Comparative Evaluation of Volatile Anaesthetic Agents for Attenuation of Venous Cannulation Pain: A Prospective, Randomized Controlled Study.

INTRODUCTION: Topical application of volatile anaesthetic agents has been found to attenuate the response to a mechanical stimulus; however, this effect of volatile anaesthetic on perception of pain during venous cannulation is not known. AIM: To compare the efficacy of topically administered volatile anaesthetic agents for attenuating venous cannulation pain. MATERIALS AND METHODS: This prospective, randomized, placebo controlled and double blind study was conducted on 120 patients, aged 20-60years. They were of American Society of Anaesthesiologists (ASA) I or II physical status, of either sex, planned for elective surgeries. These patients were randomized into 4 groups, of 30 each. Equipotent doses of halothane (1ml), isoflurane (1.5ml), sevoflurane (2.7ml) and sterile water (2.5ml; Control) were topically administered on the volar surface of forearm wrapped with cotton and aluminium foil; venous cannulation was performed with 18G intravenous cannula after 30 min. These patients were assessed for the incidence and severity of pain upon venous cannulation {visual analog scale (VAS), 0-100mm; 0 = no pain and 100 = worst imaginable pain}. Data were analysed by one-way ANOVA, Chi-square test and Kruskal-Wallis test. The p<0.05 was considered as significant. RESULTS: A significant reduction in the incidence of venous cannulation pain was observed in the halothane (79%) group as compared to control (100%; p<0.05), isoflurane (100%; p<0.05) and sevoflurane (100%; p<0.05) groups. The severity of venous cannulation pain as assessed by median (interquartile range, Q1-Q3). VAS scores was reduced in the halothane {10 (10-20); p<0.001}, isoflurane {20 (10-30); p<0.001} and sevoflurane {20 (20-30); p<0.001} groups as compared to the control group {40 (30-40)}; VAS score in the halothane group was significantly less as compared to isoflurane (p<0.05) and sevoflurane (p<0.05) groups. CONCLUSION: Topical application of halothane is most effective in reducing incidence and severity of venous cannulation pain; however, topical application of isoflurane and sevoflurane decreases only the severity of venous cannulation pain.

Evaluation of the efficacy of solifenacin and darifenacin for prevention of catheter-related bladder discomfort: a prospective, randomized, placebo-controlled, double-blind study.

BACKGROUND: Urinary catheterization during surgical interventions causes postoperative catheter-related bladder discomfort (CRBD). Antimuscarinic agents are the mainstay of treatment for overactive bladder (OAB). As the symptoms of CRBD mimic to OAB, so we designed this study to assess the efficacy of solifenacin and darifenacin for prevention of CRBD. METHODS: Ninety patients of either sex undergoing elective spine surgery and requiring urinary catheterization were randomly assigned into three groups to receive oral solifenacin 5 mg (Group S), darifenacin 7.5 mg (Group D) and placebo (Group C) 1 hour prior to induction of anesthesia. Anesthesia technique was identical in all the groups. Catheter-related bladder discomfort (CRBD) was evaluated in 4-point scale (1 = no discomfort, 2 = mild discomfort, 3 = moderate discomfort, 4 = severe discomfort), on arrival (0 hour) and at 1, 2, and 6 hours postoperatively. Patients were provided patient-controlled analgesia with fentanyl for postoperative pain relief. RESULTS: There were no significant differences in demographic profile and fentanyl requirements (P>0.05). The prevalence and severity of CRBD were significantly less in the group D and group S compared with the group C at all time intervals (P<0.05). CONCLUSIONS: Pretreatment with oral solifenacin or darifenacin reduces catheter-related bladder discomfort with no clinically relevant significant side effects.

An evaluation of the efficacy of solifenacin and darifenacin for prevention of catheter related bladder discomfort: a prospective, randomized, placebo controlled, double blind study.

BACKGROUND: Urinary catheterization during surgical interventions causes postoperative catheter related bladder discomfort (CRBD). Antimuscarinic agents are the mainstay of treatment for overactive bladder (OAB). As the symptoms of CRBD mimic to OAB, so we designed this study to assess the efficacy of solifenacin and darifenacin for prevention of CRBD. METHODS: Ninety patients of either sex undergoing elective spine surgery and requiring urinary catheterization were randomly assigned into three groups to receive oral solifenacin 5 mg (Group S), darifenacin 7.5 mg (Group D) and placebo (Group C) 1 hour prior to induction of anesthesia. Anesthesia technique was identical in all the groups. Catheter related bladder discomfort (CRBD) was evaluated in 4-point scale (1 = no discomfort, 2 = mild, 3 = moderate, 4 = severe), on arrival (0 hour) and at 1, 2, and 6 hours postoperatively. Patients were provided patient-controlled analgesia with fentanyl for postoperative pain relief. RESULTS: There were no significant differences in demographic profile and fentanyl requirements (P >0.05). The prevalence and severity of CRBD were significantly less in the group D and group S compared with the group C at all time intervals (P <0.05). CONCLUSION: Pretreatment with oral solifenacin or darifenacin reduces catheter-related bladder discomfort with no clinically relevant significant side effects.

Comparative Evaluation of Dexmedetomidine and Magnesium Sulphate on Propofol Consumption, Haemodynamics and Postoperative Recovery in Spine Surgery: A Prospective, Randomized, Placebo Controlled, Double-blind Study.

PURPOSE: Dexmedetomidine and magnesium sulfate have been used in anesthesia as adjuvant to provide hemodynamic stability and anesthetic agents sparing effect. We compared these effects of dexmedetomidine and magnesium sulfate in spine surgeries. METHODS: Ninety patients were randomly assigned to three groups. Group D received dexmedetomidine loading dose 1 µg/kg over a period of 15 minutes and maintenance 0.5 µg/kg/h throughout the surgery. Group M received magnesium sulfate loading dose 50 mg/kg over a period of 15 minutes and maintenance 15 mg/kg/h throughout the surgery. Group C received same volume of normal saline. Heart rate (HR) and blood pressure values were recorded at various intervals. The induction and maintenance doses of anesthetics and recovery parameters were also recorded. RESULTS: Heart rate in group D and group M were significantly decreased (p<0.05) during the whole intraoperative period compared to preoperative values. There was a significant difference in HR values between group C, D and M, during the whole intraoperaive period (p<0.05). Blood pressure values were statistically significantly lower in the group D and group M compared to group C after intubation and all time observations of surgery (p<0.05). Both drugs reduced the anesthetic agent's requirement during surgery. However, the recovery parameters were statistically significant increase with magnesium sulphate compared to dexmedetomidine and control groups. CONCLUSION: Dexmedetomidine is more effective than magnesium sulfate for maintaining the hemodynamic stability in spine surgeries. Both these drugs also reduce the requirements of anesthetic agents. Recovery from dexmedetomidine is as rapid as control group compared to magnesium sulfate.

Prophylactic use of pregabalin for prevention of succinylcholine-induced fasciculation and myalgia: a randomized, double-blinded, placebo-controlled study / Uso profilático de pregabalina para prevenção de mialgia e fasciculação induzidas por succinilcolina: estudo randômico, duplo-cego e controlado por placebo

ABSTRACT BACKGROUND: Succinylcholine is commonly used to achieve profound neuromuscular blockade of rapid onset and short duration. OBJECTIVE: The present study compared the efficacy of pregabalin for prevention of succinylcholine-induced fasciculation and myalgia. DESIGN: Prospective, randomized, placebo controlled, double blinded study. MATERIALS AND METHODS: Patients of both genders undergoing elective spine surgery were randomly assigned to two groups. Patients in Group P (pregabalin group) received 150 mg of pregabalin orally 1 h prior to induction of anesthesia with sips of water and patients in Group C (control group) received placebo. Anesthesia was induced with fentanyl 1.5 mcg/kg, propofol 1.5-2.0 mg/kg followed by succinylcholine 1.5 mg/kg. The intensity of fasciculations was assessed by an observer blinded to the group allotment of the patient on a 4-point scale. A blinded observer recorded postoperative myalgia grade after 24 h of surgery. Patients were provided patient-controlled analgesia with fentanyl for postoperative pain relief. RESULTS: Demographic data of both groups were comparable (p > 0.05). The incidence of muscle fasciculation's was not significant between two groups (p = 0.707), while more patients in group C had moderate to severe fasciculation's compared to group P (p = 0.028). The incidence and severity of myalgia were significantly lower in group P (p < 0.05). CONCLUSION: Pregabalin 150 mg prevents succinylcholine-induced fasciculations and myalgia and also decreases the fentanyl consumption in elective sine surgery.

RESUMO JUSTIFICATIVA: A succinilcolina é comumente usada para atingir um bloqueio neuromuscular profundo, de início rápido e de curta duração. OBJETIVO: Comparar a eficácia de pregabalina na prevenção de mialgia e fasciculação induzidas por succinilcolina. DESENHO: Estudo prospectivo, randômico, duplo-cego e controlado por placebo. MATERIAIS E MÉTODOS: Pacientes de ambos os sexos submetidos a cirurgia eletiva de coluna foram aleatoriamente divididos em dois grupos. Os pacientes do Grupo P (pregabalina) receberam 150 mg de pregabalina oral uma hora antes da indução da anestesia e os pacientes do Grupo C (controle) receberam placebo. A anestesia foi induzida com fentanil (1,5 mcg/kg) e propofol (1,5-2,0 mg/kg), seguidos de succinilcolina 1,5 mg/kg. A intensidade da fasciculação foi avaliada por um observador, cego para a alocação dos grupos, com uma escala de 4 pontos. Um observador cego registrou o grau pós-operatório de mialgia após 24 horas de cirurgia. Para o alívio da dor no pós-operatório, fentanil foi usado em sistema de analgesia controlada pelo paciente. RESULTADOS: Os dados demográficos de ambos os grupos eram comparáveis (p > 0,05). A incidência de fasciculação muscular não foi significativa entre os dois grupos (p = 0,707), enquanto mais pacientes do Grupo C apresentaram fasciculação de moderada a grave em relação ao Grupo P (p = 0,028). A incidência e a gravidade da mialgia foram significativamente menores no grupo P (p < 0,05). CONCLUSÃO: Pregabalina (150 mg) previne mialgia e fasciculação induzidas por succinilcolina, além de diminur o consumo de fentanil em cirurgia eletiva de coluna.

Prophylactic use of pregabalin for prevention of succinylcholine-induced fasciculation and myalgia: a randomized, double-blinded, placebo-controlled study.

BACKGROUND: Succinylcholine is commonly used to achieve profound neuromuscular blockade of rapid onset and short duration. OBJECTIVE: The present study compared the efficacy of pregabalin for prevention of succinylcholine-induced fasciculation and myalgia. DESIGN: Prospective, randomized, placebo controlled, double blinded study. MATERIALS AND METHODS: Patients of both genders undergoing elective spine surgery were randomly assigned to two groups. Patients in Group P (pregabalin group) received 150mg of pregabalin orally 1h prior to induction of anesthesia with sips of water and patients in Group C (control group) received placebo. Anesthesia was induced with fentanyl 1.5mcg/kg, propofol 1.5-2.0mg/kg followed by succinylcholine 1.5mg/kg. The intensity of fasciculations was assessed by an observer blinded to the group allotment of the patient on a 4-point scale. A blinded observer recorded postoperative myalgia grade after 24h of surgery. Patients were provided patient-controlled analgesia with fentanyl for postoperative pain relief. RESULTS: Demographic data of both groups were comparable (p>0.05). The incidence of muscle fasciculation's was not significant between two groups (p=0.707), while more patients in group C had moderate to severe fasciculation's compared to group P (p=0.028). The incidence and severity of myalgia were significantly lower in group P (p<0.05). CONCLUSION: Pregabalin 150mg prevents succinylcholine-induced fasciculations and myalgia and also decreases the fentanyl consumption in elective sine surgery.

[Prophylactic use of pregabalin for prevention of succinylcholine-induced fasciculation and myalgia: a randomized, double-blinded, placebo-controlled study]. / Uso profilático de pregabalina para prevenção de mialgia e fasciculação induzidas por succinilcolina: estudo randômico, duplo-cego e controlado por placebo.

BACKGROUND: Succinylcholine is commonly used to achieve profound neuromuscular blockade of rapid onset and short duration. OBJECTIVE: The present study compared the efficacy of pregabalin for prevention of succinylcholine-induced fasciculation and myalgia. DESIGN: Prospective, randomized, placebo controlled, double blinded study. MATERIALS AND METHODS: Patients of both genders undergoing elective spine surgery were randomly assigned to two groups. Patients in Group P (pregabalin group) received 150mg of pregabalin orally 1h prior to induction of anesthesia with sips of water and patients in Group C (control group) received placebo. Anesthesia was induced with fentanyl 1.5mcg/kg, propofol 1.5-2.0mg/kg followed by succinylcholine 1.5mg/kg. The intensity of fasciculations was assessed by an observer blinded to the group allotment of the patient on a 4-point scale. A blinded observer recorded postoperative myalgia grade after 24h of surgery. Patients were provided patient-controlled analgesia with fentanyl for postoperative pain relief. RESULTS: Demographic data of both groups were comparable (p>0.05). The incidence of muscle fasciculation's was not significant between two groups (p=0.707), while more patients in group C had moderate to severe fasciculation's compared to group P (p=0.028). The incidence and severity of myalgia were significantly lower in group P (p<0.05). CONCLUSION: Pregabalin 150mg prevents succinylcholine-induced fasciculations and myalgia and also decreases the fentanyl consumption in elective sine surgery.

Comparative evaluation of dexmedetomidine and esmolol on hemodynamic responses during laparoscopic cholecystectomy.

BACKGROUND: The advent of laparoscopic surgery has benefited the patient and surgeon; however creation of pneumoperitoneum for same has bearings during the perioperative period. These effects of pneumoperitoneum are associated with significant haemodynamic changes, increasing the morbidity of the patient. AIM: The present study compared the efficacy of dexmedetomidine and esmolol on hemodynamic responses during laparoscopic cholecystectomy Materials and Methods: A total of 90 patients aged 20-60 y, American Society of Anaesthesiologists (ASA) physical status I or II, of either sex, planned for laparoscopic cholecystectomy were included. The patients were randomly divided into three groups of 30 each. Group D received dexmedetomidine loading dose 1 mcg/kg over a period of 15 min and maintenance 0.5 mcg/kg/h throughout the pneumoperitoneum. Group E received esmolol loading dose 1 mg/kg over a period of 5 min and maintenance 0.5 mg/kg/h throughout the pneumoperitoneum. Group C received same volume of normal saline. MEASUREMENTS: Heart rate (HR), systolic blood pressure, diastolic blood pressure and mean arterial pressure (MAP) were recorded preoperative, after study drug, after induction, after intubation, after pneumoperitoneum at 15 min intervals, post pneumoperitoneum and postoperative period after 15 min. Propofol induction dose, intraoperative fentanyl requirement and sedation score were also recorded. RESULTS: In group D, there was no statistically significant increase in HR and blood pressure after pneumoperitoneum at any time intervals, whereas in Group E, there was a statistical significant increase in MAP after pneumoperitoneum at 15, 45, and 60 min only and HR during the whole pneumoperitoneum period. There was a significant decrease in induction dose of propofol and intraoperative fentanyl requirement in Group D and E, compared to Group C (p<0.0001). CONCLUSION: Dexmedetomidine is more effective than esmolol for attenuating the hemodynamic response to pneumoperitoneum in elective laparoscopic cholecystectomy. Dexmedetomidine and esmolol also reduced requirements of anaesthetic agents.

The efficacy of pregabalin for prevention of catheter-related bladder discomfort: a prospective, randomized, placebo-controlled double-blind study.

OBJECTIVE: The present study evaluated the efficacy of preoperative pregabalin for prevention of catheter-related bladder discomfort. DESIGN: Prospective, randomized, placebo controlled, double blinded study. MATERIALS AND METHODS: Sixty patients of either sex undergoing elective spine surgery and requiring urinary bladder catheterization were randomly assigned to two groups. The patients in Group P (pregabalin group) received 150 mg of pregabalin orally 1 h prior to induction of anesthesia with sips of water and the patients in Group C (control group) received placebo. Anesthesia technique was identical in both the groups. Catheter-related bladder discomfort (CRBD) was evaluated on a 4-point scale (1 = no discomfort, 2 = mild, 3 = moderate, 4 = severe), on arrival (0 h) and again at 1, 2, and 6 h postoperatively. Patients were provided patient-controlled analgesia with fentanyl for postoperative pain relief. RESULTS: The incidence of CRBD was significantly less in the pregabalin group compared with the control group at all time intervals (P < 0.05). The severity of CRBD was reduced in the pregabalin group compared with the control group at all time intervals except 6 h. The postoperative consumption of fentanyl was significantly less in group P, while the sedation score was significantly higher in the group P compared to group C. CONCLUSION: Pretreatment with pregabalin 150 mg prevents CRBD and also decreases postoperative fentanyl consumption. ClinicalTrials.gov identifier: (ref: CTRI/2013/11/004170).

Comparison of dexmedetomidine, propofol and midazolam for short-term sedation in postoperatively mechanically ventilated neurosurgical patients.

BACKGROUND: Effective management of analgesia and sedation in the intensive care unit depends on the needs of the patient, subjective and/or objective measurement and drug titration to achieve specific endpoints. AIM: The present study compared the efficacy of dexmedetomidine, propofol and midazolam for sedation in neurosurgical patients for postoperative mechanical ventilation. MATERIALS AND METHODS: Ninety patients aged 20-65 years, ASA physical status I to III, undergoing neurosurgery and requiring postoperative ventilation were included. The patients were randomly divided into three groups of 30 each. Group D received dexmedetomidine 1 mcg/kg over 15 minutes as a loading dose, followed by 0.4-0.7 mcg/kg/h. Group P received propofol 1 mg/kg over 15 minutes as a loading dose, followed by 1-3 mg/kg/h. Group M received midazolam 0.04 mg/kg over 15 minutes as a loading dose, followed by 0.08 mg/kg/h. MEASUREMENTS: Heart rate, mean arterial pressure, sedation level, fentanyl requirement, ventilation and extubation time were recorded. RESULTS: Adequate sedation level was achieved with all three agents. Dexmedetomidine group required less fentanyl for postoperative analgesia. In group D there was a decrease in HR after dexmedetomidine infusion (p<0.05), but there was no significant difference in HR between group P and group M. After administration of study drug there was a significant decrease in MAP comparison to baseline value in all groups at all time intervals (p<0.05), except postextubation period (p>0.05). Extubation time was lowest in group P (p<0.05). CONCLUSION: Dexmedetomidine is safer and equally effective agent compared to propofol and midazolam for sedation of neurosurgical mechanically ventilated patients with good hemodynamic stability and extubation time as rapid as propofol. Dexmedetomidine also reduced postoperative fentanyl requirements.

Association of acute onset hypertension and tachycardia following intracisternal papaverine administration during intracranial aneurysm surgery: a case report and review of the literature.

Subarachnoid hemorrhage is associated with a number of cerebral insults as a result of cerebral vasospasm. Various pharmacological and non-pharmacological techniques are used for relief of cerebral vasospasm. Papaverine, either intraarterially or intracisternally, is advocated for management of vasospasm; however, its use is associated with a number of complications. The case of a patient with an anterior communicating artery aneurysm, who received intracisternal papaverine by instillation after aneurysm clipping, is reported. It was associated with hypertension and tachycardia that was not responsive to usual treatment.