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Obstetric anaesthesia is emerging as one of the most demanding subspecialities of anaesthesia. Obstetric anaesthesiologists are now an integral part of the multidisciplinary team managing the high-risk obstetrics. It has been recognised that targeted training in obstetric anaesthesia helps to recognise the mothers who need special care and formulate specific plan for delivery. Among the subspecialties of anaesthesia, obstetric anaesthesia has the potential to get established early. Obstetric anaesthesiologists have the prospect of choosing either a team or an independent practice. Group practice with a multidisciplinary team can mitigate some of the constraints and allows professional fulfilment and enough time for personal, family and societal commitments. Obstetric anaesthesia is a well-paid and sought-after speciality, and a dynamic field that demands excellent clinical and interpretative skills in a rapidly changing environment.
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BACKGROUND AND AIMS: Spinal anaesthesia induced hypotension (SAIH) and bradycardia may prove deleterious to both parturient and baby, hence vasopressors play a vital role in their management. Recent studies on norepinephrine as rescue vasopressor during subarachnoid block (SAB) enlighten its role for SAIH. This randomised double-blind trial was conducted to compare the effect of intermittent intravenous boluses of norepinephrine and frequently used mephentermine for management of SAIH in caesarean section (CS) to prove whether norepinephrine produces comparable effects or superior to mephentermine. METHODS: After approval from Institutional Ethics Committee and registration in Clinical Trials Registry India (CTRI/2019/06/019652), 256 parturients posted for elective CS under SAB were randomly allocated into Group-N and Group-M (n = 84) using chit system, who received boluses of intravenous norepinephrine 8µg and mephentermine 6mg for SAIH, respectively. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), Response%, Apgar score and maternal complications were analysed. RESULTS: The changes in SBP and DBP were comparable in both the groups. It was significantly low after SAB compared to baseline and significantly high compared to 1st hypotensive value in both the groups throughout the study period (<0.0001). HR was comparable for initial 10 min, thereafter it was significantly high in Group-M (<0.0001) till 40 min. Response% after the first bolus was significantly high in Group-N (59.30n ± 29.21 vs 39.78 ± 25.6; P = <0.0001). CONCLUSION: Intravenous norepinephrine is better than mephentermine with respect to high response% and stable maternal HR although both are equally effective in maintaining blood pressure following SAIH during elective CS.
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BACKGROUND AND AIMS: There has been a paradigm shift of focus toward quality of spinal anesthesia with sedation being an integral aspect of this regional anesthesia technique. Thus, this study was designed to compare efficacy of intravenous dexmedetomidine and propofol for moderate sedation during spinal anesthesia. MATERIAL AND METHODS: A total of 120 patients of age group 18-60 years of American Society of Anesthesiologists grade I & II, posted for surgeries under spinal anesthesia were randomly divided in to three groups (n = 40 each); Group D received infusion of dexmedetomidine 1 µg/kg over 10 min followed by maintenance infusion of 0.5 µg/kg/h. Group P received infusion of propofol 6 mg/kg/h for 10 min followed by the infusion maintenance of 2.5 mg/kg/h. Group C (control group) received normal saline. Level of sedation (using observer's assessment of alertness/sedation score), pain intensity (by visual analogue scale), onset and recovery from sedation, hemodynamic changes, and overall patient's satisfaction were assessed. RESULTS: The onset and recovery from sedation were significantly earlier with propofol (15.57 ± 1.89 min vs. 27.06 ± 2.26 min; P < 0.001) however intraoperative sedation (level 4), and overall patient's satisfaction was significantly better with dexmedetomidine group (p < 0.05). Duration of postoperative analgesia was significantly prolonged with dexmedetomidine (225.53 ± 5.61 min vs. 139.60 ± 3.03 min; P = 0.0013). Mean heart rate and blood pressure were significantly lower in the propofol group (P < 0.05). CONCLUSION: Dexmedetomidine with its stable cardio-respiratory profile, better sedation, overall patient's satisfaction, and analgesia could be a valuable adjunct for intraoperative sedation during spinal anesthesia.
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AIM: To evaluate the effect of intravenous (IV) clonidine premedication for the bloodless surgical field in patients undergoing middle ear or nasal surgery comparing three different doses. SUBJECTS AND METHODS: This prospective randomized, clinical trial was performed on 90 normotensive patients belonging to American Society of Anesthesiologists grade I/II, aged 18-60 years, of either sex, undergoing routine middle ear or nasal surgery. These patients were divided into three Groups A, B, and C with 30 patients in each according to the dose of IV clonidine used as premedicant that is 3, 4, and 5 µg/kg, respectively. The hypotensive period commenced 10 min after the start of surgery till the surgeon's request for no hypotension required any longer. The target mean blood pressure for producing bloodless surgical field was 60-70 mmHg. During the hypotensive period, the surgeons were asked to rate the bleeding severity score on a six-point scale from 0 (no bleeding) to 5 (severe bleeding). STATISTICAL ANALYSIS USED: ANOVA, Chi-square test, Z-test, standard deviation and P value. RESULTS: IV clonidine premedication in a dose of 4 and 5 µg/kg reduces bleeding and provides a clear field for surgery. It also reduces the requirement of isoflurane, fentanyl, and metoprolol for controlled hypotension. However, clonidine 5 µg/kg was not more effective than clonidine 4 µg/kg in producing these effects rather was associated with some side effects. CONCLUSION: IV clonidine premedication in a dose of 4 µg/kg is safe and effective for producing a bloodless surgical field in the middle ear and nasal surgery.
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BACKGROUND: Various anatomical measurements and non-invasive clinical tests, singly or in various combinations can be performed to predict difficult intubation. Recently introduced "Upper lip bite test" (ULBT) and "Ratio of height to Thyromental distance" (RHTMD) are claimed to have high predictability. We conducted a study to compare the Predictive Value of ULBT and RHTMD with Mouth opening (Inter-Incisor gap) (IIG), Modified Mallampatti Test (MMT), Head and neck movement (HNM) and Thyromental Distance (TMD) for Difficult Laryngoscopy. MATERIALS AND METHODS: In this prospective, single blinded observational study, 480 adult patients of either sex, ASA grade I and II were assessed and graded for ULBT, RHTMD, TMD, MMT, IIG, and HNM according to standard methods and correlated with the Cormack and Lehane grade. RESULTS: ULBT and RHTMD had highest sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio, i.e., 74.63%, 91.53%, 58.82%, 95.7%, 31.765 and 71.64%, 92.01%, 59.26%, 95.24%, 8.96 respectively, compared to TMD, MMT, IIG and HNM. CONCLUSIONS: ULBT is the best predictive test for difficult laryngoscopy in apparently normal patients but RHTMD can also be used as an acceptable alternative.
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Modified electroconvulsive therapy (ECT) is a safe and most effective treatment modality for major depressive disorders with suicidal tendencies. For this, one must have an ideal intravenous anaesthetic agent for induction which provides rapid onset, short duration of action, attenuates adverse physiological effect of ECT, rapid recovery without adverse shortening of seizure duration and minimum rise in serum potassium. The studies in search of an ideal intravenous anaesthetic agent are limited. Aim is to compare the effect of iv thiopentone, propofol and midazolam on induction time and quality, haemodynamics, Seizure duration, recovery time and changes in serum potassium level. 90 patients of ASA I and II of either sex having major depressive illness were randomly allocated into three groups (n = 30) based on iv induction agent used. Group I, Group II and Group III patients were induced with iv thiopentone 5 mg/kg, propofol 2 mg/kg and midazolam 0.2 mg/kg, respectively. The induction time, quality of induction, haemodynamic changes, seizure duration, recovery time and change in serum potassium level were measured and analyzed by Z test. Induction was quicker in propofol group i.e., 41.03 ± 6.11 sec than in thiopentone (50.6 ± 6.32 sec) and midazolam group (77.30 ± 6.67 sec). Seizure duration was significantly shorter in midazolam group compared to propofol and thiopentone groups. Though significant rise in HR, SBP DBP was observed in all the three groups following ECT, but rise was significantly higher in thiopentone group compared to other two groups. Significantly, faster recovery was observed with propofol. Rise in serum potassium after ECT was not significant in any of the groups. Propofol is a safe and suitable intravenous anaesthetic agent for induction of anaesthesia for modified ECT.
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The laryngeal mask airway (LMA) is a supraglottic airway management device. The LMA is preferred for airway management in paediatric patients for short duration surgical procedures. The recently introduced ProSeal (PLMA), a modification of Classic LMA, has a gastric drainage tube placed lateral to main airway tube which allows the regurgitated gastric contents to bypass the glottis and prevents the pulmonary aspiration. This study was done to compare the efficacy of ProSeal LMA with an endotracheal tube in paediatric patients with respect to number of attempts for placement of devices, haemodynamic responses and perioperative respiratory complications. Sixty children, ASA I and II, weighing 10-20 kg between 2 and 8 years of age group of either sex undergoing elective ophthalmological and lower abdominal surgeries of 30-60 min duration, randomly divided into two groups of 30 patients each were studied. The number of attempts for endotracheal intubation was less than the placement of PLMA. Haemodynamic responses were significantly higher (P<0.05) after endotracheal intubation as compared to the placement of PLMA. There were no significant differences in mean SpO(2) (%) and EtCO(2) levels recorded at different time intervals between the two groups. The incidence of post-operative respiratory complications cough and bronchospasm was higher after extubation than after removal of PLMA. The incidence of soft tissue trauma was noted to be higher for PLMA after its removal. There were no incidences of aspiration and hoarseness/sore throat in either group. It is concluded that ProSeal LMA can be safely considered as a suitable and effective alternative to endotracheal intubation in paediatric patients for short duration surgical procedures.