Priyanka Suresh

Abstract

Background: Laryngoscopy and endotracheal intubation are potent stimuli causing increased sympathoadrenal activity. The objective of this study is to assess and compare the effects of intravenous fentanyl versus a combination of intravenous fentanyl and paracetamol in blunting the hemodynamic responses to laryngoscopy and endotracheal intubation. Materials and Methods: Sixty patients of ASA status I and II, aged 18-60 years of either sex posted for surgeries under general anaesthesia were selected. Patients in group A received intravenous fentanyl 2mcg/kg. Patients in group B received intravenous fentanyl 2mcg/kg and paracetamol 15mg/kg. After intubation vital parameters were recorded at 1, 2, 4 and 6 minute and later once every 10minutes. Results : After intubation, there was an initial increase in heart rate in both groups. However, this was significantly higher (p=0.004) with group A as compared to group B and remained significantly high for another 6 minutes(p=0.03). Results There was an increase of mean arterial pressure after intubation in both the groups, however, this was significantly higher in group A and remained significantly high for 6 minutes as compared to group B[p=0.003]. Mean SpO2 was similar in both the groups, and there were no complications during the study. Conclusion: Intravenous fentanyl and paracetamol is more effective in blunting the hemodynamic responses due to laryngoscopy and endotracheal intubation when compared to intravenous fentanyl alone.   Keywords: Intubation response, Laryngoscopy, Paracetamol, Fentanyl

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Abstract

Background: Interscalene nerve block is very commonly performed for clavicle & proximal humerus surgeries. However very few studies have evaluated the effect of add on magnesium sulphate to local anaesthetic for interscalene nerve block. Materials and Methods: Sixty patients of American Society of Anaesthesiologist (ASA) physical status I and II undergoing surgeries for fracture clavicle and proximal humerus were recruited in this trial. Following randomisation, ultrasound guided interscalene block was performed with 10ml of 2% lignocaine and 20ml of 0.5% bupivacaine either with adjunct 125 mg (MS 125 group, n=30) or 250 mg (MS 250 group, n=30) magnesium sulphate. Primary outcome was to measure and compare the postoperative analgesia, duration of sensory and motor blockade. Results: There was no significant difference between the groups in the duration of sensory blockade [MS 125 v/s MS 250; Mean±SD [Median]; 505.3±44.6 (500) minutes v/s 501.1±45.9(498) minutes; p= 0.65], duration of motor blockade [MS 125 v/s MS 250; Mean±SD [Median]; 314.9±31.1(307) minutes v/s 311.4±34.2(305) minutes; p= 0.7] and the duration of post-operative analgesia [MS 125 v/s MS 250; Mean±SD [Median]; 519±46.1(512) minutes v/s 498±95.8(507 minutes); p=0.43]. Conclusions: Magnesium sulfate at the dose of 125 mg is equally effective as 250 mg for prolonging sensory and motor blockade as well as for post-operative analgesia when used as an adjunct to bupivacaine and lignocaine during interscalene brachial plexus blockade. Our study is limited by small sample size. Further studies with larger sample size are needed.   Keywords: Adjunct magnesium sulfate, Interscalene nerve blockade, Peripheral nerve blockade, Upper limb surgeries.

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Background: The objective of the study was to compare effectiveness of intravenous (IV) granisetron (2 milligram) with IV lignocaine (30 milligram) in allaying pain on propofol IV administration measured at 15 seconds after propofol administration. Materials and Methods: 100 patients of age 18-50 years belonging to American Society of Anesthesiologists (ASA) physical status grades I and II, chosen for elective surgery were randomized to two different groups (group L and group G) of 50 each. Patients of group L received IV lignocaine 30 mg and the other group G received IV granisetron 2 mg as pretreatment, before administration of propofol. Patients were assessed for pain after 15 seconds of IV administration of propofol with McCririck and Hunter scale. Results: Both the pretreatments were found to prevent or decrease the pain on propofol administration. Pain assessed at the end of 15 seconds of propofol administration, showed that 76% in lignocaine group & 62%in granisetron group were not having any pain, 12% in lignocaine group and 20% in granisetron group had mild pain, and 12% in lignocaine group and 18% in granisetron group had moderate pain as assessed with McCririck and Hunter scale. There was no significant difference in the pain scores between the groups (c2 = 2.310, P= 0.315). Conclusion: Both IV granisetron (2 mg) and IV lignocaine (30 mg) are equally effective in allaying pain on propofol injection. Keywords: Granisetron, lignocaine, Pretreatment, Propofol-induced pain.

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