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

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

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.

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

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.

A prospective comparative evaluation of gabapentin vs pregabaline for the acute post-operative pain management in lower limb surgeries under spinal anaesthesia

Background: Pre emptive analgesia is multimodal approach where drug is used before surgery and has potential to be more effective than a similar analgesic treatment initiated after surgery. Pregabaline and Gabapentin are GABA analogue used is used as pre-emptive analgesic. Its analgesic action is mediated through α2δ subunit of voltage gated calcium channels on dorsal horn neurons. Material and Method:96 patients satisfying selection criteria were enrolled for this study and divided in to three groups Group P, Group G and Group C each having 32 patients. All patients were explained about visual analogue score. Result: There is significant difference between three groups regarding time of first rescue analgesia and tramadol consumption. The mean time for rescue analgesia was longer in pregabaline group then gabapentin group (482.7±113.5 min vs 343.35±70.74 min). The mean amount of dose of tramadol requirement was also less in pregabaline and gabapentin group (164.32±39.41 vs178.32±48.21 vs 272.82±83.01) in comparison control. Conclusion: The VAS score was significantly higher in control then pregabaline and gabapentin group. Both pregabaline (group P) and gabapentin (group G) are comparable to each other regarding VAS score at different time interval in post operative period. Ramsay sedation score was significantly higher in pregabaline and gabapentin group up 4 hour post operatively but after that there was no significant difference between two groups. Both pregabaline (group P) and gabapentin (group G) are comparable to each other regarding Ramsay sedation score at different time interval in post operative period.

Efficacy of Pregabalin as preemptive analgesic in laparoscopic cholecystectomy

Introduction: Different pharmacological approach for preemptive analgesia have been tried with varying degree of success. Preemptive analgesia results in decrease in postoperative opioid requirement and hence decreases opioid related complication. Objectives: This study aims to evaluate pregabalin as preemptive analgesic in scheduled cases. Methodology: Fourty ASA I and II patients posted for elective laparoscopic cholecystectomy under general anesthesia were divided into two groups of twenty. Group A received pregabalin 300 mg, two hours before induction of anesthesia but group B were not given any medication. Postoperative VAS Score, Ramsay Sedation Score, postoperative nausea and vomiting and postoperative opioid requirement in two groups were observed over 48 hours and noted.Results: The mean VAS scores were higher in control group whereas the mean Ramsay score was higher in group pregabalin in the first six hours in the post operative period which was statistically significant. The mean Ramsay sedation score was same (2) in both the group after twelve post operative period. Postoperative nausea and vomiting was lower in the pregabalin group. Requirement of post operative analgesia was higher in the control group. Conclusion: Preemptive use of Pregabalindecreasespostoperateive pain, postoperative opioid requirement and increases postoperative sedation.

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

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.

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

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.

Observation on the Analgesic Effect of Bilateral Inferior Alveolar Nerve Block Combined With Parecoxib Sodium for Mandibular Orthognathic Surgery

Background: To compare the analgesic effect and safety of bilateral inferior alveolar nerve block combined with parecoxib sodium analgesia and simple intravenous analgesia pump in analgesia after orthognathic surgery. Methods: Forty patients with simple ascending sagittal split osteotomy and ankle plasty were randomly divided into the experimental group and the control group, with 20 patients in each group. The experimental group received 2 ml 1% on both sides. Ropivacaine was treated with inferior alveolar nerve block anesthesia. Immediately after surgery, parecoxib sodium 40 mg was intravenously administered. The control group was given an intravenous analgesia pump for analgesia. Pain intensity (VAS pain score) and Ramsay sedation score were recorded at 2h, 4h, 8h, 24h, 48h after operation, and the incidence of postoperative adverse reactions was observed. Results: There was no significant difference in pain intensity and Ramsay sedation score between the two groups at each time point (P>0.05). During the analgesic treatment, the incidence of nausea and vomiting (P=0.046) in the experimental group was significantly lower than that in the control group (P<0.05). Conclusion: Bilateral inferior alveolar nerve block combined with parecoxib sodium analgesia and simple intravenous analgesia pump are effective for analgesia after mandibular orthognathic surgery, but the incidence of adverse reactions is significantly lower, more suitable for Analgesia after mandibular orthognathic surgery.