RESUMEN
BACKGROUND: Dexmedetomidine is a potent α_2 agonist which has been used for blunting the stress responses during critical events such as laryngoscopy, endotracheal intubation, pneumoperitoneum creation, and extubation. The purpose of this study was to see the efficacy of intravenously administered dexmedetomidine at a dose of 0.5 mcg/kg in attenuating the hemodynamic responses due to pneumoperitoneum during laparoscopic cholecystectomy under general anesthesia. METHODS: Sixty patients, ASA-PS class I (American Society of Anesthesiologist physical status class I), aged between 18 and 60 years, of either sex with weight ranging from 50 to 80 kg, scheduled for laparoscopic cholecystectomy were randomized into two groups (groups A and B) in a double-blinded fashion. Both groups were pre-medicated with an injection glycopyrrolate. Group A received 100 mL normal saline (NS) over 10 minutes while group B received dexmedetomidine 0.5 mcg/kg diluted in 100 mL NS over 10 minutes before induction of general anesthesia. Heart rate, systolic, diastolic, and mean arterial pressures were noted. RESULTS: Following pneumoperitoneum, there was no statistically significant difference in the hemodynamic parameters between the two groups (P > 0.05). CONCLUSION: Administration of dexmedetomidine at a dose of 0.5 mcg/kg before induction did not blunt the hemodynamic responses to pneumoperitoneum during laparoscopic cholecystectomy.
Asunto(s)
Colecistectomía Laparoscópica , Dexmedetomidina , Neumoperitoneo , Humanos , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Dexmedetomidina/farmacología , Neumoperitoneo/tratamiento farmacológico , Hemodinámica , Agonistas de Receptores Adrenérgicos alfa 2/farmacologíaRESUMEN
Acute postoperative sialadenitis is a rare complication usually after surgery involving extreme head and neck rotation, such as posterior fossa surgery. It is characterized by the development of swelling in the submandibular region, usually contralateral to the surgical side, either immediately or within hours post-operatively. We report a case of a 43-year-old woman who developed sialadenitis leading to upper airway obstruction in the postoperative period. Further, she developed bilateral neck and face swelling. Dexmedetomidine used as an infusion throughout the surgery could be an additional cause. Swelling without signs of inflammation is rapidly progressive and may cause airway obstruction. Therefore, awareness and recognition are important, as a delay in airway securement can cause a complete collapse of the airway. Keywords: airway obstruction; case reports; sialadenitis.
Asunto(s)
Obstrucción de las Vías Aéreas , Sialadenitis , Femenino , Humanos , Adulto , Obstrucción de las Vías Aéreas/etiología , Sialadenitis/diagnóstico , Sialadenitis/cirugía , Sialadenitis/complicaciones , Cuello , Inflamación , Edema , Enfermedad Aguda , Periodo PosoperatorioRESUMEN
INTRODUCTION: I-gel is a relatively new supra-glotitc airway device which is claimed to be superior to laryngeal mask airway. It can be used ingeneral anesthesia with spontaneous ventilation as well as with positive pressure ventilation.This study was designed to assess whether I-gel creates adequate laryngeal seal during positive pressure ventilation in patients undergoing laparoscopic surgery. METHODS: A prospective randomized study was made among the 60 patients who underwent laparoscopic cholecystectomy under general anesthesia. Airway was managed with either I-gel insertion or endotracheal intubation and positive pressure ventilation in 30 patients each. Airway pressure, end-tidal CO2and oxygen saturation were monitored and compared between two groups. Inhaled and exhaled tidal volume, minute volume were recorded and leak volume and leak fraction was calculated and compared between two groups. RESULTS: Oxygenation and ventilation (oxygen saturation and end-tidal carbon dioxide pressure) was within normal limit in both groups and comparable. Leak volume in tracheal tube group was 25.33±12.41 ml and in I-gel group it was 26.43±13.19 ml. Leak fraction was 0.0487±0.023 and 0.0417±0.022 in tracheal group and I-gel group respectively. The airway pressure during C02 pneumoperitoneumwas 20.55±3.25 cm H20 in tracheal tube group and 20.21± 3.97 cm H20 in I-gel group and there was no significant leak in either group. Statistically, there was no significant difference in leak volume, leak fraction and airway pressure between the two groups. CONCLUSIONS: I- gel may be an alternate to tracheal tube during general anesthesia with positive pressure ventilation in patients with normal airway pressure with acceptable leak, adequate oxygenation and ventilation.