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Objective To assess the effect of intravenous dexmedetomidine on subarachnoid anesthesia with the help of hyperbaric bupivacaine when administered as a bolus or as an infusion. Materials and methods This randomized control trial was conducted at the Department of Anesthesia, Nishtar Hospital, Multan, Pakistan, from January 2017 to December 2018. Seventy patients were enrolled in the study. Patients were segregated into three groups. At the T10 level, a sensory blockade was noted. The motor blockade was also periodically measured until a modified Bromage score of three was achieved. The depth of sedation was measured with the help of the Ramsay Sedation Scale score. Oxygen saturation and other factors were also measured and recorded. Nausea, vomiting, diarrhea, and pruritus were the adverse effects noted during the study. To check and compare the statistical differences among the variables from different groups, the Chi-square test and analysis of variance test were performed. A probability (p) value of <.05 was considered statistically significant. Results The duration of the sensory blockade was shortest in the control group receiving only bupivacaine (Group B) and longest in the group receiving bupivacaine plus dexmedetomidine as a single bolus (Group BDexB; p: <.001). The time of complete sensory and motor recovery was longest in Group BDexB and shortest in Group B. The difference was statistically significant (p: <.001). The Ramsay score was >2 (i.e., 3 or 4) in five patients from Group B, 19 from Group BDexB, and 17 from the group receiving intrathecal bupivacaine plus dexmedetomidine as an infusion (Group BDexI). Between these groups, a statistically significant difference was found (p: <.001). Conclusions Intravenous administration of dexmedetomidine as either a bolus or infusion prolonged the duration of the sensory and motor blockade.
RESUMO
BACKGROUND: Propofol is a widely-accepted medication for the successful insertion of laryngeal mask airway (LMA). When propofol is used alone, larger doses are required which can lead to cardiorespiratory distress resulting in hypotension and prolonged apnoea. The objective of this study was to evaluate the effect of premedication of midazolam on different doses of propofol for LMA insertion. METHODS: In this randomized clinical trial, eighty-six (86) patients who were scheduled to undergo elective surgery is supine position not requiring the need for tracheal intubation from September 2015 to 6 March 2016 were included. In group I (n=43), the LMA was introduced after induction of anaesthesia with Propofol alone. In Group II (n=43, the patient was premeditated with midazolam (0.05 mg/kg) before induction of anaesthesia with propofol. Each group was divided into three subgroups depending upon the dose of propofol used for LMA insertion. RESULTS: In this study, there were 53.5% females in group I and 48.8% females in group II. The mean age of Children in group I was 7.30±2.55 years and 7.47±2.46 years in group II. Incidence of incomplete Jaw relaxation, coughing and limb movements was significantly high in in Group I patients (pvalues <0.001, <0.001 and <0.001 respectively). Effectiveness of anaesthesia was compared among different subgroups. On comparison of subgroup Ia and IIa, the effectiveness rate was significantly high in subgroup IIa 50% versus only 7.1% in subgroup Ia (p-value 0.012). Similarly, in subgroup IIb effectiveness was achieved in 100% patients as compared to only 64.3% patients in subgroup IIb (p-value 0.014). There was no significant difference in effectiveness rate in subgroup Ic and IIc (p-value 0.309). CONCLUSIONS: With midazolam premedication, the dose of propofol for LMA insertion is decreased. The incidence of adverse events during LMA insertion is also low with midazolam premedication.