RESUMO
BACKGROUND: Subarachnoid blockade can be used in all surgical procedures carried out on the infraumbilical region. This study was aimed to evaluate the clinical efficacy and safety of intrathecal fentanyl as an adjuvant to 0.75% isobaric ropivacaine on onset, duration, intensity, and recovery time of sensory and motor blockade of subarachnoid block for infra umbilical surgery. METHODS: One hundred sixty adult consented patients of either gender with American Society of Anesthesiologist ASA I and II scheduled for infraumbilical surgery were randomized into two groups of 80 patients each to receive either intrathecal study solution of 4 mL of 0.75% ropivacaine with 0.4 mL of 0.9% sodium chloride (Group I-Ropivacaine Control Group RC) or fentanyl (20 µg) (Group II-Ropivacaine with Fentanyl RF). The end points were hemodynamic variability, onset of analgesia at T 10, maximum sensory analgesic level, time to complete motor blockade, duration of sensory and motor blockade and adequacy of surgical anesthesia. The post-spinal nausea and vomiting, shivering, pruritus, respiratory depression or any other side-effects were also assessed. At the end of study, data were systematically complied and analyzed for statistically significance. RESULT: The intrathecal fentanyl has accelerated the onset time to achieve sensory blockade to T10 dermatome and motor blockade. Small dose of intrathecal fentanyl with ropivacaine has prolonged the duration of analgesia in the early post-operative period when compared with intrathecal ropivacaine alone. The intraoperative hemodynamic variability showed no statistically significant differences between groups. CONCLUSION: Intrathecal fentanyl as an adjuvant to 0.75% isobaric ropivacaine demonstrated better clinical profile as compared to ropivacaine alone.
RESUMO
BACKGROUND: Intravenous dexmedetomidine is used as adjuvant during general anesthesia due to its sedative and analgesic effects. The present study was aimed to evaluate the effects of intravenous dexmedetomidine on sensory and motor block characteristics, hemodynamic parameters and sedation during subarachnoid block. MATERIALS AND METHODS: In this double-blind randomized placebo control study, 60 patients of American Society of Anesthesiologist I and II were randomized into two groups by computer generated table. Patients of Group D administered intravenous dexmedetomidine 0.5 µg/kg and patients of Group C received similar volume of normal saline, administered after 20 min of subarachnoid block with 0.5% hyperbaric bupivacaine. The cephalic level of sensory block, total duration of sensory analgesia and motor block were recorded. Sedation scores using Ramsey Sedation Score (RSS) and hemodynamic changes were also assessed. RESULTS: Demographic profile, duration of surgery and cephalic level of sensory block were comparable. The time for two segments regression was 142.35 ± 30.7 min in Group D, longer than Group C (98.54 ± 23.2 min). Duration of sensory blockade was 259.7 ± 46.8 min in the Group D versus 216.4 ± 31.4 min in Group C (P < 0.001). The mean duration of motor blockade showed no statistically significant difference between groups. There was clinically significant decrease in heart rate and blood pressure in patients of Group D. The RSS was higher (arousable sedation) in patients of Group D. No respiratory depression was observed. CONCLUSION: Intravenous dexmedetomidine in dosage of 0.5 µg/kg, administered after 20 min of subarachnoid block prolonged the duration of sensory and motor blockade with arousable sedation.
RESUMO
The management of ADHD poses a great problem before the psychologists, psychiatrists and different behavioural scientists. The multi-model approach, combining pharmacologic with different non-pharmacologic interventions, is more effective than any form of therapy. In the present study the theta feedback, a non-pharmacologic technique, has shown beneficial role among the low medicated ADHD cases. The present study also signifies the role of multi-model intervention in the management of ADHD.