THE DIFFERENT TIMING OF ORAL CLONIDINE PREMEDICATION EFFECT ON SEDATION SCORE IN SPINE SURGERY

2021 ◽  
Vol 5 (9) ◽  
Author(s):  
Satish Kumar ◽  
Sanjay Kumar
Keyword(s):  
Spine Surgery ◽  
Spinal Surgery ◽  
Ethics Committee ◽  
Sedation Score ◽  
Oral Clonidine ◽  
Adequate Sedation ◽  
Group 2 ◽  
American Society ◽  
Oral Premedication ◽  
Group 1

Background: Premedication is the administration of medication before anaesthesia. It is used to prepare the patient for anaesthesia and to provideoptimal conditions for surgery. Methods: The study of oral premedication dose of clonidine in spinal surgery at different time was conducted on sixty ASA grade-1 patients of eithersex between 20 to 60 years of age undergoing elective spine surgery. This study was performed after approval from ethics committee of the institute.Informed consent was obtained from each patient. Results: Sedation score was recorded preoperatively in both the groups when the patient were shifted to the operation theater according to score givenby American Society of Anaesthesia. In group-1, 25 patients (83.3%) had sedation score of 0 and 5 patients (16.7%) had score of 1. Similarly in group-2, 29 patients (96.7) had a sedation score 0 and only 1 patient (3.3%) had sedation score1. Conclusion: In conclusion this study establishes that the premedication with tab. clonidine 200µg (As tab. clonidine is available in 100µg) 90 minutebefore the surgery or 3.5 hour before the surgery produced adequate sedation Keywords: Clonidine, Sedation, Spine

THE DIFFERENT TIMING OF ORAL CLONIDINE PREMEDICATION EFFECT ON SEDATION SCORE IN SPINE SURGERY

2021 ◽  
Vol 5 (9) ◽  
Author(s):  
Satish Kumar ◽  
Sanjay Kumar
Keyword(s):  
Spine Surgery ◽  
Ethics Committee ◽  
Sedation Score ◽  
Average Weight ◽  
Oral Clonidine ◽  
Induction Dose ◽  
Group 2 ◽  
Oral Premedication ◽  
Total Average ◽  
Group 1

Background: Premedication is the administration of medication before anaesthesia. It is used to prepare the patient for anaesthesia and to provideoptimal conditions for surgery. Methods: The study of oral premedication dose of clonidine in spinal surgery at different time was conducted on sixty ASA grade-1 patients of eithersex between 20 to 60 years of age undergoing elective spine surgery. This study was performed after approval from ethics committee of the institute.Informed consent was obtained from each patient. Results: The total induction dose of propofol required for the induction of the patient is 2-2.5 mg/kg body weight. In our study the average weightof the patient in group-1 was 58.83 kg and in group-2, average weight of the patient was 54.77 kg. The total average weight of patient in the study was 56.80 kg. Thus the total induction dose of propofol required should have been 117.66 mg in group-1, 109.54 mg in group-2 and 113.6 mg in averagetotal. Conclusion: In conclusion this study establishes that the premedication with tab. clonidine 200µg (As tab. clonidine is available in 100µg) 90 minutebefore the surgery or 3.5 hour before the surgery reduced induction dose of propofol. Keywords: Clonidine, Propofol, Spine

scholarly journals Effect of clonidine and gabapentin as oral premedication on hemodynamic response to laryngoscopy and tracheal intubation

2018 ◽  
Vol 6 (12) ◽  
pp. 3819
Author(s):  
Prabhati R. Mishra ◽  
Manmaya Padhy ◽  
Rusikesh Satapathy ◽  
Monali Kar
Keyword(s):  
Blood Pressure ◽  
Endotracheal Intubation ◽  
Hemodynamic Response ◽  
Oral Clonidine ◽  
Arterial Blood ◽  
Induction Group ◽  
Group 3 ◽  
Group 2 ◽  
Oral Premedication ◽  
Group 1

Background: Laryngoscopy and endotracheal intubation causes stimulation of symphatho-adrenal system resulting in increase in blood pressure and heart rate. The present study compared oral clonidine, gabapentin and placebo premedication in attenuating haemodynamic response to laryngoscopy and endotracheal intubation.Methods: About 90 adult patients of ASA grade I and II patients in age group of 18-60 yrs, of either sex posted for surgery under general anaesthesia were randomly divided into three groups (30 patients in each group). The study drugs were given orally 90minutes before induction. Group 1 and Group 2 were pre treated with oral clonidine (0.2mg) and gabapentin (800mg) respectively and Group-3 received placebo. The HR, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure were recorded before induction of anesthesia and 1, 3, 5, 10min after laryngoscopy and intubation.Results: It was found that both clonidine and gabapentin reduces HR, SBP, DBP, MAP than placebo group at lminute, 3minutes, 5minutes and 10minutes after intubation. But reduction is more with clonidine as compared to gabapentine and difference was statistically significant (P = <0.0001).Conclusions: Both oral clonidine and gabapentine attenuate hemodynamic response to laryngoscopy and endotracheal intubation but effect is better with clonidine than oral gabapentine.

scholarly journals Adaptive functional change of the contralateral kidney after partial nephrectomy

2017 ◽  
Vol 313 (2) ◽  
pp. F192-F198 ◽  
Author(s):  
Se Young Choi ◽  
Sangjun Yoo ◽  
Dalsan You ◽  
In Gab Jeong ◽  
Cheryn Song ◽  
...  
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Functional Change ◽  
Functional Changes ◽  
Contralateral Kidney ◽  
Before And After ◽  
Group 2 ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Group 1

Partial nephrectomy aims to maintain renal function by nephron sparing; however, functional changes in the contralateral kidney remain unknown. We evaluate the functional change in the contralateral kidney using a diethylene triamine penta-acetic acid (DTPA) renal scan and determine factors predicting contralateral kidney function after partial nephrectomy. A total of 699 patients underwent partial nephrectomy, with a DTPA scan before and after surgery to assess the separate function of each kidney. Patients were divided into three groups according to initial contralateral glomerular filtration rate (GFR; group 1: <30 ml·min−1·1.73 m−2, group 2: 30–45 ml·min−1·1.73 m−2, and group 3: ≥45 ml·min−1·1.73 m−2). Multiple-regression analysis was used to identify the factors associated with increased GFR of the contralateral kidney over a 4-yr postoperative period. Patients in group 1 had a higher mean age and hypertension history, worse American Society of Anesthesiologists score, and larger tumor size than in the other two groups. The ipsilateral GFR changes at 4 yr after partial nephrectomy were −18.9, −3.6, and 3.9% in groups 1, 2, and 3, respectively, whereas the contralateral GFR changes were 10.8, 25.7, and 38.8%. Age [β: −0.105, 95% confidence interval (CI): −0.213; −0.011, P < 0.05] and preoperative contralateral GFR (β: −0.256, 95% CI: −0.332; −0.050, P < 0.01) were significant predictive factors for increased GFR of the contralateral kidney after 4 yr. The contralateral kidney compensated for the functional loss of the ipsilateral kidney. The increase of GFR in contralateral kidney is more prominent in younger patients with decreased contralateral renal function.

Decreased Rejection and Improved Survival of First and Second Marrow Transplants for Severe Aplastic Anemia (A 26-Year Retrospective Analysis)

Blood ◽  
1998 ◽  
Vol 92 (8) ◽  
pp. 2742-2749 ◽  
Author(s):  
Anne Stucki ◽  
Wendy Leisenring ◽  
Brenda M. Sandmaier ◽  
Jean Sanders ◽  
Claudio Anasetti ◽  
...  
Keyword(s):  
Aplastic Anemia ◽  
Graft Rejection ◽  
Marrow Transplant ◽  
Severe Aplastic Anemia ◽  
Probability Of Survival ◽  
Gvhd Prophylaxis ◽  
Group 3 ◽  
Group 2 ◽  
American Society ◽  
Group 1

Abstract Between 1970 and 1996, 333 patients with severe aplastic anemia underwent HLA-matched related marrow transplant after conditioning with cyclophosphamide (CY). Thirty-five percent of patients transplanted between 1970 and 1976 (group 1), 12% of those transplanted between 1977 and 1981 (group 2), and 9% of patients transplanted between 1982 and 1997 (group 3) had graft rejection. Graft rejection occurred later among group 3 patients (median, 180 days) than among those in groups 1 and 2 (medians, 28 and 47 days, respectively; P &lt; .001 group 3 v 2). In group 3, 92% of rejecting patients underwent a second transplant, compared with 78% and 77% in groups 1 and 2, respectively. Group 1 patients received various conditioning regimens before second transplant, whereas most patients of groups 2 and 3 received CY combined with antithymocyte globulin (ATG). Graft-versus-host disease (GVHD) prophylaxis after second transplant consisted of methotrexate (MTX) for all group 1 and 2 patients, whereas group 3 patients received MTX combined with cyclosporine (CSP). Over the three time periods studied, first graft rejection decreased from 35% to 9%, and the proportion of rejecting patients undergoing second transplants increased from 77% to 92%. The 10-year probability of survival after second transplants increased from 5% to 83%. Multivariate analysis showed MTX/CSP GVHD prophylaxis to be a significant factor accounting for the increase in patient survival after second transplant. © 1998 by The American Society of Hematology.

scholarly journals The efficacy and safety of intraoperative acute normovolaemic haemodilution in complex spine surgery in a private surgical facility in Ghana

2021 ◽  
Vol 55 (1) ◽  
pp. 2-8
Author(s):  
Irene Wulff ◽  
Henry O. Duah ◽  
Audrey Oteng-Yeboah ◽  
Henry O. Tutu ◽  
Kwadwo P. Yankey ◽  
...  
Keyword(s):  
Blood Loss ◽  
Spine Surgery ◽  
Autologous Blood ◽  
Allogeneic Blood ◽  
Spine Deformity ◽  
Allogeneic Transfusion ◽  
Spine Deformities ◽  
Acute Normovolaemic Haemodilution ◽  
Group 2 ◽  
Group 1

Objectives: To assess the safety and clinical benefits of intraoperative acute normovolaemic haemodilution (ANH) incomplex spine surgery. Design: Prospective comparative cohort studySetting: A private orthopaedic hospital in GhanaPatients: Seventy-six patients who underwent complex spine deformity surgeryInterventions: Patients were randomly assigned to two groups. 45 patients to the acute normovolaemic haemodilution(ANH) or Group 1 and 31patients to the non-ANH or Group 2. Following anesthetic administration and before incision, autologous blood was collected from patients in Group1 and was reinfused during/shortly after surgery while patients in Group2 were transfused with compatible allogeneic blood intraoperatively.Main Outcome Measures: Changes in haemodynamic parameters and incidence of allogeneic transfusions and related complications.Results: The mean age (years), gender ratio, deformity size and aetiology, fusion levels, and operative times were similar in both groups. Blood loss (ml) of patients in groups 1 and 2 were 1583ml± 830.48 vs 1623ml ± 681.34, p=0.82, respectively. The rate of allogeneic blood transfusion in groups 1 and 2 were 71% vs 80.65%, p=0.88, respectively. Haemoglobin levels (g/dL) in groups 1 and 2 were comparable in both groups at Post-operative Day (POD) 0 and POD 1. Incidence of minor allogeneic transfusion reaction was 1/45 vs 1/31, p=0.80, group-1 and group-2, respectively.Conclusion: Acute normovolaemic haemodilution can be safely performed in complex spine surgery in underserved regions. However, its use does not obviate allogeneic transfusion in patients with complex spine deformities in whom large volumes of blood loss is expected.

scholarly journals Effects of Preoperative Oral Carbohydrate Loading on Preoperative and Postoperative Comfort in Patients Planned to Undergo Elective Cholecystectomy: A Prospective Randomized Controlled Clinical Trial

2020 ◽  
Keyword(s):  
Controlled Clinical Trial ◽  
Fasting Period ◽  
Rich Solution ◽  
The Mean ◽  
Group 2 ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Elective Cholecystectomy ◽  
Group 1 ◽  
Operational Time

Background: Cholecystectomy is a widespread abdominal procedure. A period of 8-hour-fasting for this relatively rapid surgery negatively affects the patients’ comfort. Objectives: The current study aimed to evaluate the effects of the presurgical intake of carbohydrate on patients’ comfort. Materials and Methods: This prospective study was carried out on 42 cholecystectomy patients (with the American Society of Anesthesiologists grade of I-II) divided into two groups. The patients in group 1 underwent laparoscopic cholecystectomy after an 8-hour-fasting period. The subjects in group 2 received a carbohydrate-rich solution with 12.5% dextrose before the surgery (125 g of sugar melted in 1 L of water; 800 and 200 mL 8 and 2 h before the surgery, respectively). Thirst, hunger, and nausea at the 9th preoperative hour and 30 min before the surgery in addition to nausea and vomiting at the 2nd, 8th, and 24th postoperative hours were assessed in both groups. Results: The mean age and body mass index (BMI) values of the patients were 48.38±12.68 years and 29.85±5.20 kg/m², respectively. The mean operational time was 36.5 min (range: 26-114 min). No difference was observed between the two groups in terms of age, BMI, and operational time. The investigation 30 min before cholecystectomy revealed that the rates of hungry and thirsty patients were higher in group 1, compared to those reported for group 2 (P=0.003 and P=0.032). Nevertheless, at the 2nd and 8th postoperative hours, the rate of patients complaining of nausea were higher in group 2 in comparison to that of group 1 (P=0.048 and P=0.014). Conclusions: It is suggested that the intake of carbohydrate-rich fluids up to the preoperative 2nd hour decreased presurgical hunger/thirst. The results of this study are in line with the findings of previous studies. It is believed that the intake of CHO-rich solutions up to 2 h before surgery may provide comfort by decreasing hunger/thirst. Nevertheless, it is necessary to take into account a potential rise in a feeling of nausea among these patients.

The Staircase Phenomenon

2001 ◽  
Vol 95 (2) ◽  
pp. 403-407 ◽  
Author(s):  
Aaron F. Kopman ◽  
Sanjeev Kumar ◽  
Monika M. Klewicka ◽  
George G. Neuman
Keyword(s):  
Mechanical Response ◽  
Additional Information ◽  
Laryngeal Mask Insertion ◽  
Train Of Four ◽  
Group 3 ◽  
Group 2 ◽  
American Society ◽  
Time Required ◽  
Few Data ◽  
Group 1

Background Repeated indirect stimulation enhances the evoked mechanical response of muscle (the staircase phenomenon). There are few data that document the magnitude of this effect in man. Inexpensive acceleromyographic monitors of neuromuscular function are now available. If these units are to be used as scientific tools or clinical monitors, additional information regarding how to achieve proper baseline stabilization and calibration is needed. Methods Anesthesia was induced and maintained with nitrous oxide, propofol, and an opioid. Tracheal intubation or laryngeal mask insertion was accomplished without muscle relaxants. Thirty adult patients classified as American Society of Anesthesiologists physical status I or II were divided into groups of 10. The mechanical response of the thumb to supramaximal ulnar nerve stimulation was recorded continuously with an acceleromyograph. Group 1 had train-of-four stimuli at 15-s intervals for 25 min. Group 2 had single stimuli at 1.0 Hz for 10 min. Group 3 had the same stimuli as group 1 except that a 50-Hz tetanus of 5 seconds' duration immediately preceded instrument calibration. Results In group 1, average twitch height (T1) increased rapidly to 148+/-19% (mean +/- SD) of control at 15 min and then more slowly to reach 158+/-26% of control at 25 min. The train-of-four fade ratio did not vary with the duration of stimulation. In group 2, T1 increased to 172+/-19% of control after 400 stimuli (6.7 min) and 180+/-22% of control at 10 min In group 3, average T1 did not decrease below 97+/-5% or increase above 105+/-15% of control at any time. Conclusions A 5-s, 50-Hz tetanus administered before initial twitch calibration considerably shortens the time required to achieve baseline stability.

Decreased Rejection and Improved Survival of First and Second Marrow Transplants for Severe Aplastic Anemia (A 26-Year Retrospective Analysis)

Blood ◽  
1998 ◽  
Vol 92 (8) ◽  
pp. 2742-2749
Author(s):  
Anne Stucki ◽  
Wendy Leisenring ◽  
Brenda M. Sandmaier ◽  
Jean Sanders ◽  
Claudio Anasetti ◽  
...  
Keyword(s):  
Aplastic Anemia ◽  
Graft Rejection ◽  
Marrow Transplant ◽  
Severe Aplastic Anemia ◽  
Probability Of Survival ◽  
Gvhd Prophylaxis ◽  
Group 3 ◽  
Group 2 ◽  
American Society ◽  
Group 1

Between 1970 and 1996, 333 patients with severe aplastic anemia underwent HLA-matched related marrow transplant after conditioning with cyclophosphamide (CY). Thirty-five percent of patients transplanted between 1970 and 1976 (group 1), 12% of those transplanted between 1977 and 1981 (group 2), and 9% of patients transplanted between 1982 and 1997 (group 3) had graft rejection. Graft rejection occurred later among group 3 patients (median, 180 days) than among those in groups 1 and 2 (medians, 28 and 47 days, respectively; P < .001 group 3 v 2). In group 3, 92% of rejecting patients underwent a second transplant, compared with 78% and 77% in groups 1 and 2, respectively. Group 1 patients received various conditioning regimens before second transplant, whereas most patients of groups 2 and 3 received CY combined with antithymocyte globulin (ATG). Graft-versus-host disease (GVHD) prophylaxis after second transplant consisted of methotrexate (MTX) for all group 1 and 2 patients, whereas group 3 patients received MTX combined with cyclosporine (CSP). Over the three time periods studied, first graft rejection decreased from 35% to 9%, and the proportion of rejecting patients undergoing second transplants increased from 77% to 92%. The 10-year probability of survival after second transplants increased from 5% to 83%. Multivariate analysis showed MTX/CSP GVHD prophylaxis to be a significant factor accounting for the increase in patient survival after second transplant. © 1998 by The American Society of Hematology.

Anti-Emetic Efficacy of Tropisetron and Metoclopramide

1996 ◽  
Vol 24 (3) ◽  
pp. 266-270 ◽  
Author(s):  
A Yilmazlar ◽  
T Yilmazlar ◽  
E Gürpinar ◽  
N Korun ◽  
O Kutlay
Keyword(s):  
Rescue Medication ◽  
Surgical Patients ◽  
Saline Control ◽  
Double Blind ◽  
Number Of Patients ◽  
Post Operation ◽  
Group 2 ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Group 1

Post-operative vomiting, especially in ambulatory surgical patients, remains a troublesome problem. This placebo-controlled, randomized, prospective double-blind trial was designed to evaluate the efficacy of two prophylactic anti-emetic regimens on post-operative vomiting in 1-day thyroid surgery. Altogether 60 elective surgical patients were followed for 4 h post-operatively. All patients were American Society of Anesthesiologists physical status of I or II and aged between 22 and 60 years: group 1 was saline control; in groups 2 and 3, metoclopramide (0.2 mg/kg) or tropisetron (5 mg) was administered, respectively, as an intravenous single dose during induction. Patients were pre-medicated. A standardized anaesthetic technique consisting of thiopentone-succinylcholine for induction and fentanyl-nitrous oxide-halothane-pancuronium for maintenance of anaesthesia was used. A ‘rescue’ anti-emetic was provided in case of continued vomiting or at the patient's request. Anti-emetic inefficacy was defined as request for rescue anti-emetic and/or vomiting episode during the first 4 h post-operation. The number of patients vomiting was 12/20 (60%), 10/20 (50%) and 1/20 (5%) within the first 2 h post-operation in groups 1, 2 and 3, respectively ( P > 0.05 for groups 1 and 2; P < 0.01 for groups 2 and 3; P < 0.001 for groups 1 and 3). In group 2, three patients required rescue medication during the first 2 h post operation, but no signiñcant difference was observed between groups 2 and 3 ( P > 0.05). None of the cases in any of the groups needed any rescue medication during post-operative 2 – 4 h. It is concluded that tropisetron is a highly effective anti-emetic drug in the prophylaxis of post-operative vomiting.

scholarly journals Comparative study of effective-site target controlled infusion with standard bolus induction of propofol for laryngeal mask airway insertion

2010 ◽  
Vol 4 (1) ◽  
pp. 177-182 ◽  
Author(s):  
Krairerk Sintavanuruk ◽  
Sukanya Pongruekdee ◽  
Russana Thaharavanich ◽  
Surajak Laosuwan ◽  
Somrat Charuluxananan
Keyword(s):  
Success Rate ◽  
Induction Time ◽  
Quality Score ◽  
Laryngeal Mask Airway Insertion ◽  
Target Controlled Infusion ◽  
Group 2 ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Effective Site ◽  
Group 1

Abstract Several studies demonstrated induction of anesthesia with different plasma target-controlled infusion (TCI) of propofol for LMA insertion. However, there has been no study to compare the standard bolus propofol induction with the effective site TCI for LMA insertion. Objective: Compare the efficacy of induction of anesthesia with propofol for LMA insertion between the effective-site TCI, using 6 μg/mL, and the standard bolus propofol dose of 2.5 mg/kg in elective surgical patients. Methods: A randomized, prospective, single-blinded, clinical study was used for this study. Seventy-eight unpremedicated patients, American Society of Anesthesiologists (ASA) physical status I and II undergoing elective surgical procedure were randomly allocated between two groups. Group 1 received the standard bolus propofol dose of 2.5 mg/kg. Group 2 received effective site TCI (Schnider model) dose of 6 μg/mL for LMA insertion. The hemodynamics and anesthetic depth (Bispectral index score) were monitored and recorded during and immediately after LMA insertion. The number of insertion attempted, insertion quality score, induction time, and propofol doses used were recorded and compared between groups. Results: The success rate of first insertion attempt was equal in both groups (92.3%). There was no significant hemodynamic response difference between the groups during pre-induction, induction, insertion, and post insertion period. The BIS score was significantly lower during post insertion period in group 1 (51.4+11.0) than group 2 (58.4+3.2) (p=0.013). The propofol doses in group 2 were significantly lower than in group 1 (110.6+14.8 vs. 153.5+21.5) (p <0.001). Patients in group 2 required significantly more induction time than group 1 (146.9+42.3 vs. 103.4+33.6 (p <0.001). Conclusion: Propofol induction with TCI provided equal success rate as compared with standard bolus propofol induction for LMA insertion and insertion quality score. TCI significantly lowered the propofol consumption when compared with the standard 2.5 mg/kg propofol dose.

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