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Background and Aims: Awake fibreoptic intubation is considered a safe approach in airway management of a patient with difficult airway. Awake fibreoptic endoscopy needs appropriate anaesthesia of airway to suppress airway reflexes and prevent discomfort. We planned this study to evaluate effect of adding dexmedetomidine to lignocaine nebulization on conditions for awake videoendoscopic intubation. Material and Methods: In this prospective randomized double blind controlled study, ninety six ASA grade I, II patients of either gender, aged 18-65 years, scheduled for elective surgeries under general anaesthesia, were randomly allocated into two groups, Group D and L to receive nebulization with 4% Lignocaine 5 ml + Dexmedetomidine 2 mcg/kg and 4% Lignocaine alone respectively, 20 min before procedure. Time taken to intubate the patient, ease of intubation assessed by cough severity score, patient comfort score, post-intubation patient satisfaction and hemodynamic changes were recorded and compared. Results: Group D and L had comparable intubation time (196.8 ± 61.2 s) and (205.8 ± 52.2 s) (p = 0.437). Cough severity, patient comfort and quality of procedure with post intubation patient satisfaction score were significantly better in Group D. Haemodynamics parameters were better post nebulization in group D as compared to group L. Conclusion: Addition of Dexmedetomidine 2 mcg/kg with 4% Lignocaine during nebulization improves intubating conditions during awake flexible videoendoscopy in terms of ease of intubation, cough severity, patients comfort and satisfaction along with providing stable Haemodynamics profile.

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INTRODUCTION: Epidural volume extension is technique aiming to mitigate spinal anaesthesia induced hypotension, by reducing the dose of local anaesthetics. The present study was executed to determine the effect of epidural volume extension subarachnoid block with 0.5% hyperbaric bupivacaine in patients undergoing proximal femoral nailing (PFN) regarding characteristics of sensory-motor block and postoperative analgesia. MATERIAL AND METHODS: In this prospective, double-blind trial conducted from October 2021 to April 2022, 105 adult patients scheduled to undergo PFN were randomised into groups: control (C), 10 mL NS (E1), and 20 mL NS (E2), to receive 10 mg hyperbaric bupivacaine intrathecally plus additional epidural volume extension with 10 and 20 mL normal saline in groups E1 and E2, respectively. The primary outcome measured was the duration of postoperative analgesia. The secondary outcomes measured included onset of sensory- motor block and duration of sensory block. P < 0.05 was considered statistically significant. RESULTS: A significantly longer duration of postoperative analgesia was noted in patients receiving 10 and 20 mL epidural volume extension (365.09 ± 101.83 and 330.06 ± 35.22 vs. 265.77 ± 38.01 min in the control group, P < 0.01). Patients who received any epidural volume extension with either 10 or 20 mL had significantly quicker onset of sensory and motor block as well as prolonged duration of sensory block. No significant difference in duration of postoperative analgesia, and onset and duration of block was observed between patients receiving either 10 or 20 mL epidural volume extension. CONCLUSIONS: Epidural volume extension significantly shortened the onset of sensory-motor block and increased the duration of sensory block and postoperative analgesia in patients undergoing PFN under subarachnoid block; however, no such difference was observed between 10 and 20 mL epidural volume extension.

Asunto(s)

Anestesia Raquidea , Fijación Intramedular de Fracturas , Adulto , Humanos , Anestesia Raquidea/métodos , Estudios Prospectivos , Anestésicos Locales , Bupivacaína , Método Doble Ciego

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BACKGROUND AND AIMS: The aim is to determine the effect of addition of clonidine to ropivacaine for epidural labor analgesia with regard to onset of analgesia, duration of analgesia, neonatal outcome, and quality of analgesia. MATERIAL AND METHODS: A total of 60 term parturients of the American Society of Anesthesiologists Grade I and II with uncomplicated pregnancy, vertex presentation, posted for on-demand epidural labor analgesia after informed consent were divided in two groups. Group R (n = 30) patients received 10 ml solution comprising 0.2% ropivacaine. Group RC (n = 30) patients received a total of 10 ml of 0.2% ropivacaine and clonidine 1 µg/kg. Characteristics of the block, onset and duration of analgesia, and total analgesic requirements were noted. Pain and overall satisfaction scores were assessed with a 10-point visual analog scale. Mode of delivery and neonatal APGAR scores were recorded. RESULTS: Maternal demographic characteristics were comparable between the groups. Addition of clonidine to ropivacaine shortened the onset and prolonged the duration of analgesia with decrease in ropivacaine requirement in Group RC. There was a significant difference between the two groups regarding visual analog score and quality of analgesia, which was better in Group RC. There were no significant differences between the two groups regarding motor block, hemodynamic parameters, and neonatal outcomes. CONCLUSION: We conclude that clonidine in low doses is a useful adjuvant to local anesthetics for epidural labor analgesia and a good alternative to opioids.

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CONTEXT: Pharmacological agents are used to reduce postoperative blood loss. AIMS: To assess the effects of tranexamic acid on prevention of bleeding and requirement of blood transfusion after major hip and femoral surgeries. SETTINGS AND DESIGN: A prospective, randomized, double blinded study was conducted in the tertiary care teaching hospital. METHODS: Ninety ASA grade I-II patients undergoing hip fracture surgery were included in this prospective study. Forty-five patients received tranexamic acid (TA) given in a bolus dose of 500 mg 15 min before surgical incision followed by continuous infusion. The remaining, 45 patients were allocated as a control group. Postoperative bleeding (volume of blood in the drain), percentage fall of hemoglobin, transfusions and complications were recorded. RESULTS: Mean volume of blood in the drain was 39.33±10.09 ml (mean±SD) as compared to 91.11±17.61 ml in placebo group showing a P<0.001. Mean percentage fall in Hb at day 0 was 2.99±3.45 in the study group as compared to 7.70±6.05 in the placebo group (P<0.001), and fall at day 2 in the study group was 0.35±0.74, compared to 2.72±2.70 in the placebo group (P<0.001). The number of patients required blood transfusions were lower in the study group than in the placebo group (P=0.01). CONCLUSIONS: We conclude that tranexamic acid significantly reduces postoperative blood loss and transfusion requirements during major hip and femoral surgeries.