RESUMO
BACKGROUND: Intrathecal neostigmine and magnesium sulfate (MgSO4) produce substantial antinociception, potentiate analgesia of bupivacaine without neurotoxicity. AIMS: The aim was to investigate the effect of neostigmine and MgSO4 on characteristics of spinal anesthesia (SA), hemodynamic stability and postoperative analgesia when added to 0.5% hyperbaric bupivacaine for SA. SUBJECTS AND METHODS: In this prospective, randomized, double-blind study 75 American Society of Anesthesiologist status I and II adult females posted for major gynecological surgery were assigned to one of the three groups (n = 25). Group N received Neostigmine 25 µg, Group M received MgSO4 50 mg, Group C received 0.5 ml saline as an adjuvant to 17.5 mg hyperbaric bupivacaine. Onset, duration of block, heart rate, mean arterial pressure, postoperative analgesia, analgesic requirement, and adverse effects were recorded. Data expressed as mean (standard deviation) or number (%). P <0.05 were statistically significant. RESULTS: The three groups were comparable in characteristics of SA. The mean duration of analgesia was significantly longer in Group N (5.1 h) followed by Group M (4.2 h) and Group C (3.8 h) (P = 0.0134). Analgesic requirement was significantly less in Group N followed by Group M and Group C (P = 0.00232). The pain score was significantly less in Group M (P < 0.05). The incidence of hypotension and vasopressor requirement was lowest (48%) in Group N than in Group M (64%) and Group C 84% (P = 0.0276). The incidence of bradycardia and atropine requirement was the lowest in Group M (P = 0.0354). Sedation was observed in 56% patients in Group M compared to 20% in Group N and 8% in Group C (P = 0.0004). CONCLUSION: Intrathecal Neostigmine and MgSo4 does not affect characteristics of SA. Postoperative analgesia of neostigmine was better than MgSO4. Neostigmine provides some protection against hypotension of SA whereas MgSO4 protects against bradycardia.
RESUMO
Patients undergoing surgery are having high levels of anxiety and stress. Though not life threatening it adds an unnecessary financial burden to the hospital. We assessed the anxiolytic effects of oral propranolol 20 mg and 40 mg when given as premedication. This is a double blind, randomised, prospective clinical study involving 60 healthy patients (ASA I and II) undergoing minor elective surgery. Subjects in control group without any anxiolytic premedication (group I, n = 20) were compared with those receiving oral propranolol 20 mg (group II, n = 20) or 40 mg (group III, n = 20) with sips of water 2-hour prior to surgery. Anxiety level was assessed using 4-point anxiolysis score (1--tearful, 2--anxious but easily reassured, 3--calm, 4--asleep) in the holding area, after entering operating room, immediate postoperative and 2 hours after surgery. Fluctuation in pulse rate and BP was recorded. Statistical data was analysed using one-way ANOVA with posthoc test.Value of p < 0.05 was taken as significant. Twenty subjects in each group were required as calculated from reference study with difference of up to 30%, type I error of 0.5 and power of 80%. Anxiolysis score in operating room (group I--1.40 +/- 0.48, group II--1.95 +/- 0.58, group III--1.90 +/- 0.53) and immediate postoperative period (group I--1.25 +/- 0.43, group II--1.90 +0.53, group III--2.10 +/- 0.29) were significantly improved (p < 0.05) in groups II and III compared with control group. Variations in systolic BP and pulse rate were less in test groups (p < 0.05). No statistically significant difference was found after Intergroup comparison of test groups. Bradycardia (25%) and hypotension (10%) were more with 40 mg propranolol. Both 20 mg and 40 mg doses of propranolol are effective for pre-operative anxiolysis but 20 mg dose gives significant reduction in anxiety with minimal side-effects. Thus 20 mg propranolol premedication for reducing peri-operative anxiety and for cardiovascular stability is recommended.
