RESUMO
Background and Aims: The current study was designed to compare the effects of two different doses of 3% hypertonic saline with mannitol on intraoperative events during decompressive craniectomy in traumatic brain injury (TBI). Primary outcome measures included assessment of intraoperative brain relaxation, hemodynamic variables, and serum electrolytes. Effect on the postoperative outcome, in terms of the Glasgow coma scale (GCS), length of stay in the ICU, and mortality were the secondary outcome measures. Material and Methods: Ninety patients with TBI undergoing craniotomy were enrolled. Patients were assigned to receive 300 mL (328 mOsm) of mannitol (n = 26, M) only or 300 mL of mannitol with 150 mL (482 mOsm) of 3% HS (n = 35, HS1) or with 300 mL (636 mOsm) of 3% HS (n = 29, HS2). Brain relaxation was assessed and if required, a rescue dose of mannitol (150 mL) was given. GCS was assessed preoperatively, 24 h postoperatively, and at the time of discharge from the ICU and total duration of stay was noted. Results: Acceptable brain relaxation was observed in 89.66% (n = 26, HS2) and 80% (n = 28, HS1) patients as compared to 46.1% (n = 12, M) patients (P < 0.001) with significantly less number of patients requiring rescue doses of mannitol in groups HS1 and HS2(n = 7 and 3, respectively) as compared to group M (n = 14) (P < 0.05). There was a significant improvement in GCS at 24 h and at the time of discharge from the ICU in patients with a severe head injury in group HS2 (P = 0.029). In patients with moderate head injury there was a significant improvement in GCS at the time of discharge among all the three groups (P < 0.05). Conclusion: Increasing osmotic load by addition of 3% HS to mannitol provides better intraoperative brain relaxation than mannitol alone during decompressive craniectomy. An addition of 300mL 3% HS was found to be more effective in improving GCS in patients with severe TBI.
RESUMO
Background and Aims: Recovery from surgery and anaesthesia is usually observed through conventional indicators. The Quality of Recovery (QoR-15) score was specially designed to measure psychometric and functional recovery from the patient's perspective. This study aimed to evaluate QoR-15 following the administration of intravenous (IV) lignocaine or IV fentanyl in patients undergoing septoplasty surgery. Methods: This randomised, controlled trial was conducted on 64 patients of American Society of Anesthesiologists (ASA) physical status I and II, of either sex, of ages between 18 and 60 years, and who were scheduled for septoplasty. The primary end point was to compare the quality of recovery following the administration of IV lignocaine(group L) and IV fentanyl (group F) using the QoR-15 score in patients undergoing septoplasty. Secondary end points were to compare postoperative analgesia, recovery characteristics, and adverse effects in both groups. Statistical analysis was done using the Shapiro-Wilk test, paired t test/ Wilcoxon signed-rank test, and unpaired t test/Mann-Whitney U test. A P-value <0.05 was considered statistically significant. Results: There was a significant improvement in the postoperative QoR-15 score than in the preoperative score in both groups (P < 0.000). However, the postoperative QoR-15 score was significantly higher in group L compared to group F (P < 0.001). Total consumption of analgesic doses were reduced in group L (P=0.000). Time taken to achieve an Aldrete score >9 and gastrointestinal recovery was shorter in group L compared to group F. Conclusion: Both IV lignocaine and IV fentanyl improved postoperative QoR-15 score; however, lignocaine had a higher postoperative QoR-15 score than fentanyl, in addition to showing early discharge readiness, better analgesia, and better recovery profile in patients following septoplasty surgery.