scholarly journals Dexmedetomidine versus midazolam and fentanyl for monitored anaesthesia care in tympanoplasty under local anesthesia: Ramsay sedation score

2021 ◽  
Vol 4 (4) ◽  
pp. 21-23
Author(s):  
Dr. Raghu SP ◽  
Dr. Peram Srividya
Keyword(s):  
Local Anesthesia ◽  
Sedation Score ◽  
Anaesthesia Care ◽  
Ramsay Sedation Score

scholarly journals The Efficacy and Safety of Nabufen and Sufentanil in the Prevention of Visceral Pain After Gynecological Laparoscopic Surgery: A Randomised Controlled Trial

2020 ◽  
Author(s):  
Xiaoxia Gu ◽  
Jingjing Wang ◽  
Huihua Liao ◽  
Jian Mo ◽  
Weiming Huang ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Adverse Reactions ◽  
Visceral Pain ◽  
Sedation Score ◽  
Efficacy And Safety ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Group D ◽  
Ramsay Sedation Score

Abstract Background: To compare the efficacy and safety of different compatibility schemes in the prevention of visceral pain after gynecological laparoscopic surgery. Methods: from April 2019 to April 2020, patients undergoing elective gynecological laparoscopic surgery in our hospital were randomly divided into four groups: group A: sufentanil 3 μ g / kg; group B: low-dose nalbuphine group: 0.1 mg / kg of nabufen + 3 μ g / kg of sufentanil; group C: medium dose of nabufen group: 1 mg / kg of nabufen + 2 μ g / kg of sufentanil; group D: high-dose nabufen 2 There were 30 cases in each group. The degree of pain and the number of adverse reactions at 2, 4, 8, 12, 24 and 48 hours after operation were observed and recorded. The number and dosage of morphine used as a remedial analgesic were recorded. The pain degree was assessed by visual analogue scale (VAS). The total amount of analgesic pump used, the total number of times of pressing and the effective times of pressing were recorded. The adverse reactions included respiratory depression, nausea and vomiting, drowsiness, restlessness and skin The skin itches. Results: the analgesic effect of group B was similar to that of group A, and there was no significant difference in the number of invalid pressing, total pressing times and rescue analgesia rate (P > 0.05), while the invalid pressing times, total pressing times and remedial analgesia rate of group C and group D were significantly lower than those of group A (P < 0.05). There was no significant difference between group C and group D in the number of invalid compressions, the total number of compressions and the rate of remedial analgesia (P > 0.05), suggesting that increasing the dose of nalbuphine could not significantly increase the analgesic effect. The incidence of postoperative nausea and vomiting, skin pruritus, lethargy and Ramsay Sedation score in group B and group C were significantly lower than those in group A (P < 0.05). Ramsay Sedation score and incidence of drowsiness were lower than those in group D, which indicated that the incidence of adverse reactions was higher in group D than group B and group C.Conclusion: the combination of 1 mg / kg nabufen and 2 μ g / kg sufentanil is a safe and effective combination scheme for the prevention of visceral pain after gynecological laparoscopic surgery with small adverse reactions.Trial registration: http://www.chictr.org.cn/showproj.aspx?proj=40635Registration number：ChiCTR1900025076 . Prospectively registered on 10 August 2019.

scholarly journals Efficacy of intravenous Tramadol in prevention of catheter-related bladder discomfort in upper urinary tract surgery

2019 ◽  
Vol 6 (2) ◽  
pp. 45-50
Author(s):  
Sujita Manandhar ◽  
Kishor Manandhar
Keyword(s):  
Urinary Tract ◽  
General Anesthesia ◽  
Normal Saline ◽  
Upper Urinary Tract ◽  
Sedation Score ◽  
Adult Patients ◽  
Urinary Catheterization ◽  
Medical Sciences ◽  
Analgesic Requirement ◽  
Ramsay Sedation Score

Introductions: Catheter-related bladder discomfort (CRBD) is common in patients with urinary catheterization. Centrally acting intravenous opioid like Tramadol inhibits detrusor activity and incidence of CRBD. Present study aims to analyze efficacy of intravenous (IV) Tramadol in prevention of CRBD in patients undergoing upper urinary tract surgery. Methods: Adult patients undergoing elective open upper urinary tract surgeries at Bir Hospital, National Academy of Medical Sciences (NAMS), Nepal, over a period of six months, requiring urinary catheterization were randomly divided into Control (C) and Tramadol (T) groups. After general anesthesia, patients in T-group received IV Tramadol 1.0 mg/kg and C-group received normal saline 30 minutes before extubation. In post-operative ward, CRBD was graded as mild, moderate or severe at 0, 1, 2 and 6 hours. Post-operative Ramsay sedation score and nausea vomiting were compared in two groups. Results: There were total 70 patients, 35 in each of groups-T and C. Incidence of CRBD in T-group was significantly low compared to the C-group at all points of evaluation (p<0.05). Postoperative sedation score, analgesic requirement and nausea vomiting were not significantly different in two groups. Conclusions: Intravenous Tramadol administered before extubation in upper urinary tract surgery reduces the incidence of CRBD.

scholarly journals Effects of Transcutaneous Electrical Acupoint Stimulation on Stress Response during Intubation and Extubation in Patients Undergoing Video-Assisted Thoracoscopic Surgery: A Prospective, Randomized Controlled Trial

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Zhiyan Yu ◽  
Yuying Zhang ◽  
Huan Zhang ◽  
Xue Zhao ◽  
Hua Wei ◽  
...  
Keyword(s):  
Stress Response ◽  
Postoperative Complications ◽  
Thoracoscopic Surgery ◽  
Plasma Concentrations ◽  
Quality Score ◽  
Sedation Score ◽  
Control Group ◽  
Acupoint Stimulation ◽  
Video Assisted Thoracoscopic Surgery ◽  
Ramsay Sedation Score

Objective. The study aimed to evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on the stress response during intubation and extubation in patients undergoing video-assisted thoracoscopic surgery (VATS). Methods. 122 patients undergoing VATS lobectomy were randomly divided into two groups: the TEAS group (n = 62) and the control group (n = 60). Patients in the TEAS group underwent electroacupuncture stimulation of bilateral Neiguan (PC6), Hegu (L14), Lieque (LU7), and Chize (LU5) acupoints from 30 min before anesthesia to the end of surgery. The patients in the control group did not undergo stimulation. The primary endpoints were the hemodynamic parameters and plasma concentrations of epinephrine, norepinephrine, and cortisol. The secondary endpoints were the consumption of remifentanil and propofol, Ramsay sedation score and arousal time, extubation quality score, and postoperative complications. Results. The hemodynamic variables and plasma concentrations of epinephrine, norepinephrine, and cortisol during intubation and extubation were lower in the TEAS group at T1, T3, and T4 compared with the control group. TEAS led to a reduction in the consumption of remifentanil ( P < 0.01 ), as well as a reduction in the incidence of postoperative complications. The extubation quality score was lower ( P < 0.01 ) while the Ramsay sedation score was higher ( P < 0.01 ) in the TEAS group than in the control group. However, the arousal time and consumption of propofol were not significantly different between the two groups. Conclusion. TEAS can maintain hemodynamic stability, reduce the stress response during intubation and extubation, improve the quality of anesthesia recovery, and decrease the incidence of postoperative complications in patients undergoing VATS.

COMPARISON OF DEXMEDETOMIDINE AND FENTANYL ON INTUBATION CONDITIONS DURING AWAKE FIBREOPTIC BRONCHOSCOPIC INTUBATION- A RANDOMISED DOUBLE BLIND STUDY.

2021 ◽  
pp. 1-2
Author(s):  
Asha .A ◽  
E. Arunmozhi
Keyword(s):  
Heart Rate ◽  
Study Drug ◽  
Sedation Score ◽  
Double Blind ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Post Intubation ◽  
Ramsay Sedation Score ◽  
Mean Heart Rate

INTRODUCTION:Awake Fibreoptic Intubation is indicated in patients with anticipated diffcult airway, failed tracheal intubation, unstable cervical spine injury.Drugs used for conscious sediation includes Benzodiazepines, opioids, Propofol, either alone or in combination. All these drugs, though results in favourable intubating conditions, may also result in upper airway obstruction, hypoventilation, difcult airway instrumentation and oxygen desaturation. In order to address and overcome these issues, we compared the effects of parenteral dexmedetomidine and fentanyl on favourable conditions during awake breoptic bronchoscopic intubation. MATERIALS AND METHODS:A prospective,double blind,randomised study. 60 patients belonging to age group 25 to 60 years, ASA PS I & II posted for elective surgery under general anaesthesia with endotracheal intubation were randomly allocated into two groups, Group A(n=30) received injection dexmedetomidine, Group B(n=30) received injection fentanyl before awake breoptic bronchoscopic intubation. Hemodynamic parameters, cough score, postintubation tolerance score, ramsay sedation score were noted in both groups. The observed datas were analysed by SPSS version 21.0 software. RESULT: Demographic variable such as age,weight,ASA physical status were comparable in both the groups. The mean heart rate at 5mins,10mins after administration of study drug,intubation, 5mins postintubation are 76.73±5.51,73.63±5.99,76.37±8.11 and 75.03±7.94 respectively in Group A.The mean heart rate at 5mins,10mins after administration of study drug,intubation, 5mins postintubation are 78.57±5.04,76.93±5.11,103.30±4.21 and 99.37±4.02 respectively.The mean MAP at 5mins,10 mins after administration of study drug,intubation,5 mins post intubation are 86.80±2.33,85.77 ±2.56,87.83 ±5.73 and 87.30 ± 2.52mmHg respectively in Group A.The mean MAP at 5mins,10mins after administration of study drug,intubation,5 mins post intubation are 87.37±3.58,85.63 ±3.58,107.80 ±2.59 and 105.00 ±2.52 mmHg respectively. The post intubation SpO2 was 97.10 ±1.77 and 93.43± 1.17 % for Group A and Group B respectively.In Group A mean Ramsay sedation score is 2.87± 0.43 and in Group B the mean is 2.13 ±0.35. CONCLUSION:Dexmedetomidine group showed better hemodynamic stability and tolerance to awake endotracheal tube insertion through breoptic bronchoscope.Dexmedetomidine provides favourable intubating conditions during awake breoptic bronchoscope procedures with adequate sedation and without desaturation than fentanyl.

Effects of Total Intravenous Anaesthesia with Propofol in Patients Undergoing Burr Hole Drainage for Chronic Subdural Haematoma: A Prospective, Randomized, Controlled Clinical Trial

2019 ◽  
Vol 8 (2) ◽  
pp. 100-104
Author(s):  
Muhammad Shamsul Arefin ◽  
Kazi Nur Asfia ◽  
Abdur Rahim ◽  
AZM Saifuddin ◽  
Md Monzurul Islam ◽  
...  
Keyword(s):  
Local Anaesthesia ◽  
Subdural Haematoma ◽  
Chronic Subdural Haematoma ◽  
Sedation Score ◽  
Burr Hole ◽  
Total Intravenous Anaesthesia ◽  
Intravenous Anaesthesia ◽  
Group A ◽  
Group B ◽  
Ramsay Sedation Score

Background: Burr hole drainage for chronic subdural haematoma is a common neurosurgical treatment. Traditionally which were done under local anaesthesia with sedation. The primary aim of this prospective study was to assess the effects of Total intravenous anaesthesia with Propofol forBurr hole drainage of chronic subdural haematoma. Method: Sixty adults patients age group ranging from 20-80 years without gender discrimination scheduled for Burr hole drainage of chronic subdural haematoma were enrolled in this study. The patients were randomized into two groups. Group A received Inj. propofol I/V @ 1mg/kg over 10 min followed by 25-50 ìg/kg/ min infusion. Group B received Inj. Midazolam0.05mg/kg I/V followed by normal saline infusion at 0.2 ml/ kg/hr infusion. Perioperative GCS Score, Heart Rate (HR), mean arterial pressure (MAP), SpO2, Ramsay sedation score (RSS), complications, rescue drugs requirements are recorded and compared at specific time. Results: The MAP and HR was monitored throughout the perioperative period in both groups and they were more in Group B than Group A in most time intervals and was statistically significant. The Ramsay sedation score (RSS) was significantly lower in Group B patients when compared with Group A.Perioperative requirements of rescue drugs and complications like nausea, vomiting (11.7%) and shivering (13.3%) consecutively were more in group B than in group A and it was statistically significant. Conclusion: This study suggests that Total intravenous anaesthesia with propofol is safe & effective technique alone for Burr hole drainage of CSDH than local anaesthesia with sedation. It also facilitates patient comfort and surgical competence during surgery, perioperative haemodynamicstability,less perioperative complications, thus reduced hospital stay. Bang. J Neurosurgery 2019; 8(2): 100-104

scholarly journals Ketofol vs Dexamedetomidine Effect on Conscious Sedation for Patients with Chronic Nonsurgical Low Back Pain

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
N E Y Salama ◽  
A A El Shebiny ◽  
D M Kamaleldin ◽  
A Abdeldaim ◽  
M M A Fawaz
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Conscious Sedation ◽  
Sedation Score ◽  
Low Back ◽  
Hemodynamic Stability ◽  
Heart Rates ◽  
Significant Difference ◽  
Ramsay Sedation Score

Abstract Context Treatment of low back pain is challenging. A variety of therapeutic interventions is available, but no single modality appears to be superior, and evaluations vary depending on the cause of pain and on individual, social, and occupational factors. Scientific evidence supports the use of some nonsurgical treatment alternatives in patients with acute and chronic low back pain. Dexmedetomidine had been successfully used in conscious (moderate) sedation as a good competitive to the popular agent (midazolam). Also different concentrations of ketamine and propofol combinations (ketofol) have been used for procedural sedation and analgesia. Objective The aim of this study is to compare the effect of dexamedetomidine and ketofol on conscious sedation in patients undergoing non-surgical interventions for chronic low back pain regards the efficacy of sedation, hemodynamic stability, respiratory effects, speed of recovery, analgesic effects and incidence of complications. Methodology This study was conducted in Ain Shams University affiliated hospitals on 60 patients of both sexes between 30 and 50 years old, of ASA physical status I–II scheduled for nonsurgical intervention for chronic low back pain. In the current study, the patients were randomly divided into 2 equal groups of 30 patients each. Patients received either sedation with Ketofol (group K) or Dexmedetomidine (group D). Results As regards the demographic data (age, sex and body weight); there was no statistically significant variation between the two study groups. This provided a uniform platform to evenly compare the results obtained. Concerning the duration of the procedure, the time recorded for each patient showed statistically non-significant difference between the two groups. Regarding sedation of the patients during the procedure evaluated according to Ramsay sedation score, there was a highly significant difference between the two groups (p-value &lt; 0.001), where the dexmedetomidine group needed more time (17.71 ± 2.86 min) to reach the targeted Ramsay sedation score (3-4) to commence the surgical procedure while the ketofol group needed less time (9.79 ± 1.87 min) to reach the same score. Conclusion Both drugs provided hemodynamic stability althrough the procedure although dexmedetomidine group showed lower heart rates and lower mean arterial blood pressures towards the end of the procedure which makes it difficult to be used in older population or those having low baseline heart rates. Both drugs proved to be safe concerning respiration, SPO2 and CO2 values, however dexmedetomidine showed higher respiratory rates during the procedure.

scholarly journals Ketamine-Dexmedetomidine Combination for Monitored Anaesthesia Care in Tympanoplasty Surgery: An Observational Study

2020 ◽  
Author(s):  
Vikas Sharma ◽  
GV Krishna Prasad ◽  
Debashish Paul
Keyword(s):  
Observational Study ◽  
Pain Score ◽  
Middle Ear ◽  
Diastolic Pressure ◽  
Anaesthetic Agent ◽  
Sedation Score ◽  
Haemodynamic Instability ◽  
Rescue Analgesia ◽  
The Mean ◽  
Anaesthesia Care

Introduction: Monitored Anaesthesia Care (MAC) has been widely used for patients undergoing middle ear surgeries. Previous studies have shown that the use of local anaesthesia has many advantages over general anaesthesia in performing ear surgeries. The use of Dexmedetomidine as a sole anaesthetic agent had many disadvantages owing to its insufficient sedative effect, increased recovery time and haemodynamic instability. Hence, using a combination of low dose ketamine with Dexmedetomidine can prove to be useful in middle ear surgeries. Aim: To evaluate the effects of Dexmedetomidine-Ketamine (DK) combination on the quality of sedation/analgesia and recovery profiles for MAC in tympanoplasty surgery. Materials and Methods: In this observational study, a total of 20 patients were included. All the demographic data- including, age, sex and American Society of Anesthesiologists (ASA) grade were recorded before the surgery. Before the surgery, all patients received 1 μg/kg dexmedetomidine over 15 minutes followed by infusion of 0.2-0.7 μg/kg/h to maintain 2 or 3 of modified observer’s assessment of analgesia and sedation score. Both the scores were checked every 10 minutes. Ketamine was infused at the rate of 10-15 mcg/kg/min, 10 minutes before the start of the procedure. The Heart Rate (HR), systolic and diastolic pressure, pain score and sedation score were monitored every 10 minutes until 120 minutes of the preoperative condition after the nerve block was used. Statistical analysis was performed using IBM SPSS Version 25.0 (IBM, New York, United States). Continuous data values were shown in the form of mean±standard deviation. To compare the mean difference between the groups, student’s t-test was used and p<0.05 was considered as statistically significant. Results: The mean age of the population was 39.45±12.66 years; among which 15 patients (75.0%) were females. Out of 20 patients, 12 (60.0%) were in the ASA-I and 8 (40.0%) were in the ASA-II grade. The result of the study showed not a single instance of complication. All the patients were haemodynamically stable and HR was also found to be constant in both pre and postoperative instances. The pain score was found to be around 2 even after 120 minutes after the surgery (2±0.93). No rescue analgesia was required in any of the patients and all the patients recovered within 3-5 minutes after the infusion was stopped. No postoperative nausea and vomiting instances were also reported. Conclusion: The present study showed that DK combination provides good haemodynamic stability, higher sedation score and lower pain score. In addition, this study also showed that for patients undergoing tympanoplasty surgery this is a safe and effective method of anaesthesia that provides good MAC.

Comparison of Midazolam and Dexmedetomidine for sedation in Postoperative intubated patients of head and neck surgery on spontaneous ventilation in Intensive care unit

2021 ◽  
pp. 2557-2562
Author(s):  
Ashok Chaudhari ◽  
Amol Singam ◽  
Ayushma Jejani
Keyword(s):  
Blood Pressure ◽  
Neck Surgery ◽  
Sedation Score ◽  
Spontaneous Ventilation ◽  
Loading Dose ◽  
Midazolam Group ◽  
Group D ◽  
Ramsay Sedation Score ◽  
Oromaxillofacial Surgery

Introduction: Sedation is important in the care of the critically ill and postoperative patients. Amount of drug and duration for which it is given, is important in determining patient outcome. Aim: Study aimed to compare the safety and efficacy of injection midazolam and injection dexmedetomidine for sedation in postoperative patients of oromaxillofacial surgery with endotracheal tube in-situ, on spontaneous ventilation in ICU. Methodology: This prospective, randomized, comparative study was conducted on 60 patients undergoing oromaxillofacial surgery who were randomized in two groups of 30 patients each. Group D received injection demedetomidine loading dose of 1μg/kg over 15 minutes, followed by infusion at the rate of 0.2-0.7µg/kg/hr (microgram/kilogram/hour) and Group M received injection midazolam loading dose of 0.05mg/kg over 15 minutes followed by maintenance infusion at the rate of 0.02-0.06mg/kg/hr (milligram/kilogram/hour). The monitored indices included heart rate, systolic blood pressure, diastolic blood pressure, respiratory rate, SpO2 and Ramsay sedation score at the start of sedation when the Ramsay sedation score (RSS) was I and time to extubation after stopping sedation. Results: Target sedation range was achieved in a mean duration of 10.36 ± 3.05 minutes in dexmedetomidine group and that in midazolam group was 7.43±2.06 minutes. Highest value of RSS score in dexmedetomidine group was 2.43±0.50, which was observed at the 4th and 10th hour whereas in midazolam group it was 2.83±0.38 which was observed at 6th hour of the study period. Total dose of rescue analgesic required was more in midazolam group as compared to the dexmedetomidine group. The mean duration of extubation after cessation of sedation was 33.27±11.37 minutes in dexmedetomidine group and 49.43±5.58 minutes in midazolam group. Conclusion: Injection dexmedetomidine is better as compared to injection midazolam for postoperative sedation.

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