A Prospective Study to Compare the Effects of General Anaesthesia and Regional Anaesthesia among Patients Posted for Laparoscopic Appendicectomy, in SV Medical College, Tirupati, Andhra Pradesh

2021 ◽  
Vol 8 (26) ◽  
pp. 2333-2338
Author(s):  
Nirmala Devi B ◽  
Surisetty Sreenivasa Rao ◽  
Raju Bhukya
Keyword(s):  
General Anaesthesia ◽  
Spinal Anaesthesia ◽  
Postoperative Analgesia ◽  
Postoperative Period ◽  
Postoperative Nausea ◽  
Regional Anaesthesia ◽  
Laparoscopic Appendicectomy ◽  
P Value ◽  
Medical College ◽  
Spinal Group

BACKGROUND We wanted to compare the effects of general anaesthesia and regional anaesthesia in cases posted for laparoscopic appendicectomy and also compare various parameters like hemodynamic changes, postoperative analgesia, and postoperative complications in both the techniques. METHODS After obtaining permission from scientific and ethical committee of SVMC, Tirupati, we conducted the study on 60 patients attending SV Medical College, Tirupati from September 2018 to August 2019, who were in ASA GRADE 1 & 2, and posted for laparoscopic appendicectomy. We divided them into two groups Group - S – those who received spinal anaesthesia & Group - G – those who received general anaesthesia. RESULTS 60 patients of ASA 1 and 2 were taken up for laparoscopic appendicectomy from September 2018 to August 2019. Out of 60 patients, 30 patients were grouped under Group - S, Other 30 patients grouped under Group - G. Intraoperative vitals, including blood pressure, heart rate, oxygen saturation, and respiratory rate and end-tidal CO2 levels, were within baseline values, whereas postoperative analgesia was better in Group - S than Group - G. There were 3 patients in the spinal group who developed postoperative hypotension and were managed with injection mephentermine sulphate. Out of 30 in each group, 11 patients in spinal, and 22 patients in GA group developed postoperative nausea and vomiting, which subsided with antiemetics. There were 4 patients in spinal, and 3 patients in the GA group who complained of shoulder tip pain in the postoperative period. Patients had minimal pain and no requirement of analgesia in the initial 3 hours of the postoperative period in the spinal group. CONCLUSIONS Patients who underwent laparoscopic appendicectomy under spinal anaesthesia (Group - S) showed significant postoperative analgesia (P - value < 0.05) and better haemodynamic stability than the patients who underwent laparoscopic appendicectomy under general anaesthesia (Group - G), But alertness for any emergency by anaesthesiologist was more needed in spinal anaesthesia than general anaesthesia because airway was not protected, and patient was taking spontaneous respirations. KEYWORDS RA - Regional Anaesthesia, SA - Spinal Anaesthesia, GA - General Anaesthesia, PONV (Postoperative Nausea & Vomiting)

scholarly journals Corrected Scoliosis, Cholinesterase Deficiency, and Cesarean Section: A Case Report

2009 ◽  
Vol 2009 ◽  
pp. 1-3 ◽  
Author(s):  
Roy Somers ◽  
Yves Jacquemyn ◽  
Luc Sermeus ◽  
Marcel Vercauteren
Keyword(s):  
Case Report ◽  
Caesarean Section ◽  
Cesarean Section ◽  
General Anaesthesia ◽  
Spinal Anaesthesia ◽  
Regional Anaesthesia ◽  
Previous Caesarean Section ◽  
Corrective Surgery ◽  
Ultrasound Guided ◽  
Severe Scoliosis

We describe a patient with severe scoliosis for which corrective surgery was performed at the age of 12. During a previous caesarean section under general anaesthesia pseudocholinesterase deficiency was discovered. Ultrasound guided spinal anaesthesia was performed enabling a second caesarean section under loco-regional anaesthesia.

HYPOTENSION DURING SPINAL ANAESTHESIA FOR CAESAREAN SECTION: IMPLICATIONS, DETECTION PREVENTION AND TREATMENT

2006 ◽  
Vol 17 (2) ◽  
pp. 157-183 ◽  
Author(s):  
KIM S KHAW ◽  
WARWICK D NGAN KEE ◽  
SHARA WY LEE
Keyword(s):  
Caesarean Section ◽  
General Anaesthesia ◽  
Spinal Anaesthesia ◽  
Regional Anaesthesia ◽  
Maternal Morbidity ◽  
Morbidity And Mortality ◽  
Maternal Deaths ◽  
Maternal Morbidity And Mortality ◽  
Prevention And Treatment

Regional anaesthesia is preferred by most anaesthetists for the majority of caesarean sections. The major advantage of regional anaesthesia is the avoidance of maternal morbidity and mortality associated with general anaesthesia. The importance of this can be seen in the most recent Report of Confidential Enquires into Maternal Deaths in which it was reported that of the direct maternal deaths attributed to anaesthesia, all six were associated with difficulties during general anaesthesia. Although a number of regional anaesthesia techniques are available, spinal anaesthesia is particularly popular because it is fast, easy to perform and provides excellent intraoperative analgesia.

scholarly journals Comparative Efficacy of Ondansetron Versus Granisetron to Prevent Perioperative Nausea and Vomiting in Patients undergoing Gynaecological Surgery under Spinal Anaesthesia

2017 ◽  
Vol 6 (1) ◽  
pp. 1371
Author(s):  
Robina Makker ◽  
Amit Bhardwaj ◽  
Arwinder Pal Singh ◽  
Asha Anand
Keyword(s):  
Spinal Anaesthesia ◽  
Postoperative Period ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Study Groups ◽  
Early Postoperative Period ◽  
Nausea And Vomiting ◽  
Gynaecological Surgery ◽  
Significant Difference ◽  
Late Postoperative Period

<p><strong>Background</strong>: Posotoprative nausea and vomiting remains a persistent and distressing problem inspite of many advances on perioperative care and anti-emetic drugs. A newer antiemetic drug Granisetron has not been studied in patients undergoing gynaecological surgery under spinal anaesthesia.</p><p><strong>Objective</strong>: A randomized double blind study was conducted to compare Ondansetron and Granisetron for prevention of postoperative nausea and vomiting in patients undergoing gynaecological surgery under spinal anaesthesia.</p><p><strong>Material and methods</strong>: 60 consecutive patients, age between 20-65 years, ASA grade I and II undergoing gynaeacologicla surgery under spinal anaesthesia were randomized into two goups of 30 each. One group received intravenous Ondansetron 4.0 mg and the second received intravenous Granisetron 2.0 mg 5 minutes before induction of anaesthesia. For the first 24 hours postoperatively all episodes of nausea and vomiting were recorded. A complete response to the drug was considered if there was no nausea or vomiting and no need for rescue anti-emetic. The observations were tabulated and analysed.</p><p><strong>Results</strong>: During early postoperative period (0-3 hrs) there was statistically no significant difference in the study groups. Statistically significant difference was found in the study groups in the late postoperative period (3-24 hrs).</p><p><strong>Conclusion</strong>: In the early postoperative period both Ondansetron and Granisetron are equally effective in preventing postoperative nausea and vomiting in patients undergoing gynaecological surgery under spinal anaesthesia. Granisetron is better than Ondansetron in the late postoperative period of upto 24 hrs.</p>

scholarly journals Evaluation of anaesthetic techniques for caesarean

2018 ◽  
Vol 6 (5) ◽  
pp. 1742
Author(s):  
Alaka Banerjee ◽  
Dhrubajyoti Sarkar ◽  
Banasree Bhadra
Keyword(s):  
Caesarean Section ◽  
Spinal Anaesthesia ◽  
Epidural Anaesthesia ◽  
Regional Anaesthesia ◽  
Caesarean Section Rate ◽  
Elective Caesarean Section ◽  
Anaesthetic Techniques ◽  
Medical College ◽  
Obstetrics And Gynaecology ◽  
Spinal Epidural

Background: The anaesthetic technique to be used in Caesarean section is determined according to factors such as urgency, presence of coexisting health problems, preference of patient and preference and experience of the anaesthetist and surgeon.Methods: This is a retrospective study of all the caesarean deliveries that occurred in the period between 1st Jan 2010 to 31st Dec 2017 in the department of obstetrics and Gynaecology in Silchar Medical College. The anaesthesia techniques used for caesarean sections were evaluated in this study. Anaesthesia methods were recorded as general anaesthesia (GA) and regional anaesthesia (RA), and RA was classified into spinal anaesthesia (SA), epidural anaesthesia (EA) and combined spinal epidural anaesthesia (CSEA) subgroups.Results: During the study period a total of 75685 patients delivered and 25805 patients had undergone caesarean section. The caesarean section rate at the institution comes to be around 34.1%. Among the indications, it was observed that foetal distress (32.8%) was the commonest cause followed by post caesarean pregnancy (26.76%). The majority of the CS (75.6%) were done as an emergency procedure. Regional anaesthesia was the most frequently used method both in emergency (92.87%) and elective caesarean section (84.21%). SA was the commonest used RA (89.2%).Conclusions: In recent years, the rate of regional anaesthesia administration in caesarean section is gradually increasing, and the spinal anaesthesia technique is the mostly preferred regional anaesthesia. There is need to explore the use of the other forms of regional anaesthesia also.

scholarly journals Comparison of Cardiovascular Response during Induction of General Anaesthesia Using Etomidate Versus Using Propofol under Bispectral Index Guidance in a Tertiary Care Medical College, Dibrugarh

2021 ◽  
Vol 10 (32) ◽  
pp. 2645-2651
Author(s):  
Utpal Dutta ◽  
Shahbaz Bin Sabir ◽  
Rituparna Bora
Keyword(s):  
Heart Rate ◽  
General Anaesthesia ◽  
Bispectral Index ◽  
Cardiovascular Response ◽  
Tertiary Care ◽  
Cardiovascular Responses ◽  
P Value ◽  
Induction Agent ◽  
Medical College ◽  
Significant Fall

BACKGROUND The present study was done to compare the cardiovascular responses of etomidate and propofol as induction agents of general anaesthesia under Bispectral index (BIS) guidance and evaluate the effect of intravenous induction agent etomidate and propofol on the variation in heart rate and blood pressure during induction of general anaesthesia. METHODS This is a prospective randomized and double blinded comparative study done in Assam Medical College and Hospital on patients scheduled for elective surgeries under general anaesthesia from June 2019 to May 2020. 80 patients were randomly allocated to group E (etomidate group) and group P (propofol group) of 40 each. All patients were pre-medicated with fentanyl 2 microgram / kg intravenously. Group E received etomidate infusion at 0.05 mg / kg / min and group P received propofol infusion at 0.5 mg / kg / min until Bispectral index value dropped to 60. Patients were intubated with vecuronium 0.1 mg / kg and maintenance of anaesthesia was continued according to institutional protocol. At the end of anaesthetic period, extubation was done after acceptable recovery. Haemodynamic parameters were recorded in both the groups until 10 minutes of induction. RESULTS Statistically significant fall in heart rate was seen in group P than that of group E starting from 3 minutes of induction up to 10 minutes with P value < 0.05 and statistically significant fall in systolic, diastolic, and mean arterial pressure (MAP) was seen in propofol group from that of etomidate group starting from 1 minute of induction up to 10 minutes was seen. CONCLUSIONS We conclude that etomidate is haemodynamically more stable than propofol during the time of induction of anaesthesia. KEY WORDS Etomidate, Propofol, Bispectral Index

scholarly journals A Prospective Randomised Trial Comparing Spinal Anaesthesia using Hyperbaric Cinchocaine with General Anaesthesia for Lower Limb Vascular Surgery

1986 ◽  
Vol 14 (4) ◽  
pp. 373-380 ◽  
Author(s):  
P. T. Cook ◽  
M. J. davies ◽  
K. D. Cronin ◽  
P. Moran
Keyword(s):  
Vascular Surgery ◽  
General Anaesthesia ◽  
Spinal Anaesthesia ◽  
Lower Limb ◽  
Myocardial Infarct ◽  
Randomised Trial ◽  
Limb Amputation ◽  
Significant Difference ◽  
Spinal Group ◽  
General Anaesthesia Group

One hundred and one patients were randomly allocated to have their peripheral vascular surgery performed under general anaesthesia (51 patients) or spinal anaesthesia (50 patients). Intraoperative haemodynamic changes were markedly different between the two groups with a higher incidence of hypotension in the spinal group (72% vs 31%) and a higher incidence of hypertension in the general anaesthesia group (22% vs 0%). Blood loss was significantly less in the spinal group (560, SD 340, ml vs 792, SD 440, ml). Postoperatively three patients from the general anaesthesia group died from causes unrelated to the anaesthesia, and one had a myocardial infarct. Two patients in the spinal group had myocardial infarcts, both had been treated for bradycardia and hypotension intraoperatively, and one died. There was a significantly higher incidence of postoperative chest infection in the general anaesthesia group (33% vs 16%). There was no significant difference between the groups in the incidence of postoperative confusion, or lower limb amputation rate or need for further surgery prior to hospital discharge.

scholarly journals Comparison of effect of isobaric bupivacaine vs hyperbaric bupivacaine on haemodynamic variables in thorcic combined spinal epidural anaesthesia for laparoscopic cholecystectomies

2018 ◽  
Vol 6 (10) ◽  
pp. 3413
Author(s):  
Loveleen Kour ◽  
Kuldip C. Gupta
Keyword(s):  
General Anaesthesia ◽  
Spinal Anaesthesia ◽  
Epidural Anaesthesia ◽  
Regional Anaesthesia ◽  
Hyperbaric Bupivacaine ◽  
Combined Spinal Epidural ◽  
Group I ◽  
Operative Complications ◽  
Lumbar Spinal ◽  
Spinal Epidural

Background: Regional anaesthesia has always been an attractive option for laparoscopic surgeries in patients who are not fit for general anaesthesia. Also, regional anaesthesia has certain advantages over general anaesthesia like lesser oropharyngeal morbidity, lesser blood loss and decreased chances of thrombosis. Lumbar spinal anaesthesia has been synonymous with the term regional anaesthesia for laparoscopic surgeries for quite some time now. In the light of recent works by Imbelloni and Zundert, thoracic spinal anaesthesia has been shown to be a promising alternative not only for healthy patients but for high risk patients as well. Baricity defines the density of the drug with respect to CSF density. This undoubtedly makes it is one of the most important factors that influence drug distribution in the subarachnoid space. Drugs of differing baricities have been studied previously in lumbar spinal anaesthesia. We aimed at studying the behaviour of isobaric and hyperbaric bupivacaine using a different approach which in this study was thoracic combined spinal epidural anaesthesia. Authors evaluated the haemodynamic changes as well as neurological and any other post operative complications that occurred in any of the patients.Methods: There were 60 ASA I and II patients undergoing elective laparoscopic cholecystectomy who were chosen for this study. They were randomly divided into two equal groups - group I and group H. Thoracic combined spinal epidural anaesthesia (CSE) was performed at T9-T10 / T10-T11 interspace. Patients in group I received 1.5ml of isobaric bupivacaine 0.5% (5mg/ml) + 25µg (0.5ml) of fentanyl and group H patients were given 1.5ml of hyperbaric bupivacaine 0.5% (5mg/ml) + 25µg (0.5ml) of fentanyl.Results: There was no significant difference among the haemodynamic variables between the two groups and no neurological complication was seen in any patient.Conclusions: Thoracic combined spinal epidural anaesthesia allows haemodynamic stability in laparoscopic cholecystectomies with minimal neurological and post operative complications irrespective of baricity of the drug used.

Preemptive use of oral gabapentin or pregabalin for acute postoperative pain following lower limb orthopaedic surgery under spinal anaesthesia

2019 ◽  
Vol 8 (1) ◽  
pp. 3-7
Author(s):  
Utsav Acharya ◽  
Aashish Ghimire ◽  
Balkrishna Bhattarai ◽  
Satyendra Narayan Singh ◽  
Jagat Narayan Prasad ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Spinal Anaesthesia ◽  
Postoperative Analgesia ◽  
Lower Limb ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Sedation Score ◽  
Nausea And Vomiting ◽  
Total Consumption ◽  
Perioperative Morbidity

Background: Postoperative pain is a major cause of perioperative morbidity and functional impairment. Preemptive analgesia is an analgesia regimen instituted before the surgery, to desensitize the pain pathways. Pregabalin and gabapentin have been claimed to be effective in reducing postoperative pain without significant alterations in hemodynamics. Objectives: This study was conducted to compare the effectiveness of pregabalin and gabapentin in reducing postoperative pain, total opioid consumption, postoperative nausea and vomiting and sedation in patients undergoing lower limb orthopaedic surgeries under spinal anaesthesia. Methodology: Eighty patients undergoing lower limb orthopaedic surgeries under spinal anaesthesia were divided into two groups, to either receive 300mg gabapentin or 150mg pregabalin, one hour before surgery. The patients were evaluated at one, two, six, 12 and 24 hours postoperatively and Visual Analogue Scale score for pain, postoperative nausea vomiting, and sedation score were monitored. Tramadol 50 mg was used as rescue analgesic and total consumption over 24 hours was recorded. Results: The mean duration of postoperative analgesia was significantly higher with pregabalin (282±106 minutes versus 234 ± 97minutes, p=0.009). The sedation score was significantly higher with pregabalin in the first hour (p=0.001). The total tramadol consumption was higher with gabapentin; however, it was statistically insignificant. The occurrence of postoperative nausea and vomiting was comparable between the groups. Minor adverse effects such as dizziness, sedation and headache were observed in both groups. Conclusion: Pregabalin 150 mg orally significantly increases the duration of postoperative analgesia than gabapentin 300mg following lower limb orthopaedic surgeries. Although sedation is frequently observed, it doesn’t alter the hemodynamics and thus, may be used safely.

scholarly journals Comparative study of acupressure wristband versus palonosetron for prophylaxis of postoperative nausea and vomiting in elective laparoscopic cholecystectomy under general anaesthesia

2016 ◽  
Vol 5 (1) ◽  
pp. 96 ◽  
Author(s):  
Suchismita Naik ◽  
Shweta Kujur ◽  
Miltan Debbarma ◽  
Miltan Debbarma ◽  
Madhumita G. Murthy
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
General Anaesthesia ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
P Value ◽  
Double Blind Study ◽  
Post Operative Nausea ◽  
Rescue Antiemetic ◽  
Wrist Bands

Background: Postoperative nausea and vomiting (PONV) is common complication after general anesthesia and surgery. This randomized double-blind study was designed to compare the effects of acupressure wrist bands and palonosetron for the prevention of post-operative nausea and vomiting (PONV) in laparoscopic cholecystectomy under general anaesthesia.Methods: Sixty ASA I and II patients undergoing elective laparoscopic surgeries under general anaesthesia were divided into two groups. In Group A patients, acupressure wrist bands were applied on p6 point on both hands half an hour before induction. Group P patients received inj. palonosetron 0.075 m.g. i.v. just before induction. Anaesthesia technique was standardized. Post-operatively patients were monitored for nausea, retching or vomiting upto 24 hours. If patients vomited more than once, they were given inj. Metoclopramide 10mg as rescue antiemetic. Efficacy of drugs was compared using Chi square test. ‘p’ value of <0.05 is considered significant.Results: The incidence of PONV and requirement of rescue antiemetic were lower in palonosetron group than acupressure wrist band group.Conclusions: Palonosetron is more effective than acupressure wrist band for prophylaxis of post- operative nausea and vomiting in the patients undergoing laparoscopic cholecystectomy under general anaesthesia, but acupressure wrist band can also be used as an alternative non-pharmacological method.

scholarly journals Effects of addition of Magnesium sulphate to heavy Bupivacaine for spinal anesthesia in vaginal hysterectomy

2014 ◽  
Vol 2 (2) ◽  
pp. 63-68
Author(s):  
Sushila Tabdar ◽  
Uzma Shrestha ◽  
Ekraj Kadariya
Keyword(s):  
Spinal Anesthesia ◽  
Spinal Anaesthesia ◽  
Magnesium Sulphate ◽  
Vaginal Hysterectomy ◽  
Motor Block ◽  
Sensory Block ◽  
P Value ◽  
Double Blind ◽  
Medical College ◽  
To Receive

Background: Adequate pain management is essential for every patient to recover and return to their normal activity quickly. Central sensitization is one of the mechanism which increases excitability of spinal neurons and results persistent pain postoperatively. Objectives: The aim of the study was to investigate the effects of addition of 100 mg 50% Magnesium Sulphate intrathecally to 0.5% heavy Bupivacaine on sensory onset up to T4 level, complete motor block, post-operative analgesia and complications in patients planned for vaginal hysterectomy under spinal anesthesia. Methods: The design of the study was prospective randomized and double blind. With the Institutional improvements and informed consent in Kathmandu Medical College from January 2011 till December 2012, 60 American society of Anesthesiologist class (I, II) patients of age between (40 to 70) years, weight between (45 to 70) kg and height between (4.8 to 5.2) feet undergoing routine vaginal hysterectomy not exceeding one and half hour in spinal anaesthesia were included in the study. The exclusion criteria were patients not following above criteria, having coagulopathy, renal function derangements, uncontrolled hypertension or severe hypotension and having dysarrhythmias. Total patients were randomized into two groups of thirty each. Group A was allocated to receive four ml 0.5% Bupivacaine +0.25 ml normal saline and group B was allocated to receive four ml 0.5% Bupivacaine + 100 mg of 50% Magnesium Sulphate. The anaesthesiologist who was double blind to the drug preparation performed spinal anaesthesia with either of the drug for the whole study.The recorded parameters were time of onset of sensory block upto T4 level, onset of complete motor block, total duration of analgesia and complications in both the groups. Data analysis was done by Computer software polystat XLS using Student’s “t” test. P value <0.05 was considered statistically significant.  Result: The addition of 100 mg of 50% Magnesium sulphate to 0.5% Bupivacaine intrathecally resulted early onset of sensory block upto T4 level in (Mean± SD) (3.79 ± 0.25) min Vs (9.61 ± 0.75) min with sole 0.5% Bupivacaine where p value was < 0.05. Similarly onset of complete motor block with 0.5% Bupivacaine plus Magnesium Sulphate was (1.9 ± 0.23) min verses (10.4 ± 0.63) min with 0.5 % Bupivacaine only. Here again p value was < 0.05. Duration of analgesia with 0.5 % Bupivacaine plus Magnesium Sulphate was (176.8 ± 19. 85) min than that of 0.5% Bupivacaine (105 ± 26.82) min with P value< 0.05. Conclusion: The study concluded that onset as well as analgesic effect of 0.5% Bupivacaine was potentiated by intrathecal Magnesium Sulphate without major side effects.DOI: http://dx.doi.org/10.3126/jkmc.v2i2.10628Journal of Kathmandu Medical College, Vol. 2, No. 2, Issue 4, Apr.-Jun., 2013, Page: 63-68

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