Comparative Study of Efficacy of Buprenorphine and Fentanyl on Attenuation of Hemodynamic Changes to Laryngoscopy and Intubation: A Prospective, Randomized Double-Blind Study.

BACKGROUND: Hemodynamic changes are the most common predicted response after laryngoscopy and intubation during general anesthesia. We compared the efficacy of buprenorphine with fentanyl to attenuate this stress response. METHODS: One hundred and thirty patients of either sex between the age group of 18-70 years, admitted for the routine surgical procedure under general anesthesia were enrolled in this double blind, randomized, clinical study. Patients were randomly assigned into two equal groups (60 patients in each group): group F received fentanyl 2 µg/kg, and group B received buprenorphine 2.5 µg/kg; both via intravenous route. Each group received a total volume of 10 mL by adding normal saline to the total drug volume, given over 60 seconds, 5 minutes before intubation. Thereafter patients were induced using routine balanced anesthesia technique, and the hemodynamic parameters were observed at baseline (0 minute), 1, 3, and 5 minutes after the administration of the study drug and again at 1, 3, 5, 7, and 10 minutes after intubation. Continuous variables were presented as mean with an 80% confidence interval, and a t-test was applied for comparing the difference of means between two groups after we checked the normality condition. Chi-square test was applied to test the independence of attributes of categorical variables. Repeated measures two-way analysis of variance was performed to compare the outcome variables between the two groups. RESULTS: In both groups, mean arterial blood pressure (MAP) and heart rate (HR) were statistically insignificant up to 5 minutes after study drug, thereafter mean HR and MAP at 1, 3, 5, 7, and 10 minutes after intubation, were statistically significant between the two groups, and P value was less than 0.05. CONCLUSIONS: The dose of 2.5 µg/kg buprenorphine is an effective alternative to fentanyl 2 µg/kg for attenuating the hemodynamic response accompanying laryngoscopy and tracheal intubation without causing any hemodynamic adverse effect.

Comparisons of single-injection thoracic paravertebral block with ropivacaine and bupivacaine in breast cancer surgery: A prospective, randomized, double-blinded study.

BACKGROUND: Regional anesthesia using paravertebral block has been suggested as an ideal adjunct to general anesthesia for modified radical mastectomy. Paravertebral block is an effective management of peri-operative pain for Modified radical mastectomy, however, there are no established guidelines regarding what is the most suitable strategy when varying drugs and dosages between different groups. AIM: To evaluate the effectiveness of paravertebral block comparing the most frequently employed drugs in this procedure (bupivacaine vs ropivacaine). STUDY DESIGN: Prospective randomized double blind study. METHODS: A total 70 ASA I and II adult female patients undergoing Modified radical mastectomy under paravertebral block followed by general anesthesia were randomly divided into two groups. The first group was administered 0.375% Ropivacaine in a dose 0.25 ml /kg in paravertebral block. The second group was administered bupivacaine 0.375% in dose 0.25 ml /kg in paravertebral block. Standard induction technique followed. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), were recorded pre block, post block 5 min, post block 10 min, at skin incision, post skin incision initially at 5 interval for first 15 min till one hour, and every 30 min till end of surgery. Post-operative visual analogue score for pain was recorded at 1 hr, 6 hr and 24 hr. STATISTICAL ANALYSIS: Chi-square test (Fisher's exact test) for qualitative variables. Independent sample t-test for quantitative data. RESULTS: Ropivacaine and Bupivacaine had no difference in intraoperative analgesia as shown by intraoperative hemodynamic parameters. Bupivacaine got better post-operative VAS scores (P < 0.05) in mean and after first, 6 h and 24 h.

Anesthetic considerations in a patient with visceral leishmaniasis.

PURPOSE: To describe the anesthetic problems in a patient with visceral leishmaniasis undergoing general anesthesia. CLINICAL FEATURES: A 17-yr-old man with visceral leishmaniasis was booked for emergency appendectomy. He received parentral sodium stibogluconate 600 mg per day. The patient was pale, afebrile and had hepatosplenomegaly. Preoperative investigations showed a hemoglobin of 6.2 g.dL(-1), platelet count of 80 x 10(9).L(-1) and serum albumin of 2.1 g.dL(-1). The electrocardiogram and chest x-ray were normal. Anesthesia was induced with 100 microg fentanyl and 50 mg propofol iv and tracheal intubation was facilitated with 3 mg vecuronium iv. Maintenance of anesthesia was done with intermittent positive pressure ventilation using 50% nitrous oxide and 0.4% isoflurane in oxygen. Reversal of neuromuscular blockade was achieved with 1.0 mg neostigmine and 0.2 mg atropine iv. 50 mg tramadol iv every six hours was used for postoperative analgesia. The perioperative course was uneventful. CONCLUSION: Patients with visceral leishmaniasis have problems unique to them that may influence the anesthetic management. Of particular concern to an anesthesiologist are the presence of hematological abnormalities (anemia, leukopenia, thrombocytopenia), and hypoalbuminic malnutrition. The combination of low hemoglobin and thrombocytopenia may necessitate blood component therapy perioperatively. Drugs affecting coagulation should be used judiciously. Hypoalbuminemia may adversely affect the pharmacokinetics of agents that are highly protein bound. The anesthetic management in a patient with visceral leishmaniasis may be further complicated by the presence of coexisting infections like pneumonia and tuberculosis. Leishmaniasis is a recognized complication of infection with human immunodeficiency virus.

Prostate specific antigen as tumor marker: relationship with histologic grading.

PSA is emerging as the best marker in oncology and had a profound impact on all aspects of prostate cancer care. From clinically suspected prostate tumor, 395 serum samples were taken out and estimated for serum PSA. Among elevated serum PSA, 98 were correlated with histologic findings. 42(42.8%) cases were BHP among 98 cases and 78.7% had serum PSA level within 10 ng/ml. 5 patients (5.1%) had PIN histologically, 3(60%) of which had PSA level upto 10 ng/ml and 2(40%) had serum PSA upto 20 ng/ml. 51(52%) were adenocarcinoma prostate of different grades and PSA level varies from less than 10 ng/ml to more than 50 ng/ml which almost correlates with the tumor grades.