RESUMEN
BACKGROUND AND AIM: Midazolam has been the most popular oral premedicant in children despite its side effects. Dexmedetomidine with its favorable clinical profile is a suitable alternative, but with limited research. The aim of this study was to compare the effectiveness of dexmedetomidine and midazolam as oral premedicants in children. MATERIAL AND METHODS: Eighty children of the American Society of Anesthesiologist physical status I scheduled for elective herniotomy were included in this prospective randomized double-blind study. Patients were randomly assigned to receive either dexmedetomidine 4 µg/kg (Group A, n = 40) or midazolam 0.5 mg/kg (Group B, n = 40) orally 40 min before induction. Pre-operative sedation, response to parental separation and venepuncture, emergence agitation, recovery nurse satisfaction, and side effects were compared between the two groups. Quantitative data were compared using unpaired Student's t-test and categorical variables with Chi-square test. RESULTS: Pre-operative sedation and response to parental separation and venepuncture were similar between the two groups. Group A had a significantly lower incidence and severity of emergence agitation (P = 0.000). Recovery nurse satisfaction was significantly higher in Group A (P = 0.002). However, incidence of hypotension and bradycardia was found to be more in Group A (P = 0.04). CONCLUSION: Premedication with oral dexmedetomidine is as effective as oral midazolam in providing sedation and anxiolysis in children. Dexmedetomidine in addition reduces the incidence and severity of emergence agitation.
RESUMEN
BACKGROUND: Dexmedetomidine, an α2 adrenergic agonist, has been found to be a useful adjuvant to local anesthetics. It has been found to produce satisfactory block with lower doses of spinal bupivacaine. AIM: The aim of this study is to compare the difference in spinal block characteristics and hemodynamic effects of 7, 8, and 9 mg hyperbaric bupivacaine combined with 5 µg dexmedetomidine and to find out the optimum dose that would provide satisfactory block and hemodynamic stability for lower limb orthopedic surgeries. SETTINGS AND STUDY DESIGN: This was a prospective, observational study. MATERIALS AND METHODS: Ninety patients undergoing lower limb orthopedic surgeries were allocated to three groups of thirty each. Group A received 7 mg, Group B 8 mg and Group C 9 mg 0.5% hyperbaric bupivacaine along with dexmedetomidine 5 µg. The spinal block characteristics, hemodynamic stability, and side effects were compared. STATISTICAL ANALYSIS: The quantitative variables were compared using ANOVA test and the qualitative variables using Chi-square test. RESULTS: All three groups had satisfactory anesthesia and analgesia. The onset of analgesia was slower and peak sensory level lower in Group A. The onset of motor block, time to attain peak sensory levels, duration of analgesia, maximum pain scores, and requirement of rescue analgesics were comparable among groups. Duration of motor block and time of regression of sensory level were more in Group C. Hemodynamics and sedation scores were comparable. CONCLUSION: Dexmedetomidine with lower doses of bupivacaine produces satisfactory anesthesia without hemodynamic instability. A dose of 7 mg bupivacaine with 5 µg dexmedetomidine may be sufficient for orthopedic surgeries.
RESUMEN
Conjoined twins are a rare congenital anomaly of unknown aetiology. We report the successful anaesthetic management of separation of ischiopagus tetrapus conjoined twins. The importance of a multidisciplinary approach, thorough pre-operative evaluation and planning, vigilant monitoring and anticipation of complications such as massive blood and fluid loss, haemodynamic instability, hypothermia and intensive, post-operative care are emphasised.