Ramsay Sedation Score Research Articles

Effect of Postoperative Analgesia with the Combination of Dexmedetomidine and Butorphanol after Posterior Spinal Surgery

<p><strong>Background and Objective: </strong>Opioid medications used to be the key method for the pain management after spine surgery; most of the opioids may cause many adverse reactions. The purpose of this research was to observe the role of dexmedetomidine combined with butorphanol in the pain management of patients after posterior spinal surgery.<br /><strong>Methods: </strong>This research was conducted in the First Hospital Affiliated to Jinzhou Medical University, China from May 2018 to January 2019. Sixty patients who underwent posterior spinal surgery were equally divided into two groups randomly: Group B who received butorphanol 0.125 mg/kg and Group DB who received dexmedetomidine (DEX) 0.1 μg/kg/hour plus butorphanol 0.125 mg/kg. The patient-controlled analgesia was conducted to deliver a bolus dose of 0.5 ml. followed by an infusion of 2 ml/hour and a lockout time of 15 minutes. Heart rate, mean arterial pressure, respiration rate, pulse oxygen saturation, visual analog scale score (VAS), and Ramsay sedation score were recorded as follows: 1 hour (T1), 2 hours (T2), 6 hours (T3), 12 hours (T4), and 24 hours (T5) post‑surgery. The total number of buttons pressing of patient controlled intravenous analgesia (PCIA) and supplementary analgesic agents was observed and adverse drug reactions and total rate of patient satisfaction were evaluated statistically.<br /><strong>Results:</strong> VAS scores at different intervals in DB group were significantly lower compared with the B group after surgery; while the score of Ramsay sedation was remarkably higher in DB group. The total number of buttons pressing of PCIA was less than that of the B group and the frequency of nausea was notably lower in DB group (p < 0.05). The total rate of satisfaction with analgesia in DB group was higher after surgery.<br /><strong>Conclusion: </strong>DEX could enhance the analgesic effect of butorphanol after posterior spinal surgery with lesser adverse reactions</p>

Comparative Evaluation of Effect of Dexmedetomidine Versus Normal Saline on Blood Glucose Levels in Diabetes Mellitus Patients Undergoing Spinal Anaesthesia Surgeries

ontext: Surgical trauma gives rise to a stress response in the human body resulting in hyperglycaemia in the perioperative period. This adversely affects the patient’s outcome. Hyperglycaemia is particularly detrimental in patients with diabetes mellitus. Dexmedetomidine, an alpha 2 adrenoreceptor agonist attenuates this surgical stress response and helps in preventing perioperative hyperglycaemia. Aims: The aim of our study was to monitor and compare the effect of dexmedetomidine versus normal saline on blood glucose levels intraoperatively and postoperatively in patients with diabetes mellitus undergoing spinal anaesthesia surgeries. Other objectives were, to compare haemodynamic changes, ramsay sedation scores intraoperatively andthe requirement of analgesia in the postoperative period between both the groups. Methods: A double blind prospective randomized controlled study was conducted in a tertiary hospital. Out of 60 patients with diabetes mellitus, 30 random patients were administered with intravenous dexmedetomidine after giving spinal anaesthesia. The other half of patients received a placebo. Vital parameters and blood glucose levels were monitored and compared in both the groups. Statistical analysis used: Data was tabulated and compared using unpaired T-test. Results: Statistically significant differences were found in mean heart rate and blood pressure between both the groups. The differences in the blood sugar values in the intra operative period and the postoperative period between both the study groups were also statistically significant. Requirement of additional postoperative analgesics were also considerably less in the dexmedetomidine group. Conclusion: Intravenous dexmedetomidine attenuates the surgical stress response by inhibiting the adrenal surge and prevents hyperglycaemia.

Eustachian tube dysfunction in an intensive care unit: A prospective observational study

BackgroundEustachain tube (ET) dysfunction can aggravate the morbidity in ICU patients, but is often ignored. In this prospective observational study we followed a cohort of patients (without pre-existing ET dysfunction) requiring in-patient management, hospitalized either to ICU or to non ICU wards, for any development of ET dysfunction during hospitalization. MethodsPatients requiring hospitalization to ICU or non ICU wards from Dec 2018 to Jun 2019 were included. Those with pre-existing ET dysfunction, disease of ear/nose or sinuses, head neck tumours and history of radiotherapy or glucocorticoid therapy were excluded. All patients were evaluated by serial tympanometry. Type A curve was considered normal while type B, C1 and C2 were considered as ET dysfunction. ResultsThere were 385 patients, 258 (67.01%) males and 127 (32.99%) females in the ICU group; while non ICU group comprised 129 patients, 86 (66.67%) males and 43 (33.33%) females. ET dysfunction developed in 107 (27.79%) patients in ICU group, but only in 3 (2.3%) in non ICU group (Relative risk 11.95, 95% CI 3.86 to 36.99, P < 0.0001). Within ICU, ET dysfunction showed significant positive association with endotracheal intubation, Ramsay sedation score and number of days on tracheostomy; but not with age, male gender, number of days in ICU, mechanical ventilation or route of feeding. ConclusionOur study demonstrates high incidence of ET dysfunction in patients admitted to ICU.

Comparison of inhalational methoxyflurane (Penthrox®) and intramuscular tramadol for prehospital analgesia.

Treatment of pain is an important component of prehospital care. Inhalational analgesia agents have attractive strengths, but there is a paucity of studies comparing these with more conventional agents. We aimed to compare inhalational methoxyflurane and intramuscular (IM) tramadol as first-contact analgesia in the Singapore national ambulance service. Ambulances were randomised to carry either methoxyflurane or IM tramadol for the first six months and crossed over to the other arm after six months. Patients aged ≥ 16 years, with acute pain arising from musculoskeletal trauma with Numerical Rating Scale (NRS) score ≥ 3 were enrolled. Variables included NRS reduction, time variables, adverse effects, Ramsay Sedation Scores, and patient and paramedic satisfaction scores on a Likert scale. A total of 369 patients were enrolled into this study, but 26 patients were excluded due to missing data. The methoxyflurane arm had a shorter median time taken from arrival at the scene to drug administration (9.0 [interquartile range 6.0-14.0] minutes vs. 11.0 [interquartile range 8.0-15.0] minutes). For patients who achieved reduction in NRS ≥ 3 within 20 minutes, those in the methoxyflurane arm took a shorter time. However, the methoxyflurane (46.7%) arm experienced lower proportion of patients not achieving NRS reduction ≥ 3 when compared to the tramadol (71.6%) arm after over 20 minutes. The methoxyflurane arm had significantly higher paramedic and patient satisfaction scores. For the doses of medication used in this implementation study, methoxyflurane was superior in efficacy, speed of onset and administration, but had more minor adverse effects when compared to IM tramadol.

Comparison of Midazolam and Dexmedetomidine for sedation in Postoperative intubated patients of head and neck surgery on spontaneous ventilation in Intensive care unit

Introduction: Sedation is important in the care of the critically ill and postoperative patients. Amount of drug and duration for which it is given, is important in determining patient outcome. Aim: Study aimed to compare the safety and efficacy of injection midazolam and injection dexmedetomidine for sedation in postoperative patients of oromaxillofacial surgery with endotracheal tube in-situ, on spontaneous ventilation in ICU. Methodology: This prospective, randomized, comparative study was conducted on 60 patients undergoing oromaxillofacial surgery who were randomized in two groups of 30 patients each. Group D received injection demedetomidine loading dose of 1μg/kg over 15 minutes, followed by infusion at the rate of 0.2-0.7µg/kg/hr (microgram/kilogram/hour) and Group M received injection midazolam loading dose of 0.05mg/kg over 15 minutes followed by maintenance infusion at the rate of 0.02-0.06mg/kg/hr (milligram/kilogram/hour). The monitored indices included heart rate, systolic blood pressure, diastolic blood pressure, respiratory rate, SpO2 and Ramsay sedation score at the start of sedation when the Ramsay sedation score (RSS) was I and time to extubation after stopping sedation. Results: Target sedation range was achieved in a mean duration of 10.36 ± 3.05 minutes in dexmedetomidine group and that in midazolam group was 7.43±2.06 minutes. Highest value of RSS score in dexmedetomidine group was 2.43±0.50, which was observed at the 4th and 10th hour whereas in midazolam group it was 2.83±0.38 which was observed at 6th hour of the study period. Total dose of rescue analgesic required was more in midazolam group as compared to the dexmedetomidine group. The mean duration of extubation after cessation of sedation was 33.27±11.37 minutes in dexmedetomidine group and 49.43±5.58 minutes in midazolam group. Conclusion: Injection dexmedetomidine is better as compared to injection midazolam for postoperative sedation.

Midazolam for conscious sedation in transcatheter device closure of atrial septal defects guided solely by transthoracic echocardiography.

To investigate the safety and feasibility of midazolam for conscious sedation in transcatheter device closure of atrial septal defects guided solely by transthoracic echocardiography. A retrospective analysis was performed on 55 patients who underwent transcatheter device closure of atrial septal defects from October, 2019 to May, 2020. All patients received intravenous midazolam and local anesthesia with lidocaine to maintain sedation. A group of previous patients with unpublished data who underwent the same procedure with general anesthesia was set as the control group. The relevant clinical parameters, the Ramsay sedation scores, the numerical rating scale, and the post-operative satisfaction questionnaire were recorded and analyzed. In the midazolam group, the success rate of atrial septal defect closure was 98.2%. Hemodynamic stability was observed during the procedure. None of the patients needed additional endotracheal intubation for general anesthesia. Compared with the control group, the midazolam group had no statistically significant differences in the Ramsay sedation score and numerical rating scale scores. Patients in the midazolam group experienced more post-operative satisfaction than those in the control group. Conscious sedation using midazolam is a safe and effective anesthetic technique for transcatheter device closure of atrial septal defects guided solely by transthoracic echocardiography.

Effect of pre-extubation low-dose fentanyl on attenuation of haemodynamic response and quality of extubation: A prospective randomised trial

BackgroundEmergence from anaesthesia, tracheal stimulation during extubation alters the hemodynamics, and coughing generates aerosol that needs to be avoided. AimThe study aimed to evaluate the effectiveness of low doses (0.5 μg/kg) of fentanyl at the end of the surgery in attenuating hemodynamic response and extubation quality. MethodsThis prospective, randomized, double-blind trial was conducted in a tertiary care center, with a total of 70 ASA PS I&II patients scheduled for elective laparoscopic cholecystectomy. Standard protocol followed for induction of the patients. At the end of the surgery, patients were randomly allocated to either Group-F and Group-C to receive intravenous fentanyl 0.5 μg/kg or an equal volume of normal saline respectively. Hemodynamic parameters before and after the drug, at awakening, while extubation (T0), one and minutes post-extubation (T1&T5 respectively) were measured. Airway reflex scores (ARS), extubation quality score (EQS), and Ramsay sedation scores (RSS) monitored during extubation. ResultsGroup-C patients had significantly higher mean arterial pressure at T1 (P = 0.021), higher incidence of agitation at T0(P = 0.002), T1(P = 0.002), and T5 (P = 0.009). Group-F patients had significantly better ARS at T0 and T1 (P < 0.001) and better EQS (P < 0.001). ConclusionLow-dose fentanyl at the time of extubation is an effective way to achieve smooth extubation, control unstable hemodynamics and agitation.

Dexmedetomidine combined with sufentanil and dezocine-based patient-controlled intravenous analgesia increases female patients\u2019 global satisfaction degree after thoracoscopic surgery

BackgroundThere are no studies on the use of dexmedetomidine combined with sufentanil and dezocine-based patient-controlled intravenous analgesia (PCIA) in females undergoing thoracic surgery. We postulate that introducing dexmedetomidine to a combination of dezocine-based PCA drugs and sufentanil will increase female patients’ global satisfaction degree.MethodsOne hundred fifty-two female patients with physical classification type I or II according to the American Society of Anesthesiologists undergoing thoracoscopic surgery were arbitrarily classified into two categories, either receiving sufentanil and dezocine-based PCIA (group C) or incorporating dexmedetomidine with sufentanil and dezocine-based PCIA (group D). The patients’ global satisfaction degree, postoperative nausea and vomiting (PONV), PCA bolus, rescue analgesia requirements, drug-related adverse effects, rest and coughing visual analogue scale (VAS) ratings, and Ramsay sedation scores (RSS) were measured at 6, 12, 24, 36 and 48 h after surgery.ResultsCompared with the C group, the patient satisfaction degree was significantly higher; pain scores at rest and coughing were significantly different at 6, 12, 24, 36 and 48 h postoperatively; less rescue analgesia and PCA bolus were required; and a lower incidence of PONV was found in the D group. There were non-significant trends for the sedation scores and drug-related adverse effects in both groups.ConclusionsDexmedetomidine combined with sufentanil and dezocine increased female patients’ global satisfaction degree after thoracoscopic surgery. This effect could be linked to the improvement in postoperative analgesia and reduction in postoperative nausea and vomiting; the combined treatment did not increase drug-related adverse effects in female patients.Trial registrationChinese Clinical Trial Registry number, ChiCTR2000030429. Registered on March 1, 2020.

Comparative Study between Dexmedetomidine and Midazolam in Inducing Conscious Sedation in Patients Undergoing Cataract Surgery

Background: Cataract surgery are usually done in elderly patients. Dexmedetomidine is a potent non-opiod sedative and analgesic devoid of respiratory depression. Midazolam is the most commonly used sedative which is commonly associated with respiratory depression specially in elderly patients. Objectives: To compare the effects of intravenous dexmedetomidine and midazolam on the haemodynamic stability, sedation and intraocular pressure and to study the safety profile of the drug Methodology: After obtaining permission from institutional ethical committee and patient informed consent, study was conducted at BMCRI from November 2016 to May 2018 in ASA Grade 1 and 2 patients of 40 to 70 year age undergoing cataract surgery. Patients were randomly allocated to two Group D and M of 32 each. Group D received inj. dexmedetomidine 0.25mcg/kg, Group M received inj. midazolam 0.02mg/kg diluted to 10ml over 10 minutes as intravenous injection. Peribulbar block was given with 8-10ml of injection 2% lignocaine with adrenaline with hyaluronidase. Haemodynamic parameters like Heart Rate, Mean Arterial Pressure and SpO2, Intra Ocular Pressure in non-operating eye, Ramsay Sedation Score, Visual Analogue Score and Modified Aldrete Score were recorded. Results: We concluded that in our study demographic data were comparable. Patients of Dexmedetomidine group had reduction of IOP after drug injection (p=0.001) and at post bulbar block (p=0.002) which is statistically significant compared to Group M patients and also there was statistically significant difference in RSS Score between two groups. Conclusions: Dexmedetomidine provides same conscious sedation as Midazolam. Dexmedetomidine reduces intraocular pressure and maintains SpO2 when compared to Midazolam in cataract surgery.

Analgesia for the Change of Dressing in Burn Victims: A Comparison Between Oral Ketamine and Oral Dexmedetomidine

Objective: To compare the efficacy of oral ketamine with oral dexmedetomidine for providing adequate analgesia for change of dressing in burn patients in burn dressing room. Methods: This randomized controlled trial was carried out in Jinnah Burn and Reconstructive Surgery Center, Lahore, from April 2019 to September 2019 after getting the approval from the Ethical Committee of Jinnah Hospital / Allama Iqbal Medical College, Lahore. 80 patients between 20 to 50 years, with 1st and 2nd degree burns and 20 to 40% of total body surface area involved were allocated in two groups A and B. The patients in group A received oral ketamine at a dose of 5mg/kg in 15 ml of water 30 mins while those in group B received dexmedetomidine, 4 ug/kg orally, in 15 ml of water 30 mins before the start of dressing change. The change of dressing was carried out with continuous vital monitoring. Pain was assessed via visual analogue scale (VAS) and sedation via Ramsay sedation score. All the observations were recorded on the predesigned proforma. SPSS version 21 was used for data analysis. Result: The baseline mean VAS score of patients in group A was 7.67 + 0.55 and in group B was 7.70 + 0.57 (p value = 0.799). Significant decrease in pain score in both groups was noted after 30 mins of drugs administration (p=0.000). Also a significant difference in pain scores was seen between the two groups (p&lt; 0.05), with the patients in group A having lower pain scores as compared to patients in group B. Conclusion: both ketamine and dexmedetomidine provide adequate analgesia for the change of burn dressing when administered orally with ketamine providing better analgesic state as compared to dexmedetomidine. Key Words: Burn, ketamine, dexmedetomidine, analgesia. How to cite: Sohail F., Bangash R.L., Azim W., Arshad F, Anwar A., Niazi K.A. Analgesia for the Change of Dressing in Burn Victims: A Comparison between Oral Ketamine and Oral Dexmedetomidine. Esulapio 2021;17(01):39-44

A Randomized Double-Blind Controlled Trial to Assess the Efficacy of Ultrasound-Guided Erector Spinae Plane Block in Cardiac Surgery

Cardiac surgical pain is of moderate-to-severe intensity. Ineffective pain control may lead to increased cardiopulmonary complications and poor surgical outcomes. This study aimed to assess the efficacy of ultrasound-guided erector spinae plane block in providing analgesia in adult cardiac surgeries. Prospective, randomized, double-blinded clinical trial. Single-center, tertiary care hospital with university affiliation. Thirty patients of either sex, aged 18-to-60 years, body mass index 19-to-30 kg/m2, undergoing elective on-pump single-vessel coronary artery bypass grafting or valve replacement under general anesthesia. Patients were randomly categorized into two groups of 15 patients each to receive bilateral erector spinae plane block with 20 mL per side of 0.25% levobupivacaine (group E) or sham block with 20 mL of normal saline (group C). Mean analgesic requirement in terms of fentanyl equivalents (µg) in the first 24 hours postoperatively was 225 ± 112 in group E and 635 ± 145 in group C (95% confidence interval, 313.10-506.90; p < 0.05). Mean time to first rescue analgesia was 356.9 ± 34.5 in group E and 123.9 ± 13.1 minutes in group C (p < 0.05). Cox proportional hazard ratio for rescue analgesic requirement in group E-to-group C was 5.0. Duration of mechanical ventilation was 88.4 ± 17 and 103.5 ± 18 minutes in groups E and C, respectively (p < 0.05). Ramsay sedation score at six hours postextubation was 1.45 ± 0.53 in group E and 3.19 ± 0.62 in group C (p < 0.05). Mean numerical rating score was 3.67 ± 1.41 in group E and 4.50 ± 1.00 in group C (p = 0.17). No significant differences were observed in the incidences of postoperative nausea vomiting, pruritus, and erector spinae plane block-related infection and pneumothorax. Single-shot erector spinae plane block provides superior analgesia as compared with sham block. It decreased the first 24-hour postoperative analgesic consumption by 64.5% and risk of pain by five times in the authors' population. It also reduced the sedation and duration of mechanical ventilation in postcardiac surgery patients.

TO COMPARE THE INTUBATING CONDITIONS WITH DEXMEDETOMIDINE VERSUS MIDAZOLAM-FENTANYL COMBINATION FOR AWAKE FIBREOPTIC INTUBATION

Objectives:To compare the intubating conditions of dexmedetomidine alone versus fentanyl -midazolam combination during AFOI Methodology: Group-I patients (n=30) received dexmedetomidine 1µg/kg bolus infusion over 10 minutes, followed by infusion of 0.1 µg/kg/hr titrated to 0.7 µg/kg/hr whereas Group-II patients (n=30) received i.v fentanyl 2µg/kg bolus followed by midazolam infusion of 0.02-0.1mg/kg/hr until they were adequately sedated i.e. Ramsay Sedation Score (RSS) of 3 .Intraoperatively Total Comfort Score, 5 point FOI score was noted and Questionnaire assessment was done 24 hours after surgery. Results: During preoxygenation, the mean TCS was not statistically signicant different between the two groups but during FOS and during intubation, the mean TCS was lower in group-1than group-2and the difference between the two groups was statistically signicant.(p&lt;0.05). Signicant differences in the patient's reaction to tube were found during FOS and after intubation between the two groups with lower reaction in dexmedetomidine group(p≤0.05). During follow-up assessment 24 hours after the surgical procedure, the dexmedetomidine group patients judged their sedation more positively and were having less pain and discomfort during the procedure than fentanyl plus midazolam patients. Conclusion: The use of dexmedetomidine at 1mcg/kg bolus over 10 minutes, with maintenance rates of 0.1-0.7 μg/kg/hr offer better tolerance, preservation of a patent airway and spontaneous ventilation, while maintaining hemodynamic stability during AFOI.

Comparative Study Among Ketamine, Fentanyl, and Ropivacaine, as Pre-incisional Analgesic Given by Surgical Site Infiltration, in Cases Posted for Elective Lower Segment Cesarean Section Under General Anesthesia.

AimThe aim of this study was to evaluate the effect of surgical site infiltration prior to giving incision, with ketamine, fentanyl, and ropivacaine, on perioperative hemodynamic parameters, pain, and any adverse outcomes.MethodsThe study was carried out on 68 patients divided into four groups of 17 each. After intubation, the study drug was infiltrated subcutaneously at the surgical site, seven min before incision, by the surgeon who was unaware of the injectate. Hemodynamic variables were monitored and recorded during the intraoperative period and postoperative period at one, two, four, six, eight, 12, and 24 hours. The level of sedation was assessed using the Ramsay sedation score (RSS). The fetal outcome was assessed by the APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) score at one, five, and 10 minutes.ResultsThe mean visual analog scale (VAS) scores were significantly (p < 0.05) lower in group A as compared to other groups for most of the postoperative period. Hemodynamic stability was also significantly better with group A as compared to other groups during the perioperative period. The fetal outcome was comparable between the study groups with the APGAR scores similar between the groups at 10 min. However, significantly lower APGAR values were seen in group C as compared to the other study groups, at one and five minutes.ConclusionKetamine infiltration resulted in a better hemodynamic profile, a significantly longer duration of the postoperative pain-free interval, and more sedation in the postoperative anesthesia care unit (PACU). It did not affect the fetal wellbeing, as discernable from the APGAR scores.

Comparison of Gabapentin and Pregabalin Premedication for Attenuation of Hemodynamic Changes in Elective Laparoscopic Appendicectomy

Introduction: General anaesthesia is the gold standard anaesthetic technique for laproscopic appendicitis. However, this procedure is not risk free. Carbon dioxide is used to create pneumoperitoneum in laproscopic surgeries causes various hemodynamic changes such as abrupt elevation of arterial pressure, systemic vascular resistance and decreased cardiac output. These changes are well tolerated in healthy patients. There is also an increase in circulatory catecholamines during laryngoscopy and intubation. Many pharmacological techniques were evaluated either in the premedication or during the induction to attenuate the hemodynamic response to pneumoperitoneum such as – deepening the anaesthesia, pretreatment with vasodilators, adrenoceptor blockers, calcium channel blockers and opiods. This study is designed to evaluate the hemodynamic changes associated by laryngoscopy, tracheal intubation and pneumoperitoneum in laparoscopic appendicectomy by premedicating the patients with Gabapentin (900mg) and Pregabalin (150mg). Materials and Methods: The study was carried out as a hospital based double blinded randomized prospective comparative study after obtaining institutional ethics committee approval in the Department of Anaesthesiology, SMVMCH Puducherry. The sample size was calculated as 72 with 36 in each group. Patients scheduled for elective laparoscopic appendicectomy were selected for the study based on predetermined inclusion and exclusion criteria. The study drug, Gabapentin 900mg or Pregabalin 150mg, was sealed in a black covered envelope and was given to the patient with sips of water 1 hour before the induction of anaesthesia by an anaesthetist not involved in study. Anaesthetic and surgical techniques were standardized for all patients. HR, SBP, DBP, MAP, SpO2 were recorded at the following points of time:(i) Prior to induction, (ii) 2-3 minutes after intubation, (iii) Before creating pneumoperitoneum, (iv) After creating pneumoperitoneum, (v) 2 minutes after extubation, (vi) Intra op,every 5 mins till the end of surgery, (vii) Post op, every 10 mins for the 1st 30 minutes and then every 30 minutes till 3 hours, along with Ramsay sedation score.

Comparison of Intubating Conditions using “Spray-as-You-Go” Technique versus Transtracheal Instillation of Lignocaine for Airway Topical Anesthesia during Awake Nasal Fiberoptic Intubation

Introduction: Awake fiberoptic intubation (AFOI) is the gold standard for the management of recognized difficult airway. Good airway anesthesia along with sedation is necessary to ensure patient comfort. Aim: The aim of the study was to evaluate topical lignocaine administered by “spray-as-you-go” versus transtracheal injection technique on intubating conditions during AFOI. Patients and Methods: After obtaining written informed consent, 36 patients were randomly allocated to one of two groups: Group T – transtracheal technique and Group S – Spray-as-you-go technique. All patients were sedated with intravenous dexmedetomidine infusion titrated to a Ramsay Sedation Score of 2–3 during AFOI. All patients received oral gargle and nasal packing with lignocaine 2%. Patients in Group T received 2 mL lignocaine 2% intratracheally just prior to beginning fiberscopy. Patients in Group S received 2 mL lignocaine 2% spray over the vocal cords and another 2 mL below the vocal cords during fiberscopy. Tracheal intubation was then performed. Primary outcome measure was a composite score of patient comfort. Secondary measures were intubation and fiberscopy time, adverse effects, and postoperative patient evaluation. Results: The demographic data were comparable. A composite score of <10 was considered optimal, 10–15 as acceptable, and >15 unacceptable. Significantly more patients in Group T had optimal composite score compared to Group S. There were no differences between the two groups as regards postintubation score, ease of intubation, and postoperative survey. Conclusion: During awake nasal fiberoptic intubation, in comparison with spray-as-you-go technique, the transtracheal instillation of lignocaine improves patient tolerance and comfort during tracheal intubation and provides better patient satisfaction.

A comparative study of buprenorphine in two different doses as an adjuvant to levobupivacaine in US-guided lumbar plexus block for postoperative analgesia

BackgroundLumbar plexus block (LPB) is a proven modality to provide analgesia following lower limb surgeries. The present study compared the effect of buprenorphine in different doses viz. 150 μg and 300 μg as an adjuvant to levobupivacaine in unilateral lumbar plexus block. In this prospective, controlled, and double-blind study, ninety patients undergoing hip, thigh, and knee surgeries under subarachnoid block were enrolled. The patients were randomly allocated into three groups of thirty each, to receive LPB with 0.25% levobupivacaine plain (group L), 0.25% levobupivacaine with 150 μg buprenorphine (group BL), or 0.25% levobupivacaine with 300 μg buprenorphine (group BH), after the sensory level of subarachnoid receded to T10. Total volume administered was 30 ml. The duration of analgesia post LPB, total pain-free period, cumulative rescue analgesic doses per patient, number of patients requiring rescue analgesic, pain scores using visual analog scale (VAS), and sedation levels were noted at protocolized predetermined intervals in each case.ResultsThe duration of analgesia post LPB was significantly prolonged in both the buprenorphine groups (9.76 ± 1.39 h in group with 150 μg buprenorphine and 10.13 ± 1.5 h in group with 300 μg buprenorphine) as compared to 4.25 ± 0.93 h in the control group (p < 0.001). The total pain free-period of 12.81 ± 1.49 h was maximum in group BH as compared to 12.42 ± 1.47 h in group BL and 7.01 ± 0.89 h in group L and was statistically significant with the control group (p = 0.001). The cumulative rescue analgesic doses per patient was also significantly higher in control group L (3.10 ± 0.40) as compared to groups BL (1.77 ± 0.5) and BH (1.33 ± 0.48). There was significant decrease in pain scores in patients of both buprenorphine groups compared to the control group up to 24 h (p < 0.001). In group BH, patients were sedated in the first hour with a modified Ramsay Sedation Score of 1.93 ± 0.86 which was statistically significant from the group L (modified RSS of 1.00 ± 0.00, p = 0.003) as well as from group BL (modified RSS of 1.47 ± 0.50, p = 0.043).ConclusionsBuprenorphine in either of the doses (150 μg or 300 μg) as an adjuvant to levobupivacaine in lumbar plexus block provided comparable postoperative analgesia. A dose of 300 μg, however, resulted in significant sedation and respiratory depression. Hence, buprenorphine 150 μg appears to be an optimal dose providing prolonged postoperative analgesia and minimal sedation.

Determination of the ED95 of a single bolus dose of dexmedetomidine for adequate sedation in obese or nonobese children and adolescents

BackgroundWith the increasing prevalence of children who are overweight and with obesity, anaesthesiologists must determine the optimal dosing of medications given the altered pharmacokinetics and pharmacodynamics in this population. We therefore determined the single dose of dexmedetomidine that provided sufficient sedation in 95% (ED95) of children with and without obesity as measured by a minimum Ramsay sedation score (RSS) of 4. MethodsForty children with obesity (BMI >95th percentile for age and gender) and 40 children with normal weight (BMI 25th–84th percentile), aged 3–17 yr, ASA physical status 1–2, undergoing elective surgery, were recruited. The biased coin design was used to determine the target dose. Positive responses were defined as achievement of adequate sedation (RSS ≥4). The initial dose for both groups was dexmedetomidine 0.3 μg kg−1 i.v. infusion for 10 min. An increment or decrement of 0.1 μg kg−1 was used depending on the responses. Isotonic regression and bootstrapping methods were used to determine the ED95 and 95% confidence intervals (CIs), respectively. ResultsThe ED95 of dexmedetomidine for adequate sedation in children with obesity was 0.75 μg kg−1 with 95% CI of 0.638–0.780 μg kg−1, overlapping the CI of the ED95 estimate of 0.74 μg kg−1 (95% CI: 0.598–0.779 μg kg−1) for their normal-weight peers. ConclusionsThe ED95 values of dexmedetomidine administered over 10 min were 0.75 and 0.74 μg kg−1 in paediatric subjects with and without obesity, respectively, based on total body weight. Clinical trial registrationChiCTR1800014266.

Butorphanol in combination with dexmedetomidine provides efficient pain management in adult burn patients

ObjectiveThis study aimed to compare the sedation and analgesic effects of butorphanol alone and butorphanol in combination with dexmedetomidine on dressing changes in adult burn patients. MethodFrom June 2016 to May 2019, 44 adult burn patients from our department were enrolled in this prospective, double-blinded study. Their total burn surface area (TBSA) varied from 10% to 30%; and the depth of burn injury ranged from second degree to third degree. The patients were randomized into two groups. In the control group, butorphanol combined with saline was injected into the body via venous route during dressing change. In the observation group, butorphanol in combination with dexmedetomidine was injected. The variation in mean blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation were recorded at various time-points of the procedure. Visual Analogue Scale (VAS) of pain and Ramsay Sedation Scores (RSS) were also recorded at different time points. Consumption of butorphanol and adverse events in these two groups were compared. ResultsThe mean blood pressure and heart rate were significantly decreased in the observation group before butorphanol injection (P < 0.05) and before the dressing change (P < 0.05). The respiratory rates and peripheral oxygen saturation of these two groups showed no significant differences at all time points (P > 0.05). Patients in the observation group had lower VAS scores during dressing change (P < 0.05). The RSS Scores in the observation group were higher than those in the control group during (P < 0.05) and after the dressing change (P < 0.05). The consumption of butorphanol was more in the control group (P < 0.05), and the adverse events recorded in the control group were higher (P < 0.05). ConclusionButorphanol combined with dexmedetomidine can reduce analgesic use of butorphanol during dressing change. This combination resulted in a higher sedation score and fewer adverse effects.

A Randomised Blinded Comparison of Epidural Infusion of Ropivacaine, Ropivacaine with Fentanyl for PONV and Sedation in Elective Lower Abdominal Oncosurgeries

Introduction: Epidural analgesia is one of the preferred and convenient mode of perioperative management. Neuraxial opioids augment local anaesthetic effect, thus reducing their requirement for analgesia. The addition of fentanyl may cause side-effects like Postoperative Nausea and Vomiting (PONV), sedation which results in patient discomfort, thus effecting postoperative recovery. Aim: To estimate the incidence, compare the requirement of rescue antiemetics for PONV and Ramsay Sedation Scores within first 24 hours of postoperative period in patients undergoing elective lower abdominal oncological sugeries. Materials and Methods: The present study was a randomised study which was carried out from September 2016 to May 2018, in 70 patients of American Society of Anesthesiologists (ASA) 1 and 2, scheduled for elective lower abdominal oncological surgeries. The study population was divided into group R, comprising of patients receiving epidural infusion of 0.2% ropivacaine and group RF with patients receiving epidural infusion of 0.2% ropivacaine with 2 μg/mL fentanyl. The incidence of PONV, rescue antiemetics for PONV and the incidence of sedation using Ramsay sedation score were evaluated in each group and compared. All data was statistically analysed and compared using Student's t-test, Chi-square. The p-value &lt;0.05 was considered to be statistically significant. Results: Groups were comparable with regard to demographic data. The incidence of PONV in group R was 37.1% and in group RF was 28.6%. The requirement of rescue antiemetic for PONV were comparable in the study groups. However, this was not statistically significant. Patients in group RF had higher mean Ramsay sedation scores at 0, 1, 2, 4, 6, 12, 18 and 24 hours but the observed difference in both the groups was statistically significant p&lt;0.05 except at 0 and 2nd hours which were not statistically significant (p&gt;0.05). Conclusion: This study concludes that the patients receiving epidural infusion of ropivacaine with fentanyl should be given prophylactic antiemetic to minimise patient’s discomfort. Also, these patients when compared to patients receiving epidural infusion of ropivacaine alone require monitoring for sedation during the postoperative period.

A prospective comparative evaluation of gabapentin vs pregabaline for the acute post-operative pain management in lower limb surgeries under spinal anaesthesia

Background: Pre emptive analgesia is multimodal approach where drug is used before surgery and has potential to be more effective than a similar analgesic treatment initiated after surgery. Pregabaline and Gabapentin are GABA analogue used is used as pre-emptive analgesic. Its analgesic action is mediated through α2δ subunit of voltage gated calcium channels on dorsal horn neurons. Material and Method:96 patients satisfying selection criteria were enrolled for this study and divided in to three groups Group P, Group G and Group C each having 32 patients. All patients were explained about visual analogue score. Result: There is significant difference between three groups regarding time of first rescue analgesia and tramadol consumption. The mean time for rescue analgesia was longer in pregabaline group then gabapentin group (482.7±113.5 min vs 343.35±70.74 min). The mean amount of dose of tramadol requirement was also less in pregabaline and gabapentin group (164.32±39.41 vs178.32±48.21 vs 272.82±83.01) in comparison control. Conclusion: The VAS score was significantly higher in control then pregabaline and gabapentin group. Both pregabaline (group P) and gabapentin (group G) are comparable to each other regarding VAS score at different time interval in post operative period. Ramsay sedation score was significantly higher in pregabaline and gabapentin group up 4 hour post operatively but after that there was no significant difference between two groups. Both pregabaline (group P) and gabapentin (group G) are comparable to each other regarding Ramsay sedation score at different time interval in post operative period.