scholarly journals Assessment of the role of gabapentin in patients with supratentorial tumours undergoing craniotomy under general anaesthesia: A double-blind randomised study

2017 ◽  
Vol 04 (03) ◽  
pp. 147-154
Author(s):  
Rabie Soliman ◽  
Gomaa Zohry
Keyword(s):  
Intracranial Pressure ◽  
General Anaesthesia ◽  
Neuroprotective Effect ◽  
Central Venous Line ◽  
Control Group ◽  
Arterial Line ◽  
Double Blind ◽  
Randomised Study ◽  
Arterial Blood ◽  
End Tidal

Abstract Background: Gabapentin attenuates the haemodynamics, decreases the catecholamine release and has a neuroprotective effect. The aim of the present study was to assess the effect of gabapentin in patients with supratentorial brain tumours undergoing craniotomy under general anaesthesia. Methods: A radial arterial line, central venous line and ventriculostomy catheters were inserted before surgery. Anaesthesia was induced with thiopental, fentanyl and atracurium and maintained with sevoflurane, fentanyl and atracurium infusion. The study included 160 patients classified randomly into two groups: Group G: The patients received gabapentin capsules 1200 mg orally 2 h before surgery. Group C: The patients received placebo capsules. Results: The heart rate, mean arterial blood pressure and intracranial pressure decreased significantly with gabapentin as compared to the control group (P < 0.05). The dose of fentanyl and end-tidal sevoflurane was lower with gabapentin than the control group (P < 0.05). The urine output was higher in the gabapentin group than the control group (P < 0.05). The Glasgow coma scale score was better in the gabapentin group as compared to the control group (P < 0.05). The incidence of nausea and vomiting was lower in the gabapentin group as compared to the control group (P < 0.05). Conclusions: Pre-operative administration of gabapentin in patients undergoing craniotomy under general anaesthesia minimised the fluctuations in haemodynamics, reduced the requirements for sevoflurane and fentanyl, decreased intracranial pressure and improved the outcomes. There were some side effects associated with gabapentin such as hypotension and bradycardia.

scholarly journals Influence of two-handed jaw thrust during tracheal intubation on postoperative sore throat: a prospective randomised study

2021 ◽  
Vol 49 (2) ◽  
pp. 030006052096123
Author(s):  
Hyub Huh ◽  
Doo Yeon Go ◽  
Jang Eun Cho ◽  
Jihoon Park ◽  
Jiwon Lee ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
General Anaesthesia ◽  
Sore Throat ◽  
Randomised Trial ◽  
Control Group ◽  
Single Centre ◽  
Postoperative Sore Throat ◽  
Double Blind ◽  
Clinical Trial Registration ◽  
Randomised Study

Objective General anaesthesia with tracheal intubation results in sore throat. We evaluated the influence of the two-handed jaw thrust on postoperative sore throat in patients who require tracheal intubation. Methods In this prospective, double-blind, single-centre, parallel-arm, and randomised trial, 92 patients who were scheduled for general anaesthesia for total hip arthroplasty were allocated to one of two groups. In the jaw thrust group (n = 46), the two-handed jaw thrust manoeuvre was applied at intubation. In the control group (n = 46), conventional intubation with sham jaw thrust was performed. Incidences of airway morbidities including sore throat, hoarseness, and cough at 2, 4, and 24 hours postoperatively were compared. Results During the postoperative 24 hours, the incidence of sore throat (8 [17%] vs. 20 [44%]) and hoarseness were lower in the jaw thrust group (8 [17%] vs. 18 [39%]) compared with the control group. The incidence of cough during the postoperative 24 hours was similar between the groups. Conclusions The jaw thrust manoeuvre significantly reduced sore throat and hoarseness in patients after general anaesthesia using tracheal intubation. Clinical trial registration: NCT 03568279.

Abstract 10355: Physiologic Effect of Repeated Epinephrine Doses During Cardiopulmonary Resuscitation: A Randomized Porcine Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Bjarne Madsen Härdig ◽  
Michael Götberg ◽  
Malin Rundgren ◽  
Matthias Götberg ◽  
David Zughaft ◽  
...  
Keyword(s):  
Systolic Pressure ◽  
Blood Gases ◽  
Brain Perfusion ◽  
Saline Control ◽  
Control Group ◽  
Arterial Blood ◽  
Pressure Peak ◽  
Blood Pressures ◽  
Lactate Levels ◽  
End Tidal

Objectives and Method: This porcine study was designed to explore the effect of repetitive epinephrine (EPI) doses on physiologic parameters during CPR. Thirty-six adult pigs were randomized to four injections of: EPI 0.02 mg/kg/dose, EPI 0.03 mg/kg/dose or saline control, given during 15 minutes of CPR. The effect on systolic, diastolic and mean arterial blood pressures (ABP), cerebral perfusion pressure (CePP), end tidal carbon dioxide (ETCO2), SpO2, cerebral tissue oximetry (SctO2), were analyzed immediately prior to each injection and at peak arterial systolic pressure. Arterial blood gases was analyzed after the baseline and after 15 min. Result: Prior to and following 4 minutes of baseline chest compressions without drug administration, there were no significant differences between the three groups. In the group given a 0.02 mg/kg/dose, there were increases in all ABP’s and CePP at the first 3 pressure peaks; at the 4th only mean ABP was increased. Decreased ETCO2 following peak 1 and beyond was seen. SctO2 and SpO2 were lowered following injection 2 and beyond. In the group given a 0.03 mg/kg/dose, all ABP’s and CePP increased at the first 3 pressure peaks. Lower ETCO2 was seen at peak 1 and beyond. SctO2 and SpO2 were lower following injection 2 and beyond. In the saline control group the systolic ABP was significantly lower at pressure peak 1 and beyond, no other parameter changed significantly compared to baseline. In the two EPI groups, pH and Base Excess were lower and lactate levels higher compared to baseline as well as compared to control. Conclusion: Repetitive EPI doses increased ABP’s and CePP, but this did not translate into better organ or brain perfusion.

scholarly journals Prophylactic Intramuscular Ephedrine Prior to Caesarean Section

1992 ◽  
Vol 20 (4) ◽  
pp. 448-452 ◽  
Author(s):  
C. C. Rout ◽  
D. A. Rocke ◽  
R. Brijball ◽  
R. V. Koovarjee
Keyword(s):  
Caesarean Section ◽  
General Anaesthesia ◽  
Control Group ◽  
Double Blind Study ◽  
Double Blind ◽  
Maximum Increase ◽  
Arterial Ph ◽  
Maternal Hypertension ◽  
Acid Base Status ◽  
Umbilical Arterial Ph

Thirty healthy parturients, having given informed consent, were randomly allocated in a double-blind study to receive an intramuscular injection of either 0.9% sodium chloride (control), ephedrine 25 mg, or ephedrine 50 mg, 30 minutes prior to general anaesthesia for caesarean section. Nine patients (90%) in the 50 mg group and five patients (50%) in the 25 mg group demonstrated reactive hypertension of 20% or greater from control. The mean maximum increase in the 50 mg group was 28.2% (range 4.4–38.3%). Maternal pH was significantly lower (P = 0.03) in the ephedrine 50 mg group. Neonatal acid base status was significantly impaired in the ephedrine 50 mg group with umbilical venous pH (P = 0.0001) and umbilical arterial pH (P = 0.001) being significantly lower than the control group. The associated increase in umbilical arterial base deficit suggests a metabolic component due to fetal asphyxia related to decreased uterine blood flow. We conclude that the prophylactic administration of intramuscular ephedrine prior to spinal anaesthesia is associated with an unacceptably high incidence of maternal hypertension, and should the spinal fail and general anaesthesia be required, also results in adverse neonatal biochemical changes. The technique is therefore not to be recommended.

Intraabdominal Carbon Dioxide Insufflation in the Pregnant Ewe

1996 ◽  
Vol 85 (6) ◽  
pp. 1395-1402. ◽  
Author(s):  
Antonio M. Cruz ◽  
Lucy C. Southerland ◽  
Tanya Duke ◽  
Hugh G. G. Townsend ◽  
James G. Ferguson ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Blood Flow ◽  
Intraabdominal Pressure ◽  
Control Group ◽  
Uterine Blood Flow ◽  
Carbon Dioxide Insufflation ◽  
Carbon Dioxide Pneumoperitoneum ◽  
Arterial Blood ◽  
End Tidal Carbon Dioxide ◽  
End Tidal

Background Laparoscopic surgical procedures are being performed in pregnant women with increasing frequency. Maternal-fetal physiologic changes occurring during intraabdominal carbon dioxide insufflation are poorly understood, and maternal-fetal safety is of concern during carbon dioxide pneumoperitoneum. A previous pilot study using end-tidal carbon dioxide-guided ventilation resulted in maternal and fetal acidosis and tachycardia during carbon dioxide pneumoperitoneum. Using serial arterial PCO2 to guide ventilation, this study was designed to evaluate maternal-fetal cardiopulmonary status, uterine blood flow, and the intraamniotic pressure effects of intraabdominal carbon dioxide insufflation in singleton pregnant ewes between 120 and 135 days of gestation. Methods In a prospective randomized cross-over study, nine ewes were to receive either abdominal insufflation with carbon dioxide to an intraabdominal pressure of 15 mmHg (n = 9; insufflation group) or receive no insufflation (n = 9; control group). Anesthesia was induced with thiopental and maintained with end-tidal halothane (1 to 1.5 minimum alveolar concentration/100% oxygen). Mechanical ventilation was guided by serial maternal arterial blood gas analysis to maintain PaCO2 between 35 and 40 mmHg. Data from insufflated animals were collected during insufflation (60 min) and after desufflation (30 min). Control group data were collected and matched to similar time intervals for 90 min. Ewes were allowed to recover, and after a rest period (48 h) they were entered in the cross-over study. Results During insufflation there was a significant increase (P &lt; 0.05) in maternal PaCO2 to end-tidal carbon dioxide gradient and minute ventilation, with concomitant decreases in maternal end-tidal carbon dioxide and PaO2. Intraamniotic pressure increased significantly during insufflation. No significant changes were observed in maternal hemodynamic variables, fetal variables, or in uterine blood flow during the study. There were no fetal deaths or preterm labor in any of the animals during the experiment. Conclusions During the 1-h insufflation, a marked increase in PaCO2-to-end-tidal carbon dioxide gradient was observed, suggesting that capnography may be an inadequate guide to ventilation during carbon dioxide pneumoperitoneum in the pregnant patient. No other significant circulatory changes were observed.

Effects of Two Target-controlled Concentrations (1 and 3 ng/ml) of Remifentanil on MACBARof Sevoflurane

2004 ◽  
Vol 100 (2) ◽  
pp. 255-259 ◽  
Author(s):  
Andrea Albertin ◽  
Andrea Casati ◽  
Piercarlo Bergonzi ◽  
Greta Fano ◽  
Giorgio Torri
Keyword(s):  
Nitrous Oxide ◽  
Skin Incision ◽  
Double Blind Study ◽  
Double Blind ◽  
Surgical Incision ◽  
Arterial Blood ◽  
Sequential Allocation ◽  
Sympathetic Responses ◽  
American Society ◽  
End Tidal

Background The aim of this prospective, randomized, double-blind study was to determine the effects of two different target-controlled concentrations of remifentanil (1 and 3 ng/ml) on the sevoflurane requirement for blunting sympathetic responses after surgical incision (MACBAR). Methods Seventy-four patients aged 20-50 yr, with American Society of Anesthesiologists physical status I, were anesthetized with propofol, cisatracurium, and sevoflurane with a mixture of 60% nitrous oxide in oxygen. Then, patients were randomly allocated to receive no remifentanil infusion (n = 27) or a target-controlled plasma concentration of 1 ng/ml (n = 27) or 3 ng/ml remifentanil (n = 20). Sympathetic responses to surgical incision (presence or absence of an increase in either heart rate or mean arterial blood pressure of 15% or more above the mean of the values measured during the 2 min before skin incision) were determined after a 20-min period of stable end-tidal sevoflurane and target-controlled remifentanil concentrations. Predetermined end-tidal sevoflurane concentrations and the MACBAR for each group were determined using an up-and-down sequential-allocation technique. Results The MACBAR of sevoflurane was higher in the group receiving no remifentanil (2.8% [95% confidence interval: 2.5-3.0%]) as compared with patients of the groups receiving 1 ng/ml (1.1% [0.9-1.3%]; P = 0.012) and 3 ng/ml remifentanil (0.2% [0.1-0.3%]; P = 0.006). When considering a minimum anesthetic concentration (MAC) value in this age population and the contribution of 60% nitrous oxide (0.55 MAC), the combined MACBAR values, expressed as multiples of the MAC, were 1.95 MAC, 1.1 MAC, and 0.68 MAC, in the three groups, respectively. Conclusion A target-controlled concentration of 1 ng/ml remifentanil results in a 60% decrease in the MACBAR of sevoflurane combined with 60% nitrous oxide. Increasing the target concentration of remifentanil to 3 ng/ml produces a further 30% decrease in the MACBAR values of sevoflurane.

scholarly journals RANDOMISED CONTROLLED STUDY TO EVALUATE THE EFFECTS OF NITROGLYCERINE SUBLINGUAL SPRAY ON TRACHEAL EXTUBATION RESPONSE IN NORMOTENSIVE PATIENTS UNDERGOING SURGERIES UNDER GENERAL ANAESTHESIA

2020 ◽  
pp. 1-6
Author(s):  
Surendra Kumar Raikwar ◽  
Anil Kori* ◽  
Aditya Agarwal
Keyword(s):  
Stress Response ◽  
General Anaesthesia ◽  
Tracheal Extubation ◽  
Controlled Study ◽  
Control Group ◽  
Pain Anxiety ◽  
Arterial Blood ◽  
Variable Success ◽  
Related Stress ◽  
Randomised Controlled

Tracheal extubation is the translaryngeal removal of a tube from the trachea via the nose or mouth and associated with awakening, pain, anxiety, airway irritation which may cause a cough or difculties in breathing and may contribute to an increase in haemodynamic response (1) .Several modalities, both pharmacological and nonpharmacological have been tried to decrease this stress response with variable success. We undertook this study to assess the efcacy of NTG spray in decreasing extubation related stress response in normotensive patients undergoing elective surgeries under general anaesthesia. Material and methods : Sixty normotensive patients were included in study and randomly subdivided into two groups of 30 patients each – group N receiving NTG spray and Group C not receiving NTG spray prior to extubation. Hemodynamic stress response during extubation was noted in both the groups and compared. Result and conclusion : Extubation was associated with signicant rise in systolic, diastolic and mean arterial blood pressure and heart rate in both the groups, but this stress response was signicantly less in NTG Group as compared to control group.

scholarly journals Gastric pH in patients premedicated with Esomeprazole or Famotidine undergoing routine surgery under general anaesthesia

2013 ◽  
Vol 1 (2) ◽  
pp. 71-76
Author(s):  
BR Shrestha ◽  
S Shrestha ◽  
S Moktan ◽  
OS Shrestha
Keyword(s):  
General Anaesthesia ◽  
Ph Value ◽  
Elective Surgery ◽  
Gastric Ph ◽  
Control Group ◽  
Ph Indicator ◽  
Double Blind ◽  
Group Iii ◽  
Group I ◽  
American Society

Background: Stress and anxiety in patients planned for surgery under anaesthesia may change pH of gastric secretion. Premedication of surgical patients with pH altering drugs may modify the pH favourably. With the advent of newer agents, premedication has been carried out with different agents. Most of the time choice of drug is made by the perioperative physician on his/her own. Objective: To study gastric pH in patients premedicated either with Esomeprazole or Famotidine. Methods: This is a randomized controlled double blind prospective study conducted in 150 patients of American Society of Anesthesiologists grade I and II posted for elective surgery under general anaesthesia. The patients enrolled in the study were randomly assigned to three groups having 50 patients in each. Group I (control group) did not receive any pH altering drug, Group II (Famotidine Group) received 40 mg of Famotidine and Group III (Esomeprazole Group) received 40 mg of Esomeprazole the night before surgery. The observer was totally blind about the groups or drugs given to the patients. On the day of surgery, after induction of anaesthesia gastric juice was obtained via nasogastric tube and was checked for pH using pH indicator paper. Results: The pH raised by Esomeprazole was statistically significant (p<0.001) when compared to that of control group or Famotidine group. The mean pH value in control group was less than 2.5 whereas the pH value was higher than 2.5 in patients premedicated with either Famotidine or Esomeprazole. Conclusions: Gastric pH is raised by Famotidine or Esomeprazole premedication prior to routine surgery, Esomeprazole being superior to Famotidine, p<0.001. Patients (84%) not premedicated with either of the drugs had pH less than 2.5. DOI: http://dx.doi.org/10.3126/jkmc.v1i2.8141 Journal of Kathmandu Medical College, Vol. 1, No. 2, Oct.-Dec., 2012: 71-76

scholarly journals Use of 0.1% chlorine dioxide to inhibit the formation of morning volatile sulphur compounds (VSC)

2007 ◽  
Vol 21 (1) ◽  
pp. 70-74 ◽  
Author(s):  
Daiane Cristina Peruzzo ◽  
Priscila Fontoura Castelo Branco Jandiroba ◽  
Getulio da Rocha Nogueira Filho
Keyword(s):  
Chlorine Dioxide ◽  
Fold Increase ◽  
Experimental Period ◽  
Dental Students ◽  
Control Group ◽  
Sulphur Compounds ◽  
Double Blind ◽  
Randomised Study ◽  
Significant Difference ◽  
And Control

The aim of this study was to evaluate the VSC-inhibiting effect of a commercially available mouthrinse (0.1% chlorine dioxide) when compared to its placebo. A 2-step double blind, crossover, randomised study was conducted with 14 dental students with healthy periodontium, who refrained from any mechanical plaque and tongue coating control during two 4-day experimental periods. The subjects were instructed to rinse 3 times daily with the assigned product during each period. A 7-day washout interval was established. VSCs levels were measured by a sulphide monitor at the beginning (baseline) and at the end of each experimental period. Statistical analyses were performed using Wilcoxon's and Mann-Whitney's non-parametric tests. At baseline, intragroup analysis revealed that VSCs levels did not differ between groups (p > 0.05); at day 5, the use of the chlorine dioxide mouthrinse did not change the baseline VSCs scores in the control group (p > 0.05), while a 2-fold increase was observed with the use of the placebo mouthrinse (p < 0.05). Intergroup analysis showed a significant difference between the VSCs levels of the test and control groups (40.2 ± 30.72 and 82.3 ± 75.63 ppb, p < 0.001) at day 5. Within the limits of this study, the findings suggest that a mouthrinse containing chlorine dioxide can maintain VSCs at lower levels in the morning breath.

scholarly journals Use of Low Dose Pregabalin for Attenuation of Hemodynamic Response to Laryngoscopy and Intubation in Treated Hypertensive Patients

2019 ◽  
Vol 2 (2) ◽  
pp. 215-219
Author(s):  
Puja Thapa ◽  
Sunita Panta ◽  
Mallika Rayamajhi ◽  
Santosh Khadka ◽  
Bishwo Ram Amatya ◽  
...  
Keyword(s):  
Low Dose ◽  
Hemodynamic Response ◽  
Sedation Scale ◽  
Double Blind ◽  
Hypertensive Patients ◽  
Randomised Study ◽  
Arterial Blood ◽  
Ramsay Sedation Scale ◽  
Dose Oral ◽  
Baseline Characteristics

Introduction: Laryngoscopy and tracheal intubation are two powerful noxious stimuli that can be potentially deleterious especially in hypertensive patients. This study evaluated the efficacy of low dose oral pregabalin used as a premedication for attenuation of this marked sympathetic response of airway instrumentation.Materials and Methods: This was a double-blind randomised study done at a tertiary level referral hospital. The trial was registered as UMIN-000037103 (https://www.umin.ac.jp/ctr/). Patients were randomly assigned into two groups. Placebo arm received multivitamin capsule and treatment arm received Cap. Pregabalin (75 mg), 60 minutes before the induction of general anesthesia. The level of preoperative sedation was assessed with the Ramsay Sedation Scale. Heart rate, systolic, diastolic and mean arterial blood pressure were monitored and recorded before and during induction, during laryngoscopy and 1, 3 and 5 minutes of intubation.Results: A total of 50 patients, 25 in each arm were enrolled. The baseline characteristics were comparable. SBP was significantly lower in the Pregabalin group than in Placebo at all the periods of recording, however, DBP and MAP decreased significantly during, after 1 and 3 minutes of laryngoscopy (p=0.001). Sedation was significantly better in the Pregabalin group with 86% in RSS 3 compared to 80% of a placebo arm in RSS2 (P <0.001).Conclusions: Premedication with a single oral dose of Pregabalin (75 mg) is effective for sedation and attenuation of hemodynamic response to direct laryngoscopy and endotracheal intubation in controlled hypertensive patients without any side effects.

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