Manas Ranjan Panigrahi

Abstract

Introduction: Postoperative pain control is an important component of surgical patient care. Inadequate pain control in postoperative period increases mortality and morbidity to great extent. Studies have shown transdermal diclofenac is as effective as intramuscular diclofenac injection in postoperative analgesia, but a comparison of diclofenac rectal suppository and transdermal route is lacking. This research proposal intends to study and compare the effectiveness of Diclofenac transdermal patch and rectal suppository. Study Design: Randomized, Single Blind, Prospective, Comparative study. Materials and Methods: ASA 1 and 2 patients scheduled for open cholecystectomy withsample size 60 patients divided between group TD (transdermal patch, n=30) and RS (rectal suppository, n=30). 100 mg diclofenac epolamine patch was applied on inner aspect of left arm in TD group’s 1hr before incision Patch was changed 12hrly for 48 hrs. 100 mg diclofenac sodium was introduced per-rectally in PR group just before induction of anesthesia and repeated 12hrly for 48hrs. Each patient was monitored and data collected in PACU, PCA remote was again shown to patients and advised them to press button whenever they feel. Result: It has been found that both the groups were comparable in their demographic distribution, in terms of age and sex. 14 readings were taken from just after OT till 48hrs from starting surgery. None of the patients in the study showed the sign or symptoms of opioid overdosing. The pain was better controlled with Diclofenac through per rectal route than the transdermal route. Conclusion: Considering mean rank of VAS till 6hrs after skin incision and drugs given during 1st , 2nd and 3rd readings at 6th hr., 12th hr., 18th hr. and continue 6hrly and total drugs given till 48hrs, pain after open cholecystectomy was better controlled with diclofenac sodium rectal suppository in comparison to diclofenac epolamine patch. Keywords: Open cholecystectomy, Diclofenac sodium rectal suppository, Diclofenac epolamine, Patch, PCA pump.

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Abstract

Introduction: Hypotension is a common side effect when neuraxial analgesia is administered to the obstetric population. To find out the efficacy of mephentermine and phenylephrine for management of hypotension following spinal anesthesia in cesarean section. The study has been undertaken at the Department of Anesthesiology of ESI- PGIMSR, Manicktala, Kolkata, after obtaining approval from Institute Ethical Committee Study Design: Uni-centric randomized, single blind, prospective & comparative study Statistical Analysis Used: Unpaired Student’s t-test, chi-square test, Fisher’s exact test Materials and Methods: The 40-female scheduled for elective caesarean section were randomly divided into two groups of 20 each. Subarachnoid block was performed with 2.2mL of 0.5% hyperbaric bupivacaine. Prophylactic infusion of vasopressor started at a rate of 60 ml/h 0f 50 mcg/min for phenylephrine (group P, n=20) and 600 mcg/min for mephentermine (Group M, n=20) Hemodynamic parameters were monitored. At the end of surgery and the patients were transferred to the postoperative care unit (PACU). Results: Considering absolute values of hypotension, both groups are comparable in terms of preventing hypotension; however, phenylephrine had better control of maintenance over blood pressure than that of mephentermine. Reactive hypertension is common in phenylephrine infusion. Bradycardia is more prevalent in phenylephrine infusion than that of mephentermine while tachycardia is more common in mephentermine. Side effects like dyspnea, nausea/vomiting, headache is more common during hypotensive episodes. None of the drugs causes any untoward effect on fetus. Keywords: Phenylephrine, Mephentermine, Intraoperative hypotension, Procedural Sedation, Spinal Anesthesia.

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Abstract

Introduction: General anesthesia is a medically induced coma with loss of protective reflexes resulting from the administration of one or more general anesthetic agents Our study is to compare the role and efficacy of preoperative oral Melatonin, Ramelteon, and Midazolam therapy on the dose requirement of induction agent (Propofol). Materials and Methods: Were divided into Case and Control Group. Case group of people were given Oral Melatonin (6mg)/Ramelteon (8mg) as premedication 2 to 3 hours before induction in OT and the control group were given oral Midazolam (5mg). After checking all the parameters, the induction process Total number of 60 people was randomly selected from ASA grade I & grade II, aged between 20 to 50 years, started with injection Propofol slowly in intravenous route and subsequently the BIS level up 60 was noted. After complete reversal of General Anesthesia, post-operative sedation level of the patient was measured using Ramsey sedation scale. Result: Melatonin and Ramelteon shows significant reduction in preoperative anxiety state of the patient in comparison to Midazolam, measured by Hamilton Anxiety rating scale. The sedation status was measured by Ramsey Sedation Scale for each drug and it shows no significant difference between the drugs. Conclusion: Considering absolute values and statistical values, all three drugs are potent premedication in general anesthesia. Among them, Melatonin is most potent in reducing the induction dose of injection Propofol. Ramelteon is also effective in reducing induction dose of Propofol. Along with, both are potent anxiolytic agent in pre-operative state. Keywords: General anesthesia, Melatonin, Ramelteon, Propofol, Post-operative sedation.

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