Incidence Of Hypotension In Group Research Articles

A randomized single-blinded comparative experimental study to test the influence of timing of intravenous fluid therapy on maternal hemodynamics during lower segmental caesarean section under spinal anaesthesia

: Spinal anaesthesia-induced hypotension can be prevented by several techniques and methodologies, which is very important as the life of the mother and fetus is at risk. This study compared the efficacy of crystalloid administration 6 hours and half an hour before spinal anaesthesia on reducing hypotension.: After obtaining informed consent, 110 ASA 2 patients aged between 20 and 40 were scheduled for elective lower segmental caesarean section under spinal anaesthesia. Patients were randomly allocated into two groups. Group 1: Participants were kept nil per oral overnight, and Ringer's lactate was administered over half an hour before surgery. Group 2: participants were given ringer lactate. The amount was based upon the Holiday Segar formula (first 10 kg received 4ml/kg, 10-20 kg- 2ml/kg and remaining received 1 ml/kg) and given steadily over half an hour and 6 hours respectively in both groups. The incidence of hypotension and the need for rescue vasopressor in the two groups was recorded.: The two groups were statistically comparable in terms of age, height and weight. The incidence of Hypotension in Group 1 was 12.7%, and in Group 2 was 25%, which was statistically insignificant. Seven out of 55 patients in Group 1 had SBP<20% from baseline, whereas in Group 2, 14 patients out of 55 patients had SBP <20% from baseline, which was statistically insignificant. The incidence of ephedrine usage was statistically insignificant in both groups.: This study's results showed no statistically significant difference in preventing hypotension whether the fluids were given as 6 hours or half an hour before surgery. Therefore, to deliver preload of fluid, it is unnecessary to delay surgery.

Effects of single-use alfentanil versus propofol on cognitive functions after colonoscopy: A randomized controlled trial

PurposeColonoscopy is often accompanied by short-term postoperative cognitive decline. We aimed to explore whether single-use alfentanil for patients undergoing elective colonoscopy could reduce cognitive impairment at discharge compared with propofol. Patients and methods172 adult patients undergoing elective colonoscopy were randomized to receive intravenous propofol at 2 mg/kg (group P) or alfentanil at 10 μg/kg (group A); 40 healthy volunteers were included in the blank group. Cognitive function was considered the primary outcome and was measured using five neuropsychological tests before sedation and discharge. The z-score method was used to determine cognitive dysfunction according to z-score >1.96 in two types of neuropsychological tests. Other outcomes included discharge time, vital signs, associated adverse events during colonoscopy, and the satisfaction level of patients and endoscopic physicians. Results164 patients (78 in group A and 86 in group P) completed the study protocol. At discharge, the incidence of cognitive dysfunction in group P was 23% and was significantly lower in the alfentanil group (2.5%), with a relative risk of 0.11 (95% confidence interval: 0.03–0.46, P < 0.001). The incidence of hypotension in group A was lower than that in group P (3.8% vs 22.1%, relative risk = 0.17 [95% confidence interval: 0.05–0.46, P = 0.001]), and the discharge time in group A was shorter than that in group P (5 [3–9] vs 13 [10–18] min, P < 0.001). ConclusionFor patients undergoing colonoscopy, single-use alfentanil causes less damage to postoperative cognitive function, less risk of hypotension, and shorter discharge time than propofol.

Effects of phenylephrine and ephedrine in prevention and treatment of hypotension during spinal anaesthesia for elective cesarean section

Introduction: Hypotension and bradycardia are common side effects of spinal anaesthesia. It can have a potentially deleterious maternal and fetal impact. Phenylephrine is preferred vasopressor in prevention and treatment of post spinal hypotension (PSH) and Ephedrine investigated as an alternative to phenylephrine with promising results. Aim: To compare the efficacy and safety of Ephedrine with Phenylephrine for the prevention and treatment of hypotension under spinal anesthesia for cesarean delivery. Methods: This prospective, randomized study was done at tertiary care centre. Total 80patients of ASA I/II posted for elective Cesarean Section were randomly divided into 2 equal groups, Group P (Phenylephrine) received 100ug of Inj. Phenylephrine i.v. and Group E (Ephedrine) received 10mg of Inj. Ephedrine i.v. Result: Incidence of bradycardia was higher in phenylephrine group after induction. SBP, DBP and mean blood pressure measured during pre-operative, per-operative and post-operative periods in both groups showed low incidence of hypotension in Group P as compared to Group E. Conclusion: Phenylephrine is more efficient in managing hypotension during spinal anaesthesia for elective caesarean delivery. Neonatal outcome remains equally good in both the groups.

A study to evaluate perfusion index as a predictor of hypotension following spinal anesthesia for caesarean section.

Background and Aims:The perfusion index (PI) has been used as a marker of peripheral perfusion. A lower PI indicates greater peripheral vascular tone and increased risk of hypotension following spinal anesthesia. The present study was conducted to evaluate and correlate perfusion index (PI) with incidence of hypotension following spinal anesthesia for caesarean section.Material and Methods:The present prospective, double blind, observational study included sixty full term parturients in the age group 18-35 years belonging to American Society of Anesthesiologists (ASA) physical status I and II, having singleton pregnancy undergoing caesarean section under spinal anesthesia. On the basis of baseline PI, patients were allocated into one of the two groups: Group I (n = 30) Patients with baseline PI ≤.3.5 and Group II (n = 30) Patients with PI >3.5.Results:The incidence of hypotension in group I was 40% as compared to 73.3% in group II (p = 0.009). Thus, the incidence of hypotension in group II with baseline PI >.3.5 was more as compared to group I. Patients in group II with baseline PI >.3.5 had significantly more episodes of hypotension as compared to those in group I with baseline PI ≤3.5.Conclusion:PI can be used as a useful tool for predicting hypotension in parturients undergoing elective caesarean section under spinal anesthesia in everyday practice.

Incidence of Intraoperative Hypotension and Bradycardia in Spinal Anaesthesia with 0.5% Bupivacaine alone and 0.5% Bupivacaine with Fentanyl for Abdominal Hysterectomy: A Cross-sectional Study

Introduction: Bupivacaine hydrochloride, when used for spinal anaesthesia, is associated with varying degree of hypotension and bradycardia. Intrathecal opioids provides haemodynamic stability and improves quality of perioperative analgesia. Aim: To compare the incidence of intraoperative hypotension, bradycardia and its side-effects when using 0.5% hyperbaric bupivacaine alone and with 25 µg fentanyl added to it for subarachnoid block for abdominal hysterectomy. Materials and Methods: This cross-sectional study was conducted at Government Medical College, Thrissur, Kerala, India from June 2019 to May 2020 on 96 American Society of Anaesthesiologists Physical Status (ASA-PS) I and II patients posted for total abdominal hysterectomy under lumbar subarachnoid block. They were divided into Group A and B, carrying 48 patients in each group. Group A received 3.3 mL of 0.5% hyperbaric bupivacaine alone. Group B received 3.3 mL of 0.5% hyperbaric bupivacaine and 25 µg fentanyl. Haemodynamic characteristics, analgesic properties and side-effects were compared between Group A and Group B. Data were entered in Microsoft Excel Software, and analysed using Statistical Package for the Social Sciences (SPSS) software version 16.0 and p-value &lt;0.05 was considered as statistically significant. Results: The incidence of hypotension in group A was 41.7% and in group B was 39.6%. Incidence of analgesia was significantly higher in group B (group A - 181.2±4.9, group B - 220.9±13.9). In group A, no one had nausea and vomiting. In group B, 8.3% experienced nausea and vomiting and none in both groups experienced pruritus. Conclusion: There was no difference in the development of hypotension and bradycardia when fentanyl was added to bupivacaine for spinal anaesthesia and had the advantage of increased duration of postoperative analgesia.

Extraluminal Placement of a Bronchial Blocker Compared with Carbon Dioxide Artificial Pneumothorax in Infants Undergoing Video-Assisted Thoracoscopic Surgery.

Objective: To investigate the safety and effectiveness of extraluminal placement of a bronchial blocker compared with carbon dioxide (CO2) artificial pneumothorax in infants undergoing video-assisted thoracoscopic surgery (VATS).Methods: The study involved 33 infants (group A) who underwent one-lung ventilation (OLV) with extraluminal placement of a bronchial blocker and 35 other infants (group B) who underwent CO2 artificial pneumothorax. Clinical characteristics, the degree of lung collapse, and complications were compared.Results: The degree of lung collapse in group A was significantly higher than that in group B at T2 and T3. The mean arterial pressure (MAP) of group B was significantly lower than that of group A at 10 min and 30 min after OLV. The partial pressure of carbon dioxide (PaCO2) of group B was significantly higher than that of group A at 30 min after OLV. The incidence of hypotension in group B was higher than that in group A.Conclusion: Compared with CO2 artificial pneumothorax, extraluminal placement of a bronchial blocker is associated with a better degree of lung collapse, fewer episodes of hypotension, and lower PaCO2 accumulation during OLV in infants undergoing VATS.

To Study Preloading and Relative Efficacy of Ringer’s Lactate and Pentastarch 6% Prior to Spinal Anaesthesia in Lower Abdominal and Lower Limb Surgeries

Background and Objectives: Hypotension after spinal anaesthesia remains a common and a seriouscomplication. Various method have been recommended for the prevention and treatment of this problem.Preloading has become the cornerstone for prophylaxis of hypotension post spinal anaesthesia. This currentstudy reassessed the efficacy of this volume preloading and also compared the efficacy between Ringer’slactate and Pentastarch 6%.Method: In this study, 60 patients (ASA I &amp; II) presenting for elective lower abdominal and lower limbsurgeries under spinal anaesthesia were allocated into two groups, group P and group R to receive 5 ml/kg of6% Pentastarch and 10 ml/kg of Ringer’s lactate preload respectively. After institution of spinal anaesthesiain a sitting position with 3.8 ml of Bupivacaine 0.5% (heavy) using 23G Quincke spinal needle, patientswere made to assume supine position. The heart rate(HR), systolic blood pressure(SBP) and diastolic bloodpressure(DBP) were monitored intra-operatively every 2 minutes for first 10 minutes and every 5 minutesfor next one hour and every 15 minutes thereafter. Electrocardiogram (ECG) and oxygen saturation(SpO2)were monitored continuously. The amount of ephedrine, used intra-operatively were noted and comparedamong the different groups.Results: The incidence of hypotension in group R was more than that in group P. There were no significantdifference in HR and the SpO2 between the groups. The difference in mean basal SBP and DBP werestatistically insignificant in both groups. Thereafter, the fall in SBP and DBP was more prominent in groupR at all time intervals with a statistically highly significant difference between the two groups (p value&lt;0.001). The amount of ephedrine used in group R was more than that used in group P. There were minimalcomplications like shivering and vomiting which were statistically non–significant . There were no allergicreactions to the fluids used.Conclusion: Volume preloading, still has a substantial role in reducing the incidence and severity ofhypotension in patients operated under spinal anaesthesia. Pentastarch 6% is found to be a better agent forpreloading, as it is safe and effective in preventing spinal-induced hypotension in patients.

Prediction of Post spinal anesthesia hypotension in patients undergoing cesarean section using Perfusion index

Introduction: Spinal anesthesia induced hypotension frequently complicates Cesarean delivery. This is usually due to sudden sympatholysis causing decreased venous return which can be aggravated by physiological changes of pregnancy leading to change in baseline peripheral vascular tone. Strategies to prevent hypotensive episodes should be the primary aim of anesthetic management. A simple noninvasive measurement of perfusion index derived from pulse oximeter predicting hypotension during the routine intraoperative course could provide a new dynamism to the management and improving the safe execution of anesthesia.&#x0D; Objectives: The primary objective of this study was to compare incidence of hypotension following SAB for LSCS in patients with baseline PI ≤ 3.5 to those with PI &gt; 3.5. The secondary objectives were to compare PI, HR, SBP, MAP at various time intervals and also to study the side effects between the two groups.&#x0D; Methodology: This prospective observational study was conducted at Nobel Medical College Teaching Hospital from to July 2019 to October 2019. 73 Term parturients presenting for elective cesarean delivery were included for the study.&#x0D; Upon arrival in the operation room, standard monitors were attached and baseline HR, SBP, DBP, MAP, PI and SPO2 were recorded in supine position. The patients with baseline PI ≤ 3.5 were enrolled into Group I and those with a PI &gt; 3.5 were enrolled into Group II. Spinal Anesthesia with 10mg of 0.5% heavy Bupivacaine and 20mcg Fentanyl ( total 2.4ml) was given at L3-L4 interspace in sitting position using midline approach. Patient was then returned to supine position with left lateral tilt of 15 degrees to facilitate left uterine displacement. Upper sensory level was checked at 5 minutes using alcohol swab. Once T-6 level was reached, surgery was started. Maternal SBP, DBP, MAP, HR and PI were recorded at 1 minute intervals between spinal injection and delivery and then 3 minutes until end of surgery. Clinically relevant hypotension was defined as the decrease in MAP by 20% or more from baseline value.&#x0D; Results: The incidence of hypotension in Group I was 18.8% (6/30) compared to 81.3% (26/38). This was clinically and statistically highly significant (P = 0.000, odds ratio 0.11). On Spearman’s rank correlation we found highly significant correlation between baseline PI &gt;3.5 and number of episodes of hypotension (rs 0.482, P = 0.000). The sensitivity and specificity of baseline PI with cut-off 3.5 for predicting hypotension were 81.3% and 66.7% respectively. The ROC curve analysis showed 3.53 as appropriate cut‑off for our findings. The area under the ROC curve (AUC) was 0.734 [Figure 6](Lower bound 0.608 and upper bound 0.861, P=0.001). &#x0D; Conclusion : This study demonstrates that baseline PI of &gt; 3.5 correlates with incidence of hypotension after spinal anesthesia for cesarean delivery in healthy parturients compared to a baseline PI of &lt; 3.5.

Effectiveness of Granisetron in Prevention of Hypotension Following Spinal Anaesthesia in Patients Undergoing Elective Caesarean Section

Background and aim: Spinal anesthesia is the most common type of anesthesia administered for caesarean section and it is frequently associated with hypotension. When post-spinal hypotension is accompanied with bradycardia, the condition may become more complicated. Numerous pharmacological agents have therefore been tried for prevention of hypotension and 5HT3 antagonists are the latest in the armamentarium. However, studies have shown conflicting evidence regardings the effectiveness of 5HT3 inhibitors (ondansetron and granisetron) in preventing spinal hypotension. We have tried to address this controversy and also wanted to explore the adverse effects of granisetron on the foetus, if any.Materials and methods: Two hundred patients were included in the study and divided into two groups of 100 patients each. Group S patients received 5ml of 0.9% normal saline while Group G patients received IV granisetron 1mg (diluted to 5ml) 10 minutes prior to administration of spinal anesthesia. Analysis of variance (ANOVA) test was used for comparing the data, Student t-test was applied to compare the difference between the two means and Chi-Square test was used to test significance of difference of proportions.Results: The incidence of hypotension in Group S was 69%, whereas it was 37% in Group G (p<0.001), hence patients of Group S required a significantly higher (p=0.001) amount of mephentermine. Haemodynamic parameters were well maintained throughout the study period in patients of Group G. The neonatal outcome was assessed by Apgar score at 0 minutes, one minute, and five minutes after delivery, and it was comparable between the two study groups.Conclusion: Intravenous granisetron 1mg if administered before administering spinal anesthesia can effectively attenuate hypotension in parturients without any adverse effects on the mother and the neonate.

Incidence of hypotension between Intrathecal Hyperbaric Bupivacaine with and without Fentanyl in Geriatric Patients Undergoing Urological Surgeries

Objective: We aimed to assess the efficacy, the incidence of hypotension and adverse consequences of using intrathecal hyperbaric bupivacaine in comparison to a combination of low dose hyperbaric bupivacaine and fentanyl, in geriatric patients undergoing urological surgeries.Material and Methods: Our study was a prospective, triple-blinded and randomized controlled. One hundred and fortyeight geriatric participants scheduled for urological surgeries were randomly assigned into two groups: Group B (n=74) received intrathecal injection with 0.5% hyperbaric bupivacaine 1.5 milliliters (ml) alone (7.5 milligrams; mg), while Group F (n=74) received 0.5% hyperbaric bupivacaine 1 ml (5 mg) plus 0.5 ml of fentanyl (25 micrograms; mcg) making up to a total volume of 1.5 ml.Results: One hundred and forty-eight patients were included however, six patients were excluded from statistical analysis, due to an inadequate level of anesthesia; hence, 142 patients were analyzed. The incidence of hypotension in group B was: 9.7%, and in group F the percentage was 12.9%, respectively (p-value=0.74). There was no significant difference in regards to the highest sensory level in both groups. The anesthesia level in group B was Thoracic level 11 (T10-T12), and in group F it was 11 (T10-T12) (p-value=0.68), while the analgesia level in group B was Thoracic level 7 (T6-T8) with group F being a Thoracic level 6 (T6-T8) (p-value=0.16). The occurrence of bradycardia, and respiratory depression did not differ between the 2 groups.Conclusion: Intrathecal administration of 5 mg of 0.5% hyperbaric bupivacaine, plus 25 mcg of fentanyl provided an adequate level of sensory blockade, but did not decrease the frequency of hypotension.

Effect of nonpharmacological methods on incidence of postspinal hypotension during cesarean delivery

Introduction Hypotension is caused by upward spread of anesthetic into the subarachnoid space; this results in venous pooling in the capacitance vessels of the lower limbs as a result of block of sympathetic tone and unopposed activity of parasympathetic tone. It also may be caused by aorto-caval syndrome and is accompanied by bradycardia, nausea, and vomiting. Hypotension may have deleterious effects on mother and fetus and may result in uteroplacental hypoperfusion, as placental perfusion is pressure dependent, and lack of autoregulation of placental blood vessels, if persisted, may threaten the life of the fetus. Aim The primary aim of the work is to compare incidence of intraoperative hypotension between the three groups. The secondary outcome is to assess Appearance, Pulse, Grimace, Activity, Respiration (Apgar) score, vasopressor consumption, and occurrence of complications (nausea, vomiting, and bradycardia). Patients and methods A total of 150 patients undergoing cesarean delivery under spinal anesthesia were included. Patients were divided into three equal groups, using simple randomization method, with 50 patients each: group S, in which the patient will sit for 1 min after induction of spinal anesthesia and then will lie down; group E, in which patient's legs will be elevated to 30° from the horizontal plane; and group C in which the patient will lie down immediately after induction of spinal anesthesia as a control group. Then, heart rate, systolic blood pressure, diastolic blood pressure, and mean blood pressure were measured every 2 min until delivery of fetus and then every 5 min until the end of surgery. Sensory level was assessed before start of surgery, subsequently after lying down, and every 1 min using hot and cold test until it reaches T6 sensory level. Fetal well-being was assessed by Appearance, Pulse, Grimace, Activity, Respiration (Apgar) score measured by a pediatrician blinded to the study protocol at 1 and 5 min after delivery. Incidence of hypotension is defined as ‘at least one episode of decrease in systolic blood pressure to less than 90 mmHg or decrease in systolic pressure more than 20% from the baseline till the end of surgery’. It was treated immediately by 200 ml intravenous bolus fluids and injection of 5 mg ephedrine intravenous bolus every 2 min until elevation of blood pressure, and the total of ephedrine consumption was calculated. Duration of surgery and intraoperative complications was recorded as bradycardia, defined by heart rate below 60 beats/min, which was treated by 0.5 mg atropine sulfate, and nausea and vomiting, which were treated by ondansetron intravenous 4 mg after correction of hypotension. Results A total of 150 cesarean delivery patients between 22 and 34 years of age were included in the study. Regarding basic clinical and demographic data, it was found that the median age of all cesarean delivery patients was 30 years. The median BMI of all cesarean delivery patients was 32.5. Regarding the surgery duration, the median surgery duration of all cesarean delivery patients was 40 min. Regarding level of sensory block, most patients had sensory block at T6 (70%), and 30% at T4 in groups C, E, and S, correspondingly. Regarding primary outcome (incidence of hypotension mean arterial blood pressuer (MAP)&lt;70 mmHg), there was a highly significant increase in incidence of hypotension in group C compared with other groups of patients, with highly significant statistical difference (P=0.0092). The incidence of hypotension in group C was 70%, in group E was 50%, whereas in group S was 40% (P=0.0092). Regarding secondary outcomes (ephedrine consumption, Apgar scores, and complications), there was a highly significant increase in ephedrine consumption in group C compared with other groups (P=0.000002). The median value of ephedrine consumption in group C was 7.5 mg, in group E was 2.5 mg, whereas no ephedrine was consumed in group S (P=0.000002). Moreover, there was a nonsignificant difference regarding Apgar score at 1 min (P&gt;0.05). There was a highly significant increase in Apgar score at 5 min in group S compared with other groups (P=0.0047). There was a highly significant increase in bradycardia in group C compared with the other groups (P=0.0015). There was a highly significant increase in nausea in group C compared with the other groups (P=0.0008). There was a highly significant increase in vomiting in group C compared with the other groups (P=0.0008). Conclusion Incidence of hypotension in patients undergoing cesarean delivery under spinal anesthesia markedly decreased in patients who sat for 1 min after induction of spinal anesthesia and then lied down (group S) compared with patients who lied down immediately after induction of spinal anesthesia.

Effect of Glucose Containing Crystalloid Infusion on Maternal Hemodynamic Status After Spinal Anesthesia for Cesarean Section.

BackgroundDespite preventive strategies, hypotension is the most common complication of spinal anesthesia in cesarean section.ObjectivesThe aim of this study was to assess the effect of glucose-containing crystalloid infusion on maternal hemodynamic status after spinal anesthesia for cesarean section.MethodsIn this prospective, randomized, double-blind clinical trial, 80 parturients undergoing elective cesarean section with spinal anesthesia were studied. In group A (n = 40) ringer with 1% glucose solution (10 gr glucose in 1000 mL ringer) and in group B (n = 40) only ringer solution infused before and after spinal anesthesia. Demographic data, hemodynamic change, complications and their treatments, maternal blood sugar level and neonatal APGAR (appearance, pulse, grimace, activity and respiration) score, intraoperative fluid, duration of surgery, and anesthesia were recorded in the two groups.ResultsThe incidence of hypotension in group A was significantly lower than group B (27.5% vs 75%) (P = 0.002). Other complications (sustained hypotension, nausea, pallor, and shivering were significantly lower in parturients of the group A (P < 0.05). Maternal blood sugar (BS), before and after surgery, was not significantly different in the two groups (P = 0.207 and P = 0.239, respectively). There was no statistically significant difference in the APGAR score of neonates at the 1st and 5th minutes of the birth between the two groups (P = 0.076).ConclusionsIt seems that adding 1% glucose to crystalloid solution improves the hemodynamic status and decreases post-spinal anesthesia complications without significant changes in the maternal blood sugar level and APGAR score of neonates.

Perfusion index as a predictor of hypotension following spinal anaesthesia in lower segment caesarean section.

Background and Aims:Perfusion index (PI) is a new parameter tried for predicting hypotension during spinal anaesthesia for the lower segment caesarean section (LSCS). This study aimed at investigating the correlation between baseline perfusion index and incidence of hypotension following SAB in LSCS.Methods:In this prospective observational study, 126 parturients were divided into two groups on the basis of baseline PI. Group I included parturients with PI of ≤3.5 and Group II, parturients with PI values >3.5. Spinal anaesthesia was performed with 10 mg of injection bupivacaine 0.5% (hyperbaric) at L3–L4 or L2–L3 interspace. Hypotension was defined as mean arterial pressure <65 mmHg. Statistical analysis was performed using Chi-square test, independent sample t-test and Mann–Whitney U-test. Regression analysis with Spearman's rank correlation coefficient was done to assess the correlation between baseline PI and hypotension. Receiver operating characteristic (ROC) curve was plotted for PI and occurrence of hypotension.Results:The incidence of hypotension in Group I was 10.5% compared to 71.42% in Group II (P < 0.001). There was significant correlation between baseline PI >3.5 and number of episodes of hypotension (rs0.416, P < 0.001) and total dose of ephedrine (rs0.567, P < 0.001). The sensitivity and specificity of baseline PI of 3.5 to predict hypotension was 69.84% and 89.29%, respectively. The area under the ROC curve for PI to predict hypotension was 0.848.Conclusion:Baseline perfusion index >3.5 is associated with a higher incidence of hypotension following spinal anesthesia in elective LSCS.

Ketofol versus fentofol as induction agents for endotracheal intubation in emergency room

Methods The study was a randomized, double blinded study conducted between April 2014 and September 2014 in our Tertiary care Research Institute and Hospital. All Patients presenting to Emergency Department in need of Endotracheal Intubation were included in the study. The drugs used as Induction agents for Endotracheal Intubation were randomly numbered in Pre-filled syringes every day. Propofol was given in a dose 1.5 mg/kg (100 mg) for all patients in study population. Ketamine at 1 mg /kg (Group A) and Fentanyl at 1 μg/kg (Group B) were numbered and kept in 10 ml Prefilled syringes, either one of which was administered along with Propofol. The primary outcomes were based on the Sedation level using the Ramsay Sedation Scale (RSS) and adverse respiratory events based on Quebec Criteria. Secondary outcomes were based on Hypotension, Cormack Lehane Grading, gag reflex, successful attempts at Intubation, oral and tracheobroncheal secretions, sedation time, procedure time, recovery time, recovery agitation and Optic nerve sheath diameter. Patients with Cardio-respiratory arrest, age less than 18 years, head injury, glaucoma, hypotension, evidence of raised ICP and failure to give consent were excluded from the study. Results A total of 286 patients were eligible for the study, of which 104 were included. 54 patients were randomized to Group A (Propofol plus Ketamine) and 50 patients were randomized to Group B (Propofol plus Fentanyl). RSS of ≥ 5 was considered adequate. 45 (83.33%) patients in Group A and 39 (78%) patients in Group B had adequate sedation. Overall Incidence of Adverse respiratory events was less in Group A with 9 (9.25%) patients compared with Group B with 16 (32%) patients. Secondary outcome criteria had minimal statistically significant difference, especially reduced incidence of hypotension in Group A compared to Group B.

ED 50 and ED 95 of intrathecal bupivacaine coadministered with sufentanil for cesarean delivery under combined spinal-epidural in severely preeclamptic patients.

Background:Spinal anesthesia was considered as a reasonable anesthetic option in severe preeclampsia when cesarean delivery is indicated, and there is no indwelling epidural catheter or contraindication to spinal anesthesia. However, the ideal dose of intrathecal bupivacaine has not been quantified for cesarean delivery for severe preeclamptic patients. This study aimed to determine the ED50 and ED95 of intrathecal bupivacaine for severely preeclamptic patients undergoing elective cesarean delivery.Methods:Two hundred severely preeclamptic patients are undergoing elective cesarean delivery under combined spinal-epidural anesthesia enrolled in this randomized, double-blinded, dose-ranging study. Patients received 4 mg, 6 mg, 8 mg, or 10 mg intrathecal hyperbaric bupivacaine with 2.5 μg sufentanil. Successful spinal anesthesia was defined as a T6 sensory level achieved within 10 minutes after intrathecal drug administration and/or no epidural supplement was required during the cesarean section. The ED50 and ED95 were calculated with a logistic regression model.Results:ED50 and ED95 of intrathecal bupivacaine for successful spinal anesthesia were 5.67 mg (95% confidence interval [CI]: 5.20–6.10 mg) and 8.82 mg (95% CI: 8.14–9.87 mg) respectively. The incidence of hypotension in Group 8 mg and Group 10 mg was higher than that in Group 4 mg and Group 6 mg (P < 0.05). The sensory block was significantly different among groups 10 minutes after intrathecal injection (P < 0.05). The use of lidocaine in Group 4 mg was higher than that in other groups (P < 0.05). The use of phenylephrine in Group 8 mg and Group 10 mg was higher than that in the other two groups (P < 0.05). The lowest systolic blood pressure before the infant delivery of Group 8 mg and Group 10 mg was lower than the other two groups (P < 0.05). The satisfaction of muscle relaxation in Group 4 mg was lower than other groups (P < 0.05). There was no significant difference in patients’ satisfaction and the newborns’ Apgar score and the blood gas analysis of umbilical artery serum (P > 0.05).Conclusion:Our study showed that the ED50 and ED95 of intrathecal bupivacaine for severely preeclamptic patients undergoing elective cesarean delivery were 5.67 mg and 8.82 mg, respectively. In addition, decreasing the dose of intrathecal bupivacaine could reduce the incidence of maternal hypotension.

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OBJECTIVE: The aim of the study was to assess the efficacy of single prophylactic dose (10mg) of ephedrine given to prevent hypotension in patients during spinal anesthesia. STUDY DESIGN: Semi experimental. Place and Duration of Study: This study was conducted at Anesthesia Department of our institution over a period of 6 months from June 2010 to November 2010. MATERIAL AND METHODS: Sixty patients, who were to be operated under spinal anesthesia, for lower abdominal general surgery, obstetric-gynecological and lower limb orthopedic surgery, were divided into two groups. Group I (n=30) received Ringer's lactate solution 15 ml/kg as preload and group II (n=30) received Ringer's lactate solution 15 ml/kg as preload along with single prophylactic dose of injection ephedrine 10 mg intravenously which was given after administering spinal anesthesia. Various parameters of the patients were recorded and the comparison was made between groups I and group II. Heart rate, systolic and diastolic blood pressures and oxygen saturation were monitored at 5 minutes interval till the completion of surgery. RESULTS: Out of 60 patients 36 were males and 24 were females. 37 patients belonged to American Society of Anesthesiologist (ASA)-1 and 23 patients belonged to ASA II. In group I the average age of the patients was 26.24±6.4 years while in group II it was 24.12±3.2 years. There were no significant statistical differences for age, weight and height of the patients between two groups. The changes in heart rate, systolic and diastolic blood pressures were compared between groups, after taking baseline readings, at 5 minutes interval till the end of surgery. The base line readings were not significantly different statistically but subsequent readings showed significantly low incidence of hypotension in group II as compared to group I. CONCLUSION: Administration of single prophylactic dose (10mg) of ephedrine prevents hypotension in patients during spinal anesthesia

Midazolam and propofol used alone or sequentially for long-term sedation in critically ill, mechanically ventilated patients: a prospective, randomized study.

IntroductionMidazolam and propofol used alone for long-term sedation are associated with adverse effects. Sequential use may reduce the adverse effects, and lead to faster recovery, earlier extubation and lower costs. This study evaluates the effects, safety, and cost of midazolam, propofol, and their sequential use for long-term sedation in critically ill mechanically ventilated patients.MethodsA total of 135 patients who required mechanical ventilation for >3 days were randomly assigned to receive midazolam (group M), propofol (group P), or sequential use of both (group M-P). In group M-P, midazolam was switched to propofol until the patients passed the spontaneous breathing trial (SBT) safety screen. The primary endpoints included recovery time, extubation time and mechanical ventilation time. The secondary endpoints were pharmaceutical cost, total cost of ICU stay, and recollection to mechanical ventilation-related events.ResultsThe incidence of agitation following cessation of sedation in group M-P was lower than group M (19.4% versus 48.7%, P = 0.01). The mean percentage of adequate sedation and duration of sedation were similar in the three groups. The recovery time, extubation time and mechanical ventilation time of group M were 58.0 (interquartile range (IQR), 39.0) hours, 45.0 (IQR, 24.5) hours, and 192.0 (IQR, 124.0) hours, respectively; these were significantly longer than the other groups, while they were similar between the other two groups. In the treatment-received analysis, ICU duration was longer in group M than group M-P (P = 0.016). Using an intention-to-treat analysis and a treatment-received analysis, respectively, the pharmaceutical cost of group M-P was lower than group P (P <0.01) and its ICU cost was lower than group M (P <0.01; P = 0.015). The proportion of group M-P with unbearable memory of the uncomfortable events was lower than in group M (11.7% versus 25.0%, P <0.01), while the proportion with no memory was similar (P >0.05). The incidence of hypotension in group M-P was lower than group (P = 0.01).ConclusionSequential use of midazolam and propofol was a safe and effective sedation protocol, with higher clinical effectiveness and better cost-benefit ratio than midazolam or propofol used alone, for long-term sedation of critically ill mechanically ventilated patients.Trial registrationCurrent Controlled Trials ISRCTN01173443. Registered 25 February 2014.

Autonomic Dysfunction and Adrenal Insufficiency in Thoracic Spine Tuberculosis

While autonomic dysfunction has been reported in patients with spinal TB, little is known of the consequences. We matched 25 paraplegic patients with thoracic spine tuberculosis scheduled for spinal surgery (Group S) with 25 nontubercular American Society of Anesthesiologists Grade I patients scheduled for nonspinal surgeries (Group C) under identical operative conditions. All patients underwent four autonomic tests in the operating room, and a preoperative adrenocorticotropic hormone stimulation test was performed for patients in Group S. Compared to Group C, Group S had higher resting heart rate (103 +/- 20 beats/minute versus 81 +/- 10 beats/minute), lower expiratory:inspiratory ratio (1.14 +/- 0.11 versus 1.22 +/- 0.10), and higher heart rate variability (20 +/- 12 beats/minute versus 14 +/- 7 beats/minute), indicating probable parasympathetic dysfunction along with a relative sympathetic overactivity. Eight of the 17 patients who received an adrenocorticotropic hormone stimulation test had evidence of adrenal insufficiency. Incidence of hypotension in Group S and Group C was 100% and 44%, respectively. Mean systolic and diastolic blood pressure in Group S showed substantial decrease after induction and positioning of patients not associated with compensatory tachycardia. Coexisting pulmonary tuberculosis appears an important determinant of surgical approach as well as postoperative respiratory morbidity.

Effects of different doses of remifentanil combined with propofol on tracheal intubating conditions and hemodynamic changes to laryngoscopy and tracheal intubation

喉镜置入和气管插管常可引起心动过速、高血压、心律失常、血浆儿茶酚胺浓度升高及敏感患者的心肌缺血、动脉瘤破裂等,可能导致对机体的损伤.采用静脉注射阿片类药物可以抑制机体的应激反应.异丙酚是一种起效快的新型麻醉药,广泛应用于麻醉诱导和麻醉维持.瑞芬太尼具有理想的阿片类受体激动剂特性和独特的药理学特点,现已广泛应用于临床麻醉诱导和维持[1].异丙酚复合瑞芬太尼用于麻醉诱导,既能使麻醉达到一定深度,又能减轻气管插管的心血管反应[2].本研究以血压、心率及患者的反应作为观察指标,旨在观察不同剂量瑞芬太尼复合异丙酚麻醉诱导后气管插管条件及血流动力学的变化,为临床合理应用瑞芬太尼提供参考。

Effect of Multiple Trauma on Mortality and Neurological Recovery after Spinal Cord or Cauda Equina Injury

We conducted a retrospective study in which we related the outcome of spinal cord injury to the presence of serious accompanying injuries. From 1974 through 1979, 144 patients with spinal cord trauma were admitted to the Acute Spinal Cord Injury Unit of Sunnybrook Medical Centre, 27 (19%) of whom had other major injuries of Grade 3 or higher according to the Abbreviated Injury Scale. These additional injuries included, among others, cerebral contusion, hemothorax, major intraabdominal bleeding, and femoral fracture. These 27 patients (Group 1) were compared to the 117 patients (Group 2) who had only spinal cord injuries. The two groups were similar in age and sex distribution. The incidence of hypotension on admission was higher in Group 1 (59%) than in Group 2 (7%) (p<0.001). In Group 1, 74% had either complete cord injury or incomplete injury with severe paresis, whereas only 58% of Group 2 had injuries of this magnitude. This difference was even more pronounced at discharge, when 78% of Group 1 were in the complete or severe injury categories, as compared with 52% in Group 2 (p<0.02). The Sunnybrook Cord Injury Recovery Index from admission to discharge was 1.9% in Group 1 and 19.8% in Group 2 (p<0.01), indicating that Group 2 patients had much better recovery. Mortality during hospitalization was 19% in Group 1 and 4% in Group 2 (p<0.01). Our results indicate that patients with spinal cord injury accompanied by other major injuries had more severe initial neurological deficits, poorer neurological recovery, and a higher mortality rate than those with cord injury alone. The higher incidence of hypotension in Group 1 may have played a significant role in the less favorable neurological outcome.