Milon V Mitragotri

Abstract

Objective: Fentanyl has evinced its property of being a potent opioid and benumbing stress response to laryngoscopy and intubation (L&I). However respiratory depression and chest wall rigidity limits its utility at high doses. Nalbuphine, reported to have a ceiling effect for respiratory depression, can serve as an alternative.We studied and compared the efficacy of fentanyl and nalbuphine in preventing the rise in heart rate and blood pressure after L&I. Materials and Methods: A randomized double blind study was conducted in 60 subjects divided in two groups (Group F n=30 and Group N n=30) was done. Group F received 2µg kg-1 fentanyl intravenously while group N received nalbuphine 0.2mg kg-1 intravenously. Hemodynamic variables including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were measured at baseline and at intervals of five minutes of administering test drug, each minute up to five minutes after intubation, 10 minutes and 30 minutes after intubation. Complications, if any, were recorded after surgery. Change in HR, SBP, DBP and MAP between the two groups was compared using independent t-test. Results: The two drugs were equally effective in preventing HR rise at all-time points except after 30 minutes where fentanyl performed better. The change in SBP, DBP and MAP from baseline in both the groups was comparable. Conclusions: Nalbuphine can serve as an alternative to fentanyl in obtunding stress response when given five minutes before intubation. Keywords: Nalbuphine, Fentanyl, Intubation.

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Abstract

Introduction: Propofol has surmounted it’s place in day care and ambulatory surgeries. However pain on propofol injection (POPI) still remains bothersome to most patients. Umpteen measures have been tried with variable results. In our study, 50% Magnesium sulphate with its unique and advantageous clinical profile was compared with the proven control, intravenous local anaesthetic 2% lignocaine to test their efficacy in reducing propofol induced pain. Aims: To compare pre-treatment of intravenous 50% magnesium sulphate and intravenous 2% lignocaine (preservative free) as an effective method in controlling POPI. Settings and Design: A sample of 100 patients of age 15-60 years belonging to ASA I and II posted for elective surgeries performed under general anaesthesia were allotted randomly into two groups. Methods and Material: In Group M, 50% MgSO4 1ml (500mg) and in Group L, 2% Lignocaine 1ml (20mg) was used administered. The patients were observed for pain on injection at 5, 10, 15 and 20 s with injection of propofol. Pain was assessed using a four point scale. Quantitative data collected was assayed using chi-square test. Results: There was no significant difference in the pain scores between both the groups (P value=0.6463). Conclusions: 50% MgSO4 is equally effective as 2% lignocaine in prevention of POPI and is a useful alternative for the same. No significant side effect were noted with the use of these drugs. Keywords: Propofol, Pain, Lignocaine, Magnesium sulphate.

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