scholarly journals CONTROL OF INTRAOPERATIVE SHIVERING UNDER SPINAL ANAESTHESIA- A PROSPECTIVE RANDOMIZED COMPARATIVE STUDY OF NALBUPHINE WITH TRAMADOL

2021 ◽  
pp. 1-3
Author(s):  
Shivrambhai Dhanabhai Prajapati ◽  
Ankit Rajeshbhai Sorathiya
Keyword(s):  
Spinal Anesthesia ◽  
Spinal Anaesthesia ◽  
Lung Ventilation ◽  
Carbon Dioxide Production ◽  
Cardiac Work ◽  
Neuraxial Blockade ◽  
Metabolic Heat ◽  
Adverse Impacts ◽  
Venous Oxygen Saturation ◽  
Thermoregulatory System

spinal anesthesia is a widely used technique for both elective and emergency surgeries. Shivering is one of the most commonly recognized complications of the central neuraxial blockade because of impairment of thermoregulatory control, reported in 40%-70% of the patients undergoing surgery under spinal anaesthesia. Post-anesthetic shivering is defined as an involuntary,spontaneous,rhythmic oscillating muscle hyperactivity that increases metabolic heat production up to 600% after anesthesia. Shivering during neuraxial anesthesia is a common issue that could have possibly adverse impacts, for example, increased oxygen consumption, carbon dioxide production, lung ventilation and cardiac work, as well as causing diminished mixed venous oxygen saturation. Spinal anesthesia impedes the thermoregulatory system by restraining tonic vasoconstriction which assumes significant role in the regulation of temperature

scholarly journals A Comparison of Oral Gabapentin and Oral Pregabalin as Preemptive Analgesia for Orthopedic Surgery Under Spinal Anaesthesia

2021 ◽  
Vol 9 (1) ◽  
pp. 74-78
Author(s):  
Neena Jain ◽  
Rahul Bankapur ◽  
Preeti Lamba ◽  
saurav Singh
Keyword(s):  
Side Effects ◽  
Postoperative Pain ◽  
Spinal Anesthesia ◽  
Spinal Anaesthesia ◽  
Orthopedic Surgery ◽  
Lower Limb ◽  
Analgesic Efficacy ◽  
Double Blind Study ◽  
Group A ◽  
Group B

Background and Aims: Gabapentin and pregabalin, by decreasing noxious stimulus induced excitatory neurotransmitter release at central nervous system, may attenuate central sensitization and eventually decrease development of postoperative pain. We evaluated preemptive analgesic efficacy of single dose of oral gabapentin 600 mg and pregabalin 75mg for postoperative pain in patients undergoing lower limb orthopedic surgery under spinal anesthesia. Material and methods: A prospective, randomized, double blind study was conducted on 70 patients aged between 18 to 60 years with ASA grade 1 and 2 posted for lower limb surgeries under spinal anaesthesia. Patients were allocated into Group A and Group B receiving oral gabapentin(600mg) and oral pregabalin (75mg) respectively 1.5 hours before surgery. Primary objective was assessing duration and quality of analgesia by Visual Analogue Scale (VAS) score at 2,4,6,8,10,12,16,20 and 24 hours.Secondary objective was to assess total dose of rescue analgesic in first 24 hours, perioperative hemodynamic change and various side effects. Statistical Analysis used: Categorical data was compared using Chi- square test. Quantitative parametric data was analysed using unpaired student t-test. P value < 0.05 was considered statistically significant. Results: Mean duration of analgesia in Group A (10.53 ± 2.686 hours) was longer than Group B (7.943±3.199hr) (P = 0.0006).Mean number of analgesic dosesrequired in first 24 hourswere less in Group A (1.429 ± 0.5021) ascompared to Group B (1.771±0.6897) (P = 0.0202).All patients remained hemodynamically stable with no significant side effects noted in either group. Conclusion: We conclude that preemptive analgesic efficacy of oral gabapentin 600mg is better in comparison to oral pregabalin 75 mg for patients posted for lower limb orthopedic surgeries under spinal anesthesia.

Mechanisms of thermal stability during flight in the honeybee apis mellifera

1999 ◽  
Vol 202 (11) ◽  
pp. 1523-1533 ◽  
Author(s):  
S.P. Roberts ◽  
J.F. Harrison
Keyword(s):  
Thermal Stability ◽  
Heat Loss ◽  
Heat Production ◽  
Radiative Heat ◽  
Carbon Dioxide Production ◽  
Metabolic Heat Production ◽  
Evaporative Heat Loss ◽  
Radiative Heat Loss ◽  
Convective Heat Loss ◽  
Metabolic Heat

Thermoregulation of the thorax allows honeybees (Apis mellifera) to maintain the flight muscle temperatures necessary to meet the power requirements for flight and to remain active outside the hive across a wide range of air temperatures (Ta). To determine the heat-exchange pathways through which flying honeybees achieve thermal stability, we measured body temperatures and rates of carbon dioxide production and water vapor loss between Ta values of 21 and 45 degrees C for honeybees flying in a respirometry chamber. Body temperatures were not significantly affected by continuous flight duration in the respirometer, indicating that flying bees were at thermal equilibrium. Thorax temperatures (Tth) during flight were relatively stable, with a slope of Tth on Ta of 0.39. Metabolic heat production, calculated from rates of carbon dioxide production, decreased linearly by 43 % as Ta rose from 21 to 45 degrees C. Evaporative heat loss increased nonlinearly by over sevenfold, with evaporation rising rapidly at Ta values above 33 degrees C. At Ta values above 43 degrees C, head temperature dropped below Ta by approximately 1–2 degrees C, indicating that substantial evaporation from the head was occurring at very high Ta values. The water flux of flying honeybees was positive at Ta values below 31 degrees C, but increasingly negative at higher Ta values. At all Ta values, flying honeybees experienced a net radiative heat loss. Since the honeybees were in thermal equilibrium, convective heat loss was calculated as the amount of heat necessary to balance metabolic heat gain against evaporative and radiative heat loss. Convective heat loss decreased strongly as Ta rose because of the decrease in the elevation of body temperature above Ta rather than the variation in the convection coefficient. In conclusion, variation in metabolic heat production is the dominant mechanism of maintaining thermal stability during flight between Ta values of 21 and 33 degrees C, but variations in metabolic heat production and evaporative heat loss are equally important to the prevention of overheating during flight at Ta values between 33 and 45 degrees C.

scholarly journals PREVENTION OF SHIVERING DURING LOWER SEGMENT CESAREAN SECTION;

2013 ◽  
Vol 20 (03) ◽  
pp. 409-415
Author(s):  
ASHFAQ AHMED ◽  
MOHAMMAD ASLAM
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Carbon Dioxide Production ◽  
Double Blind Study ◽  
Lower Segment ◽  
Chi Square ◽  
Double Blind ◽  
Lower Segment Cesarean Section ◽  
Group I ◽  
Group Ii

Objectives: To compare the efficacy of low-dose prophylactic use of ketamine with ketamine plus midazolam for theprevention of shivering caused by spinal anesthesia, during lower segment cesarean section. Main Outcome Measures: Heamodynamicmonitoring, avoidance of lactic acidosis/ increased carbon dioxide production and patient satisfaction. Design: Prospective RandomizedControlled trial. Place: Department of Anesthesia and ICU PNS Shifa Karachi. Duration of study: March 2010 to June 2010. Patients andMethods: 100 ASA-I & II consecutive patients who reported for LSCS in PNS Shifa Hospital were studied. In this double-blind study,patients were randomly allocated to receive ketamine alone (Group I, n= 50), and ketamine plus midazolam (Group II, n = 50). Afterstandardized Spinal anesthesia, a shivering was recorded at 5 min intervals for 15 minutes. Results: Shivering was observed in 9/50(18%) patients of group I (Ketamine only) as compared to only 2/50 (4%) patients in Group II (ketamine + midazolam) (p=0.025) whichis statically significant. The two groups were comparable regarding distribution of age (p=0.37), BMI (p=0.27) and duration of surgery.Results were analyzed by using chi square test. Conclusions: The efficacy of i.v. ketamine plus midazolam is better as compared to lowdosei.v. ketamine alone in preventing shivering in lower segment Cesarean Section patients, during spinal anesthesia.

Effects of oxygen inhalation on responses to cold exposure

1961 ◽  
Vol 16 (4) ◽  
pp. 627-632 ◽  
Author(s):  
D. M. Maccanon ◽  
D. D. Eitzman
Keyword(s):  
Cold Exposure ◽  
Ventilatory Response ◽  
Carbon Dioxide Production ◽  
Metabolic Responses ◽  
Body Temperatures ◽  
Healthy Male ◽  
Metabolic Heat ◽  
Oxygen Breathing ◽  
Oxygen Inhalation ◽  
Male Subjects

The effects of oxygen inhalation on shivering and thermal and metabolic responses to exposure to cold (10 C) were determined in ten healthy male subjects. The results showed that oxygen breathing reduced shivering and promoted a feeling of greater comfort. The ventilatory response to cold was diminished, and oxygen consumption was significantly lower during the later periods of the cold exposure. Carbon dioxide production was reduced and the mobilization of nitrogen during the initial periods of cold exposure was also noted. Since body temperatures and their rates of fall were not significantly altered by oxygen inhalation, a shift to more efficient metabolic heat production seems indicated. Submitted on February 6, 1961

scholarly journals Ultrasound Imaging Facilitates Spinal Anesthesia in Adults with Difficult Surface Anatomic Landmarks

2011 ◽  
Vol 115 (1) ◽  
pp. 94-101 ◽  
Author(s):  
Ki Jinn Chin ◽  
Anahi Perlas ◽  
Vincent Chan ◽  
Danielle Brown-Shreves ◽  
Arkadiy Koshkin ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Spinal Anesthesia ◽  
Body Mass ◽  
Ultrasound Imaging ◽  
Technical Difficulty ◽  
Needle Insertion ◽  
Lumbar Spine Surgery ◽  
Distributed Data ◽  
Anatomic Landmarks ◽  
Neuraxial Blockade

Background Poor surface anatomic landmarks are highly predictive of technical difficulty in neuraxial blockade. The authors examined the use of ultrasound imaging to reduce this difficulty. Methods The authors recruited 120 orthopedic patients with one of the following: body mass index more than 35 kg/m² and poorly palpable spinous processes; moderate to severe lumbar scoliosis; or previous lumbar spine surgery. Patients were randomized to receive spinal anesthetic by the conventional surface landmark-guided technique (group LM) or by an ultrasound-guided technique (group US). Patients in group US had a preprocedural ultrasound scan to locate and mark a suitable needle insertion point. The primary outcome was the rate of successful dural puncture on the first needle insertion attempt. Normally distributed data were summarized as mean ± SD and nonnormally distributed data were summarized as median [interquartile range]. Results The first-attempt success rate was twice as high in group US than in group LM (65% vs. 32%; P &lt; 0.001). There was a twofold difference between groups in the number of needle insertion attempts (group US, 1 [1-2] vs. group LM, 2 [1-4]; P &lt; 0.001) and number of needle passes (group US, 6 [1-10] vs. group LM, 13 [5-21]; P = 0.003). More time was required to establish landmarks in group US (6.7 ± 3.1; group LM, 0.6 ± 0.5 min; P &lt; 0.001), but this was partially offset by a shorter spinal anesthesia performance time (group US, 5.0 ± 4.9 vs. group LM, 7.3 ± 7.6 min; P = 0.038). Similar results were seen in subgroup analyses of patients with body mass index more than 35 kg/m and patients with poorly palpable landmarks. Conclusion Preprocedural ultrasound imaging facilitates the performance of spinal anesthesia in the nonobstetric patient population with difficult anatomic landmarks.

Relative contribution of core and cutaneous temperatures to thermal comfort and autonomic responses in humans

1999 ◽  
Vol 86 (5) ◽  
pp. 1588-1593 ◽  
Author(s):  
Steven M. Frank ◽  
Srinivasa N. Raja ◽  
Christian F. Bulcao ◽  
David S. Goldstein
Keyword(s):  
Thermal Comfort ◽  
Heat Production ◽  
Human Subjects ◽  
Critical Role ◽  
Skin Surface ◽  
Metabolic Heat Production ◽  
Behavioral Thermoregulation ◽  
Metabolic Heat ◽  
Relative Contribution ◽  
Thermoregulatory System

Subjective thermal comfort plays a critical role in body temperature regulation since this represents the primary stimulus for behavioral thermoregulation. Although both core (Tc) and skin-surface (Tsk) temperatures are known afferent inputs to the thermoregulatory system, the relative contributions of Tc and Tsk to thermal comfort are unknown. We independently altered Tc and Tsk in human subjects while measuring thermal comfort, vasomotor changes, metabolic heat production, and systemic catecholaminergic responses. Multiple linear regression was used to determine the relative Tc/Tskcontribution to thermal comfort and the autonomic thermoregulatory responses, by using the ratio of regression coefficients for Tc and Tsk. The Tc/Tskcontribution ratio was relatively lower for thermal comfort (1:1) than for vasomotor changes (3:1; P = 0.008), metabolic heat production (3.6:1; P = 0.001), norepinephrine (1.8:1; P = 0.03), and epinephrine (3:1; P = 0.006) responses. Thus Tc and Tsk contribute about equally toward thermal comfort, whereas Tcpredominates in regulation of the autonomic and metabolic responses.

scholarly journals Comparison of dexmedetomidine and buprenorphine as an adjuvant to bupivacaine during spinal anaesthesia for tibial interlocking nailing surgeries

2017 ◽  
Vol 4 (6) ◽  
pp. 1653
Author(s):  
Amitha S. ◽  
Pradeep R.
Keyword(s):  
Spinal Anesthesia ◽  
Spinal Anaesthesia ◽  
Motor Blockade ◽  
Hyperbaric Bupivacaine ◽  
Chi Square ◽  
Double Blind ◽  
Sensory Blockade ◽  
Exact Test ◽  
Interlocking Nailing ◽  
Group 3

Background: Buprenorphine is being used as an adjuvant to local anaesthetic for spinal anaesthesia since long. Dexmedetomidine is a new drug which has got alpha 2 agonistic property, and is being tried for spinal anesthesia along with bupivacaine in recent times. Settings and Design: This study was conducted in a prospective, randomized, controlled and double-blind manner. The study included ninety American Society of Anaesthesiologists class I and II patients undergoing tibial interlocking nailing surgeries under spinal anaesthesia.Methods: The patients were randomly divided into three groups (n=30 each) by closed envelope technique. Patients in group 1 received 15 mg of 0.5% hyperbaric bupivacaine, group 2 received 15 mg of 0.5% hyperbaric bupivacaine with 30μg of buprenorphine, and group 3 received 15 mg of 0.5% hyperbaric bupivacaine with 5μg dexmedetomidine for spinal anesthesia. The duration of motor and sensory blockade and any adverse events were recorded. Data were analysed using Chi-square test or Fisher’s exact test for categorical data and analysis of variance for continuous data. A value of P<0.05 was considered as statistically significant.Results: In our study the subjects in group 3 (dexmedetomidine) group had significantly longer period of motor blockade (240±20min) and sensory blockade (180±22.2min) compared to other groups, which is statistically significant (P=0.0001 and P= 0.006 respectively). The time to first request of analgesic in the post-operative period was also longer (240±30.2min) in dexmedetomidine group when compared with other groups (P=0.0001). There were no untoward complications (hypotension, sedation) in any groups.Conclusions: We concluded that dexmedetomidine (5μg) with bupivacaine for spinal anesthesia gives significantly longer duration of sensory and motor blockade, than buprenorphine (30μg) with bupivacaine for spinal anaesthesia.

scholarly journals Evaluation of effect of Kati basti in spinal anaesthesia induced low backache

2016 ◽  
Vol 7 (3) ◽  
Author(s):  
Richa Tripathi ◽  
Tripathi JS
Keyword(s):  
Spinal Anesthesia ◽  
Spinal Anaesthesia ◽  
Symptomatic Relief ◽  
Lumbar Vertebrae ◽  
Thoracic Vertebrae ◽  
Lateral Flexion ◽  
Present Context ◽  
Preliminary Study

Low backache is localized pain between twelfth thoracic vertebrae and fifth lumbar vertebrae. About 60% population in India suffers with backache at least once in their life. But in the present context we are concerned with backache, which arises, in postoperative cases following spinal anesthesia. We cannot avoid SA because of its tremendous good effects and the ease, which it provides during surgery to both the surgeon and the patient, but backache after SA has become very common problem. According to Ayurveda this type of backache can be considered as Aghat Janya Kati Shoola. The procedure is done at the site between L1 – L4 vertebrae where there is assortment of various structures like Sira, Sandhi, Asthi, Mansa, Snayu etc. including three important Marma named Nitambha, Kukundar and Katikatarun. Objective: To evaluate the efficacy of Kati Basti in spinal anesthesia induced backache. Methods: Kati Basti with Til Taila was performed for fourteen days in thirty patients. Results: The preliminary study yields significant reduction in the symptoms of stiffness, pain, tenderness, lateral flexion, rotation, SLR, fatigue and ADL. In this condition, Kati Basti is the treatment of choice as it provides long-term symptomatic relief and nourishes the traumatized structures and helps them to heal better.

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