Indian Journal of Anesthesia and Analgesia

Myasthenia gravis patients represent a significant management problem for the anesthesiologist, as the anesthetic considerations in these patients include a marked sensitivity to the non-depolarizing skeletal muscle relaxants and an increase in the risk of prolonged postoperative mechanical ventilation. Regional anesthesia, including USG guided nerve blocks are an excellent option, wherever feasible. In situations where regional techniques are contraindicated or fail to provide surgical anesthesia, general anesthesia without muscle relaxants can be a handy option.
 

Introduction: Leprosy is a chronic infectious disease caused by Mycobacterium leprae and affects the skin and nerves. Leprosy patients in which peripheral neuropathy and the involvement of other organs may have dysautonomia in the heart and respiratory system and autonomic involvement. Case Report: A 65 year-old patient was posted for fixing of right intertrochanteric with left subtrochanteric fracture femur. The possibility of a difficult airway was considered because of the mouth and nose deformities. Difficult airway equipment, such as a fibre-optic bronchoscopy and laryngeal mask (LMA) were made available. The patient’s vitals were normal. The haemogram and biochemistry measurements were normal. Under aseptic conditions in the sitting position at the L3–4 level, the subarachnoid space was identified with a 18-G Tuohy needle, the catheter was threaded into subarachnoid space and fixed at 10cm.1.2 mL(6mg) of 0.5% hyperbaric bupivacaine (6mg) administered. After 1hour from the starting of procedure, again 1.2 ml(6mg) of 0.5% hyperbaric bupivacaine administered through the catheter. Level achieved till T10. BP was 72/42mmHg, treated with 12mg Mephentermine. Inj.Fentanyl 50mcg given through the catheter and the catheter was removed. Conclusion: Appropriate assessment before anaesthesia and preparation are important in the management of anaesthesia of patients with leprosy. Regional anaesthesia can be used as an alternative for patients without autonomic neuropathy and with a suspicion of systemic involvement and with difficult intubation

Background: Although, postoperative pain is a distinctive and most common form of pain, it remains poorly treated. Aim: To evaluate the efficacy of Transdermal diclofenac patch versus IM diclofen patients undergoing lower abdominal and perineal surgeries under Subarachnoid during postoperative period. Methodology: This randomised comparative study included 90 ASA I and II patien either sex aged 18 – 60 years. Patients were randomly divided by computer generated into two groups of 45 patients each. Group A was applied with a Transdermal Diclofenac (100mg) at the beginning of surgery after subarachnoid block. In groupB 75mg of Diclofenac sodium was given intramuscularly half an hour befo end of surgery. Data was analysed using Chi-square test and Mann Whitney U test Results: The mean difference in the time of administration of rescue analgesia in grou 8hr 37 mins ± 1 hr 4.2 mins and group B is 6hrs 19 mins ±58.6 mins ( P value is < 0.0001 ) effects in group A were very minimal. Conclusion: Thus transdermal diclofenac patch is effective, non- invasive and safer w treating postoperative pain.

Decreasing the fresh gas flow rate during anaesthesia in surgeries may minimise costs, reduce environmental pollution and preserve heat and humidity in the respiratory system.

 

Laparoscopy, has emerged as the main stay for most of the commonly performed surgeries. Pneumoperitoneum and different positions of the patient during laparoscopy contribute to adverse cardiovascular effects like elevated arterial pressure, increased systemic and pulmonary vascular resistance and reduced cardiac output. This randomised controlled double blind prospective study was conducted to compare the efficacy of intravenous(I.V) Lidocaine and I.V. Clonidine in providing hemodynamic stability in patients undergoing laparoscopic surgeries. Methods: Seventy five adult patients of ASA grade 1 and 2, scheduled for elective laparoscopic surgery with a mean duration of 30- 90 minutes, were randomly allocated to one of the three groups. Group A: Clonidine group (n=25) - received injection Clonidine 1.5 mcg/kg 15 minutes prior to induction of anaesthesia. Group B: Lidocaine group (n=25) - injection Lidocaine 1.5 mg/kg 90 seconds prior to induction of anaesthesia. Group C: Control group (n=25) - received 10 ml normal saline intravenously. Results: There is no statistically significant difference between lidocaine and control group regarding mean HR, SBP, DBP, MAP during the entire period of pneumoperitoneum. Whereas, there is significant increase of blood pressures (SBP, DBP, MAP) in the lidocaine and control groups compared to the clonidine group from intubation, throughout the period of pneumoperitoneum. Clonidine also decreases the requirement of propofol for induction. Conclusion: I.V Clonidine 1.5mcg/kg premedication is more effective than Lidocaine 1.5mg/kg at preventing changes in hemodynamic parameters induced by carbondioxide pneumoperitoneum.

To compare the efficacy of IV Lignocaine(preservative free) (1.5mg/kg body weight) and IV Magnesium sulphate(20 mg/kg body weight) in elective surgery under general anesthesia for controlling the hemodynamic response to laryngoscopy and endotracheal intubation. It can be observed from the present study, the two groups were comparable for age, sex, weight and ASA status of the patients. Magnesium sulphate at 20 mg/kg bodyweight produced significant decrease in heart rate and blood pressure than lignocaine group. The mean heart rate was 92.16 + 10.98 and 123.84 + 8.78 per minute(p=0.0001) at one minute post intubation in Magnesium sulphate group and Lignocaine group respectively. The mean systolic pressure was 130.92 + 8.17 mm of Hg and 158.20 + 4.76 mm of Hg (p=0.0001) and the mean diastolic pressure was 87.64 + 5.7 mm Hg and 99.28 + 4.3 mm of Hg (p=0.0001) at one minute post intubation in Magnesium sulphate group and Lignocaine group respectively. It can be observed from the above result that Magnesium sulphate (in a dose of 20 mg/kg body weight) 3 minutes prior to laryngoscopy when compared to lignocaine (in a dose of 1.5 mg/kg body weight) 3 minutes prior to laryngoscopy causes greater attenuation of stress response to laryngoscopy and endotracheal intubation resulting in greater reduction of heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and rate pressure product thus causing better hemodynamic stability and thus proving beneficial in patients with hypertension or history or coronary artery disease making it a desirable choice for such patients.

Context: Supraglottic airway devices (SGAs) are tools used for airway management in anaesthesia and provide a good alternative to tracheal intubation.Comparison of I-gel and ProSeal LMA (PLMA) was done because of time taken for insertion, fiberoptic view of the larynx, ease of Ryle’s tube insertion, and post-operative sore throat assessment. Methods and Material: In the present prospective, randomized study instead of manner, 60 adult patients of the American Society of Anaesthesiologists I-II of either gender between 18 and 60 years presenting for an elective surgical procedure, under general anaesthesia were enrolled. The airway was secured using either the I-gel or PLMA. An experienced non-blinded anaesthesiologist inserted appropriate sized I-gel or PLMA in patients using standard insertion technique and compared both devices in terms of time taken for insertion, effective seal, fibre optic view of the larynx, number of attempts, and hemodynamic changes during insertion. Results: The time required for insertion of I-gel was lesser (14.32 ± 1.23 and 20.23± 1.82s in Group I and Group P, respectively; P < 0.001). The numbers of attempts for successful insertions were comparable and in the majority, the device was inserted in the first attempt. The fiber optic view of glottis was better with I gel (p-value=0.048),hemodynamic changes and incidence of complications were comparable in both groups. Conclusions: The time required for successful insertion of I-gel was shorter in adult patients undergoinga surgical procedure under general anesthesia on controlled ventilation.The fibre optic view of the glottis was better with the proseal indicating better utility as a conduit for intubation.

Spinal anaesthesia is commonly used for abdominal and lower limb surgeries. This study has been designed to evaluate the addition of two doses of dexmedetomidine(10μg and 15μg) as an adjuvant to 0.5% hyperbaric bupivacaine 3ml intrathecally for elective abdominal and lower limb surgeries. Methods: In this randomized, double-blind prospective study, 60 patients of ASA I and II were randomized to three groups: group I, II and III(n=20). All patients received a drug volume of 3.5ml containing 3 ml hyperbaric bupivacaine(15 mg). They received dexmedetomidine 10μg (Group II) or 15 μg (Group III) added to bupivacaine ; the control group (Group I) received 0.5ml of 0.9% saline added to bupivacaine. Results: It was found that the onset of sensory block upto T10 and motor block is significantly faster in group II (174 sec and 109.5 sec) and III (93 sec and 57.75 sec) over group I (294 sec and 155.25 sec).The mean time for two segment regression and sensory regression to L1, the mean duration of analgesia and motor blockade is significantly prolonged in Group III(138.75 min,469.5 min,438 min,510.5 min) over Group II (104.25 min, 321 min,277.5 min, 323.25 min) and Group II over Group I(88.5 min,257.25 min,238.5 min,265.5 min) (p<0.001). Conclusion: I conclude that 15μg of dexmedetomidine added to local anaesthetic in subarachnoid block has proved to be a better adjuvant in prolonging the sensory and motor blockade and the duration of postoperative analgesia.

Aims and Objective: To evaluate the efficacy of Flupirtine in reducing acute postoperative pain after laparoscopic cholecystectomy as compared to Ibuprofen when administered by oral route prior to surgery and to observe and compare side effect profile of oral Flupirtine maleate and Ibuprofen. Method: This study was conducted in 60 patients of ASA1/2,21to70 years of age who were randomly divided into two groups to receive either 200mg oral flupirtine maleate or 800 mg oral Ibuprofen 2 hrs prior to the procedure. Post operatively patient was observed for vas score, RSS, rescue analgesia requirement and post-operative nausea and vomiting. Result: Patients from flupirtine group had lower VAS score than that of ibuprofen group in first 6 hours. RSS score was satisfactory in first 4 hours in flupirtine group than ibuprofen group. Rescue analgesia requirement was more in ibuprofen group than flupirtine group also post-operative nausea and vomiting was seen more in ibuprofen group than flupirtine group. Conclusion: This study concluded that, patients undergoing laparoscopic cholecystectomy, pre-emptive use of oral flupirtine 200 mg is more effective compared to oral ibuprofen 800 mg and flupirtine provides better pain relief with additional muscle relaxation and mild sedation in early post-operative period.

Maxillo-facial trauma involving maxillary and mandibular structures presents with difficulties in maintaining airway and sometimes challenges anaesthesiologist and surgeon more often at intra-operative period. Patient can have serious destruction of soft tissue, bony and cartilagenous components of the upper airway. Nasal intubation in these patients is controversial1, more particularly when performed without fibre optic bronchoscope. The necessity of intra-operative restoration of occlusion by maxillo-madibular fixation(I.M.F) makes oral intubation not feasible. For patients with pan facial trauma where nasal and oral intubation not possible and tracheostomy is the only option and only when short term post operative airway control is required, submental intubation can be a valuable option2. In our study submental intubation was done on 12 patients with a technical modification to prevent tearing of the oral mucosa which is known to be common in submental intubation.