Suchita Joshi Khadke

Abstract

Background: Tracheal extubation is associated with a 10–30% increase in arterial pressure and heart rate that could be detrimental in patients with hypertension, ischemic heart disease, and cerebrovascular disease. A reliable technique for rapid & smooth extubation with stable hemodynamics is still not fully evolved. Aims: To compare the effect of intravenous magnesium sulphate and esmolol for attenuating hemodynamic response to extubation after general anesthesia. Setting and Design: Prospective, randomized, double blind study conducted at tertiary care hospital. Methods: Sixty adult subjects undergoing major surgery were randomly divided into 2 groups. Group M received magnesium sulphate 40 mg/kg & Group E received esmolol 0.6 mg/kg IV infusion over 5 minutes before extubation. Heart rate, systolic & diastolic blood pressure, mean arterial pressure, rate pressure product, pain score & sedation score were compared from extubation till 15 minutes after extubation. Statistical Analysis: Students ‘t’ test used for continuous variables & Chi Square test for categorical data. Results: 21.82% fall in heart rate was observed in group M with a plateau at 10 -15 minutes compared to 37.07% in group E with a peak at 15 minutes (p=0.0150). Fall in Systolic blood pressure was 18.86% in group M & 21.15% in group E (p=0.4298). Rate pressure product was significantly lower in group E (50.40%) than group M (36.66%). Postoperative pain score was significantly less in group M compared to group E (p Conclusion: Magnesium sulphate provides better hemodynamic stability with postoperative analgesia compared to esmolol when used for attenuating hemodynamic response to extubation. Keywords: Magnesium sulphate, Esmolol, Hemodynamic response, Extubation response, Postoperative analgesia.

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Abstract

Background: Total Anomalous Pulmonary Venous Connection (TAPVC) is congenital heart disease in which the pulmonary veins do not connect normally to left atrium. Instead they connect to right atrium, often by way of systemic vein. There may be associated cardiac malposition. Anaesthetic management requires detailed assessment of cardiac an extracardiac anomalies & its pathophysiological effects. Here we report a case of TAPVC posted for LSCS and its successful management. Case Presentation: 25yrs female known case of TAPVC at 34.5 wks of gestation admitted 3 weeks prior, Vitaly stable, we did this patient under plain epidural anaesthesia without haemodynamic instability. Conclusions: Epidural anaesthesia a better technique than general anaesthesia for supracardiac TAPVC posted for LSCS. Meticulous intraoperative monitoring is important. Cardiac Output must be maintained, avoid fall in Systemic Vascular Resistance (SVR) ensuring minimal change in shunt. Keywords: Supracardiac TAPVC, LSCS, Epidural Anaesthesia.

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