Deepesh

Abstract

Background: To observe the effects of propofol and etomidate induction on patients undergoing laproscopic cholecystectomies regarding serum cortisol level, hemodynamic parameters, pain on injection, myoclonus, and apnea on induction. Materials and Methods : It is a prospective, randomized, double blind study. After approval from Institute Ethics Committee, sixty patients of age between 18 and 60 years with ASA grade I and II scheduled for laproscopic cholecystectomy under general anesthesia were randomly divided into two groups: Group A (n=30) would receive injection propofol 2 mg/kg i.v., Group B (n=30) would receive injection etomidate 0.3 mg/kg i.v. as induction agent. Vital parameters at induction, laryngoscopy and thereafter recorded. Pain on injection, myoclonus, apnea on induction were carefully watched. Serum Cortisol is measured at 1 hour before induction and at 2 hours and 24 hours after induction. Results: Demographic variables and baseline parameters were comparable in both groups.Propofol group show significant decrease in heart rate and mean blood pressure after induction in comparison to etomidate group. Pain on injection was more in group A while myoclonus activity was higher in Group B. Serum cortisol level is significantly lower in Group B post induction compared to Group A which comes to above baseline after 24 hrs but in normal range. Conclusion: Etomidate is a better induction agent than propofol in view of hemodynamic stability but also led to chemical evidence of adrenocortical insufficiency in patients with ASA grade I & II undergoing elective laproscopic cholecystectomy under general anaesthesia which returns to normal in 24 hrs.   Keywords: Biood cortisol, Propofol, Etomidate

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Abstract

Background: The brachial plexus block is an easy and relatively safe procedure for upper limb surgeries though there are different approaches to it, it is a block of roots, divisions and cords of the brachial plexus, out of which supraclavicular approach is most widely used method for anaesthesia and preoperative pain management in surgery below shoulder joint. It is performed at the trunk level where the plexus is presented most compactly. Another advantage is that it can be performed with the patient’s arm in any position to provide excellent anaesthesia for elbow, forearm and hand surgery. Various local anaesthetic agents are used for Brachial Plexus Block but most commonly used drugs are; Bupivacaine, and Lignocaine. Bupivacaine is long acting whereas Lignocaine is short acting drug. Novel adjuncts studied to date include butorphanol, buperonorphine, dexamethasone, Clonidine, Neostigmine, Tramadol, Midazolam, Dexmedetomidine etc. Dexmedetomidine is an anxiolytic sedative and analgesic agent, it is a selectivea2 – adrenoreceptor agonist and is approximately 8 times more potent than clonidine. It was superior to clonidine also in quality for anesthesia in tourniquet tolerance, and postoperative analgesia and it is notable for its ability to provide sedation without risk of respiratory depression and can provide cooperative or semi arousable sedation. The mechanism by which a2 adrenergic receptor agonists produce analgesia is likely to be multifactorial. Peripherally a2 adrenergic agonists produce analgesia by reducing the release of norepinephrine and a2 receptor independent inhibitory effect on nerve fibre action potential. Recent pre-clinical and clinical studies show that the glucocorticoid dexamethasone appears to be effective as adjuvant to local anesthetics since it posses anti-inflammatory and analgesic properties. In addition, perineural injection of steroid does influence post operative analgesia. This study was done to compare the adjuvant effect of dexamethasone and dexmedetomidine, when aded with local anesthetics in Supraclavicular brachial plexus block. Materials and Methods: It was a prospective randomized control trial conducted for 18 months in LLR hospital Kanpur. 90 patients of ASA grade 1 and 2 aged more than 18 yrs of either sex were included and Thirty patients were randomly divided in each of the three groups and observations were made regarding hemodynamic changes such as HR, MAP, SPO2 and onset of sensory, motor block and duration of motor, sensory effect. Student t test and analysis of variance were the methods used for analysis. Result: Additions of injection dexamethasone and injection dexmedetomidine with lignocaine markedly prolonged duration of sensory and motor block however duration of injection dexmedetomidine was found to be longer as compared to dexamethasone. Conclusion: Dexmedetomidine has longer duration of motor and sensory effect when used as an adjuvent as compared to dexamethasone. Keywords: Dexmedetomidine, Dexamethasone, Brachial plexus block.

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