Dexmedetomidine for reducing succinylcholine-induced myalgia in patients undergoing electroconvulsive therapy: A randomised controlled trial.

Background and Aim: Electroconvulsive therapy (ECT) is an effective intervention for psychiatric patients. Succinylcholine is considered the drug of choice for muscle relaxation for ECT. Significant adverse effects of succinylcholine include fasciculation and myalgia. Dexmedetomidine is a highly selective α-2 adrenergic agonist. This study aims to determine the efficacy of a low dose of dexmedetomidine in reducing succinylcholine-induced myalgia in patients receiving ECT. Methods: This randomised controlled trial was conducted on 100 patients, aged 18-65 years, undergoing ECT, who were randomly allocated into two groups with an allocation ratio of 1:1. Group D received intravenous (IV) dexmedetomidine 0.25 µg/kg, and Group C received IV normal saline (0.9%). Patients' self-reported myalgia scores were measured after 60 min of the procedure. Fasciculations were noted after IV succinylcholine administration. Heart rate (HR) and mean blood pressure (MBP) were measured at baseline, after infusion (5 min) and after ECT (0, 2.5, 5, 10, 15, 30 min). Continuous data were analysed using a Student's t-test for two-group comparisons, a mixed model analysis of variance for group comparisons and various time point analyses. Categorical data were analysed using the Chi-square/Fisher's exact test. Results: There were no differences between the groups regarding demographics. Myalgia and fasciculations were less in Group D than in Group C (P < 0.001). MBP and HR changes were comparable (P > 0.05). Conclusion: A low dose of dexmedetomidine (0.25 µg/kg) effectively reduces myalgia and fasciculations due to succinylcholine in patients undergoing electroconvulsive therapy.

Airway Management of Type-III Arnold Chiari Malformation: An Anaesthetic Challenge.

Arnold Chiari malformation (ACM) is defined as protrusion of the meninges and brain components into a congenital defect in the cranium or in the vertebral column. It was originally described by Austrian pathologist Hans Chiari. Among the four types, type-III ACM is the rarest and may associate with encephalocele. We report a case of type-III ACM associated with large occipitomeningoencephalocele with herniation of dysmorphic cerebellum, vermis, kinking/herniation of medulla with cerebrospinal fluid, tethering of spinal cord with posterior arch defect of C1-C3 vertebrae. The anaesthetic challenge for such patients lies in the proper preoperative work up; proper positioning of the patient during intubation; safe anaesthetic induction; intraoperative management of intracranial pressure, normothermia, and fluid and blood loss; and postoperative planning of extubation to prevent aspiration are the prerequisites to overcome the dificult airway management and anaesthetic challenge in the management of type III ACM.

Comparison between Intravenous Dexmedetomidine and Spray as you Go with 4% Lignocaine Versus Intravenous Fentanyl and Transtracheal Injection of 4% Lignocaine for Awake Nasotracheal Intubation with Flexible Vedioscope - A Randomized Single-Blind Prospective Study.

Background: Awake fiber-optic bronchoscopy-guided intubation is the method of choice in difficult airway which requires effective airway anesthesia to ensure patient comfort and acceptance. Aims: This study was conducted to assess the quality of airway anesthesia, patient comfort during intubation, and postoperative satisfaction of patients. Settings: Patients posted for surgeries under general anesthesia with Mallampati Grade I and II in a medical college. Patients were followed in the operation theater and postoperative ward. Study Design: This was a prospective randomized single-blind study. Materials and Methods: Group D received intravenous (i.v.) dexmedetomidine 1 µg.kg-1 i.v. over 10 min and 3 ml of 4% lignocaine spray as you go (SAYGo). Group F received i.v. fentanyl 2 µg.kg-1 over 10 min and transtracheal injection 3 ml of 4% lignocaine. Parameters assessed were endoscopic time, intubating condition, vocal cord position, cough severity, comfort during intubation, postoperative patient satisfaction, and any adverse effects such as sore throat, hoarseness, unpleasant memories, and hemodynamic response during intubation. Statistical Analysis: Independent Student's t-test, Mann-Whitney, Chi-squared test, or Fisher's exact test were used. P ≤ 0.05 was considered statistically significant. Results: Intubating conditions, vocal cord position, cough severity, comfort during intubation, and postoperative patient satisfaction were statistically significant (P ≤ 0.05) in favor of Group D though endoscopic time was longer. Conclusion: IV dexmedetomidine with SAYGo is effective than IV fentanyl with transtracheal block for awake fiber-optic videoscopic intubation in terms of intubating conditions, vocal cord position, cough severity, comfort during intubation, and postoperative satisfaction of patients with significant attenuation of postintubation hemodynamic response and better preservation of respiration though endoscopic time is more.