Comparison of the effects of caffeine, aminophylline, and saline on the recovery from total intravenous anesthesia in laparoscopic surgeries: A randomized controlled trial.

Background and Aims: The return of consciousness (ROC) after general anesthesia (GA) is by stopping the administration of anesthetic agents. At present, no drug is given to reverse the loss of consciousness produced by general anesthetic agents. This study is conducted to find whether caffeine and aminophylline hasten the ROC. Material and Methods: This study was conducted on 75 American Society of Anesthesiologists (ASA) I and II female patients undergoing laparoscopic hysterectomy, aged between 18 and 60 years. The patients were divided into three equal groups (Group C: caffeine citrate, Group A: aminophylline, and Group S: saline) of 25 each by a computer-generated random number table. GA was induced with propofol, fentanyl, and maintained with propofol infusion. On completion of the surgery, the neuromuscular blocking agent was reversed and then the infusion of propofol was stopped. The study drug was administered intravenously when the BIS 60 was achieved. Time to achieve BIS 90, return of first gag reflex, eye-opening on verbal command, and extubation after study drug administration were noted. Hemodynamic parameters and SpO2 were also monitored. Results: The time for BIS 60 to 90 was 10 (4.25) min in the caffeine group, 13 (4.25) min in the aminophylline group, and 26 (9.0) min in the saline group. The time to return of gag reflex and time to extubation were shorter in the caffeine and aminophylline group compared to the saline group. The time to eye-opening on verbal command was shorter in the aminophylline group compared to the saline group. Hemodynamic parameters after infusion of the study drug were comparable in all three groups. Conclusion: Caffeine hastens the recovery from total intravenous anesthesia with propofol and fentanyl in laparoscopic hysterectomy as effectively as aminophylline.

The midpoint transverse process to pleura (MTP) block for postoperative analgesia in patients undergoing modified radical mastectomy: A case series.

Among the various regional anesthesia techniques used for postoperative analgesia in the modified radical mastectomy (MRM), thoracic paravertebral block (TPVB) is presently considered the technique of choice. Nevertheless, TPVB may lead to complications like inadvertent vascular puncture, hypotension, epidural or intrathecal spread, pleural puncture, or pneumothorax. Recently, a newer technique "midpoint transverse process to pleura" (MTP) block has been described in which the tip of the needle is placed at the midpoint between the transverse process and pleura. In this case series, we included ten patients of American Society of Anesthesiologist status I/II scheduled for MRM. Ultrasound-guided MTP block was performed and the catheter was inserted on the side of the surgery at the level of T4 level. The block was successful in the all patients as their median visual analogue score at rest and movement was 2 and 3, respectively, in first 24 h postoperatively. Only three patients required rescue analgesia in the first 24 h. No procedural-related complications were noticed in any patient. We concluded that MTP block provided effective perioperative analgesia with minimal rescue analgesia requirement and satisfactory safety profile.

Role of melatonin in attenuation of hemodynamic response to intubation and anesthetic requirements: a randomized, controlled, double-blind study

Abstract Background Melatonin has been studied to have anxiolytic, sedative, and analgesic effects. However, there is limited data on the effect of melatonin in the attenuation of hemodynamic response to intubation. We aimed to study whether preanesthetic oral melatonin attenuates hemodynamic responses to intubation and anesthetic requirements. Methods Sixty-four patients scheduled for laparoscopic cholecystectomy were randomized into melatonin or placebo group (n = 32 each). Melatonin group received two tablets (3 mg each) of melatonin, and the placebo group received two tablets of vitamin D3 120 min before induction. Hemodynamic parameters were recorded during induction and postintubation for 15 minutes. Total induction dose of propofol, total intraoperative fentanyl consumption, and adverse effects of melatonin were also noted. Results Postintubation rise in heart rate (HR) was less in the melatonin group compared to the placebo group (10.59% vs. 37.08% at 1 min, respectively) (p< 0.0001). Maximum percentage increase in systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean blood pressure (MBP) was lesser in melatonin group than placebo group (SBP 9.25% vs. 37.73%, DBP 10.58% vs. 35.51%, MBP 9.99% vs. 36.45% at 1 min postintubation. respectively) (p< 0.0001). Induction dose of propofol (1.42 mg.kg-1 vs. 2.01 mg.kg-1) and the number of patients requiring additional fentanyl intraoperatively (3 vs. 11) were also significantly reduced in the melatonin group. Conclusion Premedication with 6 mg of oral melatonin resulted in significant attenuation of postintubation rise in HR, SBP, DBP, and MBP. It also reduced the induction dose of propofol, total intraoperative fentanyl consumption without any adverse effects.

Congenital Melanocytic Nevus with Scrotal Mass: A Diagnostic Dilemma.

Congenital melanocytic nevus is deposition of pigment producing cells of melanocytic lineage in the dermis. We present an extremely rare case of congenital melanocytic nevus with a scrotal mass associated with deposition of melanin in the brain. The mass may mimic like a testicular tumour on clinical presentation.

Effect of dexmedetomidine on attenuation of hemodynamic response to intubation, skin incision, and sternotomy in coronary artery bypass graft patients: A double-blind randomized control trial.

BACKGROUND AND AIMS: Coronary artery bypass grafting (CABG) surgery involves various noxious stimuli resulting in stress response, which in turn increases the risk of perioperative myocardial ischemia. The present study was conducted to evaluate the effect of dexmedetomidine on the attenuation of hemodynamic response to intubation, skin incision, and sternotomy in CABG surgery. MATERIAL AND METHODS: Sixty patients were randomized into two groups of 30 each. Group D patients received dexmedetomidine 1 µg/kg as loading dose over 10 min, followed by continuous infusion of 0.5 µg/kg/h. In group P, normal saline was infused as loading and maintenance dose at similar rate. Hemodynamic parameters, total induction dose of thiopentone, and adverse effects were recorded. Statistical analysis was performed using SPSS version 20.0. Chi-square test and ANNOVA test were used and P < 0.05 was considered significant. RESULTS: The percentage increase in heart rate was significantly lesser in group D than group P after intubation (7.04% v/s 15.08%), skin incision (5.91% v/s 10.11%), and sternotomy (5.33% v/s 11.65%). Similarly increase in systolic, diastolic, and mean blood pressure were significantly lesser in group D than group P after intubation, skin incision, and sternotomy. There was a significant reduction of mean total of thiopentone in group D in comparison to group P. (1.16 mg/kg v/s 2.44 mg/kg) (P<0.001). CONCLUSION: Dexmedetomidine resulted in significant attenuation of hemodynamic response to intubation, skin incision, and sternotomy in CABG surgery without significant adverse effects. It also significantly reduced the dose of thiopentone required for induction.

Comparison of 0.5% Ropivacaine and 0.5% Levobupivacaine for Sciatic Nerve Block Using Labat Approach in Foot and Ankle Surgery.

OBJECTIVE: Compared to ropivacaine, levobupivacaine is more lipophilic and a more potent vasoconstrictor. The study was conducted to compare the effect of 0.5% ropivacaine and 0.5% levobupivacaine in sciatic nerve block using conventional Labat approach in foot and ankle surgery. METHODS: A prospective double-blind, randomised study was carried out in 100 patients of either sex, aged between 20 to 60 years, and American Society of Anesthesiologist (ASA) grades I and II. Patients were randomly allocated into groups R and L of 50 each with 0.5% ropivacaine and 0.5% levobupivacaine, respectively, for sciatic nerve block using the Labat approach. We assessed the onset and duration of sensory and motor block, duration of analgesia, consumption of analgesic, and any untoward effect over 24 hours. RESULTS: Both the groups were comparable with regard to demographic variables and onset of sensory and motor block (p>0.05). Group L compared to group R had significantly longer median (95% confidence interval) duration of sensory block (647.50 min [624.99-674.41] vs. 535 min [524.77-559.83], respectively; p<0.0001) as well as motor block (1065.0 min [1054.5-1068.90] and 945 min [947.13-1013.30], respectively; p<0.0001). Postoperative analgesia also lasted significantly longer in group L compared to group R (1320 min [1273.4-1321.8] vs. 840 min [759.23-812.77]; p<0.0001]). Patients in group L had significantly better visual analogue scale (VAS) score and lesser consumption of analgesics (p<0.0001). None of the groups developed any adverse effect over the observation period. CONCLUSION: Levobupivacaine provides prolonged postoperative analgesia in sciatic nerve block with reduction in postoperative analgesic consumption.

Acquired Tracheo-oesophageal Fistula: A Challenging Complication of Tracheostomy.

Acquired tracheo-oesophageal fistula (TEF) after tracheostomy is a life threatening complication and can occur in about 1% of cases of tracheostomy. Percutaneous tracheostomy was performed in intensive care unit on a 40 years male patient for long-term mechanical ventilation. Subsequently patient developed TEF as the complication of tracheostomy. He was initially managed with endoscopically inserted self expanding plastic stent but later on required surgery for definitive repair. The problems associated with acquired TEF and its management are discussed hereby.

Ruptured intrathoracic cyst during induction of anaesthesia: Anaesthetic challenges.

Congenital benign cysts are among the rare types of mediastinal masses. When symptomatic, complete surgical excision through thoracotomy is the definitive treatment. Rarely they may present with symptoms due to complications like rupture. However, rupture following the induction of general anaesthesia poses unique challenges for anaesthesiologist. We report our experience of a rare variant of intraparenchymal cyst (lung), which was subsequently found to be a bronchogenic cyst.