Indian Journal of Anesthesia and Analgesia

Acromegaly, a neuroendocrine disorder due to excess growth hormone and insulin like growth factor-1, has large spectrum of underlying comorbidities. Hereby we report acromegalic cardiomyopathy in 65 year old male patient who also had acromegalic changes involving various other systems and anesthetic management of the same when he was scheduled for definitive transnasal trans-sphenoidal resection of pituitary adenoma.

Context: It is clear that the number of elderly is going to rise in coming days. Hence, number of elderly requiring surgery and anesthesia is also on increase. At the same time, there are newer developments in the field of anesthesia. Hence, operation theatre staff and doctors should know which agent is better when given the choice.

Aim: To compare recovery and postoperative cognitive functions after general anesthesia with sevoflurane or desflurane based technique in elderly patients.

Settings and Design: Prospective Randomized Controlled Comparative Interventional study was conducted at KIMS Hospital, Kondapur, Hyderabad.

Methods: 120 patients undergoing surgeries under general anesthesia were included. They were randomly assigned in two groups of 60 each; with one group receiving Sevoflurane and the other desflurane. Two groups were compared for different parameters.

Statistical Analysis: Chi Square Test was applied for categorical data and t test for the continuous data.

Results: Both the groups were comparable in terms of age and sex. Mean BMI was significantly higher in desflurane group compared to sevoflurane group (p < 0.05). Mean duration was significantly higher in desflurane group cases. The recovery indices were significantly better in desflurane group cases (p<0.05). MMSE scores were not significantly different in two groups (p>0.05). Incidence of POCD in two groups was comparable (p>0.05).

Conclusion: Both the drugs i.e. desflurane and sevoflurane are equally effective among elderly cases undergoing surgery under general anesthesia in preventing POCD.

Key messages: Desflurane and sevoflurane can be used in elderly patients undergoing surgery under general anesthesia.

Objective: To compare the analgesic effect of different doses of nalbuphine when added to bupivacaine in spinal anaesthesia. To compare the onset of sensory blockade (time taken form 3, 5 min and then every 5 min until the end of the procedure.

Methods: 100 ASA grade 1 and 2 patients grouped into group A, group B, group C and group D randomly. Age group of 18-60 years. Patient undergoing elective lower abdominal and orthopedic surgery received with Group A : included 25patients with 0.5% hyperbaric bupivacaine 3 cc (15mg) + N.S. 0.2 ml. Group B: included 25 patients with 0.5% hyperbaric bupivacaine (3 cc) 15 mg + 0.8mg nalbuphine + N.S. 0.2 ml. Group C: included 25 patients with 0.5% hyperbaric bupivacaine (3 cc) 15 mg + 1.6mg nalbuphine + N.S. 0.2 ml. Group D: included 25 patients with 0.5% hyperbaric bupivacaine (3 cc) 15 mg + 2.4 mg nalbuphine + N.S. 0.2 ml.

Results: The mean sensory onset of study subjects in group A, B, C and D were 8.4±0.5, 5±0.9, 5.6±1 and 8.2±1.4 respectively and this difference was statistically significant. The mean motor onset of study subjects in group A, B, C and D were 10.2±0.7, 6.8±0.9, 6.1±1.2 and 8.6±1.1 respectively and this difference was statistically significant. The mean sensory duration of study subjects in group A, B, C and D were 176.8±29.3, 282±6.8, 300.2±6.6 and 286.2±9.8 respectively and this difference was statistically significant. The mean time for maximum sensory level of study subjects in group A, B, C and D were 11.5±1, 8.8±0.8, 5.6±1.6 and 8.2±1.2 respectively and this difference was statistically significant. The mean T 10 time of study subjects in group A, B, C and D were 8.5±0.5, 8.7±0.7, 5.6±1.6 and 8.6±1 respectively and this difference was statistically significant. The mean time for 2 segment regression of study subjects in group A, B, C and D were 76.6±2, 92.2±2.3, 95.8±3 and 90.6±4.4 respectively and this difference was statistically significant. The mean motor duration of study subjects in group A, B, C and D were 179.8±8.9, 184.6±6, 203.2±7 and 187±9.9 respectively and this difference was statistically significant. The mean analgesic duration of study subjects in group A, B, C and D were 175.8±4.1, 271.1±7.8, 303.8±9.9 and 279±10.7 respectively and this difference was statistically significant.

Conclusion: We came to conclusion that 0.5% hyperbaric bupivacaine (15mg) with nalbuphine (0.8mg, 1.6 mg, 2.4 mg) in subarachnoid block. Therefore addition of 1.6 mg nalbuphine to 15mg of 0.5% hyperbaric bupivacaine 15 mg in subarachnoid block can be considered safe with minimum complication, and provides excellent quality and longer duration of postoperative analgesia with good sedation compared with 0.8 mg and 2.4 of nalbuphine. So it is useful for prolonged duration of postoperative analgesia.

Background: Postoperative sore throat (POST) is a common complaint during postoperative period after tracheal intubation. We evaluated and compared the effects of preoperative ketamine or tramadol nebulization on POST in patients undergoing general anaesthesia with tracheal intubation.

Methods: Sixty patients, aged 18-60 years of ASA status 1 & 2 scheduled for elective surgery lasting upto 2 hours under general anaesthesia with endotracheal intubation were randomly divided into two groups; Group K: patients received Ketamine 50 mg (1 ml) with normal saline (4 ml) nebulisation, Group T: patients received Tramadol 50 mg (1 ml) with normal saline (4 ml) nebulization 30 min before induction. Incidence of postoperative sore throat and its intensity, nausea vomiting, sedation and any side effects of drugs were recorded.

Result: No significant difference was observed in the incidence of postoperative sore throat between the ketamine group and tramadol group patients. Severity of POST was higher in group T as compared to group K but it was statistically insignificant. Nausea, vomiting and sedation incidence was comparable in both groups.

Conclusion: Preoperative nebulisation with ketamine is clinically more effective than tramadol nebulization in prevention of postoperative sore throat.

Background: Prolongation of analgesia in Neuraxial anaesthesia is achieved by adding various adjuvants intrathecally along with local anaesthetic agent. Using two adjuvants together in lower doses will prolong the duration of analgesia without causing much side effects.

Aims: To compare the efficacy and safety of Intrathecal Magnesium v/s Fentanyl with Magnesium sulphate as an adjuvant to 0.5% Bupivacaine in terms of onset and duration of Sensory and Motor Blockade and Duration of Postoperative analgesia.

Material and Methods: Prospective randomized double blinded study was conducted on 70 ASA 1 & 2 patients undergoing elective caesarean section. They were randomly divided into two groups (35 each). All patients received spinal anaesthesia. Group M received 1.7 ml of 0.5% bupivacaine, 0.1 ml (50 mg) magnesium sulphate and 0.2 ml of normal saline intrathecally. Group FM received 1.7 ml of 0.5% bupivacaine, 0.1 ml (50 mg) magnesium sulphate and 0.2 ml (10microgram) of fentanyl intrathecally.

Results: Onset of sensory block was similar in Group M and Group FM. Duration of sensory block was prolonged in group FM (191±45.60) compared to Group M (178.12±38.06). Duration of analgesia was significantly prolonged.

Conclusion: We conclude that, the addition of both intrathecal magnesium sulphate and fentanyl to bupivacaine for spinal anesthesia, in parturients undergoing elective LSCS results in prolonged duration of analgesia.

Background: In recent years, interfacial plane blocks are used to reduce pain and opioid consumption for multimodal analgesia strategies. Serratus Anterior Plane (SAP) block is widely used clinical practice, in which local anesthetics are injected into the fascial plane superficial or deep to the serratus anterior muscle (SAM). This will block the lateral cutaneous branches of the intercostal nerves, this effectively relieving postoperative pain for procedures such as breast surgery, thoracoscopic surgery, rib fractures, and minimally invasive heart surgery.

Aim & Objective of the Study: The study aims to compare Serratus Anterior Plane Block between 0.125% Bupivacaine 20ml and 0.2% Ropivacaine 20ml for the duration of postoperative Analgesia.

Methods: The clinical study was conducted in the Department of Anaesthesiology at Rajah Muthiah Medical College and hospital, Annamalai University from December 2019 to September 2021. The study includes 40 adults patients coming for elective adult breast surgeries. Patients were assigned by random numbers into one of the two treatment groups: Serratus Anterior Plane block with 20ml Bupivacaine 0.125% (group B) and 20ml Ropivacaine 0.2% (Group R). The parameters monitored and recorded are heart rate, blood pressure,VAS score, and side effects. The results were subjected to statistical analysis.

Results: Heart rate variation between the groups, (group B and group R) at regular intervals from 0 mins to 24 hours is not statistically significant (p > 0.05). Systolic Blood Pressure variation between the groups (group B and group R) at regular intervals from 12 to 24 hours, is statistically significant (p <0.05). Diastolic Blood Pressure variation between the groups, group B and group R, at regular intervals from 0 to 24 hours, is not statistically significant (p >0.05). Duration of postoperative analgesia was prolonged in Group R 16.7±3.8 hrs when compared with Group B 9±1.7hrs. The p value was based on independent sample t test which gives a value of.

Background: Neuraxial administration of opioids with local anaesthetics improve the quality of intraoperative analgesia. It is also known to produce a longer duration of postoperative analgesia. The purpose of this study was to compare the efficacy of intrathecal plain bupivacaine with bupivacaine and fentanyl combination in patients who undergo a lower segment caesarean section.

Methods: A total of 100 patients were randomized into two groups of 50 each to receive either plain bupivacaine or bupivacaine with fentanyl. The hemodynamic changes, sensory and motor blockade were observed both intraoperatively and postoperatively.

Results: 10 mg of 0.5% bupivacaine with 12.5 µg fentanyl produces an effective level of the sensory blockade and maintains stable intraoperative hemodynamic parameters with decreased incidences of adverse effects like nausea and vomiting. The total duration of effective analgesia was significantly longer in the fentanyl group.

Conclusions: Intrathecal fentanyl in a dose of 12.5µg of fentanyl with bupivacaine for spinal anaesthesia in caesarean section provides good intraoperative analgesia and also significantly reduces the demand for postoperative analgesia.