Quality Of Surgical Anesthesia Research Articles

Observations on tiletamine-zolazepambutorphanol- dexmedetomidine anaesthesia in six dogs undergoing various surgeries

Six client-owned dogs which underwent various surgical procedures under multimodal general anaesthesia with meloxicam premedication (0.2mg/kg IM), and induction thirty minutes later with a combination of tiletamine-zolazepam (2 mg/kg), butorphanol (0.2 mg/kg) and dexmedetomidine (5 mcg/kg) and administered intramuscularly, were studied. The signs of sedation and induction of anaesthesia, and their respective times of onset were observed and recorded. All animals received 100% oxygen through an endotracheal tube connected to a breathing circuit of anaesthesia machine. The quality of induction, quality of surgical anaesthesia and response to intraoperative surgical stimuli were noted and recorded. Prolongation of general anaesthesia, when anaesthesia becomes lighter, was done using isoflurane in oxygen with or without propofol. All observations were recorded, and the findings are reported here.

Role of Fentanyl With Bupivacaine During Spinal Anaesthesia for Caesarean Section in Reducing Hypotension

Background and Objectives: The hypotension following spinal anaesthesia is a common problem incaesarean section. The combination of reduced dose of local anaesthetics with intrathecal opioids makesit possible to achieve adequate spinal anaesthesia with minimum hypotension. We investigated whetherthis synergistic phenomenon could be used to provide less frequent hypotension while incurring adequatespinal anaesthesia for caesarean section. Methods: Sixty women scheduled for caesarean delivery (thirty in each group) were divided into twogroups of patients who received a spinal injection of either 12.5 mg of hyperbaric bupivacaine or 10 mgof hyperbaric bupivacaine with 25 mg fentanyl added. Each measurement of a systolic blood pressureless than 95 mmHg or a decrease in systolic pressure of greater than 25% from baseline was consideredas hypotension and treated with a bolus of 5 to 10 mg of intravenous ephedrine. The quality of surgicalanaesthesia was evaluated also. Results: Spinal block provided excellent surgical anaesthesia in almost all patients. Peak sensory levelwas higher (D2-3 vs. D4-5) and motor block was more intense in the hyperbaric bupivacaine group; thepatients from bupivacaine group were more likely to require treatment for hypotension (75% vs. 15%)and had more persistent hypotension (4.6 vs. 1.0 hypotensive measurements per patient) than patients inthe reduced bupivacaine-fentanyl group. Mean ephedrine requirements were 15.0 mg and 3.5 mg,respectively. Patients in the bupivacaine group also complained of emetic effects more frequently thanpatients in the reduced dose bupivacaine-fentanyl group. Conclusions: Bupivacaine 10 mg plus fentanyl 25 mg provided spinal anaesthesia for caesarean deliverywith less hypotension and vasopressor requirements while ensuring excellent perioperative surgical anaesthesia. JBSA 2019; 32(1): 28-34

Optimizing heavy marcaine dose for spinal anesthesia in short stature pregnant female individuals undergoing cesarean section

Background and objectives Hypotension after spinal anesthesia is still widespread in cesarean delivery, especially in pregnant women with short stature. The use of a reduced dose of local anesthesia allows adequate spinal anesthesia with minimal hypotension. We investigate the lowest dose of heavy bupivacaine that can be used to reduce the frequency of hypotension associated with adequate spinal anesthesia in short stature pregnant female individuals undergoing cesarean section. Patients and methods Sixty women scheduled for cesarean section were divided into three groups of patients (20 in each group) receiving spinal injections of 0.04 mg heavy bupivacaine/cm height (group A), 0.05 mg heavy bupivacaine/cm height (group B), and 0.06 mg heavy bupivacaine/cm height (group C). A decrease in systolic pressure greater than 20% of the baseline was considered low blood pressure and was treated with a bolus of 5–10 mg intravenous ephedrine. The quality of surgical anesthesia was assessed among groups. Results Groups B and C were assigned a higher sensory level block than group A after spinal anesthesia, and the difference was statistically significant (P Conclusions This study showed that the use of spinal anesthesia in pregnant women of short stature using heavy bupivacaine at a concentration of 0.05 mg/cm body weight showed a clear benefit in terms of adequate anesthesia and stable hemodynamics.

Addition of Fentanyl to Hyperbaric Bupivacaine in spinal anesthesia for Caesarian section – effect on dose of local anesthetic and duration of postoperative analgesia – a randomized comparative study

Background: Spinal anesthesia is commonly used for caesarian section for its reliability and ease of administration. However, it is limited by fixed duration of anesthesia, hypotension and lesser control of block height. The combination of reduced dose of local anesthetic agent with intrathecal opioid makes it possible to achieve adequate spinal anesthesia with minimum hypotension and prolonged postoperative analgesia. The study aims to monitor the effect of intrathecal fentanyl and bupivacaine on reduction of higher blocks and simultaneously improving the quality and avoiding higher doses of local anesthesia agents.
 Methods: Forty patients scheduled for elective caesarian section were divided in to two groups of twenty each. Group I patients received Bupivacaine 12.5 mg (0.5%) for spinal anesthesia and group II patients received combination of Bupivacaine 8.5 mg (0.5%) with fentanyl 25 mcg. Patients were observed for hypotension, bradycardia, nausea, pruritus, quality of surgical anesthesia and duration of postoperative analgesia.
 Results: All the patients had adequate surgical anesthesia for the procedure and in no patient conversion to general anesthesia was required. Peak sensory level was higher (T2-T3 vs T4-T6) and motor block was more intense in the regular dose bupivacaine group of patients. More patients in bupivacaine only group developed hypotension and the requirement of vasopressors was significantly higher than the low dose bupivacaine with fentanyl group. Also the Visual analogue scale score for pain was less in the bupivacaine-fentanyl group, who received less postoperative analgesics for first twelve hours.
 Conclusions: We conclude that combination of low dose bupivacaine (8.5mg) with fentanyl provides adequate surgical anesthesia for caesarian section and with low incidence of hypotension and nausea. Also, addition of fentanyl helps in prolongation of postoperative analgesia. JMS 2017;20(2):62-68

Effect of mini-dose epidural dexmedetomidine in elective cesarean section using combined spinal-epidural anesthesia: a randomized double-blinded controlled study.

Combined spinal-epidural anesthesia is commonly used for elective cesarean section. Our study aimed to evaluate the effect of adding dexmedetomidine to epidural bupivacaine and fentanyl in patients undergoing elective cesarean section using combined spinal-epidural anesthesia. Eighty healthy women at term were randomly assigned to two groups: a control group (n = 40; "Bup/Fen group") received combined spinal-epidural anesthesia with intrathecal hyperbaric bupivacaine 5 mg and an epidural mixture of 10 mL plain bupivacaine 0.25 % and fentanyl 50 μg, whereas the study group (n = 40; "Dex/Bup/Fen group") received 1 mL epidural dexmedetomidine 0.5 µg/kg in addition. The primary outcome measure was the difference between the groups in the supplementary fentanyl analgesic required. The quality of surgical anesthesia, incidences of hypotension and bradycardia, APGAR scores, intraoperative pain assessment, and onset of postoperative pain, sedation score, and side effects were recorded. There was no statistically significant difference between the groups regarding block characteristics. Significantly less intraoperative and postoperative fentanyl were required by the Dex/Bup/Fen group (P = 0.015 and P = 0.0011, respectively). There was no statistically significant difference between the groups regarding sedation score or the incidences of hypotension, nausea and vomiting, dizziness, and pruritus. The addition of mini-dose epidural dexmedetomidine 0.5 µg/kg as a single injection to bupivacaine fentanyl in women undergoing elective cesarean section with combined spinal-epidural anesthesia improved intraoperative conditions and the quality of postoperative analgesia.

English

BACKGROUND: Caudal epidural is one of the most popular reliable & safe technique mainly used for intra and post-op analgesia in pediatric patients undergoing infra umbilical surgeries. To prolong the duration of analgesia various adjuvants like epinephrine, opioids, ketamine, midazolam, tramadol, clonidine, were added to local anesthetic. The aim of this study was to evaluate the clinical efficacy and safety of CAUDAL administration of plain Ropivacaine 0.2% (1miligram/kilogram body weight) with and without dexmedetomedine (2 microgram/kilogram body weight) in children undergoing infraumbilical surgeries; in terms of quality of surgical anesthesia and the duration of post-operative analgesia. METHOD: After approval from the institutional ethics committee and written informed consent of the parents, 60 children of (age 1-10 years) ASA gr. I and II undergoing elective lower abdominal and urogenital surgeries, were randomly divided into two groups of 30 each. After careful pre-anesthetic examination, children were kept fasting for an appropriate period prior to surgery. All patients received Injection Glycopyrrolate- 0.01 milligram /kilogram body weight, Injection midazolam- 0.1 milligram /kilogram body weight, Injection ketamine - 1 milligram /kilogram body weight, intravenously, just prior to caudal block. Caudal block was performed under all aseptic precautions. No surgical stimulus was allowed for the next 10 minutes i.e. the onset time for sensory block to occur, after which surgery was performed under the residual effect of ketamine and caudal block only. Patients were randomly allocated to receive Injection Ropivacaine 0.2% (1 milliliter/kilogram body weight; Group R) +1mililitre Normal saline or Injection Ropivacaine 0.2% (1millilitre/kilogram body weight) +Injection dexmedetomedine (2 microgram/kilogram body weight; Group RD) in Normal saline 1 milliliter. Hemodynamic parameters were observed before, during and after the surgical procedure. Quality of surgical anesthesia & requirement of supplemental midazolam/ketamine were also noted. Duration of Post-operative analgesia, pain scores, level of sedation and side effects if any were looked for and duly recorded. All the results were tabulated and analyzed statistically. The variables in the two groups were compared using the non-parametric tests. For all statistical analyses, the level of significance was P <0.05. RESULT: The Mean duration of analgesia was 6.65 +/-0.25 hours in Group R compared with 12.68 +/- 0.36 hours in Group RD, with a P value of <0.05. Quality of surgical anesthesia in Group R was excellent in 20 patients as compared to 24 patients in Group RD. 12 children in group RD and 4 children in group R did not require any additional pain medication during the study period; which was statistically significant. The peri-operative hemodynamics were stable among both the groups, although patients in RD group showed lesser degree of tachycardia as compared to pre op values, but it was statistically insignificant. CONCLUSION: A single caudal injection of dexmedetomidine (2 microgram/kilogram body weight) added to 0.2% ropivacaine (1

English

Ropivacaine, a local anesthetic agent with similar pharmacological profile to that of bupivacaine has lower potential for toxic effect. The aim of our study is to compare the anesthetic characteristics of ropivacaine and bupivacaine when used for supraclavicular brachial plexus blockade in upper limb surgeries. Fifty patients was grouped equally and one group R received 0.5% ropivacaine (100mg) 20ml and another group B received 0.5% bupivacaine (100mg) 20ml. onset & duration of sensory and motor blockade, duration of analgesia and associated complications & side effects were recorded. It was found that there were no significant differences in duration of sensory & motor blockade, in complications or any other side effects in both the groups. But ropivacaine provided rapid onset of action and better quality of surgical anesthesia than bupivacaine when used in supraclavicular brachial plexus blockade.

Hemiarthroplasty in high risk elderly patient under epidural anesthesia with 0.75% ropivacaine-fentanyl versus 0.5% bupivacaine-fentanyl: Clinical trial

Background:Anesthetic management of elderly patients is a challenge as aging makes them more susceptible to hemodynamic fluctuations during regional anesthesia. This study was aimed to compare the clinical efficacy of epidural 0.75% ropivacaine fentanyl (RF)– with 0.5% bupivacaine–fentanyl (BF) for hemiarthroplasty in high-risk elderly patients.Methods:Sixty elderly consented patients of either sex with American Society of Anesthesiologist ASA II and III, scheduled for elective hemiarthroplasty were randomized into two Groups of 30 patients to receive epidural study solution of 15 mL of 0.75% Ropivacaine or 0.5% Bupivacaine with 1 mL fentanyl (50 μg). The hemodynamic variability with onset and duration of sensory and motor blocks were recorded. The adequacy and quality of surgical anesthesia were assessed. The post-epidural nausea and vomiting, shivering, respiratory parameters, or any other side effects were also recorded.Results:There was no difference in the demographic profile between groups. The mean onset time to achieve sensory block to the T10 dermatome was rapid in the Group BF (12.4±6.9 vs. 17.5±3.7 min in Group RF). The mean time to achieve motor block was 17.5±3.4 min in Group BF versus 21.7±7.8 min in Group RF. The intraoperative hemodynamic fluctuations showed statistically significant differences between groups. The pruritis was observed in five patients but post-epidural shivering, nausea, vomiting, respiratory depression, or urinary retention were not observed in any patient.Conclusion:Epidural 0.75% Ropivacaine with fentanyl showed better clinical profile as compared to 0.5% Bupivacaine with fentanyl for hemiarthroplasty in elderly patients.

Bupivacaine sparing effect of intrathecal midazolam in sub-arachnoid block for cesarean section

Background: Hypotension during subarachnoid block for caesarean section (CS) is the most common and potentially dangerous complication. Bupivacaine has been implicated for this effect in a dose dependent manner. Hypotension can be prevented by using lower doses of bupivacaine with intrathecal midazolam as an adjuvant drug, though the optimum dose-ratio of bupivacaine with midazolam remains unaddressed. Materials and Methods: A prospective, randomized, double-blind study was conducted enrolling 120 consecutive ASA grade I obstetric patients undergoing elective CS in a tertiary care hospital. A baseline supine position noninvasive blood pressure (BP) was recorded. All patients were preloaded with 500 ml of lactated Ringers' solution. Varying doses of 0.5% hyperbaric bupivacaine were used (7.5mg in group II, 6mg in group III and 5mg in group IV), in combination with 2mg midazolam in each group. Appropriately matched controls were given 11mg bupivacaine alone (Group I). Intra-operatively, BP was measured at every 2 minutes till 30 minutes and every 10 minutes thereafter. Hypotensive episodes [Systolic BP (SBP) Results: All the four groups had 30 patients each. The incidence of hypotension was significantly lower in the groups using low-dose bupivacaine and midazolam, with a lesser fall in SBP than group I. Onset of sensory and motor blocks, and quality of surgical anesthesia were unaffected in group II while significant deterioration was noticed in groups III and IV. Conclusion: We found that 7.5 mg bupivacaine with 2 mg midazolam is the optimum dose ratio combination to be used in subarachnoid block for caesarean section.

Comparison Of Intrathecal Hyperbaric Ropivacaine And Bupivacaine For Caesarean Delivery

Background: Ropivacaine a recently introduced local anaesthetic with lesser cardiotoxicity and shorter duration of anaesthesia may be of value in obstetrics. Aim of this study was to evaluate efficacy of spinal anaesthesia with 0.5% hyperbaric ropivacaine during caesarean section and to compare with that of hyperbaric bupivacaine. Methods: In this double blind prospective randomized study, block characteristics of hyperbaric ropivacaine were compared with that of hyperbaric bupivacaine in patients receiving single shot spinal anaesthesia for caesarean delivery. Eighty parturients were randomly allocated to two groups. Group R (n=39) received 15 mg of 0.5% hyperbaric ropivacaine in 8.3% dextrose and group B (n=41) received 11 mg of 0.5% hyperbaric bupivacaine (commercially available preparation).Result: Onset of sensory block was slightly slower in group R but the speed of onset of motor block was similar in both groups. Regression of sensory and motor block was faster in group R. The incidence of hypotension and other side effects was similar in the two groups. Quality of surgical anaesthesia in group R was indistinguishable from that of group B. Conclusion: It was concluded that 15 mg of ropivacaine in 8.3% dextrose provided satisfactory anaesthesia for caesarean delivery similar to that with 11 mg of 0.5% hyperbaric bupivacaine.

The effect of adding magnesium sulphate to epidural bupivacaine and fentanyl in elective caesarean section using combined spinal–epidural anaesthesia: a prospective double blind randomised study

Background Combined spinal–epidural anaesthesia is commonly used for elective caesarean section. Intrathecal injection produces rapid onset with minimal doses of local anaesthetic and epidural administration can be used to prolong the block. Our study examined the effects of adding magnesium sulphate to epidural bupivacaine and fentanyl in patients undergoing elective caesarean section using combined spinal–epidural anaesthesia. Methods Women ASA physical status I or II at term were recruited. All received 2 mL intrathecal 0.5% hyperbaric bupivacaine, 10 mL epidural 0.25% plain bupivacaine with fentanyl 100 μg, and were randomly allocated to receive either 10 mL of epidural 0.9% sodium chloride or 10 mL epidural 5% magnesium sulphate. The quality of surgical anaesthesia, incidence of hypotension, Apgar scores, intraoperative pain assessment, onset of postoperative pain, sedation scores and side effects were recorded in the postoperative period. Results Ninety women were recruited. There was no difference in the time taken for the block to reach T4 sensory level, time to reach the highest level of sensory block, time interval between first neuraxial injection and onset of surgery between the groups. Women who received magnesium had greater motor block and muscle relaxation ( P < 0.05). Apgar scores were 7 or more in almost all neonates in both groups. There was no significant difference in the incidence of hypotension, nausea and vomiting and duration of motor blockade between the groups. Women who received magnesium showed less shivering and later onset of post operative pain ( P < 0.05). Conclusion The addition of magnesium to epidural bupivacaine and fentanyl in women undergoing elective caesarean section with combined spinal–epidural anaesthesia improved intraoperative conditions and the quality of postoperative analgesia.

Hypobaric 0.15% Bupivacaine Versus Hypobaric 0.6% Lidocaine for Posterior Spinal Anesthesia in Outpatient Anorectal Surgery

Low doses of bupivacaine and lidocaine have been used for spinal anesthesia in outpatient surgery. The objective of this study was to compare hypobaric solutions of bupivacaine and lidocaine in outpatient anorectal surgery. One hundred and fifty patients, divided in two groups, physical status ASA I-II, scheduled for anorectal surgery in the jackknife position received 3 mL (4.5 mg) of hypobaric 0.15% bupivacaine or 3 mL (18 mg) of hypobaric 0.6% lidocaine. The selectivity of the blockade, quality of surgical anesthesia, intensity of the motor blockade, and time for patient recovery were compared. After patients were discharged, daily phone contact was maintained for three days and on the 30th postoperative day. Adequate surgical blockade was achieved in all patients. The mean level of cephalad dispersion was L(1), ranging from T(10)-L(3), with bupivacaine, and L(1), ranging from T(11)-L(2), with lidocaine. Motor blockade was not observed in 135 patients (65 in the bupivacaine group x 70 in the lidocaine group). None of the patients developed hypotension and bradycardia. The sensorial blockade had a mean duration of 99.1 (11.0) minutes, with bupivacaine, and 64.1 (7.6) minutes, with lidocaine (p < 0.0005). Post-lumbar puncture headache was not observed in any patient. Hypobaric solution of bupivacaine or lidocaine promotes, predominantly, sensorial blockade after subarachnoid injection in patients in the jackknife position. Hypobaric lidocaine provides analgesia with the same dispersion of that of bupivacaine, but with shorter duration. Hemodynamic stability and the absence of motor blockade represent the major advantages.

The Analgesic Effect of Paracetamol When Added to Lidocaine for Intravenous Regional Anesthesia

In this study, we evaluated the effect of paracetamol on sensory and motor block onset time, tourniquet pain, and postoperative analgesia, when added to lidocaine in IV regional anesthesia (IVRA). Sixty patients undergoing hand surgery were randomly and blindly divided into three groups. All groups received IVRA lidocaine (3 mg/kg) diluted with saline to a total volume of 40 mL. Group 1 received IVRA lidocaine plus IV saline, Group 2 received IVRA lidocaine and paracetamol (300 mg) admixture plus IV saline, and Group 3 received IVRA lidocaine plus IV paracetamol (300 mg). Sensory and motor block onset time, tourniquet pain, and analgesic use were assessed during operation. After tourniquet deflation, visual analog scale (VAS) scores at 1, 2, 4, 6, 12, and 24 h, the time to first analgesic requirement, total analgesic consumption in first 24 h, and side effects were noted. Onset of motor block was shorter and recovery of motor and sensory block was significantly longer in Group 2 (P < 0.05). Intraoperative VAS scores at intraoperative 20, 30, and 40 min were significantly lower in Group 2 (P < 0.05). Intraoperative fentanyl consumption (78 +/- 12, 58 +/- 14, 78 +/- 11 microg, respectively) and the number of patients who required fentanyl for tourniquet pain (13 patients, 3 patients, 9 patients, respectively) were significantly less in Group 2 (P < 0.05). Time to postoperative fentanyl administration was also prolonged (15 +/- 6, 25 +/- 5, 15 +/- 4 min, respectively) in Group 2 (P < 0.05). The quality of surgical anesthesia was better in Group 2 (P < 0.05). Postoperative VAS scores and time of initial analgesic requirement were similar among groups; however, the total amount of diclophenac use was less in Group 2 (P < 0.05). The addition of paracetamol during IVRA with lidocaine decreased tourniquet pain, increased anesthesia quality, and decreased postoperative analgesic consumption.

Randomized double-blind study of the clinical duration and efficacy of nesacaine-mpf 2% and 3% in peribulbar anesthesia

Purpose To compare 2 commercially available concentrations of Nesacaine®-MPF (2-chloroprocaine) to determine the time to onset of adequate motor blockade, the quality of surgical anesthesia, and the duration of motor blockade in the extraocular muscles after peribulbar anesthesia for cataract surgery. Setting Tampa Eye and Specialty Surgery Center, Tampa, Florida, USA. Methods This double-blind, randomized, single-center study comprised 40 patients scheduled to receive peribulbar anesthesia before cataract surgery. Patients were given 5 mL of Nesacaine-MPF 2% or 3% before surgery. Beginning at the end of the injection, assessments of ocular and eyelid movement were made every 2 minutes until adequate motor blockade was achieved or 25 minutes elapsed. Ocular assessments were made immediately after completion of surgery, 60 minutes after the end of the initial injection, and at 15 minute intervals thereafter until full recovery. Assessments of the quality of anesthesia achieved by the patient during surgery were made by the surgeon. Results The 3% solution provided significantly faster onset of surgical anesthesia than the 2% solution (mean 3.9 minutes ± 2.2 [SD] versus 6.0 ± 3.6 minutes) ( P = .02) but also required more time for recovery from anesthesia (98.9 ± 18.7 minutes versus 84.8 ± 20.6 minutes) ( P = .02). All patients had adequate surgical anesthesia. Duration of ocular motor function was brief enough so that all patients could be sent home without an eye patch. Both concentrations were safe for use in this procedure. Conclusion Both Nesacaine-MPF 2% and 3% produced safe and effective peribulbar anesthesia in all patients; however, the 3% solution provided better duration of clinical anesthesia.