Anaesthesia In Short Surgical Procedures Research Articles

Comparison of Nalbuphine Hydrochloride and Fentanyl Citrate for Total Intravenous Anaesthesia in Short Surgical Procedures: A Randomised Control Study

Introduction: Total Intravenous Anaesthesia (TIVA) with propofol is gaining acceptance for day care surgeries due to its advantages over inhalational agents. Opioids administered as premedication are known to enhance the hypnotic effect of propofol and provide intraoperative and postoperative analgesia. Aim: To compare the effectiveness of Nalbuphine and Fentanyl for postoperative analgesia in short surgical procedures. Materials and Methods: In present double-blinded randomised controlled trail conducted in the Department of Anaesthesia at the Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India, 60 patients aged 18 to 60 years, classified as American Soceity of Anaesthesiologists (ASA) Grade-I or II, and scheduled for elective short surgical procedures under TIVA were randomly assigned to two groups. Group N received Nalbuphine 0.05 mg/kg, and control Group F received 0.001 mg/ kg Fentanyl intravenously before induction. Parameters studied included pain scores, first rescue analgesia, haemodynamics, and side effects. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA, version 19.0 for Windows). Parametric data were analysed using paired and unpaired t-tests. Results: Data from a total of 60 patients (Group N mean age: 46.9±9.96 years and Group F mean age: 46.6±10.44 years) were collected and analysed. Both groups were comparable in terms of age, Body Mass Index (BMI), mean duration of surgery, and type of surgery (p > 0.05). Pain scores on the Visual Analogue Scale (VAS) were not significant upto 15 minutes after surgery, but thereafter, the VAS score was significantly lower in the Nalbuphine group (p-value < 0.05). Intraoperative episodes of significant hypotension were observed only in the Fentanyl group (p-value < 0.05). The total dose of propofol required was significantly lower in the Fentanyl group (p-value < 0.001). The time to the first rescue analgesia requirement (in minutes) was significantly shorter in the Fentanyl group (32.83±28.43) compared to the Nalbuphine group (56.37±25.31). Side effects such as postoperative sedation, nausea, and vomiting were observed in the Fentanyl group (p-value >0.05). Conclusion: Nalbuphine provided superior postoperative analgesic effects compared to Fentanyl when used as an analgesic component in TIVA. Postoperatively, pain scores were lower, and the time to the first rescue analgesia was longer in the Nalbuphine group.

A comparative study of awakening characteristics after propofol based total intravenous anaesthesia and sevoflurane based volatile induction and maintenance anaesthesia in short surgical procedure

To maintain hemodynamic parameters and rapid emergence is a challenge for anaesthesiologist in emerging era of early recovery. The aim of this study was to assess recovery characteristics of propofol and sevoflurane for induction as well as maintenance of anaesthesia in short surgical procedures. Sixty patients were assigned randomly into two groups. Group P patients were induced with 2mg/kg propofol intravenously followed by infusion of 12mg/kg/hr for 10mins, 10mg/kg/hr for 20 mins and 8mg/kg/hr till end of procedure. Group S patients were induced with 8% sevoflurane in 4L/min nitrous oxide and 2L/min oxygen mixture and maintained with 3.5% sevoflurane with spontaneous breathing. LMA was inserted in all patients. LMA insertion time and insertion attempt were observed. Time from end of procedure to first spontaneous movement, spontaneous eye opening, removal of LMA, followed verbal commands and became fully oriented to time and place, time to achieve Aldrete score ≥9 (phase I recovery) and time to achieve PADSS score ≥9(phase II recovery) were noted. Phase 1 recovery time was less in sevoflurane group as compared to propofol group. Phase 2 recovery time was less in propofol group as compared to sevoflurane group. They were statistically significant. Incidence of both nausea and vomiting was significantly higher in the sevoflurane group. We concluded that sevoflurane provides rapid induction with LMA insertion condition comparable with propofol. Sevoflurane provides early phase I recovery where as home readiness is early with propofol. Sevoflurane can be a suitable alternative to propofol for induction and maintenance.

COMPARATIVE STUDY OF SEVOFLURANE AND PROPOFOL FOR EASE OF I-GEL INSERTION IN ADULT PATIENTS UNDERGOING GENERALANESTHESIA FOR SHORT PROCEDURES.

Background: I-gel is a second generation supraglottic airway device designed to provide and maintain a seal around the laryngeal inlet for spontaneous ventilation and allow controlled ventilation at modest levels of positive pressure thereby endotracheal intubation can be avoided. Propofol has been the drug of choice due to its better safety prole, relaxation and suppression of airway reexes among intravenous induction agents. Sevourane with its pleasant odor, non-irritating to the airways and due to its bronchodilator property are best among the volatile agents. We aim to compare induction characteristics and ease of I gel insertion with sevourane and intravenous propofol. Methods:The study was conducted in 60 eligible adult patients undergoing general anesthesia for short surgical procedures in Pushpagiri Medical College and Research Centre.Group Preceived Propofol and Group S received Sevourane 8%. Consecutive subjects who satisfy inclusion criteria were randomly assigned into one of the two groups of 30 until sample sizes were achieved. I gel insertion attempted after adequate jaw relaxation. Ease of I-gel insertion assessed by a three-point scoring system. Data was analysed by SPSS software .The independent variables assessed in this study includes the drugs given and the comparison was done using unpaired t test. Results: Sevourane group took more time for induction than Propofol group .It was found that insertion time for sevourane was higher than the propofol group. The ease of I Gel insertion based on three point scale showed that in Sevourane group overall insertion conditions was excellent in 36.7% ;satisfactory in 63.3% as compared to group Propofol group which was 83.3%; 16.7% respectively. The results were statistically signicant (p<0.01). Conclusion:It can be concluded that sevourane can be considered as a safer alternative to propofol for I Gel insertion

Comparison of Fentanyl-Propofol and Ketamine-Propofol Combination in Induction and Maintenance with Intravenous Anesthesia for Short Surgical Procedures at Moderate Elevations.

The aim of the study is to evaluate the efficacy of Ketamine-Propofol compared to Fentanyl-Propofol combination during induction and maintenance of total intravenous anesthesia for short surgical procedures at moderate elevation. A prospective pilot study was done comparing between Fentanyl (1.2 mcg/kg)- Propofol and Ketamine (0.5mg/kg)-Propofol with 30 in each group at moderate altitude of approximately 2514 meters for the requirement of positive pressure ventilation, changes in heart rate and mean arterial pressure intraoperatively, total Propofol consumption and time to attain Modified Steward Score of 6. Requirement for positive pressure ventilation was significantly high in Fentanyl-Propofol group 18 (60%) compared to Ketamine-Propofol 1 (0.03%) [P = 0.00]. Fall in oxygen saturation was significant at 2 minute of Ketamine or Fentanyl [95% CI, 3.10-5.76, P = 0.00], after induction with Propofol [95% CI, 2.30-4.03, P = 0.00], 5 minute [95% CI, 1.66-3.54, P = 0.00], 10 minutes [95% CI, 0.55-2.32, P = 0.02], 15 minutes [95% CI, 0.50-2.09, P = 0.00] and 20 minutes [95% CI, 0.43-2.23, P = 0.00] respectively after study drug between the groups. Total Propofol consumption was significantly higher [95% CI, 0.19-0.43, P = 0.00] in KP (1.55±0.27mg/kg) compared to FP (1.23±0.16 mg/kg). At moderate elevations of 2514 meters, during the induction and maintenance of intravenous anesthesia, Ketamine-Propofol causes significantly less fall in oxygen saturation in the first 20 minutes requiring lesser need of positive pressure ventilation with comparable least fall in heart rate and mean arterial pressure with higher total Propofol consumption when compared to Fentanyl-Propofol. It took a significantly longer time to recovery with Modified steward score of maximum 6 with Ketamine-Propofol.

Comparative study of etomidate and fentanyl citrate with propofol (1%) and fentanyl citrate for total intravenous anaesthesia in short surgical procedures

Total intravenous anaesthesia (TIVA) is a combination of Induction agents, analgesic drugs and muscle relaxants, excluding simultaneous administration of any inhaled drugs. This study has major objective, to determine the efficacy of Etomidate and Propofol (1%) as anaesthetic induction agents in terms of Induction time, maintenance doses requirements and Recovery parameters. This study suggests that both Etomidate–Fentanyl citrate and propofol (1%)–Fentanyl citrate produced smooth induction, easy maintenance and quick recovery with only minor hemodynamic fluctuations makes them excellent combinations as TIVA technique. Etomidate is preferred over Propofol (1%) especially for hemodynamically unstable patients because of minimal effects on cardiovascular and respiratory system. hypotension and pain on injection was observed more frequently with Propofol (1%) while myoclonus with Etomidate. With these observations in mind and careful selection of patients, both agents appear similarly safe for use in elective and short surgical procedures.

Comparative Study of Nalbuphine and Fentanyl for Total Intravenous Anaesthesia in Short Surgical Procedures

Comparative Study of Nalbuphine and Fentanyl for Total Intravenous Anaesthesia in Short Surgical Procedures

Comparison of Propofol with Butorphanoland Propofol with Fentanyl for Total Intravenous Anaesthesia in Short Surgical Procedures

Comparison of Propofol with Butorphanoland Propofol with Fentanyl for Total Intravenous Anaesthesia in Short Surgical Procedures

Comparative Study of Propofol with Ketamine and Propofol with Butorphanol for Total Intravenous Anaesthesia in Short Surgical Procedures

Comparative Study of Propofol with Ketamine and Propofol with Butorphanol for Total Intravenous Anaesthesia in Short Surgical Procedures

Comparative Study of Propofol with Ketamine and Propofol with Butorphanol for Total Intravenous Anaesthesia in Short Surgical Procedures

Comparative Study of Propofol with Ketamine and Propofol with Butorphanol for Total Intravenous Anaesthesia in Short Surgical Procedures

Comparison of ketamine with fentanyl as co-induction in propofol anesthesia for short surgical procedures

Background and Objective:A prospective randomized control study was conducted to compare and evaluate quality of anesthesia with ketamine or fentanyl as co-induction with propofol.Materials and Methods:Sixty ASA I or II, 18–50 year old patients who were scheduled for minor surgeries of short duration (<30 min anticipated duration) were selected. The patients were randomly allocated to group I and group II comprising 30 patients each. The patients of group I were given ketamine injection 0.5 mg/kg and group II patients fentanyl injection (1.5 μg/kg) as co-induction agent. Two minutes later, induction of anesthesia was given with inj propofol (2.5 mg/kg) and appropriate-sized laryngeal mask airway was inserted. The anesthesia was maintained with 60% N2O in O2 and intermittent bolus of inj propofol (0.5 mg/kg) after observing significant changes in the heart rate, blood pressure, lacrimation, sweating, and abnormal movements.Results:There was significant decrease (P<0.05) in the pulse rate, systolic and diastolic blood pressure at 1, 3, and 5 min in group II (fentanyl group) whereas the change was insignificant (P>0.05) at 10 min.Conclusion:It was observed that ketamine as premedicant was better than fentanyl with respect to hemodynamic stability and caused less adverse effects intraoperatively and postoperatively.

Incidence of oxygen desaturation with intravenous ketamine and the effects of the basic airway management maneuvers on it

Introduction: This study was conducted to evaluate and compare the incidence of oxygen desaturation during intravenous ketamine for short surgical procedure and the effects of basic airway management maneuvers during desaturation.&#x0D; Methods: A Population based comparative study was done at two different hospitals situated in hilly regions of Nepal. Children aged between 3 months and 14 years were observed for their oxygen saturation with the help of Pulse Oxymeter during intravenous ketamine anesthesia for short surgical procedures lasting less than 15 minutes. &#x0D; Results: Seventy nine patients from United Mission Hospital (UMN), Tansen and 66 patients from Okhaldhunga Community Hospital (OCH), Okhadhunga were enrolled; the incidence of desaturation was 8(10%) and 11(16.1%) in Tansen and Okhaldhunga respectively. 7(87.5%) and 8(72.7%) of the patients with desaturation from UMH and OCH respectively, were improved to &gt;90% with chin lift only and rest needed jaw thrust.&#x0D; Conclusion: The incidence of oxygen desaturation is common within first few minutes of ketamine administration. Basic airway measures like chin lift and jaw thrust is enough to improve oxygen saturation.

Detection of Ketamine and Norketamine in Urine of Nonhuman Primates after a Single Dose of Ketamine using Microplate Enzyme-Linked Immunosorbent Assay (ELISA) and NCI-GC-MS

The general anesthetic ketamine (Ketalar, Ketaject, Vetalar) (KET) is used in human and veterinary medicine for induction of anesthesia for short surgical procedures and routine veterinary examination. Its illicit use by teenagers in rave parties has been reported, and it has recently been identified as a substance associated with sexual assault. One aim of this paper was to study the elimination of KET and its major metabolite norketamine (NKET) in urine collected from five nonhuman primates that received a single dose (5 mg/kg, I.M.) of KET and to study elimination patterns to determine how long after drug administration KET and NKET can be detected. Another aim of this study was to develop and validate a highly sensitive negative ion chemical ionization-gas chromatography-mass spectrometry (NCI-GC-MS) method for the simultaneous quantitation of KET and its major metabolite NKET in urine and to analyze urine samples collected from the animals. The last aim of this study was to apply and evaluate a newly developed ELISA screening methodology for detection of KET and its metabolites in the same urine samples collected from primates which received a single dose of KET. In two monkeys, KET was detected in urine up to 3 days after drug administration (32-7070 ng/mL); in one monkey, it was detected up to 4 days (65-13,500 ng/mL); in one monkey, it was detected only on days 1 and 2 (4000 and 70 ng/mL, respectively); and in one monkey, it was detected 10 days after KET injection (22-35,000 ng/mL). NKET concentrations ranged from 63 pg/mL to 1.75 microg/mL, and it remained in the urine throughout the entire 35-day study period in 4 out of 5 animals. In one monkey, NKET was detected up to 31 days after KET administration. Urine analysis using ELISA revealed that KET and NKET can be easily detectable at 25 ng/mL. In one monkey, KET and its metabolites were detected in urine up to 4 days after drug administration, up to 7 days in two monkeys, up to 11 days in one monkey, and 16 days after KET injection in one monkey. Urine extraction followed by screening using ELISA methodology allowed for significant extension of the detection period in all animals from the study. It is believed that the KET elimination in urine of nonhuman primates is slightly faster than in humans. We propose that NCI-GC-MS be employed to detect NKET as a target compound in urine in toxicological investigations of drug-facilitated sexual assault when KET use by the perpetrator is suspected.

Immobilization of collared peccaries (Tayassu tajacu) and feral hogs (Sus scrofa) with Telazol and xylazine.

A 1:1 mg mixture of Telazol and xylazine hydrochloride (100 mg of Telazol and 100 mg of xylazine per ml) was used to immobilize wild collared peccaries (Tayassu tajacu) and feral hogs (Sus scrofa); mean (+/-SD) intramuscular dosage rate was 4.73 +/- 0.86 mg/kg and 4.35 +/- 0.68 mg/kg for peccaries (n = 107) and hogs (n = 49), respectively. Mean (+/-SD) induction time (time from injection until complete immobilization) was 4.6 +/- 2.5 minutes for collared peccaries and 4.4 +/- 1.9 for hogs. Peccaries became conscious at 64 +/- 29 minutes and first stood at 92 +/- 33 minutes after initial injection. Hogs became conscious at 54 +/- 26 minutes and first stood at 78 +/- 38 minutes after initial injection. A 1:1 mg mixture of Telazol and xylazine provided an effective and safe method to immobilize both species and provided adequate analgesia and anesthesia for short surgical procedures.

New anesthetic approaches to gynecologic surgery

This review relates how the introduction of the short-acting narcotic alfentanil and the short-acting sedative-hypnotic propofol have expanded our capabilities both for providing conscious sedation and for administering general anesthesia for short surgical procedures. The rapid onset and limited distribution of alfentanil enable it to provide intense intraoperative analgesia without prolonged respiratory depression. The rapid elimination of propofol permits rapid titration to effect and provides recovery times significantly faster than those following thiopental. The review then focuses on the combined use of opioids and sedatives for conscious sedation. Use of these agents in concert results in potentiation of beneficial, as well as untoward, effects. Their use requires careful titration and vigilant monitoring.