Journal of Anaesthesiology, Clinical Pharmacology最新文献

{"title":"When the intra-operative neuro-monitoring techniques crossed swords with the electro-encephalogram monitoring!","authors":"Keta Thakkar, Dhritiman Chakrabarti, Srinivasa Babu Krothapalli, Georgene Singh","doi":"10.4103/joacp.joacp_96_22","DOIUrl":"10.4103/joacp.joacp_96_22","url":null,"abstract":"","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10805202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139546566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Techniques of securing endotracheal tube during cosmetic facial surgeries involving nose, cheeks, and chin","authors":"Sunil Rajan, Aishwarya P. Suresh, Madhumita Ramakrishnan, Jerry Paul","doi":"10.4103/joacp.joacp_132_22","DOIUrl":"https://doi.org/10.4103/joacp.joacp_132_22","url":null,"abstract":"Dear Editor, Securing endotracheal tubes (ETT) during facial cosmetic surgeries can be challenging.[1] We are reporting how ETT was secured in two patients who underwent cosmetic facial surgeries which demanded bilateral cheeks, chin, and nose to be free. Flexometallic ETTs were used and were secured to incisors. In case 1, a 25-year-old female was posted for rhinoplasty, chin implant placement, and liposuction of the cheeks. After intubation, ETT was brought to the midline and a firm knot was made around ETT using size 1.0 silk (Centisilk, Centenial Surgical Suture Ltd, India) that was tied twice around ETT, and the knot was kept near the inner aspect of the upper incisors. Threads were then slipped down to gum through either side of one upper incisor, like performing dental flossing, and tied firmly on the buccal aspect of the incisor [Figure 1a].Figure 1: (a) ETT secured with thread to the upper incisor, (b) ETT secured with stainless steel wire to lower incisorsIn case 2, a 55-year-old female was posted for a chin implant, neck lift, lip lift, and liposuction of nasolabial folds. As incisors were closely placed, we failed to slip the thread between teeth down to the gum. Therefore, we decided to use a pre-stretched 26 G stainless steel wire (Ortho Max Mfg Co Pvt Ltd, India) which is commonly used by dental surgeons for arch bar fixation. The wire was wound twice around ETT and twisted repeatedly by holding both wires at a short distance from ETT using a needle holder. Once the wire was tightly wound around ETT, both the free ends of the wire were brought out to the buccal aspect through the lateral part of the first two lower incisors close to the gum. Both the ends were held together and twisted repeatedly till it was secured tightly around the incisors. The extra length of twisted wire was then cut short, the free end turned away from the lip, and covered with a piece of transparent incision drape to avoid lip trauma [Figure 1b]. Fixing ETT using adhesive tapes to cheeks or chin was not practical in both patients as surgeries involved the chin and both cheeks and frequent assessment of facial symmetry intraoperatively was required. Preformed tube (oral/nasal) was avoided as surgeries involved the nose, chin, and neck. The use of a flexometallic tube prevented kinking of ETT and gave surgeons freedom to move the proximal part of ETT with an attached breathing circuit (covered in sterile plastic sheet) away from the surgical field with no distortion of facial anatomy. These requirements could have been met with submental intubation as in panfacial trauma,[2-4] but not considered as our patients were undergoing cosmetic procedures. Though tying ETT with silk to incisors is totally atraumatic, dental wires may cause minimal gum injury. As tips of incisors are always broader than root, the chance of suture slipping out intraoperatively is rare, if the knot is tied firmly close to the root of incisors. ETT should not be tied to loose or partly br","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135207765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of oral melatonin premedication on hemodynamic responses to intubation, anesthetic requirements and postoperative sedation: A randomized trial","authors":"Sunil Rajan, Reema Abubaker, Revathy Ajayachandran Kala, Niranjan Kumar Sasikumar, Mani Vignesh Kannan, Lakshmi Kumar","doi":"10.4103/joacp.joacp_159_22","DOIUrl":"https://doi.org/10.4103/joacp.joacp_159_22","url":null,"abstract":"Abstract Background and Aims: Sedative effects of melatonin may have an additive effect on general anesthesia (GA). We compared hemodynamic response to intubation following oral premedication with melatonin versus placebo. Induction dose of propofol, isoflurane and fentanyl consumption were also compared. Material and Methods: This prospective, double-blinded study was conducted in fifty patients randomized into two equal groups. Group M received oral melatonin 6 mg and group P a placebo two hours before surgery. All patients were induced with intravenous propofol of 1.5–2.5mg/kg till loss of response to verbal commands, three minutes after vecuronium, laryngoscopy was done and trachea was intubated. Heart rate (HR) and mean arterial pressures (MAP) were recorded before premedication, before induction, immediately after induction and then at 1,3,5 and 10 minutes after intubation. Results: Mean HR was comparable in both groups throughout the study period. Group M had significantly lower MAP before induction and immediately after induction ( P < 0.05). At all other time points MAP remained comparable in both groups. Mean isoflurane consumption was significantly lower in group M compared to group P (14.8 ± 4.2 vs 19.7 ± 3.2 mL). Propofol requirement for induction was also significantly lower in group M (102.4 ± 19.6 vs 122.4 ± 26.3mg). Intraoperative fentanyl consumption was comparable. Conclusion: Oral premedication with melatonin 6mg administered two hours before surgery significantly reduced MAP before and after induction of GA with a significant reduction in dose of propofol requirement.Titrating induction dose of propofol till loss of response to verbal commands did not effectively attenuate responses to laryngoscopy and intubation following melatonin oral premedication.","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135207768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of subarachnoid block in pediatric patients with dilated cardiomyopathy in congestive cardiac failure","authors":"Niranjan K. Sasikumar, Sunil Rajan, Annu S. Abraham, Jerry Paul","doi":"10.4103/joacp.joacp_287_22","DOIUrl":"https://doi.org/10.4103/joacp.joacp_287_22","url":null,"abstract":"Sir, Dilated cardiomyopathy (DCM) is characterized by enlargement and dilation of one or both ventricles along with impaired contractility with left ventricular ejection fraction (LVEF) of <40% which is progressive with poor survival rates.[1] A 4-year-old boy, weighing 14kg, was posted for wound debridement of bilateral below knee ulcers. He was admitted with breathlessness and swelling over legs. He had history of viral myocarditis, severe left ventricular (LV) dysfunction, ejection fraction (EF) of 20%, dilated LV/global hypokinesia, and was diagnosed with DCM with congestive heart failure. He was treated with intravenous (IV) frusemide 2mg/kg/day and levosimendan infusion 0.1mcg/kg/min. Currently, he was on milrinone 0.5 mcg/kg/min and frusemide 2mg/kg/day infusions; oral digoxin 1mg on alternate days; and intravenous fluid (IVF) 45mL/hour. Poor prognosis and chance of sudden cardiac death (SCD) were explained to parents. Echo on day of surgery showed DCM, severe biventricular dysfunction, mild pulmonary artery hypertension, dilated ventricles, severe global LV hypokinesia, and severe left and right ventricular dysfunction with LVEF of 14%. Serum electrolytes were normal. Chest X-ray showed cardiomegaly [Figure 1].Figure 1: X-ray chest showing cardiomegalyAs the child was irritable and not cooperative, surgery under nerve blocks and, in view of poor cardiac status, general anesthesia (GA) was not opted for. In the theater, infusions of milrinone, frusemide, and IVF were continued at the same rates through central line. Electrocardiogram, pulseoximeter, and invasive blood pressure (BP) monitors were attached. BP was 86/58 mmHg, and heart rate was 88 beats per minute. 10mg of ketamine was given IV and subarachnoid block was given with 1.6 mL of 0.5% bupivacaine heavy using a 25G spinal needle in a slightly head-up position. Systolic BP remained 90–95 mm Hg after spinal, with block upto T12 level. The surgery lasted one hour. The child underwent wound debridement three more times and skin grafting on the fourth sitting, over a period of three weeks. With gradual deterioration of cardiac status, GA was never considered. All procedures were done under subarachnoid block and were uneventful. He developed no complications pertaining to frequent dural punctures. A previous myocarditis is the most frequent cause of DCM in children with 40% mortality. Children with DCM predominantly experience SCD from pump failure and risk factors are early age at diagnosis, LV dilatation, LV posterior wall thinning (<14 mm) at presentation, heart failure, and low EF.[2,3] The main goals of anesthetic management in patients with DCM are to avoid myocardial depression, maintain adequate preload and prevent increases in afterload, avoid tachycardia, and prevent sudden hypotension by careful titration of anesthetic agents. Central neuraxial blockade may reduce afterload and improve cardiac output, but accompanying hypotension resulting in myocardial hypoperfusion must be","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135207760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Target-controlled infusion – Past, present, and future","authors":"P. Bidkar, Ankita Dey, P. Chatterjee, Rajasekar Ramadurai, J. Joy","doi":"10.4103/joacp.joacp_64_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_64_23","url":null,"abstract":"\u0000 Target-controlled infusion (TCI) is a novel drug delivery system wherein a microprocessor calculates the rate of drug to be infused based upon the target plasma or effect site concentration set by the operator. It has found its place in the operation theaters and intensive care units (ICUs) for safe administration of intravenous anesthesia and analgosedation using drugs like propofol, dexmedetomidine, opioids, and so on. Operating a TCI device requires the user to have a primitive understanding of drug pharmacokinetics and pharmacodynamics and an awareness of the practical problems that can arise during its administration. Ongoing research supports their usage in other clinical settings and for various other drugs such as antibiotics, vasopressors, and so on. In this article, we review the underlying principles and commonly used drugs for TCI, the practical aspects of its implementation, and the scope of this technology in future. TCI technology is increasingly being used in the field of anesthesiology and critical care due to the myriad advantages it offers when compared to manual infusions. It is, therefore, essential for the reader to understand the relevant principles and practical aspects related to TCI technology, as well as to be aware of the commonly used TCI models.","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48762428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of the application of double-modified nasopharyngeal airways versus the use of low-flow nasal cannula during pediatric upper gastrointestinal endoscopy: A prospective, randomized, noninferiority, controlled trial","authors":"M. Hussein, A. Amer, M. Maarouf","doi":"10.4103/joacp.joacp_113_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_113_23","url":null,"abstract":"\u0000 \u0000 \u0000 Pediatric upper gastrointestinal (GI) endoscopy is commonly performed under deep sedation, which is frequently associated with respiratory complications. The study compared the respiratory benefits of applying bilateral modified nasopharyngeal airways (NPAs) to conventional low-flow nasal cannula (LFNC).\u0000 \u0000 \u0000 \u0000 Fifty patients scheduled for an upper GI endoscopy under deep sedation, with an American Society of Anesthesiologists physical status I/II, were enrolled in the study. The patients were randomly divided into bilateral NPA group and the LFNC group. Fentanyl and propofol were administered to both groups to maintain deep sedation. After the application of NPA or LFNC, the hypoxic incidents (oxygen saturation [SpO2] <90%) and airway interventions during the procedure were noted and recorded. Other outcomes such as nasopharyngeal injuries, gastroenterologist satisfaction, the incidence of hypotension or bradycardia, and postoperative nausea and vomiting were also compared.\u0000 \u0000 \u0000 \u0000 No significant differences were noted in the demographic data. The incidence of hypoxemia was 16% (n = 4) in the NPA group versus 36% (n = 9) in the LFNC group (P = 0.634). Airway intervention was lower in the NPA group compared to the LFNC group, but the difference was not significant (P = 0.539). No significant differences were noted in the incidence of nasopharyngeal injuries, postoperative nausea and vomiting, bradycardia, and hypotension. The NPA group showed higher gastroenterologist’s satisfaction (P = 0.003).\u0000 \u0000 \u0000 \u0000 Double-modified NPA in pediatric endoscopy was noninferior to the standard LFNC for the incidence of hypoxemia and airway intervention rate, with greater gastroenterologist satisfaction.\u0000","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42295325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of propofol-based total intravenous anesthesia versus desflurane anesthesia on natural killer cell cytotoxicity after hepatocellular carcinoma resection","authors":"Kirada Apisutimaitri, Pipat Saeyup, K. Suppipat, Pongserath Sirichindakul, Nattanit Wanasrisant, Chawisachon Nonsri, Panas Lertprapai","doi":"10.4103/joacp.joacp_174_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_174_23","url":null,"abstract":"\u0000 \u0000 \u0000 Inhalation anesthesia suppresses the immune system and stimulates the growth of tumor cells, contrary to intravenous anesthesia. However, no consensus exists on which anesthetic technique is better for preventing cancer recurrence. Therefore, this study compared the effects of two different anesthetic techniques on natural killer cell cytotoxicity (NKCC) in hepatocellular carcinoma (HCC) patients undergoing open hepatic resection.\u0000 \u0000 \u0000 \u0000 Patients diagnosed with nonmetastatic HCC were scheduled for hepatic resection and randomly assigned to receive either propofol- or desflurane-based anesthesia. The primary outcome was pre- and postoperative NKCC assay. Cytokine levels were assessed by measuring interleukin (IL)-2, IL-4, IL-6, IL-10, tumor necrosis factor-alpha (TNF-α), and interferon-gamma (IFN-γ) levels, and the secondary outcome was postoperative cancer recurrence evaluated using diagnostic imaging scans for 2 years.\u0000 \u0000 \u0000 \u0000 Twenty-eight patients were analyzed, including 15 and 13 in the total intravenous anesthesia (TIVA) and inhalation (INH) groups, respectively. Two patients in the INH group were excluded due to non-HCC postoperative pathologic results. At 24 h, the postoperative change in NKCC between both groups showed no significant differences at a ratio of effector cell: target cell = 1:1, 5:1, and 10:1 (P = 0.345, 0.345, and 0.565, respectively). Also, there were no significant differences in IL-2, IL-4, IL-6, IL-10, TNF-α, and IFN-γ levels (P = 0.588, 0.182, 0.730, 0.076, 0.518, 0.533, respectively). Postoperative tumor recurrence occurred in five and six patients in the TIVA and INH groups, respectively.\u0000 \u0000 \u0000 \u0000 NKCC did not differ significantly among HCC patients undergoing open hepatic resection under either propofol or desflurane anesthesia 24 h postoperatively.\u0000","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44623770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A double-blinded randomized control trial to compare the duration of analgesia using morphine, clonidine, or dexmedetomidine as adjuvants to ropivacaine in caudal anesthesia in children undergoing infraumbilical surgeries","authors":"Aparanjit Paul Pallapati, Riya Jose, B. Devadharshini, M. Gowri, A. Joselyn","doi":"10.4103/joacp.joacp_12_23","DOIUrl":"https://doi.org/10.4103/joacp.joacp_12_23","url":null,"abstract":"\u0000 \u0000 Adjuvants added to the caudal block prolong the duration of analgesia. In a developing country with economic constraints, the choice of an adjuvant will be the medication with a longer duration of analgesia, a favorable side-effect profile, and the least expensive option. We wished to study the duration of postoperative analgesia afforded by three adjuvants: morphine, clonidine, and dexmedetomidine, at doses wherein minimal or nil adverse effects would be attributed to the adjuvant. The primary objective of the current study is to compare the duration of postoperative analgesia with morphine, clonidine, or dexmedetomidine as adjuvants to 0.2% ropivacaine in a for caudal block, in children undergoing elective abdominal, urogenital, and lower limb surgeries. The secondary objectives are (a) to study the total analgesic requirement during the first 24 hours after surgery and (b) to compare the incidence of complications among the three groups.\u0000 \u0000 \u0000 \u0000 Sixty-three children aged 1–6 years, belonging to American Society of Anesthesia (ASA) physical status I, II, and scheduled to undergo elective infraumbilical surgeries, were enrolled in the study. The children were randomly assigned to one of three groups: Group D received a caudal block with dexmedetomidine 1 μg/kg, Group M received morphine 30 μg/kg, and Group C received clonidine 1.5 μg/kg. All groups also received 0.2% ropivacaine (1–1.25 ml/kg) as part of the caudal block. The duration of analgesia, total analgesic requirements during the first 24 hours after the surgery, and the incidence of complications in the three groups were monitored by a pain nurse who was blinded to the study allocation.\u0000 \u0000 \u0000 \u0000 The three groups were comparable with respect to age, sex, weight, and duration of surgery. The median time taken for the first rescue analgesic in the dexmedetomidine group was 380 minutes, in the clonidine group was 360 minutes, and in the morphine group was 405 minutes. Though the morphine group had a longer duration of analgesia, it was not statistically significant (P = 0.843). The total perioperative opioids used and side effects were similar among the three groups. There were no episodes of intraoperative bradycardia noted in Groups D, M, and C. However, one patient in Group D required treatment for bradycardia in the postanesthesia care unit. In terms of intraoperative hypotension, 10 patients (43.5%) in Group D, 5 patients (27.8%) in Group C, and 5 patients (22.7%) in Group M required treatment, but this difference was not statistically significant (P = 0.299). There was no significant difference observed in the time to awakening after the anesthesia among the three groups. Postoperative nausea and vomiting were noted in five patients (21.7%) in Group D, one patient (5.6%) in Group C, and four patients (18.2%) in Group M (P = 0.382). One patient in Group M had a sedation score of 5 and required 4 hours of supplemental oxygen via face mask in the ward. Additionally, one patient in Group","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48426287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of subtenon and intravenous dexmedetomidine on patients undergoing cataract surgery: A comparative randomized controlled double-blind study.","authors":"Ashraf Magdy Eskandr Saad, Osama Abd-Allah Elmorsy, Sadik Abd-Elmaseeh Sadik","doi":"10.4103/joacp.joacp_362_21","DOIUrl":"10.4103/joacp.joacp_362_21","url":null,"abstract":"<p><strong>Background and aims: </strong>This prospective randomized study designed to evaluate the efficacy of dexmedetomidine either added to LA mixture or administered IV during subtenon block for cataract surgery.</p><p><strong>Material and methods: </strong>75 patients, undergoing cataract surgery with subtenon anesthesia, were assigned randomly into three equal groups, Group I received subtenon bupivacaine 0.5% (1 ml) + lidocaine 2% (1 ml) + saline 0.9% (0.5 ml) and IV infusion of normal saline. Group II received subtenon bupivacaine 0.5% (1 ml) + lidocaine 2% (1 ml) + 0.5 μg/kg dexmedetomidine (0.5 ml) and IV infusion of normal saline. Group III received subtenon bupivacaine 0.5% (1 ml) + lidocaine 2% (1 ml) + saline 0.9% (0.5 μl) and IV infusion of 0.5 mg/kg dexmedetomidine over 10 min. before subtenon block. We recorded onset and duration of sensory and motor block, pain during subtenon injection, intraoperative hemodynamics, intraocular pressure, sedation and postoperative pain score.</p><p><strong>Results: </strong>There was a significant decrease in the onset of action and an increase in the duration of sensory block in Group II. Pain during subtenon injection was significantly less in group III. Sedation Score was higher in Group III, while heart rate showed a significant reduction in the same group. The VAS was significantly decreased in group II. After the end of surgery, the intraocular pressure was significantly decreased in Groups II and III.</p><p><strong>Conclusion: </strong>Subtenon dexmedetomidine shortens onset time, prolongs sensory block durations and significantly decreases the postoperative pain score with hemodynamic stability, while, IV dexmedetomidine substantially reduces pain during subtenon block and produces intra-operative sedation.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10661625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49053588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suppression of perioperative stress response in elective abdominal surgery: A randomized comparison between dexmedetomidine and epidural block.","authors":"Rashmi Salhotra, Vishal Kamal, Asha Tyagi, Mohit Mehndiratta, Rajesh S Rautela, Edelbert A Almeida","doi":"10.4103/joacp.joacp_559_21","DOIUrl":"10.4103/joacp.joacp_559_21","url":null,"abstract":"<p><strong>Background and aims: </strong>Stress response after surgery induces local and systemic inflammation which may be detrimental if it goes unchecked. Blockade of afferent neurons or inhibition of hypothalamic function may mitigate the stress response.</p><p><strong>Material and methods: </strong>A total of 50 consenting adult ASA I/II patients undergoing elective abdominal surgery were randomized to receive either dexmedetomidine (<b>Group D</b>) or epidural bupivacaine (<b>Group E</b>) in addition to balanced general anesthesia. Laparoscopic surgery, contraindications to epidural administration, history of psychiatric disorders, obesity (BMI >30 kg/m²), on beta blockers or continuous steroid therapy for >5 days over last 1 year, and known case of endocrine abnormalities or malignancy were excluded. Serum cortisol, blood glucose, and blood urea were estimated. Hemodynamic parameters, total dose of dexmedetomidine, bupivacaine, emergence characteristics, and analgesic consumption over 24 h postoperatively were recorded. Statistical comparisons were done using Student's t-test, repeated measure analysis of variance followed by Dunnett's test, generalized linear model and Chi-square/Fisher's exact test. A <i>P</i> value <0.05 was considered significant.</p><p><strong>Results: </strong>Serum cortisol levels were significantly lower in group E than group D 24 h after surgery (<i>P</i> = 0.029). Intraoperative and postoperative glucose level was lower in group E compared with group D. Time to request of first rescue analgesic was longer in group E than group D (<i>P</i> = 0.040). There was no significant difference between the number of doses of paracetamol required in the postoperative period (<i>P</i> = 0.198).</p><p><strong>Conclusion: </strong>Epidural bupivacaine was more effective than intravenous dexmedetomidine for suppression of neuroendocrine and metabolic response to surgery. Dexmedetomidine provided better hemodynamic stability at the time of noxious stimuli and postoperatively.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10661627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70810629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}