ABSTRACT
Background: Many prior studies have utilized thoracic or lumbar spinal anesthesia with isobaric/hyperbaric bupivacaine or Ropivacaine and opioids for laparoscopic cholecystectomy and have reported variable results. our study is centered around addressing the occurrence of intraoperative right shoulder pain and its potential impact on the need for conversion to general anesthesia.Methods: This is a prospective comparative case series study in which 70 patients scheduled for elective laparoscopic cholecystectomy were. Patients in Group R received 1 ml (1 mg) of Hypobaric Ropivacaine 0.1% at T10-11 followed by 25 mcg fentanyl, and 5 mg Isobaric Ropivacaine 0.5% whereas patients in Group B received 1.5 ml (7.5 mg) Isobaric levo Bupivacaine 0.5% and 25 mcg fentanyl at T8-T10. Patients in both the groups were compared for incidence of shoulder tip pain and Hemodynamic stability.Results: Both techniques achieved satisfactory anaesthesia quality, with similar results in surgical anaesthesia onset. Average surgical duration was 45-75 minutes with average of 60 mins with longer durations in two cases common to both the groups. In group R there was there was no bradycardia or hypotension recorded more than 10% of preinduction vitals. Whereas in group B 2 patients had bradycardia and hypotension more than 10% of preinduction vitals. Conclusions: The T10-11 technique using low-dose (6 mg) hypobaric ropivacaine and isobaric Ropivacaine appears to be superior in terms of shoulder tip pain, and hemodynamic stability compared to the T8-T10 technique using isobaric levo-Bupivacaine alone in higher dose.
ABSTRACT
Background: The number and variety of procedures done onday care basis has rapidly increased in recent past. For daycare anaesthesia, the use of anaesthetics that provide fast andsmooth induction, allow quick changes in depth whilemaintaining anaesthesia, early recovery and less postoperative nausea and vomiting are recommended. The aim ofthis study to compared the haemodynamic characteristics ofsevoflurane and desflurane anaesthesia and Fast track criteriaof recovery after ambulatory surgery.Materials & Methods: A double blind randomized study in theDepartment of Anaesthesiology and Intensive Care Unit atGovt. Medical College, Amritsar. 100 patients of AmericanSociety of Anaesthesiologist grade I or II in the age group of 20to 50 years undergoing short surgical procedure under generalanaesthesia were included. Continuous monitoring of vitalswas started after attaching Multipara monitor. In first 15minutes of intra-operative period monitoring of BP, HR, SPO2and ECG pattern were done every 5 minutes after that timeinterval was changed to 10 minutes till completion of surgery.After completion of surgery emergence time was noted. Inrecovery room assessment of variables required for fast trackscoring system were recorded after every 5 minutes. All theresults were be compiled, analyzed statistically and theappropriate test was applied and the blinding of the study wasopened at the end.Results: Our study showed that the mean age of patients inboth the groups was found to be statistically insignificant(p>0.05). The mean duration of surgery in both the groups wasfound to be statistically insignificant (p>0.05). The fast trackscore in group S and D at different time interval wasstatistically insignificant (p>0.05) and the maximum number ofpatients achieving PADDS score between 60-120 minutes.83% patients were ready to go home at 120 minutes.Conclusion: We concluded that both the inhalationalanaesthetics i.e. sevoflurane and desflurane provide similarhaemodynamic stability, but desflurane is associated withfaster emergence as compared to sevoflurane.