Sole Anaesthetic Agent Research Articles

Remimazolam As a Sole Sedative Agent for Gastrostomy Tubes Placed in the Interventional Radiology Suite: A Case Series.

Remimazolam is an ultrashort acting intravenous sedative-hypnotic approved for procedural sedation. We report a series of 8 cases of radiographically placed gastrostomy tubes using remimazolam as the sole anesthetic agent. Interventional radiology (IR) gastrostomy tube placement entails anesthetizing often complex patients in a nonoperating room environment. All 8 patients reported here underwent successful gastrostomy tube placement without the need for conversion to general anesthesia. Remimazolam is a feasible option to sedate patients for gastrostomy tube placement in the IR suite.

Dexmedetomidine as a total intravenous anesthetic in pediatric patients undergoing cleft lip and palate surgery: a case series

BackgroundSurgery for pediatric cleft lip and palate repair often utilizes high-dose opioids and inhaled anesthesia, thereby causing postoperative complications such as desaturation and/or severe agitation after anesthesia. These complications are detrimental to the child and medical personnel and cause tremendous psychologic stress to parents. Our aim is to decrease these complications through dexmedetomidine, an alpha-2 receptor agonist with anxiolytic, sympatholytic, and analgetic properties. Devoid of respiratory depressant effect, it allows patients to maintain effective ventilation and reduce agitation, postoperatively. Its unique anesthetic property may shed light on providing safe anesthesia and gentle emergence to this young, vulnerable population.Case presentationA total of 21 patients of Sundanese ethnicity, aged 3 months to 8 years (9 males and 12 females), underwent cleft lip or cleft palate surgery using total intravenous dexmedetomidine. Anesthesia was induced using sevoflurane, fentanyl, and propofol, and airway was secured. Intravenous dexmedetomidine 1.5 μg/kg was administered within 10 minutes, and a maintenance dose of 1.5 μg/kg/hour was continued as the sole anesthetic maintenance agent thereafter. Hemodynamics and anesthetic depth using Patient State Index (SEDLine™ monitor, Masimo Corporation, Irvine, CA, USA) were monitored carefully throughout the surgical procedure. Dexmedetomidine did not cause any hemodynamic derangements or postoperative complications in any of our patients. We found agitation in 9.5% (2/21) of patients.ConclusionDexmedetomidine can be used as a total intravenous anesthetic agent to maintain anesthesia and provide gentle emergence to infants and young children undergoing cleft lip and palate repair.

Anesthesia Practitioners' Goals for Sevoflurane Minimum Alveolar Concentration at the End of Surgery and the Incidence of Prolonged Extubations: A Prospective and Observational Study.

Prolonged times to tracheal extubation (≥15 minutes from dressing on the patient) are consequential based on their clinical and economic effect. We evaluated the variability among anesthesia practitioners in their goals for the age-adjusted end-tidal minimum alveolar concentration ofsevoflurane (MAC) at surgery end and achievement of their goals. We prospectively studied a cohort of 56 adult patients undergoing general anesthesia with sevoflurane as the sole anesthetic agent, scheduled operating room time of at least 3 hours, and non-prone positioning. At the start of surgical closure, an observer asked the anesthesia practitioner their goal for MAC when the surgical drapes are lowered (i.e., the functional end of surgery for the studied procedures). When the drapes were lowered, the MAC achieved was recorded, and the values were compared. The standard deviation of the practitioners' MAC goal was large, 0.199 (N = 56 cases, 95% confidence interval 0.17-0.24), not significantly different from the standard deviation of the MAC achieved of0.253, P= 0.071. The MAC goal and MAC achieved were correlated pairwise, Pearson r=0.65, P< 0.0001. There was no incremental effect of operating room conversation(s) related tocase progress on the association (partial correlation ‑0.01, P= 0.96). Differences among practitioners in the MAC achieved at surgery end were consequential. Specifically, for the N = 12cases with prolonged extubation, the mean MAC was 0.60 (standard deviation 0.10) versus 0.48 (0.21) among the N = 44 cases without prolonged extubation (P = 0.0070). The standard deviation ofthe MAC goal among practitioners was sufficiently large to contribute significantly tothe variability in the MAC achieved at the end of surgery. We confirmed prospectively that the age-adjusted end-tidal MAC at the end of surgery matters clinically and economically because differences of0.60 versus 0.48 were associated with more prolonged extubations. Our novel finding isthat the MAC achieved ≥0.60 werecaused in part by the anesthesia practitioners' stated MAC goals when surgical closures started.

Intrathecal pethidine as a sole anesthetic agent for lower limb surgery: a case report

Intrathecal pethidine as a sole anesthetic agent for lower limb surgery: a case report

COMPARISON EFECTIVENESS OF DEXMEDETOMIDINE VERSUS DEXMEDETOMIDINE WITH KETAMINE FOR TYMPANOPLASTY SURGERY DONE UNDER MONITOREDANAESTHESIA CARE

Background: Monitored Anaesthesia Care (MAC) has been widely used for patients undergoing middle ear surgeries. The use of dexmedetomidine in middle ear surgeries as a sole anaesthetic agent had many disadvantages owing to its insufficient sedative effect, increased recovery time and haemodynamic instability. Aims and objectives: To evaluate the effectiveness of dexmedetomidine and ketamine combination in comparison with dexmedetomidine alone for tympanoplasty surgery under MAC. Materials and Methods: In this cross sectional observational study, a total of 100 patients were included. Before the surgery, group D received 1 μg/kg dexmedetomidine followed by infusion of 0.2μg/kg/h to maintain 2 or 3 of modified observers assessment of analgesia and sedation score. The patients in group DK received 1 μg/kg dexmedetomidine followed by infusion of 0.2μg/kg/h plus ketamine 0.5mg/kg 10 minutes before the start of the procedure. Results: In the present study total of 100 patients were included, among which 66.0% were females and 34.0% were males. The mean age of 100 patients was 38.3±11.34 years. There were no differences in baseline measurements of HR, SBP and DBP between the two groups, but Group DK had significant fall in heart rate (5-10%) (P &lt; 0.001). Average patients and surgeons satisfaction with sedation and analgesia was higher in Group DK than Group D (P = 0.001). Conclusion: Dexmedetomidine and ketamine combination provides good haemodynamic stability, higher sedation score with safe and effective method of anaesthesia that provides good MAC for patients undergoing tympanoplasty surgery.

Ketamine to Prevent Endotracheal Intubation in Adults with Refractory Non-convulsive Status Epilepticus: A Case Series.

Non-convulsive status epilepticus (NCSE) is defined as status epilepticus (SE) with no obvious motor phenomenon and is diagnosed based on electroencephalogram (EEG). Refractory SE (RSE) is the persistence of seizures despite treatment with an adequately dosed first-line and second-line agents. Although guidelines for convulsive RSE include third-line agents such as intravenous anesthetic drugs (midazolam, propofol, or barbiturates), the therapeutic approach to NCSE is not well outlined. Treatment with traditional anesthetics invariably includes endotracheal intubation, which is associated with significant adverse events. Comparatively, ketamine, a non-competitive N-methyl-D-aspartate receptor antagonist is not associated with significant cardiorespiratory depression and may help in avoiding intubation. In this case series, we describe our experience with the early use of intravenous ketamine as the first anesthetic agent in patients with refractory NCSE to avoid endotracheal intubation. We present a case series of nine patients managed in the Neurointensive Care Unit at a university-affiliated tertiary care hospital. The study was approved by the hospital and university institutional review boards and the requirement for informed consent was waived for retrospective analysis of existing data, per institutional policy. All cases of SE were identified from a prospective database, and a subsequent retrospective chart review identified all patients with a diagnosis of refractory NCSE in whom ketamine was used as the first anesthetic agent. The primary endpoint was the avoidance of endotracheal intubation while on ketamine infusion. The secondary endpoint was defined as cessation of both clinical and electrographic seizures recorded on continuous EEG within 24h of ketamine administration. A total of nine patients experiencing refractory NCSE were included in this case series, with a median age of 61 (range 26-72) years and seven patients were male. The primary endpoint, avoiding intubation, was achieved in five out of nine (55%)cases. Six patients experienced resolution of refractory NCSE with ketamine administration as the sole anesthetic agent. Four patients required endotracheal intubation and three patients had a failure of seizure cessation with ketamine. Hypersalivation and pneumonia were the most common ketamine associated adverse events. In non-intubated patients, no deaths occurred. One patient was discharged home, four to subacute rehabilitation, one to along term acute care hospital, and one patient to hospice. The use of ketamine as the primary anesthetic agent may be a reasonable option to avoid endotracheal intubation in a subset of patients with refractory NCSE. This study is limited by its small sample size, retrospective design, and reliance on information obtained from chartreview.

Ketamine for Chronic Pain and Mental Health: Regulations, Legalities, and the Growth of Infusion Clinics.

In this article, we will review evidence for ketamine's role in chronic pain and mental health conditions, its current legal status and abuse potential, and the regulations related to its administration in stand-alone infusion clinics, as well as future considerations. In the management of chronic pain, ketamine has shown potential to manage neuropathic pain and complex regional pain syndrome and has been used as a treatment for chronic pain management by clinics across the USA. Analogous to the historic rise of lidocaine clinics, ketamine clinics are demonstrating a similar pattern of unregulated growth. Ketamine is an anesthetic and analgesic agent commonly used in the perioperative setting and emergency department for sedation and pain management (Mo et al in West J Emerg Med 21(2):272-281, 2020). It was approved for use by the Federal Drug Administration in the USA in the 1970s as the sole anesthetic agent for short diagnostic and surgical procedures (Coppel et al. in Anaesthesia 28(3):293-296,1973; Schwenk et al. in Reg Anesth Pain Med 43(5):456-466, 2018). Regarding its rising popularity as a treatment option in mental health, ketamine holds promise as a rapidly acting treatment for suicidal ideation and refractory depression.

Intravenous chloral hydrate anesthesia provides appropriate analgesia for surgical interventions in male Sprague-Dawley rats.

The use of chloral hydrate as a sole maintenance anesthetic agent in rodent research has been controversial due to statements made in reference literature conflicting with results of primary research studies regarding its analgesic efficacy, and because of its associated tissue damage when administered intraperitoneally. Our aim was to assess the analgesic efficacy of chloral hydrate using an intravenous (i.v.) route of administration, in order to prevent the local tissue irritation or ileus that has been previously reported using intraperitoneal (i.p.) routes. We measured tail withdrawal latencies to a nociceptive thermal stimulus (infrared beam) in Sprague-Dawley rats-first when awake (unanesthetized), and then subsequently during i.v. chloral hydrate anesthesia. During anesthesia we also measured ongoing heart and respiration rates. Withdrawal latencies during chloral hydrate anesthesia were significantly higher, and often maximal, indicating a robust analgesic effect. Importantly, both respiration and heart rate remained unchanged following exposure to the nociceptive stimulus, and were comparable to values observed under other anesthetics and during natural sleep. Together with previous studies, these results demonstrate that i.v. chloral hydrate provides excellent anesthetic depth and analgesic efficacy for surgical manipulations in rats.

Ketamine as a sole anaesthetic agent in short surgical procedures

Background: Present clinical study was conducted to evaluate the features of ketamine hydrochloride such as rapid induction, profound analgesia and minimal cardiovascular and respiratory depression with good airway maintenance. Aim: This study has been undertaken to prove the usefulness of ketamine in the present day anaesthetic practice as a sole anaesthetic agent for short surgical procedures and evaluate the features of ketamine hydrochloride such as: 1) Rapid induction; 2) Profound analgesia; 3) Minimal cardiovascular and respiratory depression with good airway maintenance. Methods: Study was conducted on 100 patients of either sex of different age group for various short surgical procedures. All patients were pre-medicated with Inj. Atropine 0.02mg/kg and Inj. Diazepam 0.2 mg/kg IV. Following this Inj. Ketamine 2mg/kg was given intravenously. During the course of anaesthesia patient was observed for the time of onset, duration of action, hemodynamic parameters, respiration, recovery from anaesthesia and certain side effects. Results: The onset of anaesthesia after intravenous injection of ketamine was within 20-54 sec [Mean 34.3+/- 8.7]. Ketamine as a sole anaesthetic agent in short surgical procedures-a clinical studyof effect of initial dose was between 9-20 min [Mean 16.9+/- 2.9].

Combined femoral-obturator-sciatic nerve block has superior postoperative pain score and earlier ambulation as compared to spinal anaesthesia for arthroscopic anterior cruciate ligament reconstruction.

Peripheral nerve blocks can be a suitable alternative to central neuraxial blockage, as the sole anaesthetic agent for better early postoperative outcomes, decreased hospital stay and earlier mobilisation after anterior cruciate ligament reconstruction (ACLR) surgery. The purpose of this study was to compare consciousness during the procedure, pain during early postoperative period (< 7days), and perioperative outcomes following ACLR using combined sciatic, femoral, and obturator nerve blocks compared to the spinal anaesthesia. This was a prospective case-control study including patients between 18 and 55years of age, with anterior cruciate ligament (ACL) injury confirmed clinically and radiologically and undergoing ACLR. Patients were allocated in the two groups alternatively, group 1 included patients who received combined nerve blocks, and group 2 included patients who received spinal anaesthesia for the surgery. The sensory effect, motor effect, adequacy of anaesthesia, perioperative analgesic use, duration of stay, postoperative pain (visual analogue scale 0-10cm) and functional outcomes were noted. There were 60 patients in each group. A total of seven patients in group 1 (11%) and two patients in group 2 (3%) needed conversion to general anaesthesia (n.s.). In group 1, out of 53 patients who underwent surgery, 26 patients had no perception of surgery in the joint, 17 patients had perception of manipulation of the knee joint, 4 patients had sense of touch, and 6 patients had sensation of pain in the knee (VAS scale less than 3). In group 2, out of 58 patients, 42 patients had no perception of surgery, 12 had a perception of manipulation of the knee joint, 2 had sense of touch, and 2 had sensation of pain in the knee. Blockage of sensory effect was significantly better in group 2 (p = 0.0001). However, the motor effect was comparable between the two groups (n.s.). Group 1 had significantly better pain scores 6, 12, and 18h after the surgery. Moreover, patients in group 1 also had faster ambulation (mean difference of 5.5h, p = 0.0001) and reduced hospital stay (mean difference of 8.4h, p = 0.0001). Combined sciatic, femoral, and adductor canal block is an effective sole anaesthetic modality for ACLR. The sensory effect was inferior when compared to spinal anaesthesia but sufficient for the procedure without the need for supplementation with any other anaesthetic modality. Patients receiving this combined nerve block had lesser early postoperative pain scores, earlier ambulation, and shorter hospital stay as compared to the spinal anaesthesia. Level 3.

PLASMA CONCENTRATION AND PHARMACODYNAMICS OF INTRAMUSCULAR ADMINISTRATION OF ALFAXALONE IN INDIAN PEAFOWL (PAVO CRISTATUS).

Alfaxalone, a neuroactive steroid with anesthetic properties, is considered safe when used alone or in combination with other drugs for anesthesia at recommended species doses, and its use has been studied in numerous species. The objective of this study was to assess the pharmacokinetics and pharmacodynamics of IM alfaxalone in Indian peafowl (Pavo cristatus; hereafter peafowl). Eight female peafowl from one zoological institution were used. A control blood sample was obtained before administration of either 10 mg/kg (n = 4) or 20 mg/kg (n = 4) alfaxalone. Blood was collected at 5, 10, 15, 30, and 60 min after alfaxalone injection, with monitoring of sedation score, heart rate, and respiratory rate at each time point. Four peahens receiving a 10 mg/ kg dose had subjectively smoother inductions and recoveries, although sedation level was generally scored as low, with no adverse reactions noted. They were considered fully recovered by the 60-min postinjection time point, although measurable alfaxalone plasma concentrations remained present. Four peahens receiving 20 mg/kg IM experienced adverse effects including seizure-like episodes and hypersensitivity to stimuli throughout the study. This dosing group experienced prolonged recoveries consistent with high plasma concentrations (>3,000 ng/ml). Based on these results, use of 20 mg/kg IM alfaxalone as the sole anesthetic agent is not recommended in this species. Further studies should determine whether alfaxalone in conjunction with other anesthetic or analgesic agents could provide better sedation and smoother induction and recovery for peafowl and to assess the pharmacokinetics and pharmacodynamics of alfaxalone in other avian species.

Electroconvulsive therapy in treatment resistant depression: What is new?

Despite major advances in the treatment of mood disorders, major depression, a common mental disorder, remains a serious public health problem. Electroconvulsive therapy (ECT) regardless of the anesthetic agent used, is the most effective form of treatment in major depression and the gold standard therapy in treatment resistant depression. Ketamine is one of the anesthetic drugs approved by the Αmerican Psychiatric Association Task Force Report for use in ECT. However, it has been used infrequently as an anesthetic in ECT. The initial reports suggested that ketamine has antidepressant properties resulting in rapid antidepressant response when administered in subanesthetic dose (0.5 mg/kg) in slow intravenous injection in patients suffering from depression. In recent trials has been reported that ketamine as the only anesthetic or as an adjunctive to another anesthetic agent may enhance the antidepressant effect of ECT either by increasing efficacy or by producing a rapid antidepressant response. ECT with ketamine may also cause less cognitive side effects. The most notable limitations of these studies are the small number of patients enrolled and several methodological differences (patients characteristics, electrode placements, titration method, anesthetic agent used with ketamine). The results of the clinical trials have been summarized in six meta-analysis and suggest that ketamine when used as a sole anesthetic agent or as an adjunctive anesthetic in ECT may accelerates the antidepressant response but does not augment ECT efficacy. It also does not improve the cognitive profile of the treatment. Larger, double-blind randomized controlled trial are needed for a definite conclusion.

Intrathecal Pethidine as a Sole Anesthetic Agent in Cesarian Section: Case Report for Clinical Education

Pethidine was the first synthetic opioid to be used to provide analgesia in humans and was shown also to have local anesthetic activity comparable with that of cocaine. The neonatal Apgar score after birth is an important factors of mortality of the newborn. In this regard, the type of drug used for the cesarean section is very important in the Apgar score of the cesarean section. Pethidine is an intermediate lipid-soluble opioid with both a postoperative analgesic mechanism and a sensory block which is known as the only opioid which can be used alone in the cesarean section under spinal anesthesia. We used pethidine as an alternative to bupivacaine in patients going under cesarean section.

Operations supported by ketamine anesthesia in resource-limited settings: Surgeons’ perceptions and recommendations – Qualitative Study

BackgroundPrior to the COVID-19 pandemic, ketamine's wide safety margin led to its use as a sole anesthetic agent in resource-limited settings when no anesthetist was available. During this time of the pandemic the use of ketamine has increased, however there are few recommendations on approaches to intraoperative challenges associated with ketamine's unique properties. The objective of this study was to gain surgeons' perceptions on performing operations supported by ketamine and to recommend best practices and techniques. MethodsA qualitative study was conducted using semi-structured interviews of surgeons experienced with performing operations supported with ketamine as the sole anesthetic agent. Interviews continued until thematic saturation. Open-response data was analyzed using thematic analysis as well as iterative group discussions about emergent themes. ResultsSixteen surgeons were interviewed regarding their operative experiences supported by ketamine across 12 countries. Surgeons universally felt that ketamine is safe, saves lives, and that they would administer it to a loved one in support of an operation if no anesthetist was available. Although lack of muscle relaxation with ketamine may require additional strategies to gain exposure, few surgical technical changes are necessary. While ketamine side effects are manageable, a single provider must always be dedicated to ketamine administration and patient monitoring. Surgeons should advocate for global policies, training and access. ConclusionKetamine is safe, can provide increased access to emergency and essential surgery, and requires few operative technical changes. Global standards on ketamine training and use should be established.

EMERGENCY LAPAROTOMIES: VALIDATING THE ROLE OF SPINAL ANESTHESIA IN HIGH RISK CASES. A RETROSPECTIVE, FACILITY BASED OBSERVATIONAL STUDY IN SRINAGAR, GARHWAL, UTTARAKHAND

Introduction: Perforation peritonitis is very rampant in hilly areas of Garhwal due to excessive consumption of alcohol, smoking and stresses of life due to difficult terrain and working conditions. Most of the patients with co-morbities like COPD have higher pulmonary related complications following surgery under G.A. It is a challenge and concern for surgeons and anesthetists to manage and provide optimal care to these patients. The study validates the role of spinal anesthesia in such cases. Materials And Method: We reviewed all cases of emergency laparotomies done between Jan 2019 and June 2020. Ninety cases were given spinal anesthesia as sole anesthetic agent out of which sixty cases were ASA IV and thirty cases were ASA III. Outcome in all cases was analyzed and recorded. Results: All cases were adequately operated and outcome was successful in all accept three cases which required G.A due to prolonged surgeries. None needed mechanical ventilatory support post operatively. Mean hospital stay was seven days and there was no report of major renal or respiratory complications. Conclusion: Spinal anesthesis is a safe option and alternate to G.A in high risk emergency laparotomies minimizing the requirement of ventilatory support in rural tertiary care hospitals were critical care facilities are compromised.

Comparative Efficacy of Intrathecal Pethidine with Lignocaine 5% (Heavy) as Sole Anaesthetic Agent for Perineal Operations

Background: The discovery of opioid receptors and ligand in the brain and spinal cord lead to the feasibility of their use intrathecally. Pethidine is the only narcotic that has been shown to be effective intrathecally for surgery. This is probably because it as a phenyl-piperidine derivative and has a structure and action similar to that of local anaesthetic.Subjects and Methods:50 patients belonging to ASA grade 1 and 2 physical status were randomly assigned to two groups A and B. Patients in group A received 1 ml of 5% lignocaine (heavy) intrathecally and those in group B gained intrathecal Pethidine (preservative-free) 0.5mg/kg body weight. The time for onset and level of sensory blockade, onset and degree of motor blockade, hemodynamic parameters, time for regression of sensory and motor blockade, duration of postoperative analgesia and side effects were noted and compared in both the groups.Results:Two groups were comparable with respect to age, sex, height and weight. The onset of sensory and motor blockade in-group A was 2.00±1.06min and 2.56±0.88 and in-group B it was 3.56±1.64 min and 7.22±1.11 min respectively, which was statistically significant. Grade I motor paralysis was seen in 2 cases (10%) in group A and 15 cases (75%) in groupB. Grade II motor paralysis was seen in 6 cases (30%) in group A and 5 cases (25%) in group B. Grade III motor paralysis was viewed in 12 cases (60%) in group A and 0 cases(0%) in group B. Grade I and III motor paralysis in the groups were statistically significant (p&lt;0.05). Time for sensory regression at L1 was 65.12±4.83 min in-group A and 94.60±6.88 min in-group B that was statistically very significant (p&lt;0.05). The time for regression of motor blockade was 60.40±3.85 in-group A and 60.20±5.02 in group B, which was statistically not significant (p&gt;0.05). The duration of postoperative analgesia was 122.84±9.37 min in-group A and 320.60±23.02 in group B, which was statistically very significant. The incidence of side effects was comparable in both groups.Conclusion:Pethidine (preservative-free) 0.5mg/kg body weight can be used intrathecally as a sole anaesthetic agent to provide prolonged postoperative analgesia associated with hemodynamic stability and early ambulation in patients undergoing perineal surgeries.

General anesthesia during atrial fibrillation ablation: Standardized protocol and experience

Most atrial fibrillation (AF) ablations are performed with general anesthesia (GA). The ideal GA protocol is unknown, but it affects ablation outcomes and laboratory utilization. We sought to report a GA protocol used at a high-volume center, with special consideration on efficiency and optimization of mapping and ablation conditions. Our protocol consists of propofol as sole anesthetic agent and analgesia with Fentanyl. IV fluids are minimized. After transseptal access, the right phrenic nerve is tagged, rocuronium is given, and redosing avoided. Ventilation is modulated to optimize mapping and ablation. After ablation, isoproterenol is infused for 20min. After 10min, propofol is gradually decreased and ventilation set to SIMV 8 breaths/min to promote spontaneous breathing, and then switched to pressure support and propofol stopped. Paralysis is reversed and furosemide given. Patient is extubated once meeting standard criteria. A total of 1286 patients underwent AF ablation from January 2017 to December 2018 using the protocol. Mean age was 66 years (41% paroxysmal AF, CHADS2Vasc 2.6). Total procedure time was 86min. Median time to extubation was 9min (first and third quartile 6-16) after procedure completed, with total anesthesia time of 116min. On average 370mL of fluids were given by anesthesia. Only one patient who had heart failure required reintubation with no other anesthesia-related complications seen. Our GA protocol was specifically designed for AF ablation. It was safe and led to efficient recovery and extubation times. It maximizes laboratory utilization time without compromising safety.

The Unbearableness of Being Light.

The Unbearableness of Being Light.

Ketamine-Dexmedetomidine Combination for Monitored Anaesthesia Care in Tympanoplasty Surgery: An Observational Study

Introduction: Monitored Anaesthesia Care (MAC) has been widely used for patients undergoing middle ear surgeries. Previous studies have shown that the use of local anaesthesia has many advantages over general anaesthesia in performing ear surgeries. The use of Dexmedetomidine as a sole anaesthetic agent had many disadvantages owing to its insufficient sedative effect, increased recovery time and haemodynamic instability. Hence, using a combination of low dose ketamine with Dexmedetomidine can prove to be useful in middle ear surgeries. Aim: To evaluate the effects of Dexmedetomidine-Ketamine (DK) combination on the quality of sedation/analgesia and recovery profiles for MAC in tympanoplasty surgery. Materials and Methods: In this observational study, a total of 20 patients were included. All the demographic data- including, age, sex and American Society of Anesthesiologists (ASA) grade were recorded before the surgery. Before the surgery, all patients received 1 μg/kg dexmedetomidine over 15 minutes followed by infusion of 0.2-0.7 μg/kg/h to maintain 2 or 3 of modified observer’s assessment of analgesia and sedation score. Both the scores were checked every 10 minutes. Ketamine was infused at the rate of 10-15 mcg/kg/min, 10 minutes before the start of the procedure. The Heart Rate (HR), systolic and diastolic pressure, pain score and sedation score were monitored every 10 minutes until 120 minutes of the preoperative condition after the nerve block was used. Statistical analysis was performed using IBM SPSS Version 25.0 (IBM, New York, United States). Continuous data values were shown in the form of mean±standard deviation. To compare the mean difference between the groups, student’s t-test was used and p&lt;0.05 was considered as statistically significant. Results: The mean age of the population was 39.45±12.66 years; among which 15 patients (75.0%) were females. Out of 20 patients, 12 (60.0%) were in the ASA-I and 8 (40.0%) were in the ASA-II grade. The result of the study showed not a single instance of complication. All the patients were haemodynamically stable and HR was also found to be constant in both pre and postoperative instances. The pain score was found to be around 2 even after 120 minutes after the surgery (2±0.93). No rescue analgesia was required in any of the patients and all the patients recovered within 3-5 minutes after the infusion was stopped. No postoperative nausea and vomiting instances were also reported. Conclusion: The present study showed that DK combination provides good haemodynamic stability, higher sedation score and lower pain score. In addition, this study also showed that for patients undergoing tympanoplasty surgery this is a safe and effective method of anaesthesia that provides good MAC.

Sevoflurane anaesthesia for nasal surgery in a patient with multiple chemical sensitivity

Multiple chemical sensitivity syndrome is a group of complex disorders that include psychiatric disorders, chronic fatigue and/or respiratory problems. This syndrome could be triggered by specific allergens and toxins that cause neurophysiological sensitization and appearance of clinical symptomatology. Anaesthesia for these patients always poses a challenge for anaesthetist, because they need to find and use drugs that do not trigger or aggravate symptoms of disease. Therefore, sevoflurane in these circumstances might be the ideal anaesthetic. Performing general anaesthesia with sevoflurane as sole anaesthetic agent, together with a series of environmental measures formed basis for successful anaesthesia and surgery in our patient with a multiple chemical sensitivity syndrome.