Intraoperative Hemodynamic Stability Research Articles

Comparison of efficacy of intrathecal hyperbaric ropivacaine and hyperbaric bupivacaine in terms of enhanced recovery after surgery (ERAS) for ACL reconstructions

: Bupivacaine is the drug of choice in spinal anaesthesia (SA), while Ropivacaine with its comparatively shorter duration of motor block allows early mobilization post ACL reconstruction surgery which is a crucial factor in Early Recovery after Surgery. : In this randomized double-blind comparative study of a total of 60 patients irrespective of gender undergoing ACL reconstruction surgery were studied. After Administration of SA to group R (2.5ml of 0.75% Heavy Ropivacaine) & group B (2.5ml of 0.5% Bupivacaine) both were compared for their post-operative effects with Bromage score, Aldrete score & Visual Analogue Score. : The time required for complete regression of motor blockade in group R (144.5+26.1 mins) < group B (181±21.3mins) which allowed for early mobilization which over all provides better and faster recovery.: Hyperbaric Ropivacaine when compared to Bupivacaine promises better results in terms of early ambulation and intraoperative hemodynamic stability promoting ERAS in patients undergoing ACL reconstruction surgeries. Promoting ERAS policy will reduce the duration of hospital stay, thereby improving the cost-effectiveness of health services.

A COMPARATIVE STUDY OF CLONIDINE VERSUS FENTANYL FOR INTRAOPERATIVE HEMODYNAMIC STABILITY IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY UNDER GENERAL ANESTHESIA: RANDOMIZED, DOUBLE-BLIND, INTERVENTIONAL STUDY

Objective: Laparoscopic cholecystectomy, though advantageous over traditional surgery, presents hemodynamic challenges due to pneumoperitoneum, systemic CO2 absorption, and patient positioning. Clonidine and Fentanyl are evaluated for their effectiveness in maintaining intraoperative hemodynamic stability, considering their different pharmacological actions. Methods: This randomized, double-blind interventional study involved 72 patients undergoing elective laparoscopic cholecystectomy under general anesthesia. Participants were allocated into two groups, receiving either IV Clonidine or IV Fentanyl. Hemodynamic parameters, including heart rate and blood pressure, were monitored and compared. Results: Clonidine demonstrated superior control over heart rate and blood pressure compared to Fentanyl, with statistically significant differences observed in the intraoperative period and post-intubation, indicating enhanced hemodynamic stability. Conclusion: Clonidine is more effective than Fentanyl in maintaining intraoperative hemodynamic stability in patients undergoing laparoscopic cholecystectomy. This suggests a potential preference for Clonidine as a premedicant in such surgical procedures, highlighting the need for tailored anesthetic techniques.

A Comparative Study of Ultrasound Guided erector Spinae Plane Block versus Local Anaesthetic Infiltration in Spine Surgeries for Intraoperative and Post-operative Analgesia

Abstract Background: Thoracolumbar spine surgeries need multimodal analgesia to control postoperative pain and early recovery. The study is about comparing the efficacy of bilateral single-shot ultrasound-guided (USG) erector spinae plane block (ESPB) versus local anesthetic infiltration before incision in patients scheduled for spine surgeries under general anesthesia (GA). Aim: This study aimed to compare USG-guided ESPB versus local anesthetic infiltration in spine surgeries for intraoperative and postoperative analgesia. Materials and Methods: Forty patients, the American Society of Anesthesiologists I, II, and III aged 18–80 years, undergoing spine surgeries under GA were enrolled in this prospective, randomized study. Patients were randomized to two groups of 20 each. Group L received GA and local anesthetic infiltration at the incision site by the surgeon and Group E received GA and preoperative bilateral ESPB with 20 mL 0.375% bupivacaine at each site. The primary outcome was the assessment by Numeric Rating Score (NRS) and total postoperative analgesic consumption in the first 24 h. The secondary objectives were intraoperative hemodynamic stability and dexmedetomidine requirement. Results: NRS at 4-h, 6-h, and 12-h postincision was significantly higher in Group L compared to Group E (P = 0.006, P = 00.001, and P = 00.006). The requirement of intraoperative dexmedetomidine and total doses of postoperative analgesic were significantly lower in Group E compared to Group L (P = 0.001). Patients who received ESPB showed better hemodynamic stability compared to those who received local anesthetic infiltration at the incision site. Conclusion: Preoperative bilateral single-shot USG-guided ESPB provides safe and effective intraoperative as well as postoperative analgesia for spine surgeries with reduced analgesic requirement.

Quality of Postoperative Recovery in Total Intravenous Anesthesia between Remimazolam and Propofol for Intraoperative Neurophysiological Monitoring: A Prospective Double-Blind Randomized Controlled Trial.

This study compared the overall postoperative recovery of patients who underwent total intravenous anesthesia with remimazolam or propofol, using the Quality of Recovery-15 questionnaire (QoR-15). Seventy-two patients who underwent spine surgery with intraoperative neurophysiological monitoring (IONM) were randomly categorized into the remimazolam group (group R) or propofol group (group P). On the first postoperative day, the QoR-15 scores for groups P and R were 114 and 112, respectively, indicating no significant difference (p = 0.691). Similarly, group-time interaction effects on QoR-15 scores were not significantly different. In the post-anesthesia care unit, the pain intensity at rest was notably higher in group P than in group R (3.0 [0.0] vs. 2.8 [0.5], respectively, p = 0.009). Although the intraoperative consumption of remifentanil was higher in group R (1452.4 µg vs. 2066.8 µg, respectively, p < 0.001), the intraoperative use of vasopressors was lower in group R (1705.6 µg vs. 286.1 µg, respectively, p < 0.001) compared to group P. Group R exhibited significantly lower variability in mean blood pressure over time compared to group P. Remimazolam was viewed as a promising intravenous agent for general anesthesia, showing potential to replace propofol in spine surgery with IONM, considering both recovery quality and intraoperative hemodynamic stability.

Pheochromocytoma – A challenge to anesthetist

Abstract Phaeochromocytoma is a catecholamine-secreting tumor of the sympathoadrenal system. It poses a significant challenge to the anesthesiologist, as sudden and intense hemodynamic changes are common in the preoperative and intraoperative periods. Preoperative optimization with sympatholytic drugs along with fluid resuscitation and intraoperative hemodynamic stability is essential for improved patient outcome. The anatomy of the tumor and proximity to major vasculature prove a challenge to anesthetists and surgeons alike. We are presenting a case of a 53-year-old male with a phaeochromocytoma of the right adrenal gland posted for laparoscopic right adrenalectomy, with the tumor mass compressing the inferior vena cava.

Effects of ultrasound-guided lumbar plexus and sacral plexus block combined with general anesthesia on the anesthetic efficacy and surgical outcomes in elderly patients undergoing intertrochanteric fracture surgery: a randomized controlled trial

BackgroundSurgery for intertrochanteric fractures in elderly patients is challenging due to the risk of severe pain and significant stress responses. We investigated the effects of a combined approach of ultrasound-guided lumbar plexus and sacral plexus block with general anesthesia on anesthetic efficacy and surgical outcomes in these patients.MethodsA randomized controlled trial was conducted involving 150 elderly patients, divided into two groups: the combined anesthesia group (receiving ultrasound-guided lumbar plexus and sacral plexus block along with general anesthesia) and the general anesthesia alone group. Outcome measures included hemodynamic parameters, postoperative pain levels (VAS scores), postoperative recovery times, and incidence of adverse reactions.ResultsIn the combined anesthesia group, the patients had more stable intraoperative hemodynamics, lower postoperative VAS scores at 1, 3, and 6 h, and faster recovery times (eye-opening upon command and return of respiratory function) compared to the general anesthesia group. Furthermore, the incidence of adverse reactions was significantly lower in the combined anesthesia group.ConclusionsUltrasound-guided lumbar plexus and sacral plexus block combined with general anesthesia enhanced the anesthetic efficacy and improved surgical outcomes in elderly patients undergoing intertrochanteric fracture surgery.

Protocol for a prospective comparative randomized clinical study for the comparison of two different doses of dexmedetomidine with bupivacaine in pediatric caudal anesthesia for infraumbilical surgeries in a tertiary hospital in central India

Background Pediatric caudal anesthesia is a well-established technique for providing intraoperative and postoperative pain relief in children undergoing infraumbilical surgeries. Dexmedetomidine, an α2-adrenergic agonist, has shown promise as an adjuvant to local anesthetics in caudal blocks, potentially improving the quality and duration of pain relief. This study aims to compare two doses of dexmedetomidine with bupivacaine to assess their efficacy in pediatric caudal anesthesia. Methods A prospective comparative randomized clinical study will be conducted over two years in the Department of Anaesthesiology at Jawaharlal Nehru Medical College (JNMC) and Acharya Vinoba Bhave Rural Hospital (AVBRH) in Central India. Patients aged six months to six years, with American Society of Anesthesiologists (ASA) Class 1 or 2, scheduled for infraumbilical surgeries, will be included. They will be randomly allocated to receive either Group A (1 ml/kg of 0.25% bupivacaine with 1 μ/kg dexmedetomidine) or Group B (1 ml/kg of 0.25% bupivacaine with 0.5 μ/kg dexmedetomidine) in a double-masked fashion. The primary outcome is the duration of postoperative pain relief. Secondary outcomes include intraoperative hemodynamic stability, time first to rescue analgesia, incidence of adverse effects, and patient and parent satisfaction. A cost-effectiveness analysis will also be conducted. Conclusions The study will provide insights into the efficacy and safety of different doses of dexmedetomidine in pediatric caudal anesthesia for infraumbilical surgeries. The results will guide clinical practice and inform anesthesia protocols for pediatric patients in the study setting. Registration CTRI (CTRI/2023/05/057050; 29 August 2023).

Effect of a Single-dose Dexmedetomidine on Postoperative Delirium and Intraoperative Hemodynamic Outcomes in Elderly Hip Surgery; A Randomized Controlled Trial Dexmedetomidine for Postoperative Delirium

Objective: Postoperative delirium (POD) is common in elderly patients. The growing evidences suggesting the potential benefits of dexmedetomidine (DEX) infusion in reducing POD. However, the administration of a singledose DEX remains controversial. This study aims to investigate the effect of a single-dose DEX on POD in elderlypatients undergoing hip surgery. Materials and Methods: This prospective, randomized, double-blinded trial enrolled patients aged over 65 years who underwent hip surgery under spinal anesthesia. Patients were assigned to either the DEX (received intravenous DEX 0.3-0.5 μg/kg after incision), or the normal saline solution (NSS). Delirium assessments were conducted at the post anesthetic care unit (PACU) and at 24, 48 and 72 hours postoperatively using the Confusion AssessmentMethod (CAM). Results: A total of 200 patients were randomized, with 100 in the DEX and 100 in the NSS. The incidence of POD was significantly lower in the DEX compared to the NSS (P &lt; 0.001, RR 0.45, 95%CI: 0.28, 0.73). This difference remained significant at each postoperative assessment time point. There was no significant difference in sedation score and perioperative hemodynamics, except for a slightly lower intraoperative heart rate (P=0.015) and systolic blood pressure (P=0.029) observed at the PACU in the DEX, but these differences were not clinically significant. Additionally, the length of stay after surgery in the DEX was significantly shorter compare to the NSS (P=0.006). Conclusion: A single-dose dexmedetomidine can reduce the incidence of POD within 72 hours postoperatively in elderly patients undergoing hip surgery without compromising intraoperative hemodynamic stability.

Anaesthetic management of an adult patient with Hypertrophic Obstructive Cardiomyopathy and Chronic kidney disease for Minimally Invasive Video Assisted Thoracoscopic Surgery

It is not an uncommon situation to encounter a patient for anaesthesia with multiple co-morbidities. Here we report a successful anaesthetic management of a patient with Hypertrophic Obstructive Cardiomyopathy, Stage IV Chronic Kidney Disease, Chronic Lung Infection, immunosuppressed, posted for minimally invasive video assisted thoracoscopy requiring one lung ventilation. Intraoperative hemodynamic stability was maintained with etomidate, fentanyl, cisatracurium, desflurane &amp; dexmedetomidine with accurate bispectral depth for sedation and precise fluid guidance with transoesophageal echocardiography. The entire anaesthetic conduct was planned to avoid the left ventricular outflow tract obstruction and maintain a steady-state hemodynamic balance. This case report is a learning experience of how close vigilance with appropriate use of monitoring and knowledge about disease per se resulted in uneventful perioperative period.

Comparative Evaluation of Two Different Doses of Dexmedetomidine for Intra Operative Moderate Sedation During Spinal Anesthesia

Background: Intravenous (IV) sedation is often used to relieve anxiety or stress during surgery under regional anesthesia. Subarachnoid block is a widely followed regional anaesthesia technique, especially in lower abdominal and lower limb surgeries. Intense sensory and motor block, continuous supine position and the inability to move the body also brings a feeling of discomfort and phobia in many patients. Sedation has been shown to increase patient satisfaction during regional anaesthesia. Dexmedetomidine is well suited for conscious sedation as patient can be quickly aroused and oriented on demand. Aim of this study was to compare infusion doses of 0.3μg/kg/hr and 0.5μg/kg/hr, after loading dose of 1μg/kg of injection (inj).dexmedetomidine in order to obtain a better regimen for patients undergoing procedures under spinal anaesthesia in terms of sedation and hemodynamic stability.&#x0D; Objective: To compare efficacy of dexmedetomidine for intraoperative sedation and hemodynamic stability at doses of 0.3μg/kg/hr and 0.5μg/kg/hr after loading dose of 1 μg/kg in patients operated under spinal anaesthesia.&#x0D; Methods: Adult 80 Patients were randomly divided into two groups, (Group D-0.3) and (Group D-0.5). They were given spinal anaesthesia with 0.5% hyperbaric bupivacaine and initial dose of inj.dexmedetomidine 1 μg/kg was infused over 10 minutes. Group D-0.3 received maintenance dose of inj.dexmedetomidine of 0.3μg/kg/hr and Group D-0.5 received maintenance dose of 0.5μg/kg/hr. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), respiratory rate (RR), spO2 and sedation using observer’s assessment of alertness/sedation (OASS) were recorded at baseline, after loading dose, before spinal anesthesia, after spinal anesthesia at every 5 minutes upto 30 minutes, followed by every 15 minutes till the end of surgery and every 5 minutes upto 15 minutes after surgery. Data were compared using chi-square and unpaired t test. &#x0D; Results: The mean age for Group D-0.3 is 43.9+11 and for Group D-0.5 is 35.3+20. There is no statistically significant difference in demographic profile between two groups. It was also observed that there is no statistically significant difference in HR, SBP, DBP, MAP, RR and SpO2 in all point of time (p&gt;0.05). According to sedation score in group D-0.3 72% patients were sleeping comfortably but easily arousable and 8% patients were in deep sleep, while in group D-0.5 70% were sleeping comfortably but easily arousable and 15% in deep sleep.&#x0D; Conclusion: After a loading dose of 1 μg/kg intravenously, an iv infusion of dexmedetomidine at a lower rate, i.e. 0.3μg/kg/hr is equally effective in providing sedation for patients undergoing surgeries under spinal anesthesia as 0.5μg/kg/hr.

The effects of perioperative dexmedetomidine infusion on hemodynamic stability during laparoscopic adrenalectomy for pheochromocytoma: a randomized study.

Pheochromocytoma is a rare catecholamine-producing neuroendocrine tumor originating from the adrenal medulla chromaffin cells. Hemodynamic instability can occur during the induction of anesthesia and surgical manipulation of the tumor. This study investigated the effects of intraoperative dexmedetomidine administration on hemodynamic stability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma. Forty patients who underwent laparoscopic adrenalectomy for pheochromocytoma were randomly assigned to the dexmedetomidine (n = 20) or control (n = 20) group. The primary outcome of this study was intraoperative hemodynamic stability, and the secondary endpoint was the plasma catecholamine concentrations, specifically of epinephrine and norepinephrine. The intraoperative maximum blood pressures were significantly lower in the dexmedetomidine group (control vs. dexmedetomidine group: 182 ± 31 vs. 161 ± 20, 102 ± 17 vs. 90 ± 10, and 128 ± 22 vs. 116 ± 12 [mean ± SD] mmHg and p = 0.020, 0.015, and 0.040 for systolic, diastolic, and mean blood pressure, respectively). The maximum heart rate during surgery was 108 ± 15 bpm in the control group and 95 ± 12 bpm in the dexmedetomidine group (p = 0.010). Other parameters of hemodynamic instability were comparable between both groups. Plasma catecholamine concentrations did not differ between the groups. Dexmedetomidine infusion following the induction of anesthesia at a rate of 0.5 μg/kg/h significantly attenuated the maximum intraoperative SBP, DBP, MBP, and HR, contributing to improved hemodynamic stability.

A comparative study of intraoperative analgesic consumption and recovery profile between sevoflurane- and propofol-based general anesthesia in adults

Background: Many researches were performed in the past to compare propofol and sevoflurane as sole anesthetics. While some studies have reported the advantages of propofol regarding better recovery profile and post-operative analgesic sparing effect, the contrast reporting does exist. Hence, there is a further need of research to explore recovery characteristics. Whether either of these two as sole anesthetics can yield any benefit regarding intraoperative analgesics consumption has not been evaluated. Aims and Objectives: The study primarily aimed at determining total analgesic consumption in the intraoperative period (primary outcome), between those receiving either sevoflurane or propofol for induction as well as maintenance of anesthesia. In addition, intraoperative hemodynamics (heart rate and mean arterial pressure) and recovery profile were compared. Materials and Methods: Total of 168 patients, aged 18–60 years, the American Society of Anesthesiologists’ physical status I/II, undergoing elective and emergency surgeries under general anesthesia for 2–3 h finally recruited. Patients were randomly allocated to receive either sevoflurane (group S, n=84) or propofol (group P, n=84) for both induction and maintenance. Anesthetics were titrated to achieve bispectral index (BIS) value of 60. For both the groups, additional fentanyl was considered aliquots of 25 mcg whenever the hemodynamics changes occurred despite maintaining BIS value in the above-mentioned range. Results: The total intraoperative analgesic consumption was found comparable in both groups of patients. Induction time (38 vs. 59 s) and emergence time (8 vs. 10 s, P&lt;0.001) were found shorter in the propofol group than in sevoflurane. Aldrete score &gt;9 was achieved earlier with propofol compared with sevoflurane (8.5 vs. 12 min). Conclusion: Propofol-based shows no advantage over sevoflurane in view of intraoperative consumption of analgesics and intraoperative hemodynamic stability. However, the use of propofol was associated with faster induction as well as quicker emergence from anesthesia.

Effect of peripheral nerve block versus general anesthesia on the hemodynamics and prognosis of diabetic patients undergoing diabetic foot Surgery

BackgroundDiabetic foot ulcers (DFUs) represent a significant foot-related concern for patients with multiple co-morbidities, and surgical intervention is often employed. Notably, peripheral nerve block anesthesia (PNB) has emerged as a new approach for the surgical management of DFUs, providing sustained hemodynamic stability and superior postoperative pain control compared to general anesthesia (GEA).MethodsThe present study utilized a retrospective analysis of hospitalized patients who met the inclusion criteria for DFUs over a period of 7 years. Patients were categorized into two groups based on the type of anesthesia employed during the procedure: GEA or PNB. Extensive patient information was gathered and analyzed, such as demographics, intraoperative hemodynamic parameters, numeric rating scale (NRS) scores, and healing outcomes. The preliminary results assessed in this study were intraoperative hemodynamic stability and postoperative analgesic efficacy.ResultsDuring the study period, 117 patients received surgical therapy based on GEA, while 145 patients received PNB. Notably, the mean intraoperative blood pressure was significantly lower in the GEA group, and this difference remained statistically significant even after Bonferroni adjustment using linear mixed models. Additionally, the frequency of hypotensive episodes was higher in the GEA group (P < 0.05). Furthermore, the perioperative transfusion volume, overall intraoperative fluid input, and intraoperative bleeding volume were significantly more significant in the GEA group than in the PNB group. The postoperative pain NRS scores differed considerably between the two groups (Bonferroni corrected P < 0.01), with the GEA group exhibiting higher opioid consumption on the day of surgery and the first postoperative day when using patient-controlled intravenous analgesia (PCIA). Supplemental analgesic medication was more significant in the GEA group 24 h postoperatively. However, the two groups had no difference in hospital stay or treatment outcomes. There was no difference between the two groups regarding secondary surgery and amputation procedures. Although the 5-year mortality rate is 30.5%, no significant difference in mortality rates between the two groups was observed.ConclusionsCompared to GEA, PNB is a safe and effective alternative therapy for managing DFUs. Our findings suggest that PNB administration during surgical intervention for this condition results in more stable intraoperative hemodynamics and superior postoperative analgesic effects, despite no significant difference in overall treatment outcomes between the two groups. The two groups did not differ in re-surgery, amputation, or 5-year mortality.

A bispectral index guided comparative evaluation of dexmedetomidine as an adjuvant to propofol-based total intravenous anaesthesia in spine surgeries done under motor-evoked potential monitoring

BackgroundThe anaesthetic agents can affect the quality of motor-evoked potential intraoperatively as they inhibit synaptic transmission. Intravenous anaesthetics suppress motor-evoked potential lesser than inhalational agents, so total intravenous anaesthesia or a combination of intravenous with minimal inhalational anaesthetic supplementation is used when motor-evoked potential is monitored. Motor-evoked potential can get depressed at high doses of propofol required to maintain surgical depth, hence, adjuvant agents like dexmedetomidine that maintain anaesthetic depth without affecting the motor-evoked potential are often required. This study was a prospective non-randomized and comparative study (quasi-experimental) assigned into two groups of 64 each, labelled as the propofol group (group P) and Propofol + dexmedetomidine group (group PD). The primary objective of our study was to compare the total dose reduction of propofol with the addition of dexmedetomidine and their interference with motor-evoked potential readings. The secondary objective was to assess the hemodynamic changes, changes in amplitude and latency of motor-evoked potential, and complications if any.ResultsThe mean total dose of propofol consumed in our study was 502.81 ± 71.01 mg in group propofol( P) and 392.18 ± 59.00 mg in group propofol + dexmedetomidine (PD). Moreover, the mean total dose of propofol (mg) was significantly less used in group PD. Intraoperative hemodynamic stability, no difference in amplitude and latency for motor-evoked potential, and only significant bradycardia in group propofol + dexmedetomidine (PD).ConclusionsDexmedetomidine can be successfully used in propofol-based total intravenous anaesthesia for motor-evoked potential monitoring in spine surgeries, but it is better to maintain stable hemodynamics with a significant reduction of the mean dose of propofol.

COMPARISON OF BILATERAL USG-GUIDED ERECTOR SPINAE BLOCK VERSUS CONTROL GROUP FOR INTRAOPERATIVE HEMODYNAMIC STABILITY AND POST-OPERATIVE ANALGESIA IN SPINE SURGERIES UNDER GENERAL ANESTHESIA

Objectives: The aim of the study was to compare the intraoperative hemodynamics and post-operative analgesia after using bilateral erector spinae block (ESB) and conventional techniques during spinal surgeries. The study also aims at comparison of analgesics consumption in patients during post-operative period. Methods: One hundred adults aged 18–80 years with American Society of Anaesthesiology physical status I/II scheduled for elective lumbar spine surgeries (two levels) under general anesthesia (GA) were divided into two groups. Group A received erector spinae plane block (ESPB) along with GA and Group B received GA only. Injection Paracetamol 1 g intravenously was given as rescue analgesia. Intraoperative hemodynamics, visual analog score at rest and at movement in 24 h postoperatively, first rescue analgesia, total dose of analgesics in first 24 h postoperatively, and intraoperative opioid dose requirement were compared in both the groups for 7 days. Results: Intraoperative hemodynamics in ESPB group were found to be more stable than the control group. There was a significant low VAS score in Group A compare to Group B at rest and on movement (p&lt;0.001). The time for first rescue analgesia was prolonged in group ESPB as compared to control group (p&lt;0.05). The total dose of analgesia required in first 24 h was significantly lower in patients of ESP group 25±41.96 mg 82.5 than patients in control group ±22.73 mg. Conclusion: Ultrasound-guided bilateral ESB provides profound intraoperative hemodynamic stability with perioperative analgesia in comparison to conventional GA technique. The present study concluded that ESP block decreased the opioid requirement in both intraoperative and post-operative period.

Evaluation of the addition of adrenaline in a bilateral maxillary nerve block to reduce hemorrhage in dogs undergoing sharp staphylectomy for brachycephalic obstructive airway syndrome. A prospective, randomized study.

To assess the use of adrenaline (0.00198%) in a bilateral maxillary nerve block to reduce intraoperative hemorrhage in dogs undergoing staphylectomy for the treatment of brachycephalic obstructive airway syndrome (BOAS). Prospective, randomized, double-blinded controlled study. A total of 32 client owned, clinically affected dogs undergoing a cut and sew sharp staphylectomy for treatment of BOAS. A total of 16 dogs randomly assigned to adrenaline (A) group and 16 to no-adrenaline (NA) group. A bilateral maxillary nerve block was performed in all dogs prior to staphylectomy using lidocaine alone (group NA) or a combination of lidocaine and adrenaline (group A). Total hemorrhage was measured by weighing cotton-tipped applicators and swabs used on precision scales. In addition, a semi-quantitative hemorrhage score (1-5) was determined. Dogs were monitored for intraoperative hemodynamic stability during the procedure. Total hemorrhage was significantly (p = .013) lower in group A compared with group NA. The median semi-quantitative hemorrhage score was significantly lower for group A (p = .029) compared with group NA. No significant adverse effects were noted due to adrenaline usage. This study demonstrated that the use of adrenaline in a bilateral maxillary nerve block results in significantly lower intraoperative hemorrhage during cut and sew sharp staphylectomy and appeared safe to use. Potential clinical advantages include improved visualization, prevention of unnecessary blood loss and reduction in risk of blood aspiration.

Efficacy of Ultrasound Guided Bilateral Erector Spinae Block in Attenuating Pneumoperitoneal Stretch Response in Patients Undergoing Laparoscopic Abdominal Surg

Background: Increase in heart rate and blood pressure in response to pneumoperitoneum produced during laparoscopic abdominal surgeries is a challenging situation to anesthesiologists. Without adequate control of sympathetic response there is a chance of increase in morbidity of the patient during perioperative period. Aim of the study is to evaluate the efficacy of bilateral erector spinae plane block in attenuating pneumoperitoneal stretch response in patients undergoing laparoscopic abdominal surgeries under general anesthesia. Methodology: A randomised control trial was conducted among 70 patients, who underwent laparoscopic abdominal surgeries. Under general anesthesia, 35 patients received ESP block with 20 ml of 0.25 levobupivacaine bilaterally (Group B) and 35 patients without block (Group R). This study compared requirement of opioids and response of hemodynamic parameters (Heart Rate, Mean Arterial Pressure) during pneumoperitoneal stretch. Statistical tests were applied. Results: The intra-operative fentanyl requirement in Group B was 100.85+ and in Group R 119.375 + P value &lt;0.001, statistically significant. The intra-operative heart rate at the time of port insertion, at 5 min, 10 min of pneumoperitoneum and at the end of surgery in Group B (91.97 ±12.09, 90.82±10.7, 92.08±10.9 and 90.857±12.5) were significant when compared to Group R (R 99.9±10.5, 94.48±13.08, 96.68±14.14 and 95.35±14.14 and same is proven statistically. (p &lt; 0.05). Conclusion: Ultrasound guided bilateral Erector spinae block with Levobupivacaine results in intra-operative hemodynamic stability during port insertion and pneumoperitoneum.

Efficacy of intravenous dexmedetomidine-lignocaine infusion compared to morphine for intraoperative haemodynamic stability in modified radical mastectomy: A randomised controlled trial.

In recent times, non-opioid analgesic-based anaesthesia has been gaining popularity as it can achieve the goals of hypnosis, amnesia, and haemodynamic stability while avoiding opioid side effects. Our study compares the efficacy of opioid-free anaesthesia and opioid-based general anaesthesia regarding intraoperative haemodynamic stability, anaesthetic requirements, awareness, and recovery profile. After receiving ethical approval and registering the trial, we conducted this randomised, single-blinded study on American Society of Anesthesiologists (ASA) physical status I and II patients who were aged 18-65 and were scheduled for modified radical mastectomy under general anaesthesia. Patients were randomised into two groups of 60 each. Group DL received IV dexmedetomidine 1 μg/kg loading over 10 min, 10 min before induction and 0.5 μg/kg/h infusion after that along with IV lignocaine 1.5 mg/kg at bolus followed by 1.5 mg/kg/h infusion. Group MN received IV morphine 0.15 mg/kg. Standard monitoring and general anaesthesia protocol were followed. Intraoperative haemodynamics, anaesthetic requirement, extubation time, and recovery profile were monitored. Data were analysed using Stata version 14 software, and statistical tests (Chi-squared test for qualitative variables, unpaired t-test and Mann-Whitney U test for quantitative variables) were performed. Both groups had comparable haemodynamic stability (P > 0.05). Group DL had a significantly lower propofol requirement for induction and maintenance (P < 0.001). Ramsay sedation score (P = 0.002) and extubation time (P = 0.029) were significantly higher in Group MN. The recovery profile was favourable in Group DL, with there being lower postoperative complications. Dexmedetomidine and lignocaine IV infusion demonstrated stable intraoperative haemodynamic stability, lower anaesthetic requirement, and better recovery profile than morphine without significant complications.

Comparison of the Efficacy of Opioid-Free Anesthesia With Conventional Opioid-Based Anesthesia for Nasal Surgeries - A Prospective Randomized Parallel Arm Triple-Blinded Study.

Introduction In the setting of nasal surgeries, the use of opioid-free anesthesia involving the use ofdexmedetomidine,and lignocaine is being investigated as a potential alternative to opioids. This combination of drugs provides sympatholysis, pain relief, and sedative properties, thereby aiming at reducing the negative effects commonly associated with opioid usage. The objective of this study is to evaluate and compare the effectiveness of opioid-free anesthesia using dexmedetomidineand lignocaineversus conventional opioid anesthesia with fentanylfor nasal surgeries. The comparison will be based on the primary outcome of postoperative visual analog scale(VAS) scores. Secondary outcomes assessed were the amount of rescue analgesic consumption, intraoperative sevoflurane usage, intraoperative blood loss, hemodynamic stability, postoperative nausea and vomiting (PONV) scores, and postoperative Ramsay Sedation Scores. Methods A triple-blind, prospective, randomized, parallel arm study in which 48 patients planned for elective nasal surgery were allocated randomly to one of two groups. In the study, the population labeled as Group D, comprising 24 participants, received dexmedetomidine at a dosage of 1 mcg.kg-1 via intravenous infusion lasting for a duration of 10 minutes prior to the induction of anesthesia. This was followed by a continuous infusion of 0.6 mcg.kg-1 h-1 throughout the intraoperative period, and intravenous Lignocaine 1.5 mg.kg-1 was administered three minutes prior to induction, subsequently an intraoperative infusion of 1.5 mg.kg-1 h-1. In Group F, consisting of 24 participants,intravenous fentanyl of 2 mcg.kg-1was administered three minutes before the induction. This was subsequently followed by a fentanyl infusion of 0.5 mcg.kg-1h-1in the intraoperative period. Results The study findings indicate that Group D had considerably lower postoperative VAS scores from 30 minutes to two hours compared to Group F (p<0.05). The utilization of sevoflurane during the intraoperative period was comparatively reduced in Group D in order to achieve the desired bispectral index (BIS) range of 40-60 (p<0.01). Mean intraoperative blood loss was also lower in Group D (85 ml) compared to Group F (115 ml )(p<0.01). Additionally, Group D had significantly lower rescue analgesic consumption and lower incidence of PONV up to 60 minutes compared to Group F (P-value <0.01).A statistically significant difference was observed between Group D and Group F in terms of lower mean values of both mean arterial pressure (MAP) and heart rate in Group D(p<0.01). The results indicate that the postoperative sedation scores within the first two hours were significantly greater in Group D compared to Group F(p<0.01). Conclusion The usage of opioid-free anesthesia has been found to be superior to a traditional opioid-based approach in various aspects, including the provision of sufficient pain relief after surgery, maintenance of stable hemodynamics during the operation, and reduction in occurrences of postoperative nausea and vomiting.

Comparison of Intraoperative Hemodynamic Stability, Recovery Profile Desflurane vs Sevoflurane during Anesthesia for Cranioplasty: A Randomized Trial

Comparison of Intraoperative Hemodynamic Stability, Recovery Profile Desflurane vs Sevoflurane during Anesthesia for Cranioplasty: A Randomized Trial