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4.  “Protective Premedication”: A Comparative Study of Acetaminophen, Gabapentin and Combination of Acetaminophen with Gabapentin for Post-Operative Analgesia 
Background:
We carried out a study to evaluate the effects of protective premedication with Acetaminophen, Gabapentin and combination of Acetaminophen with Gabapentin on post-operative analgesia in patients undergoing open cholecys-tectomy under general anesthesia.
Patients & Methods:
The study was conducted in a double-blind randomized and controlled manner in 120 consenting patients of either sex belonging to ASA physical status grade I and II, between the age groups of 20 to 50 years, weighing between 40 to 65 kg and undergoing elective surgery (open cholecystectomy) under general anesthesia. The patients were divided into 4 groups: 1: placebo, 2: Acetaminophen 1000 mg, 3: 1200 mg Gabapentin, 4: Acetaminphen 1000 mg plus 1200 mg Gabapentin. The drugs were given two hours before induction. Time, number and total amount of rescue analgesic (tramadol) and VAS score at rest and on movement. Side effects like any episode of nausea/vomiting and level of sedation were noted.
Results:
Premedication with antihyperalgesic and analgesic agents helps to decrease postoperative pain scores. Gabapentin premedication is effective for providing better postoperative pain relief with lower and delayed requirements of rescue analgesics, but causes more episodes of nausea and vomiting and higher levels of sedation.
PMCID: PMC3087245  PMID: 21547185
Premedication; Gabapentin; Acetaminophen
9.  Intrathecal Sufentanil Versus Fentanyl for Lower Limb Surgeries - A Randomized Controlled Trial 
Background:
To compare the efficacy and safety of intrathecal sufentanil or fentanyl as adjuvants to hyperbaric bupivacaine in patients undergoing major orthopaedic lower limb surgeries in terms of onset and duration of sensory block, motor block and post-operative pain relief.
Patients & Methods:
Ninety patients were recruited in this Prospective, randomized double blind study to receive either intrathecal sufentanil 5 μg (Group S), fentanyl 25 μg (Group F) or normal saline 0.5 ml (Group C) as adjuvants to 15 mg of 0.5% hyperbaric bupivacaine. The onset and duration of sensory and motor block were assessed intraoperatively. The pain scores were assessed postoperatively. Duration of complete and effective analgesia was recorded. The incidence of side effects such as nausea, vomiting, pruritus, shivering and PDPH was recorded.
Results:
The Demographic data, hemodynamic and respiratory parameters were comparable in the three groups. There was a significantly earlier onset and prolonged duration of sensory block in the sufentanil and fentanyl groups. The duration of complete and effective analgesia were also significantly prolonged in the fentanyl and sufentanil groups. Pruritus was noticed in the study groups (Groups S&F).
Conclusions:
Intrathecal sufentanil (5 μg) and fentanyl (25 μg), as adjuvants lead to an earlier onset and prolonged duration of sensory block. The duration of effective analgesia with intrathecal sufentanil and fentanyl as adjuvants to hyperbaric bupivacaine is longer than that of bupivacaine alone.
PMCID: PMC3087250  PMID: 21547180
Intrathecal adjuvant; Fentanyl; Sufentanil; lower limb surgeries
10.  PLMA vs. I-gel: A Comparative Evaluation of Respiratory Mechanics in Laparoscopic Cholecystectomy 
Background:
Supraglottic airway devices (SADs), such as ProSealTM laryngeal mask airway (PLMA), which produce high oropharyngeal seal pressure (OSP) and have the facility for gastric decompression have been used in laparoscopic procedures. i-gel is a new SAD which shares these features with the PLMA. This study was designed to compare the respiratory mechanics of these two devices during positive pressure ventilation in anaesthetised adult patients undergoing laparoscopic cholecystectomy.
Patients & Methods:
The study included 60 ASA I-II adult patients scheduled for laparoscopic cholecystectomy. The patients were randomized to two groups of 30 each, with either PLMA or i-gel as their airway device. Anaesthesia and premedication were standardized for both the groups. In addition to routine monitoring, neuromuscular monitoring with TOF ratio, OSP and respiratory mechanics monitoring (dynamic compliance, resistance, work of breathing, measured minute ventilation and peak airway pressures) were employed. Fibreoptic evaluation of positioning of the devices and adverse events related to them were also compared.
Results:
The OSP (cm H2O) were higher for PLMA (38.9 vs. 35.6, P=0.007). The respiratory mechanics parameters using the two devices were comparable apart from the dynamic compliance, which was significantly higher with i-gel (P < 0.05). Malrotation was higher with i-gel than with PLMA (15 vs. 5, P = 0.006).
Conclusion:
The PLMA formed a better seal while the dynamic compliance was higher with the i-gel. Both devices provided optimal ventilation and oxygenation and the adverse events were also comparable.
PMCID: PMC3087251  PMID: 21547168
ProSealTM LMA; I-gel; Equipment; Masks anaesthesia; Respiratory mechanics; Laparoscopy; Ventilation
12.  Palpatory Method of Measuring Diastolic Blood Pressure 
Background:
Most common method for measuring blood pressure is palpatory but only systolic pressure can be measured with this method. In this study we are describing palpatory method of measuring diastolic blood pressure as well.
Patients & Methods:
We have studied in 200 patients and compared systolic as well as diastolic blood pressures with two methods, auscutatory and palpatory. Systolic and diastolic blood pressure were measured by one of the authors with new palpatory method and noted down. Then an independent observer, who was blinded to the palpatory method's values, measured blood pressure by auscultatory method and noted down. The values were compared in term of range and percentage.
Results:
The difference were analysed and found that 102 (51%) patients had systolic and diastolic blood pressure measured by palpatory method, within ± 2 mmHg of auscutatory method, 37 (19%) patients had within ± 4 mmHg, 52 (25%) patients had same readings as with auscutatory method, and in 9 (0.5%) patients it could not be measured.
Conclusion:
The palpatory method would be very useful where frequent blood pressure measurement are being done manually like in wards, in busy OPD, patient on treadmill and also whenever stethoscope is not available. The blood pressure can be measured in noisy environment too.
PMCID: PMC3087253  PMID: 21547184
Auscutatory method; Arterial blood pressure; Diastolic blood pressure; Palpatory method
14.  Effect of Nalbuphine on Haemodynamic Response to Orotracheal Intubation 
Background:
Laryngoscopy and intubation are associated with increase in heart rate and mean blood pressure which are deleterious for patients especially with hypertension, ischaemic heart disease, raised intraocular and intracranial pressure. This study was undertaken with an objective to determine the efficacy of nalbuphine in preventing increase in heart rate and mean arterial pressure in response to laryngoscopy and orotracheal intubation.
Patients & Methods:
A randomized controlled, prospective, double blinded study was undertaken on 60 patients ASA grade I and II posted for elective laparoscopy surgery to receive either saline (group I, control group, n=30) or Nalbuphine 0.2mg kg-1(group II, study group, n=30 ) as a bolus dose, 5 minutes before laryngoscopy. Heart rate and mean arterial pressure were taken 3 minute after study drug (T-1), just after intubation (T-2), then after every minute till 5 min (T3-7) and after 10 min of intubation (T-8). Twenty percent rise in heart rate and mean arterial pressure was considered as significant. Students ‘t’ test was used for the analysis of data by using statistical software Medcal version 11.1.1.0. and P < 0.05 was considered significant.
Results:
There was significant rise in heart rate(20.4%) in group I after intubation at T-2 compared with baseline at T-1 as compared to group II (16.66%). Mean arterial pressure showed rise of 12.35% in group I and 4.39% in group II at T-2 but was not significant. Heart rate and mean arterial pressure then gradually decreased from T3-8 but remained slightly higher than group II at 8th minute.
Conclusion:
We thus conclude that Nalbuphine 0.2 mg kg -1prevented a marked rise in heart rate and mean arterial pressure associated with laryngoscopy and orotracheal intubation.
PMCID: PMC3087255  PMID: 21547169
Nalbuphine; Orotracheal Intubation; Haemodynamic Response
15.  A Comparative Study of Two Different Doses of Epidural Neostigmine Coadministered with Lignocaine for Post Operative Analgesia and Sedation 
Background:
Adjuvants have been used to prolong analgesic effects of epidural local anaesthetics. We studied two different doses of neostigmine.
Patients & Methods:
A randomized double blind study was conducted on ninety adult females scheduled for lower intra abdominal surgeries. The study was designed to compare two doses of epidural neostigmine co administered with lignocaine, with regard to its analgesic efficacy and its effect on sedation in postoperative period. Patients were divided into three groups of 30 each. Group I received lignocaine 1% (9ml) with normal saline (1ml), group II lignocaine1% (9ml) with neostigmine 100μg in saline (1ml) and group III received lignocaine 1% (9ml) with neostigmine 200μg in NS (1ml). Group I served as a control. In operating room, after putting epidural catheter, general anesthesia was administered with propofol (2mg kg-1), succinylcholine (2mg kg-1) and maintained with O2, N2O, relaxant technique. At the end of surgery, patients were reversed. Epidural analgesic medication was administered to after proper recovery from anesthesia. Intensity of pain relief on VAS, duration of analgesia, level of sensory block, motor blockade, sedation by sedation score and complications were assessed.
Results:
The addition of neostigmine resulted in significant longer duration of analgesia (dose independent) and sedation (dose dependent). Sensory and motor blockade were identical in all three groups. There was no incidence of respiratory depression, pruritus, bradycardia or hypotension in any group. Two patients in control group and one, receiving neostigmine (200μg), developed nausea/vomiting.
Conclusion:
Co administration of epidural neostigmine and lignocaine appears to be a useful technique for postoperative analgesia as it increases the duration of analgesia and provides desirable sedation at the same time.
PMCID: PMC3087256  PMID: 21547170
Anesthesia; Epidural analgesia; Lignocaine; Neostigmine; Sedation
16.  A Comparative Study of Induction, Maintenance and Recovery Characteristics of Sevoflurane and Halothane Anaesthesia in Pediatric Patients (6 months to 6 years) 
Patients & Methods:
In a randomized , double blind clinical study, we studied 30 children, aged 6 months to 6 years, to compare halothane and sevoflurane anaesthesia in patients undergoing short surgical procedures under general anaesthesia. All the patients were premedicated with atropine 0.02mg kg-1and midazolam 0.1mg kg-1body weight intravenously and received inhalation induction using nitrous oxide in oxygen supplemented with either halothane (maximum inspired concentration of 5%) or sevoflurane (maximum inspired concentration of 8%). Induction was by inhalation of increasing concentrations of sevoflurane (1%) or halothane (0.5%) in the vaporizing setting after every three breaths of the patient.
Results:
Time to loss of eyelash reflex and tracheal intubation was more rapid using sevoflurane. Cardiac arrhythmias were significantly more frequent during halothane than sevoflurane anaesthesia. Psychomotor recovery was more rapid after sevoflurane anaesthesia. Children who received sevoflurane had comparatively less nausea and vomiting and the incidence of clinically important side effects was significantly less with sevoflurane anaesthesia.
Conclusion:
We conclude that induction with sevoflurane in nitrous oxide and oxygen leads to fast loss of consciousness and provides ideal conditions for managing the airway without supplemental opioids or muscle relaxants with haemodynamic stability and is therefore a reasonable alternative to halothane for paediatric patients.
PMCID: PMC3087258  PMID: 21547175
Halothane; Sevoflurane; paediatric; children
17.  Is Fibreoptic Percutaneous Tracheostomy in ICU A Breakthrough 
Background:
In ICUs, bedside percutaneous tracheostomy (pct) is commonly performed, but it is associated with certain drawbacks as paratracheal placement, posterior tracheal wall injury and tracheoesophageal fistula. To address these fibreoptic bronchoscope (FOB) guided PCT was introduced. We aimed to compare both these methods.
Patients & Methods:
We compared 60 age & sex matched patients into two groups of 30 each. In group 1 tracheostomy was performed by the conventional Ciaglia's method. In group 2, a fibreoptic bronchoscope was used in addition with the aid of an assistant.
Results:
The fiberoptic method took more time than the conventional method. (18±3min vs 15±2min (p=0.001)). The average no. of attempts at insertion of needle was 2.4 in group 1 and 1.2 in group 2 (p=0.001). The fall in SpO2 to <90% was seen in 1 patient in group 1 and in 6 patients in group 2, so much so that the procedure had to be abandoned in 2 patients.
Conclusion:
FOB though definitely advantageous over CPCT in terms of lesser complications and being highly useful in the obese, short necked, and those with scar marks, is not without drawbacks such as requirement of additional staff and increased expenditure. The main being inability to be used in patients with low respiratory reserve. Overall it would be complimentary for any ICU to have FOB facility and must be used in select group of patients.
PMCID: PMC3087259  PMID: 21547181
19.  Comparison of Intubating Conditions of Rocuronium Bromide and Vecuronium Bromide with Succinylcholine Using “Timing Principle” 
Background:
Rapid and safe endotracheal intubation is of paramount importance in general anaesthesia. The aim of this study was to compare the intubating conditions of succinylcholine with rocuronium bromide and vecuronium bromide using “Timing principle”. The timing principle entails administration of a single bolus dose of nondepolarizing muscle relaxant, followed by an induction drug at the onset of clinical weakness.
Patients & Methods:
75 patients were divided into three groups of 25 each. Patients allocated to Groups A and B received rocuronium 0.6 mg kg-1 and vecuronium 0.12 mg kg-1 respectively. At the onset of clinical weakness (ptosis), anesthesia was induced with propofol 2.5 mg kg-1; intubation was accomplished after 60 seconds of induction agent in both groups. Patients in Group C received propofol 2.5mg kg-1 followed by succinylcholine 2mg kg-1 and their tracheas were intubated at 60s.Train of four count was assessed at adductor pollicis muscle using nerve stimulator at intubation and time to loss of TOF was observed. in group A and B. Intubating conditions were assessed according to a grading scale and haemodynamic variables were compared at 1,3 and 5 minutes after intubation.
Results:
Intubating conditions were either excellent(84% in group A,48% in group B and 88% in group C) or good (16% in group A, 48% in group B and 12 %in group C)and only 4% pt had poor intubating conditions in group B. Patients were interviewed postoperatively, and all were satisfied with the technique of induction of anesthesia.Rocuronium and Vecuronium are haemodynamically stable drugs as compared to Succinylcholine.
Conclusion:
Rocuronium 0.6 mg kg-1 provides good to excellent intubating conditions at 60 s comparable to succinylcholine after the induction of anesthesia using the timing principle.
PMCID: PMC3087261  PMID: 21547177
Rocuronium; Vecuronium; Timing Principle; Nerve stimulator
21.  Respiratory Changes During Spinal Anaesthesia for Gynaecological Laparoscopic Surgery 
Background:
It is currently presumed that spinal anaesthesia can compromise respiratory muscle function during carbon dioxide (CO2) pneumoperitoneum. This observational study was designed to delineate the respiratory effects of CO2 pneumoperitoneum under spinal anaesthesia.
Patients & Methods:
Forty one patients undergoing elective gynecological laparoscopy were administered spinal anaesthesia with 15 mg heavy bupivacaine and 50 mcg of fentanyl. Heart rare, blood pressure, tidal volume, respiratory rate and end tidal CO2 were serially recorded before, during and after the pneumoperitoneum. Arterial blood gas analysis was done before and 20 min after initiation of pneumoperitoneum.
Results:
The mean heart rate and blood pressure decreased by less than 20% of the preoperative value. The mean tidal volume decreased from 353 ± 81(Standard Deviation) to 299±95 ml, p = 0.032, over the first 9 min after the pneumoperitoneum with a complete recovery towards the base line, 340 ± 72 ml, within 30 min during the surgery. The maximal inspiratory capacity declined from 1308±324 ml to 1067±296 ml at 20 min and recovered to 1187±267 ml, 5min after decompression. There was no observed change in the respiratory rate. Similarly, increase in the end tidal CO2 from 31.68±4.13 to 37.62±4.21 mmHg, p = 0.000, reached a plateau around 15 min and declined after decompression. Arterial carbon dioxide showed a corresponding increase at 20 min without change in arterial to end tidal CO2 difference. All observed changes were within the physiological limits.
Conclusion:
In a conscious patient undergoing laparoscopy with pneumoperitoneum, under spinal anaesthesia, the preserved inspiratory diaphragmatic activity maintains ventilation and, the gas exchange within physiological limits. Hence it is a safe alternative to general anaesthesia.
PMCID: PMC3087263  PMID: 21547173
Spinal; Pneumoperitonium; Respiratory changes
23.  A Clinical Study Comparing Epinephrine 200μg or Clonidine 90μg as Adjuvants to Local Anaesthetic Agent in Brachial Plexus Block Via Supraclavicular Approach 
Background:
A double blind randomized prospective study was undertaken to determine the effect of adjuncts like epinephrine 200μg or clonidine 90μg in combination of bupivacaine and lignocaine into the brachial plexus sheath to study the sensory and motor onset, duration of analgesia, hemodynamic changes and adverse effects.
Patients & Methods:
60 patients aged 18-65 years, with ASA grade I and II were randomly divided into group I and group II to receive 10 ml of lignocaine2% and 20 ml of bupivacaine0.5% with 1ml of 200μg epinephrine or 90μg clonidine respectively. Onset of sensory blockade was determined by pinprick method by a three point score and motor blockade by three point scale. Duration of postoperative analgesia, the hemodynamic changes, sedation scores and any adverse effects were observed. Statistical analysis was done by student's “t” test and p<0.05 was considered significant.
Results:
It was found that there was faster onset of sensory and motor blockade, the postoperative analgesia was prolonged and the amount of sedation was profound in group II as compared to group I. All the above findings were statistically significant.
Conclusion:
We thereby conclude that clonidine 90μg is a better option as an additive than epinephrine 200μg for hastening the onset of sensory and motor block with prolonged postoperative analgesia and sedation as the only adverse effect.
PMCID: PMC3087265  PMID: 21547183
Supraclavicular brachial plexus block; Clonidine; Epinephrine
24.  Effect of Supplementing Oxygen with Positive end Expiratory Pressure During Elective Caesarean Section under Spinal Anaesthesia on Foetus 
Background:
It is known fact that pre-oxygenation with positive end-expiratory pressure (PEEP) improves the Partial pressure of oxygen (PO 2). In this regard not many studies have been done in pregnant women to know its effect on foetus. In this randomised double blind controlled study, we analysed effect of pre-oxygenation with PEEP during caesarean section on foetal umbilical venous PO 2.
Patients & Methods:
40 term pregnant women, ASA I or II, undergoing elective Caesarean section under spinal anaes-thesia were randomly divided into PEEP and Non-PEEP groups of 20 each. PEEP group received oxygen flow of 6 L/minute with PEEP of 5 cmH 2O using a modified Mapleson A circuit with fixed unidirectional PEEP valve at the expiratory port during pre-oxygenation and Non PEEP group received same fresh gas flow of oxygen using same breathing circuit without PEEP. Maternal arterial blood samples were collected before applying PEEP and at the end of 5 minutes of facemask application for oxygen analysis. Immediately after baby was delivered umbilical venous samples were taken for blood gas analysis.
Results:
Both groups were comparable in terms of maternal baseline oxygen saturation (Spo 2) and base line Po 2. After 5 minutes PO 2was higher in PEEP Group than non PEEP group (491.65 + 49.96 vs. 452.08 + 77.61). Umbilical venous Po 2in PEEP group was higher than non PEEP group (34.22 + 6.50 vs. 28.29 + 6.10 mm of Hg).
Conclusion:
Application of PEEP during pre-oxygenation for spinal anaesthesia can increase foetal umbilical venous PO2.
PMCID: PMC3087266  PMID: 21547172
Pre-oxygenation; Positive end-expiratory pressure; Caesarean section; Foetus

Results 1-25 (42)