60% and 3 for 20% patients in Group V, whereas 1 in 80%, 2 in 20% in Group D. There was occurrence of bradycardia within 2 min of administration of drug in one patient in Group D. RASS score was in the range of -1 to +1 in >90% patient in Group V, whereas -3 to -1 in 80% cases in Group D. Conclusion: Single dose of dexmedetomidine (0.3 mcg/kg) given before extubation produced significant attenuation of circulatory and airway responses during extubation as compared to verapamil (0.1 mg/kg).

scholarly journals Comparison of non-invasive haemodynamic monitors of stress response to endo-tracheal intubation with perfusion index in patients undergoing elective surgery

2020 ◽  
Vol 23 (2) ◽  
pp. 9-13
Author(s):  
Sushila Lama Moktan ◽  
Manan Karki
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Stress Response ◽  
Tracheal Intubation ◽  
Endotracheal Tube ◽  
Diastolic Blood Pressure ◽  
Endotracheal Intubation ◽  
Elective Surgery ◽  
Perfusion Index ◽  
Non Invasive

Introduction: Laryngoscopy and intubation is always associated with a short term reflex sympathetic pressor response. The perfusion index is an indirect, non-invasive, and continuous measure of peripheral perfusion by pulse oximeter which can detect the stress response to intubation similar to heart rate, systolic blood pressure and diastolic blood pressure. Methods: This prospective observational study enrolled sixty-five normotensive patients of American society of anesthesiologists physical status grade I and II scheduled for elective surgery under general anaesthesia. Tracheal intubation was performed after induction with intravenous fentanyl, propofol and vecuronium. Heart rate, Systolic and Diastolic Blood Pressure and Perfusion Index were measured before induction of anesthesia, before intubation and one minute, three minutes, five minutes after the insertion of the endotracheal tube. Increase in heart rate by ?10 beats per minute, systolic and diastolic blood pressure by ?15 millimeters of mercury and decrease in Perfusion index ?10% after endotracheal intubation as compared to preintubationvalue were considered positive haemodynamic changes. Results: Endotracheal intubation produced a significant increase in heart rate and blood pressure whereas perfusion index decreased significantly. Our study showed that perfusion index response criterion achieved 97.7% (Confidence interval 97.58-97.86) sensitivity in detecting the stress response to insertion of endotracheal tube whereas systolic and diastolic blood pressure achieved sensitivity of 90% and 92% respectively. Conclusion: Perfusion Index is easier, reliable and non-invasive alternative to conventional haemodynamic criteria for detection of stress response to endotracheal intubation.

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