Effect of Dexmeditomidine on Isofluorane Consumption in Middle Ear Surgery

Background: With the introduction of intentional hypotensive anesthesia in the surgical field to achieve a relatively bloodless surgical field along with the use of the operative microscope, it has revolutionized the middle ear surgery practice. Dexmedetomidine is a relatively new and potent α2 agonist prototype found efficient in rendering bloodless intra-surgical field and inducing controlled hypotension during the surgeries of the middle ear. The objective is to present prospective study was aimed at evaluating with and without dexmedetomidine infusion effect on end-tidal isoflurane concentration for lowering blood pressure by 30%, awakening time and quality of bloodless surgical field during middle ear surgical procedure. Subjects and Methods:54 patients who were to undergo middle ear surgery and had ASA I and II were randomly divided into the two groups. In Group I Dexmedetomidine was used and in Group II Normal saline. Effect of Dexmedetomidine infusion on end-tidal isoflurane concentration for lowering blood pressure by 30%, awakening time, quality of bloodless surgical field during middle ear surgical procedure, heart rate was evaluated. The data collected were statistically analyzed. Results: The mean values of the heart rate were statistically non-significant between the groups when recorded at the baseline, whereas, a statistically significant difference was seen in the values for heart rate intra-operatively. The mean values for heart rates were significantly higher for the placebo group. A significant difference in Isoflurane concentration was found with dexmedetomidine requiring a percentage of 0.6 0.4 and normal saline 1.8 0.5. Less bleeding was seen with dexmedetomidine. Conclusion: Dexmedetomidine is a potent hypotensive agent which also reduces the requirement of Isoflurane compared to the normal saline placebo. The use of dexmedetomidine is relatively safe and provide a relatively bloodless surgical field, hence, increasing efficacy, and improving visibility at the surgical site.

Evaluation of the True View PCD Video Laryngoscope for Oral Endotracheal Intubation

Background: Truview PCD video laryngoscope is particularly planned to assist in locating the endotracheal tube in addition to observe the admission of the tube into the glottis. The present study was performed to assess the outlook of glottic opening and relief of intubation between the Truview PCD laryngoscope and Macintosh laryngoscope in patients undergoes general anaesthesia. Subjects and Methods: Ninety patients of ASA grade 1 and 2 aged 18-60 years, posted for elective surgery under general anaesthesia needing endotracheal intubation were arbitrarily allocated into group 1 (Truview PCD laryngoscope n=45) and group 2 (Macintosh laryngoscope n=45). The two groups were compared for demographic data, intubation difficulty score, Cormack-Lehane grade, time to intubate, number of intubation attempts and hemodynamic parameters. Conclusion: Truview PCD can be measured as an alternate intubation device, especially in difficult intubation conditions.

Efficacy of Intrathecal Neostigmine with Intrathecal Dexmedetomidine in Postoperative Analgesia

Background: The present study was conducted to compare the efficacy of intrathecal neostigmine with intrathecal dexmedetomidine in postop- erative analgesia. Subjects and Methods: The present study was conducted in the department of Anesthesia involving 100 patients belonging to ASA grade I and II, posted for elective Sub umbilical surgeries, under spinal anaesthesia. Group I patients received 3.0ml of hyperbaric solution of 0.5% bupivacaine + 50mcg (0.5ml) of Neostigmine. Group II patients received 3.0ml of hyperbaric solution of 0.5% bupivacaine + 10mcg (0.5ml) of dexmedetomidine. Results: The maximum patients were seen in age group 18-30 years ie 10 in group I and 16 in group II and minimum in 41-50 years ie 6 in group I and 4 in group II. The mean time for onset of sensory block in group I was 1.43 0.53 min and in group II was 2.319 0.44 min. The mean time for onset of peak sensory block in group I was 5.48 0.43 min and Group II was 7.31 0.44 min. Time for two segment regression was significantly higher in dexmedetomidine group as compared to neostigmine group, the mean time for two segment regression in group I was 124.98 21.48 min and group II was 165.24 14.45 min. The mean time for onset of motor block was 3.079 0.44 min in group I and 4.0454 0.38 min in group II. The mean duration of motor block in group I was 191.58 26.81 min and 324 36.8 min in group II. The difference was significant (P< 0.05). The mean sedation score in group I was 1.03 and in group II was 2.07. The difference was significant (P< 0.05). Conclusion: Authors recommend the use of dexmedetomidine as an adjuvant to bupivacaine in subarachnoid block

Abnormal Central Venous Oxygen Saturation as a Predictor of Mortality in Patients with Sepsis and Polytrauma in the Surgical Intensive Care Unit

Background: In postoperative heart surgery patients and patients with sepsis, pathological (low and supranormal) central venous oxygen satura- tion (ScvO2) was shown to be associated with lower mortality. The objective is we want to examine the effect of sepsis and polytrauma infection on our surgical ICU and the incidence of morbidity and death in the population. Subjects and Methods: In such patients who met the qualifying criteria and had a history of scepticism and multi-trauma, a retrospective observational review was conducted. We investigated and evaluated the association between SCV02 and mortality and other variables, such as lactate and baseline excess and period of the ICU stay and inotropic assistance within the first 6 hours, using a multivariate model review. Their entry was measured and 6 hours later. Result: The incidence of deaths in the hyperoxia group was 2.4 times higher in comparison to the general population, and the death rate in the hypoxia category was 1.25 times higher. The risk of death for the hyperoxic population was 2.4 times higher. There was no statistically relevant discrepancy of ICU, inotropic treatment, coagulopathy, dialysis, apache-11 score, baseline excess and lactate between the three levels of Scv02. Conclusion: The base excess and Scv02 were not significant when the lactates were calculated to a mortality point, but the j curve revealed that both the hypoxia group and the hyperoxia mortality had improved in contrast with the normal oxy group. Since the small sample size was sufficient to predict a trend, secondary targets were not

Epidural Fentanyl and Fentanyl Plus Magnesium for Post-Operative Analgesia in Lower Extremity Surgery

Background: The present study was conducted to assess the efficacy of epidural fentanyl with a combination of epidural fentanyl and magnesium in lower extremity surgery. Subjects and Methods : This study was conducted on 100 ASA I/II patients scheduled to undergo elective lower limb orthopedic surgeries. Group I patients received epidural fentanyl 50 µg (1cc) diluted and made up to 6cc with normal saline. Group II patients received epidural fentanyl 50 µg (1cc)+ Magnesium sulphate 50mg (4 units in insulin syringe of 50% solution) diluted and made up to 6cc with normal saline. Patient data such as indication for surgery, the anesthetic details, intraoperative monitoring, post-operative follow-up, etc was recorded. Results: Each group had 36 males and 14 females. Time is taken for the highest sensory level in group I was 13.92 4.50 minutes and 12.24 3.43 minutes in groups I and II respectively. The mean duration of surgery was 99.00 13.31 minutes in group I and 92.20 15.21 in group II. Time for Regression to L1 was 118.80 13.41 and 119.60 17.85 minutes in group I and II respectively. The duration of analgesia (min) was 107.00 25.82 and 143.40 39.57 minutes in group I and II respectively. Common adverse events were nausea/ vomiting seen 2 in group I and 4 in group II and urinary retention seen 0 in group I and 2 in group II. The difference was non- significant (P> 0.05). Conclusion: Authors found that the addition of magnesium sulfate to epidural fentanyl for elective lower limb orthopedic surgeries has prolonged the duration of fentanyl analgesia without any significant side effects.

Evaluation of Efficacy of Transversus Abdominis Plane Block and Systemic Analgesia for Post-Operative Pain in Total Abdominal Hysterectomy: A Comparative Study

Introduction: Management of post-operative Pain is gaining considerable attention with pain being recognized as the fifth vital sign. Post- operative pain management remains unresolved as pain is individualized and varies with surgery. The aim is to evaluate the analgesic efficacy of transverses abdominis plane block by continuous catheter technique and systemic analgesia for post-operative pain in total abdominal hysterectomy. Subjects and Methods: This randomized controlled trial was done in patients undergoing total abdominal hysterectomy via Pfannenstiel incision. Patients were assigned into 2 groups, systemic analgesics group (n=25) and TAP block group (n=25) randomly. Results: Out of 50 patients, 25 patients had systemic analgesics and 25 patients had TAP block. Demographics and surgical procedure times were comparable. Mean VAS pain score with coughing on day 1 and 2 in systemic analgesics group was 3.96 and 2.07 and in TAP block group were 0.7 and 0.3. Meantime taken to mobilize the patient after the surgery in the systemic analgesics group was 30.7 hours and in TAP block group was 22.4 hour. 18 patients needed rescue medication in the systemic analgesics group, and 9 patients required rescue medication in the TAP block group. In group 16 patients with systemic analgesics had post-operative nausea and vomiting, and 5 patients in group block TAP. Conclusion: Continuous TAP block provides better pain relief, denoted by lower visual analogue scores and better recovery profile enhancing recovery in patients undergoing abdominal hysterectomy.

A Comparative Study of Dexmedetomidine and Clonidine for Attenuation of Hemodynamic Response during Laryngoscopy and Intubation

Background: The present study was conducted to compare dexmedetomidine and clonidine for attenuation of hemodynamic response during laryngoscopy and intubation. Subjects and Methods: Group I patients received 0.9% normal saline (placebo), group II patients received 0.5 µg/kg of dexmedetomidine and group III patients received 3 µg/kg of or clonidine. Each group had 15 patients. Results: The mean age in group I was 28.2 years, in group II was 32.1 years and in group III was 33.2 years, mean weight was 61.2 years, in group II was 60.4 years and in group III was 62.1 years, height was 156.2 cm, in group II was 157.1 cm and in group III was 152.8 cm. There were 8 males and 7 females in group I, 6 males and 9 females in group II and 7 males and 8 females in group III. The mean SBP (mm Hg) in group I was 121.4 and in group II was 122.6, and in group III was 127.4, DBP (mm Hg) was 76.2 in group I, 78.4 in group II and 78.2 in group III. MAP (mm Hg) was 86.7 in group I, 93.2 in group II and 92.5 in group III. HR (bpm) was 74.2 in group I, 78.4 in group II and 77.3 in group III. % oxygen saturation was 98.2in group I, 98.5 in group II and 97.9 in group III. The difference was non- significant (P> 0.05). Conclusion: Authors found that both groups were equally effective in causing attenuation of hemodynamic response to endotracheal intubation.

Comparison of Various Techniques of Anesthesia for Surgical Management of Diabetic Foot

Background: Diabetes mellitus is a multisystem disease caused by an absolute or relative deficiency of insulin secretion or resistance or a combination of both. Anesthesia in them is of special concern because of complex polypharmacy, an inappropriate dose of oral hypoglycemic agents or insulin and errors in converting IV insulin to usual medication. The objective is to compare the various techniques of anesthesia for surgical management of diabetic foot in terms of intraoperative hemodynamic stability, perioperative problems related to anesthesia techniques, postoperative analgesia. Subjects and Methods: Sixty adult diabetic patients of both gender of ASA grade II-III, aged 35years undergoing surgical management of diabetic foot were elected and separated into three groups, Group A: general anesthesia with tracheal intubation, Group B: unilateral spinal anesthesia with injection 0.5% bupivacaine heavy 1.5ml (7.5mg), Group C: popliteal nerve block via lateral approach by injecting 30 ml 0.5% bupivacaine. Parameters like pulse rate, mean arterial blood pressure, respiratory rate and SpO2 were recorded at regular intervals. Postoperative pain, perioperative side effects, complications and problems related to anesthetic techniques were noted. The analysis is done by unpaired t-test and chi-square test. Results: Group C patients were hemodynamic stable than Group A and B. Post-op analgesia was prolonged in Group C. Perioperative side effects were more found in Group A. Conclusion: Popliteal nerve block and unilateral spinal anesthesia provide better hemodynamic stability and postoperative analgesia with negligible side effects as compared to general anesthesia for surgical management of diabetic foot.

Usefulness of 0.5% Hyperbaric Bupivacaine with Dexmedetomidine on Spinal Anaesthesia in Lower Limb Orthopaedic Patients

Background: The present study was conducted to assess the usefulness of 0.5% hyperbaric bupivacaine with dexmedetomidine on spinal anesthesia in lower limb orthopedic patients. Subjects and Methods: This study involved 50 patients with ASA Grade I and II of both genders. Patients were randomly allocated into group I (n=25) Patients received Dexmedetomidine 0.5 µ g/kg over 15 minutes using an infusion pump 20 minutes prior to SAB and group II (n=25) Intraoperatively HR, BP and SpO2 were measured and noted. Results: The mean heart rate at baseline was 80.00 8.49 in group I and 81.80 8.74 in group II. The mean heart rate at 5 minutes was 73.80 13.38 in group I which was significantly higher (p=0.02) compared to 65.63 12.45 in group II. The mean arterial pressure at baseline was 97.64 5.24 in group I and 97.73 6.96 in group II suggesting MAP in both groups was comparable. The MAP at 5 minutes was 90.73 14.65 in group I which was significantly higher (p=0.01) compared to 81.22 11.64 in group II, suggesting a greater fall from the baseline in group II compared to group I. The MAP in both groups was found to be comparable at 15, 30, 45, 60, 75, 90, 105, 120 minutes (p>0.05). The oxygen saturation in both groups was found to be comparable at all time intervals. The duration of onset of sensory blockade (Time is taken to reach T10 level) in 53.33% of patients in Group I is between 1 to 2 minutes (60 to 120 seconds) and less than 1 minute (60 seconds) in 46.67% of patients. The average mean time and standard deviation of onset of sensory blockade in Group I is 66 44.14 seconds. Conclusion: Authors found that dexmedetomidine was given intravenously as premedication before spinal anaesthesia using injection bupivacaine results in a quicker onset of analgesia, prolonged duration of sensory, motor block and well balanced hemodynamic parameters.

Anaesthesia and Anaesthesiologist: The Perception of Attendees at a Medical College in Rural Haryana

Introduction: Anaesthesia as a specialty is reaching its zenith with multiple sub-specialties, but anaesthesiologist remains obscure personnel behind the drapes due to lack of public perception and knowledge pertaining to their role. The aim is to the study was conducted to assess the perception and knowledge of general public about the role of anaesthesia and the anaesthesiologist. Subjects and Methods : A prospective, cross-sectional study, conducted in a 500-bedded, rural medical college over a 3-month period. A total of 172 attendees accompanying their patients for surgical procedures were enrolled and assessed based on preformed, pretested questionnaire in the pre-anaesthetic clinic. The questionnaire contained 30 questions to determine their knowledge and attitude towards anaesthesia and anaesthesia provider. Results: Out of total 172 participants, 43.02% % recognized anaesthesiologist as specially trained doctors. Eighty two (47.67%) of the attendees knew that anesthesia is administered by an anesthesiologist but 71.5% were not aware of their role in providing peri-operative care. The attendees apprised of anesthesiologists role in labour analgesia, chronic pain management, intensive care units and emergency resuscitation was Sixty seven (39%), forty nine (28.49%), forty five (26.7%) and twenty six (15.1%) out of 172 respectively. Majority of the attendees (93.6%) were receptive to know more about anaesthesia. Conclusion: The awareness regarding role of anaesthesiologist in general public is still low and the perception of people about anaesthesia as an evolved specialty is lacking. This calls for corrective measures to be taken by the anaesthesiology fraternity for propagation of anesthesiology skills via social media and other government aided platforms.