V Y Srinivas

Abstract

Introduction and Objective: Direct laryngoscopy and endotracheal intubation evokes autonomic disturbances in the form of tachycardia, raise in blood pressure, intracranial, and intraocular pressure. Thus the present study was undertaken to evaluate the efficacy of injection Labetalol 0.25mg/kg body weight in the attenuation of sympathoadrenal response to direct laryngoscopy and endotracheal intubation. Materials and Methods: The study was conducted on 60 participants belonging to ASA grade 1 or 2 aged between 18 – 55 yrs undergoing elective surgeries under general anaesthesia. The study population was randomly divided into 2 groups with 30 subjects in each group. Group LAB (Labetalol group) – received 0.25mg/kg body weight diluted upto 10ml with normal saline intravenously, over 10minutes using a syringe pump, given 10minutes before induction. Group CR (Control) received 10ml of normal saline intravenously. The study drug was administered over 10 minutes using syringe pump followed by induction with inj Thiopentone 5mg/kg body weight and inj vecuronium 0.1mg/kg body weight three minutes prior to laryngoscopy and intubation. HR(Heart rate), Systolic arterial pressure, diastolic arterial pressure, MAP(mean arterial pressure) were recorded at basal, 2 minutes, 5 minutes, 8 minutes after study drug infusion, before induction, after induction, 1st , 2nd , 3rd , 5th, 10th, 15th minute after laryngoscopy and intubation. Results: The result showed statistically significant (p Pressure, Diastolic arterial pressure and Mean arterial pressure in Group LAB compared to Group CR at all the time intervals. Interpretation and Conclusion: In the present study, it was found that inj Labetalol 0.25mg/kg body weight had effectively attenuated the sympathoadrenal response to laryngoscopy and intubation. Keywords: Labetalol, Laryngoscopy, Endotracheal intubation, Attenuation; Sympathoadrenal response.

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Abstract

Introduction and Objective: Axillary block is most commonly used regional anaesthetic technique for surgeries of forearm, wrist and hand surgeries. Various local anaesthetic been used for axillary block, among them levobupivacaine has gained more interest as it prolong the duration of analgesia with reduced cardiovascular and central nervous system toxicity. This study is done to compare the effects of 1.5% lignocaine with 1:300000 adrenaline with the 0.333% levobupivacaine in axillary brachial plexus block and the quality of postoperative analgesia. Materials and Methods: After obtaining ethical committee clearance and written informed consent, 60 patients of ASA class I and II, aged between 18-60 years, posted for elective upper limb surgeries, were randomly assigned to 2 groups of 30 in each group A and group B. Group A to receive 30ml of 1.5% lidocaine with adrenaline 1 in 300000 and group B to receive 30ml of 0.333% levobupivacaine. Through perivascular approach axillary brachial plexus block given using peripheral nerve stimulator. Onset and duration of sensory and motor block, quality of block, duration of analgesia and adverse effects if any we re evaluated. Result: Levobupivacaine had slower onset of actions but statistically significant increased duration of sensory and motor blockade, prolonged duration of analgesia were obtained in levobupivacaine group, with no haemodynamic variations and adverse effects in both groups. Conclusion: Levobupivacaine produced prolonged duration of analgesia with reduced toxic potential thus providing greater margin of clinical safety. Keywords: Axillary brachial plexus block, Lidocaine with adrenaline, Levobupivacaine.

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Background and Objective: To reduces the intraoperative blood loss and to provide better visibility of the surgical field controlled hypotension is used. Aim of this study is to compare dexmedetomidine and nitroglycerine as hypotensive agents for inducing controlled hypotension in patients undergoing elective spine surgeries. Materials and Methods: 60 ASA class I or II adult patients undergoing elective spine surgeries were randomly alloca ted into 2 groups of 30 participant in each group DX and group NG . Group DX received dexmeditomidine bolus 1 microgram/kg over 10 minutes before induction and intraoperative infusion of 0.2 - 0.7 microgram per kg per hour, while group NG received nitroglycerine intraoperative infusion at 0.5 to 10 microgram/kg/ min titrated to a mean arterial pressure (MAP) of 70 - 75 mmHg. In both groups the surgical field quality assessed using Fromme - Boezaart grading. Hemodynamic variable and adverse events were noted. Post operative sedation was also assessed using Ramsay sedation score. Results: The mean heart rate was significantly lower in group DX compared to group NG throughout the procedure. (p group NG after induction, after intubation, end of surgery, after extubation, and post operatively (p but average intraoperative values were comparable in both groups. Significantly better Fromme - BoezaarT surgical field score was noted in group DX compared to group NG during the intraoperative period. Conclusion: Controlled hypotension using dexmeditomidine as bolus dose 1 microgram per kg intravenous over 10 minutes prior to induction followed by continous intravenous infusion at 0.2 - 0.7 microgram per kg per hour, provided more stable hemodynamics and better surgical field quality compared to nitroglycerine intraoperative infusion at 0.5 to 10 microgram/kg/min. Keywords: Anaesthesia, Controlled hypotension, Spine surgeries, Dexmedetomidine, Nitroglycerine.

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