Asha G

Abstract

Introduction: Advent of Laparoscopy have benefitted patients in terms of lesser tissue damage, early ambulation, decreased duration of hospital stay and reduced analgesic needs. However caproperitoneum and position of patient during laparoscopic procedure induces pathophysiological changes that may potentially complicate anesthetic management. Various pharmacological methods have been tried to overcome complications associated with pneumoperitoneum. One among those drugs is Clonidine, a centrally acting a2-adrenergic receptors agonist has sedative, anxiolytic, analgesic properties and stabilizes circulatory system. It diminishes stress response hence increases perioperative circulatory stability in patients undergoing laparoscopic surgeries. In addition, it increases cardiac bar reflex sensitivity in hypertensive individuals, and thus, stabilizes blood pressure by enhancing the role of changes in heart rate. Objectives: To study the efficacy and post-operative sedation in intravenous and intrathecal clonidine in patients undergoing laparoscopic assisted vaginal hysterectomy under general anesthesia. Materials and Methods: Patients were divided randomly into 2 groups (A group & B group) of 30 each. Patients assigned to group a, received 50 mcg of clonidine in 50ml of normal saline over 10 minutes 10 minutes before induction. Patients assigned to group B, received intrathecal clonidine 50 mcg in 1 ml in sitting position at L3-L4 interspace using 27G quincke’s spinal needle just before induction. Intraoperative monitoring included heart rate (HR), continuous electrocardiography, noninvasive systolic (SBP), diastolic (DBP), mean blood pressure (MBP), pulse oximetry (SpO2) and EtCO2. Systolic, diastolic, mean arterial blood pressures and heart rate were recorded at regular interval and plotted on graph. Results: During capnoperitoneum, mean HR values, mean SBP values, mean DBP values, mean MAP values in (IT) group B were below the baseline and that in group A (IV) were near the baseline. Conclusion: Efficacy of Intrathecal route of clonidine administration during laparoscopic hysterectomy surgeries have better control of heart rate, mean systolic and diastolic blood pressure and mean arterial pressure is better during capnoperitoneum compared to intra venous clonidine. But post-operative sedation and adverse effects in both routes are statistically insignificant. Keywords: Intrathecal clonidine, laparoscopic surgeries, Ramsay sedation score.

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Abstract

Introduction: tracheal intubation and laryngoscopy are invariably associated with reflex sympathetic pressor responses resulting in elevated HR & BP. This may prove detrimental in preeclampsia patients. Objectives: To compare the efficacy of adding labetalol 0.5mg/kg IV to lignocaine 1.5mg/kg IV for attenuating increases in HR,SBP,DBP and MAP during laryngoscopy and intubation under general anaesthesia in parturients with preeclampsia posted for LSCS and to study the incident of any side effects. Materials and Methods: 60 patients with mild PIH presenting for LSCS, either elective or emergency, under GA were studied and randomly allocated to one of the two groups of 30 patients each. All patients were premedicated with inj glycopyrrolate 0.01mg/kg IV, inj fentanyl 1 µg/kg along with study drug labetalol 0.5mg/kg given 5minutes before laryngoscopy and intubation. Patients were induced with thiopentone 5mg/kg IV and succinylcholine 2mg/kg IV, preservative free lignocaine 1.5mg/kg IV given 2minutes before intubation. HR, SBP, DBP were recorded before and after intubation, at 1st, 3rd, 5th and 10th minutes. Results: Rise in the HR,SBP,DBP,MAP were observed in both the groups at one minute following laryngoscopy and intubation and these responses persisted for about 3 minutes after which they returned towards basal values and below the baseline in case of group 1(labetalol with lignocaine) compared to group 2(lignocaine) in preeclampsia. Conclusions: Adding labetalol 0.5mg/kg IV to lignocaine 1.5mg/kg IV is effective in further attenuation of haemodynamic response to laryngoscopy and intubation in preeclampsia patients. Keywords: Attenuation, Intubation, Laryngoscopy, Lignocaine, Labetalol, Preeclampsia.

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