Stable Hemodynamic Profile Research Articles

Comparison of efficacy and safety of etomidate with other anesthesia induction drugs for patients undergoing cardiac surgery: A systematic review and meta-analysis of randomized controlled trials

IntroductionEtomidate is commonly used to induce anesthesia in cardiac surgery patients due to its favorable cardiovascular profile. Sedative-hypnotic effects are mediated by gammaaminobutyric acid (GABA) receptor complexes in the central nervous system. There are numerous studies in which etomidate and other drugs are compared in terms of their clinical outcomes. The relative efficacy and safety of etomidate, however, remains inconclusive. In this study, we performed a systematic analysis of randomized controlled trials to assess the impact of etomidate, on patients undergoing cardiac surgery, with respect to patient outcome and adverse events. MethodsA systematic review was conducted of all existing clinical trials exploring the safety and efficacy of etomidate in patients undergoing cardiac surgery. Randomized controlled trials (RCTs) that compared etomidate with other drugs during induction in adult cardiac surgery assessing hemodynamic parameters and clinical outcomes were included, while studies involving non-cardiac or pediatric surgery and those lacking relevant outcome data were excluded. Primary outcomes were all-cause 30-day mortality. Secondary outcomes included duration of tracheal intubation, duration of intensive care unit (ICU) stay, duration of hospital stay, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) and other hemodynamic parameters, vasopressor requirements after induction and intubation, cortisol levels, and incidence of myoclonus. ResultsSixteen randomized controlled trials involving 1162 patients were included. Etomidate did not affect the all-cause 30-day mortality of patients undergoing cardiac surgery compared to comparator drugs (RR, 0.96; 95 % CI, 0.26 to 3.49; P = 0.95). There were no significant differences in the duration of tracheal intubation (MD, −0.08 h; 95 % CI, −1.96 to 1.81; P = 0.94), the duration of ICU stay (MD, −2.07 h; 95 % CI, −8.09 to 3.96; P = 0.50) or the duration of hospital stay (MD, −0.62 d; 95 % CI, −2.25 to 1.00; P = 0.45) when etomidate was compared to comparator drugs. Patients receiving etomidate demonstrated a more stable hemodynamic profile after induction and intubation compared to those receiving comparator drugs. The requirement of a vasopressor after induction and intubation was significantly reduced with etomidate compared with those with comparator drugs (RR, 0.37; 95 % CI, 0.25 to 0.56; P < 0.00001). ConclusionsThis systematic meta-analysis found a significant heterogeneity among included studies. In addition, most studies focused only on the hemodynamic profile of etomidate. Thus, efficacy and safety of etomidate could not be answered within this context. Nevertheless, for patients undergoing cardiac surgery, etomidate seems to offer a minimal beneficial cardiovascular profile in comparison with other agents during induction and intubation. However, improved hemodynamics did not improve clinical outcomes as Etomidate did not affect mortality, duration of tracheal intubation, the length of stay in ICU and hospital. Finally, infectious side effects as one important trigger for increased mortality in ICU patients due to the use of Etomidate could not be analyzed as data were mostly missing.

Comparison between the Hemodynamic Profile with Esmolol versus Morphine as an Adjuvant Agent during Induction of Anesthesia

Background: The induction of general anesthesia is a critical phase in anesthetic practice, often associated with significant hemodynamic changes. These changes can lead to complications due to autonomic adrenergic responses. Esmolol, a beta-1 antagonist, is commonly used to blunt these responses, but its availability is limited in some settings. Morphine, a pure mu receptor antagonist, presents a potential alternative. Objective: This study aimed to compare the efficacy of intravenous esmolol versus intravenous morphine in stabilizing the hemodynamic profile during the induction of general anesthesia. Methods: This randomized controlled trial was conducted at the Department of Anesthesiology, Combined Military Hospital, from January to June 2023. After obtaining ethical approval and trial registration, 220 ASA-II patients aged 25-55 years scheduled for elective surgeries under general anesthesia were enrolled. Patients were randomized into two groups: Group E (n=110) received 1.5 mg/kg intravenous esmolol three minutes before laryngoscopy and intubation, and Group M (n=110) received 0.1 mg/kg intravenous morphine five minutes before laryngoscopy and intubation. Baseline heart rate, systolic and diastolic blood pressure, and oxygen saturation were recorded after pre-oxygenation with 100% oxygen for three minutes. Post-intubation, the same parameters were measured five minutes after intubation. Statistical analysis was performed using SPSS version 25.0, with independent samples T-tests used to compare means. A p-value of ≤0.05 was considered statistically significant. Results: The mean age was 39.41 ± 5.13 years in Group E and 39.97 ± 5.08 years in Group M (p=0.414). Mean weight was 68.14 ± 3.88 kg in Group E and 68.08 ± 3.80 kg in Group M (p=0.916). Pre-induction mean heart rate was 71.75 ± 2.33 bpm in Group E and 71.58 ± 2.35 bpm in Group M (p=0.585). Five minutes post-intubation, mean heart rate was significantly lower in Group E (80.73 ± 2.54 bpm) compared to Group M (87.62 ± 2.83 bpm) (p&lt;0.001). Mean systolic blood pressure post-intubation was 132.88 ± 4.65 mm Hg in Group E and 140.25 ± 2.39 mm Hg in Group M (p&lt;0.001). Mean diastolic blood pressure post-intubation was 77.58 ± 2.35 mm Hg in Group E and 85.33 ± 3.71 mm Hg in Group M (p&lt;0.001). Oxygen saturation remained stable in both groups. Conclusion: Intravenous esmolol is superior to intravenous morphine in blunting the hemodynamic responses to laryngoscopy and intubation, providing a more stable hemodynamic profile during the induction of general anesthesia.

A COMPARATIVE STUDY BETWEEN 0.5% LEVOBUPIVACAINE AND 0.75% ROPIVACAINE IN PATIENTS UNDERGOING ELECTIVE LOWER LIMB SURGERIES UNDER SUBARACHNOID BLOCK

Objective: The aim of the study was to compare the efficacy of 0.5% levobupivacaine and 0.75% ropivacaine after intrathecal administration in elective lower limb surgeries. Methods: A prospective, randomized, controlled, and double-blind study was conducted on 100 patients undergoing elective lower limb surgeries under subarachnoid block using 0.5% levobupivacaine and 0.75% ropivacaine. Results: Demographic characteristics of both groups are comparable. It is observed the onset of sensory blockade is earlier in ropivacaine group, Grade 4 bromage scale motor blockade onset is shorter in levobupivacaine and most of the parameters are comparable between two groups. Duration of sensory blockade is more in ropivacaine when compared to levobupivacaine. Levobupivacaine is more cardiostable with stable hemodynamic profile compared to ropivacaine. Conclusion: Levobupivacaine is more cardiostable with stable hemodynamic profile compared to ropivacaine.

Peripheral Nerve Block Versus Spinal Anesthesia for Total Knee Replacement in Elderly Patients

Abstract Spinal anesthesia and peripheral nerve block anesthesia are used in total knee replacement. The aim of the study was to examine whether peripheral nerve block anesthesia would provide a more stable hemodynamic profile and analgesic effect in elderly patients undergoing total knee replacement, as compared to spinal anesthesia. This is a single-center case-control trial, with patients from our prospectively followed registry. The patients were divided into two groups, those with peripheral nerve block anesthesia and spinal anesthesia. Propensity score analysis was performed in 1:1 ratio. The primary outcome was analgesia with total analgesic effect and the secondary outcome was intraoperative hemodynamic status. The patients in peripheral nerve block anesthesia group had a longer length of analgesia (606.19±219.35 vs 359.48±106.82, P&lt;0.01) and pain scores during 24h and 48h after the surgery were lower in the same group of patients (3.21±1.74 vs 5.02±2.23, P=0.037; 3.03±1.57 vs 5.67±2.51, P=0.028). Spinal anesthesia group had a larger number of patients with significant hypotension (3.84% vs 15.38%, P=0.01), as well as a larger number of patients who received vasopressors (0% vs 9.61%, P&lt;0.01). Both anesthesia methods demonstrated sufficient analgesic efficacy in total knee replacement, although there was less pain severity and longer analgesic effect of peripheral nerve block anesthesia in patients who were 60 years old or older. Spinal anesthesia showed a significantly higher degree of hypotension than in those patients receivingperipheral nerve block anesthesia.

Effect of Dexmedetomidine on Incidence of Emergence Delirium in Adult Nasal Surgery

Background/Purpose/Question. Emergence delirium (ED) is an acute phenomenon that develops in the early phase of recovery from general anesthesia, and characterized by confusion, disorientation, &amp; possible violent behavior, and is a common occurrence particularly with nasal surgery. Dexmedetomidine is a highly selective alpha-2 adrenergic agonist that results in anxiolysis, sedation, analgesia, and sympatholysis without depressing ventilation. This educational scholarly project aimed to review the literature and investigate the effect of intraoperative dexmedetomidine on the incidence of ED in adults recovering from general anesthesia after nasal surgery. Methods/Evidence Search. PubMed and EMBASE were structurally searched from 2011 to 2021. Five randomized controlled studies (RCT) were selected that compared intraoperative dexmedetomidine to a placebo and how the recovery profile was affected in adults after nasal surgery. Key search terms included “anesthesia”, “dexmedetomidine”, “emergence”, “nasal surgery”. Synthesis of Literature/Results/Discussion. There were collectively 392 participants across these five studies, and the incidence of ED in dexmedetomidine groups was significantly lower than control groups (respectively 21% vs. 50%). The mean arterial pressure (MAP) and heart rate (HR) among dexmedetomidine groups exhibited less variability during emergence without hypotension, which indicates a more stable hemodynamic profile. Analgesic and antiemetic requirements in the post-anesthesia care unit (PACU) were decreased in dexmedetomidine groups, however these results were not statistically significant. Conclusion/Recommendations for Practice. Intraoperative dexmedetomidine significantly decreases the incidence of ED. Secondary effects, like hemodynamic stability and analgesia, were observed, but these qualities need to be further studied before they can be generalized. Overall, dexmedetomidine is a safe and effective anesthetic adjunct that facilitates a smoother emergence after nasal surgery without any complications. Keywords: Anesthesia, dexmedetomidine, emergence, nasal surgery

Dexmedetomidine versus Lignocaine in the Prevention of Etomidate-induced MyoclonusA Randomised Double-blinded Study

Introduction: Etomidate is a preferred induction agent owing to its stable haemodynamic profile, minimal respiratory sideeffects, minimal histamine release, cerebral protection and its property of rapid onset and short duration. However, myoclonus has been reported as one of its side-effects which poses great concern. Amongst the various drugs used to attenuate it, the role of intravenous (i.v.) Dexmeditomidine and Lignocaine have been reported in literature to be of great success. Aim: To compare the efficacy of Dexmedetomidine and Lignocaine in preventing Etomidate-induced Myoclonus. Materials and Methods: The randomised, double blinded study included 104 adult consented patients, of either sex, American Society of Anaesthesiology (ASA) I and II, aged 18-65 years, undergoing routine surgery under general anaesthesia. They were randomly allocated into two groups of 52 patients each viz., Group I receiving 0.5 µg/kg of injection (inj.) Dexmedetomidine i.v. and Group II 1 mg/kg of inj. Lignocaine diluted in 10 mL normal saline i.v. The incidence and severity of myoclonus were assessed and recorded within 90 seconds after etomidate injection using a four point severity scale. The collected data were entered in Statistical Package for Social Sciences (SPSS) version 21.0. Results: Total 104 subjects with the demographic parameters such as age, sex, ASA and weight comparable between the two groups were analysed. Group I recorded lesser number of patients (17, 32.7%) to myoclonus as compared with Group II (21, 40.4%), (p-value=0.41). Maximum patients in Group I developed grade I myoclonus while in Group II, it was grade 2. No patients in Group I developed grade 3 myoclonus as against 5 patients in Group II (p-value=0.03). Conclusion: Dexmedetomidine and Lignocaine were equally effective in the prevention of Etomidate-induced myoclonus but dexmeditomedine was better because of lesser incidence of severe grade myoclonus.

Intraoperative Target-Controlled Infusion of Etomidate versus Propofol for General Anesthesia in Laparoscopic Cholecystectomy

To investigate the safety and changes of hemodynamic profiles when using etomidate for general anesthesia in laparoscopic cholecystectomy compared to propofol was the objective of the study. Adult patients who received laparoscopic cholecystectomy were retrospectively categorized as etomidate and propofol group. Time to extubation, time to eye opening, pain scores at rest, postoperative nausea, vomiting and lengths of hospital stay were studied as safety outcomes. Changes in hemodynamic profiles are evaluated by coefficients of variation of systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rates were compared between groups. 291 patients were categorized as the etomidate group and 388 patients as the propofol group. There was no significant difference in age, sex, body mass index and hemodynamic profiles at baseline between the two groups (p all>0.05). Compared to propofol, the etomidate group showed similar safety outcomes (p all>0.05). Similar change patterns in the hemodynamic profiles over time were observed between the two groups, but the coefficients of variation of systolic blood pressure, diastolic blood pressure and mean arterial pressure in the etomidate group were significantly lower than that in the propofol group (p<0.05). There was no difference in safety outcomes but a more stable hemodynamic profile when comparing intraoperative target-controlled infusion of etomidate to propofol used for general anesthesia in laparoscopic cholecystectomy.

Comparative assessment of different doses of midazolam to prevent etomidate-induced myoclonus – A randomized, double-blind, placebo-controlled trial

Background: Etomidate is a popular induction agent, due to its several advantages for example, an extremely stable hemodynamic profile with no effects on sympathetic nervous system and baroreceptors, minimal effect on respiration and also prevents histamine release in healthy patients or in those with reactive airway disease. It, however, may be associated with myoclonus whose incidence has been reported as 50%–80% in nonpremedicated patients. Ideally, a pretreatment drug for preventing myoclonic movements should be short acting, not have significant effects on respiration and hemodynamics, and not prolong recovery from anesthesia. Midazolam has been used as a pretreatment to attenuate myoclonus in different doses with varied results, but the optimal dose has not been established. The present study was planned to compare the effect of three doses of midazolam, i.e., 0.015 mg/kg, 0.03 mg/kg, and 0.05 mg/kg in preventing etomidate-induced myoclonus.Materials and Methods: This study comprised 164 American Society of Anesthesiologists I/II consenting patients between 18 and 60 years. They were randomly divided into four groups after which pretreatment with normal saline in group M0, midazolam 0.015 mg/kg in group M0.015, 0.03 mg/kg in group M0.03, and 0.05 mg/kg in group M0.05 was administered. The primary outcome was the incidence of myoclonus after etomidate. The secondary outcome measures included severity of myoclonus and changes in hemodynamic parameters. One-way analysis of variance with Bonferroni's correction was used to compare quantitative data. Chi-square test was applied for qualitative data. Further, as there were four groups with multiple comparisons, Bonferroni's correction was applied and P < 0.01 was considered statistically significant.Results: We observed a significant reduction in the incidence of myoclonus of group M0.015 as compared to group M0 (P < 0.001). A significant reduction in severity of myoclonus was observed in all the three midazolam groups compared to the control group (P < 0.001) without any significance among the patients receiving different doses of midazolam.Conclusion: We recommend using midazolam pretreatment in a dose of 0.015 mg/kg for prevention of etomidate-induced myoclonus.

A clinical comparative study to evaluate the efficacy of intubating doses of atracurium and cisatracurium in patients undergoing general anesthesia

Background: Skeletal muscle relaxation is integral part of general anesthesia. Non-depolarizing neuromuscular blocking drugs like cisatracurium are devoid of any signs of histamine release and can improve the quality of intubating conditions. Aims and Objectives: We decided to assess the efficacy of Cisatracurium when compared to atracurium in terms of intubating conditions and hemodynamic parameters in patients undergoing surgeries under general anesthesia. Materials and Methods: In this study, 80 patients in the age group of 20–65 years were randomly allocated into Group A received Atracuruium 0.5 mg/kg and Group B received Cisatracurium 0.15 mg/kg for intubation after administration of induction agent. Intuabating conditions were assessed by Cooper et al., score and hemodynamic parameters such as heart rate and blood pressure were recorded at 1, 3, 5, 10, 15, and 30 min of intubation. Any signs of histamine release were noted. Results: Demographic profile was comparable between the two groups. As per Cooper et al., score intubating conditions were excellent with Cisatracurium group as compared to the atracurium group which was statistically significant. Hemodynamic parameters during intubation and after intubation were comparable between two groups. No associated signs of histamine release were noted in either of the groups. Conclusion: From our clinical comparative study, we have observed that Cisatracurium 0.15 mg/kg provides better intubating conditions and stable hemodynamic profile with no signs of histamine release as compared to atracurium 0.5 mg/kg dose.

Application of Preoperative Adductor Canal Block Coupled with General Anaesthesia in Elderly Patients Undergoing Total Knee Arthroplasty.

Objective To investigate the clinical application of preoperative adductor canal block combined with general anaesthesia in elderly patients with total knee arthroplasty. Methods Seventy-four patients scheduled for elective TKA in Shaanxi Nuclear Industry Hospital No. 215 were selected and were assigned into group A (continuous ACB prior to the induction of anaesthesia) and group B (continuous ACB after extraction of the tracheal catheter post-operatively) according to the random number table method. Pre and postoperative plasma adrenaline and noradrenaline levels were measured; mean arterial pressure (MAP) and heart rate (HR) were recorded at the admission and the surgical skin incision; intraoperative sufentanil dosage, number of analgesic pump presses at 48 h postoperatively; postoperative adverse effects and length of stay were recorded; resting and active VAS pain scores were assessed at 4, 8, 12, 24, and 48 h postoperatively. Results Group B experienced a substantial increase in MAP and HR at the time of surgical skin incision, while group A registered a smaller change and a stable haemodynamic profile (P < 0.05). The plasma adrenaline and norepinephrine concentrations in group B were elevated compared to the preoperative period, differentially with group A. Group A received less intraoperative sufentanil than Group B (P < 0.05). Conclusion Collectively, postoperative resting VAS scores and active VAS scores remained lower in TKA patients who were subjected to preoperative and postoperative ACB, while preoperative ACB in conjunction with general anaesthesia decreased intraoperative sufentanil dosage, contained the surgical stress response, and maintained a stable intraoperative haemodynamic state, in what is probably a preferable option for elderly patients undergoing TKA. This study has served as a reference for postoperative patients to reduce their medication and for clinicians in the treatment going forward.

Anaesthetic management of awake craniotomy in a patient with sick sinus syndrome: a case report

Awake craniotomies (AC) have been mainly used in functional neurosurgery, tumour resection in eloquent regions, and epilepsy surgery. However, evidence of the practice of AC for other indications is scarce. Furthermore, there is limited evidence of AC performed on patients with severe comorbidities, especially those with poor cardiorespiratory reserve. We report a successful case of AC on a patient with bilateral acute on chronic subdural haemorrhage with sick sinus syndrome on a permanent pacemaker with multiple other comorbidities presenting for emergency bilateral burr hole and drainage. We were able to achieve a stable haemodynamic profile perioperatively with no untoward complications. The patient had improved neurological outcome immediately postoperatively that eliminated the need for close monitoring in ICU and allowed earlier hospital discharge.

Анестезиологическое обеспечение при энуклеации глазного яблока в педиатрической онкохирургии

Aiml. Optimization of anesthesia during enucleation of the eyeball in pediatric oncosurgery with an emphasis on regional methods. Material and Methods. Eight anesthesias were performed in children, whose average age was 3 years, operated on for retinoblastoma from July 2021 to January 2022. All patients underwent combined endotracheal anesthesia. A triple block was used as a regional component: palatal anesthesia, infraorbital anesthesia and van Lint block. Results. The effectiveness and adequacy of the proposed method of anesthesia using regional anesthesia was assessed in terms of hemodynamics – heart rate, systolic and diastolic blood pressure, the level of oppression of consciousness (BIS-index). The assessment was made at five stages: the beginning of anesthesia, tracheal intubation, 10 minutes after the triple block, at the traumatic stage of surgery, and at the end of anesthesia before tracheal extubation. As a result, it was noted that the studied variant of anesthetic management is characterized by a stable hemodynamic profile, and also does not provoke the development of an oculocardial reflex. There was a decrease in the level of the BIS-index below 40 c.u. at the stage of maintenance of anesthesia, which indicated the possibility of using lower concentrations of sevoflurane. Conclusions. This option of anesthetic management has sufficient efficiency and safety, and also allows to ensure the comfort of the surgeon. Key words: retinoblastoma; combined anesthesia; regional anesthesia.

MO657: Low Incidence of Intradialytic Hypotension During Online Post-Dilution High-Volume Haemodiafiltration: A Randomized Cross-Over Trial between Four Intermittent Dialysis Modalities

Abstract BACKGROUND AND AIMS Compared with standard haemodialysis (S-HD), online post-dilution haemodiafiltration (HDF) is associated with improved survival, especially when high convection volumes [high-volume (HV)-HDF] are achieved [1]. A superior intradialytic haemodynamic stability may play an important role in this respect. Therefore, we assessed whether the intradialytic haemodynamic profile differs between four dialysis modalities, including S-HD and HV-HDF. METHOD In the current randomized cross-over trial (NCT03249532, ClinicalTrials.gov), 40 prevalent dialysis patients were subjected to S-HD [dialysate temperature (Td) 36.5°C], HD with cool dialysate (C-HD; Td 35.5°C), low-volume (LV)-HDF [convection volume (CV) 15 L/1.73 m2/session) and HV-HDF (CV ≥23 L/1.73 m2/session) (both Td 36.5°C). Blood pressure (BP) was measured 4x/hour. The primary endpoint was the total number of intradialytic hypotensive (IDH) episodes. IDH was defined as a nadir in systolic BP (SBP) &amp;lt;90 mmHg for a pre-dialysis SBP &amp;lt;160 mmHg and &amp;lt;100 mmHg for a pre-dialysis SBP ≥160 mmHg, independent of symptoms and interventions. In addition, an explorative analysis was performed on the incidence of early-onset IDH, which has recently been related to mortality [2]. Secondary endpoints included the intradialytic courses of SBP, diastolic BP (DBP) and mean arterial pressure (MAP). RESULTS IDH occurred significantly less frequent during C-HD (0.21 episodes/session) and HV-HDF (0.27/session) compared with S-HD (0.68/session, both P &amp;lt; .0005) (Figure 1). Furthermore, early-onset of IDH was also observed more frequently during S-HD (0.32/session) than during C-HD (0.07/session, P&amp;lt;.0005) or HV-HDF (0.10/session, P = .001) (Figure 1). After correction for multiple testing, the intradialytic courses of SBP, DBP and MAP declined only significantly during S-HD (−6.8, −5.2, −5.2 mmHg/session; P = .004, &amp;lt;.0005, .002 resp.) whereas these remained stable in the other modalities (Table 1). CONCLUSION In conclusion, during both C-HD and HV-HDF, IDH occurred least frequent and the intradialytic haemodynamic stability was best preserved. In contrast, intradialytic haemodynamic stability is most dysregulated during S-HD. Therefore, it is conceivable that the survival benefit of HV-HDF over S-HD is (at least partly) due to a more stable intradialytic haemodynamic profile and consequently less repetitive tissue injury.

Neurogenic stunned myocardium resulting from surgical brainstem handling during resection of paediatric recurrent medulloblastoma—a possible brain heart interaction

Neurogenic stunned myocardium (NSM) is characterised by an acute onset cardiac dysfunction following an acute neurological insult which mimics acute coronary syndrome. A 12-year-old male child was admitted to the neuro-intensive care unit (NICU) following midline suboccipital craniotomy and resection of recurrent medulloblastoma. Postoperatively, in NICU, he developed tachycardia and hypotension, which was unresponsive to fluid challenge requiring norepinephrine infusion. Intraoperatively, during tumour resection from the dorsal medulla, episodes of hypertension and bradycardia were observed. Intraoperative blood loss was adequately managed with a stable hemodynamic profile without postoperative anaemia. An electrocardiogram showed sinus tachycardia with T wave inversion, and blood investigation revealed elevated cardiac troponin T levels. Point of care ultrasound (POCUS) of heart and lung showed features of NSM. Infusion dobutamine was added to achieve a target mean arterial pressure of 65mm Hg with concomitant furosemide infusion and fluid restriction. Daily POCUS assessment of cardiac contractility and volume status was done. The patient was weaned from vasoactive drugs and ventilator following improvement of cardiac function and was discharged from NICU after 17days. NSM results from the excessive release of catecholamines following stimulation of trigger zones in the brain. To date, a handful of cases of pediatric NSM following primary brain tumour are reported where hydrocephalus resulted in trigger zone activation. In this presented case, direct brain stem stimulation during tumour resection might have triggered NSM. Irrespective of the cause, timely diagnosis and execution of supportive management in our patient resulted in a positive outcome.

Comparison between Ropivacaine 0.5% And Levobupivacaine 0.5% in Axillary Brachial Plexus Block for Upperlimb Surgeries in a Tertiary Health Care Centre of Tripura- A Observational Study

Introduction Axillary brachial plexus block is an anesthetic option used for surgeries of arm, forearm and elbow. The use of USG has significantly improved the quality of nerve blocks by direct visualization of nerves and related anatomical structures, needle trajectory and spread of local anesthesia during injection and significantly increases the success rate. Various drugs like Ropivacaine, bupivacine and Levobupivacaine are preferred due to greater margin of safety. However the efficacy of Levobupivacaine in Axillary Brachial Plexus Block has not been studied much. Therefore ,we designed this study to compare the clinical effect of Ropivacaine with Levobupivacaine for ABPB using USG technique. Methodology It’s a hospital- based Comparative study done in Department of Anesthesiology, AGMC &amp; GBPH from July 2016 to June 2018 (2 years) where 60 patients aged between 18-55 years with ASA grade 1 &amp; 2 who are posted for upper limb surgery were randomly allocated into two groups of 30 each. Patients belonging to ASA grade (3&amp; 4) and age &lt;18years,&gt;55years, Patient with h/o bleeding diathesis, neuromuscular disorder, morbid obesity, prolonged drug therapy &amp; local site infection were excluded from the study. USG guided axillary nerve block performed under aseptic condition. Sensory and motor blocks were assessed in each nerve territory at 2, 5, 10, 15, 20, 25, and 30 mins, 6 hr, 12 hr , 18hr, and 24 hrs after LA injection after LA injection. Onset of block, duration block and quality of analgesia has been compared. For the duration of the study, the presence of hypotension, bradycardia, hypoxia or nausea and vomiting was recorded and treated according to standard clinical practice. Result Among 60 study subjects Mean age was 34.7±12.6 years and majority of the study subjects were males (73.3%) and 26.7% were females. The pre-operative parameters e.g. age, sex, body weight etc. were compared between two groups but there was no statistically significant difference between the two groups (p&gt;0.05). The onset of motor blockade among patients of Ropivacaine group was also shorter than patients received Levobupivacaine which was significant. Duration of sensory blockade was shorter in Ropivacaine group &amp; duration of motor blockade was also shorter in Ropivacaine group than Levobupivacaine group and these difference were found to be statistically significant (p&lt;0.05). There was no significant change in vital parameters after administration of both the drugs when observed at specific time intervals. VAS Scores were comparable in both the groups. Conclusion The following conclusion can be made from the present study • Ropivacaine has faster onset of sensory and motor blockade when compared with Levobupivacaine. • But duration of both sensory and motor blockade was lesser than Levobupivacaine • Ropivacaine provides stable haemodynamic profile similar to Levobupivacaine. • It provides satisfactory intra-operative &amp;post-operative analgesia comparable to Levo

Hemodynamics in Helicopter Emergency Medical Services (HEMS) Patients Undergoing Rapid Sequence Intubation With Etomidate or Ketamine.

Rapid sequence intubation (RSI) is performed by helicopter emergency medical services (HEMS) providers to establish airway control. Common induction agents are etomidate and ketamine, both touted to have relatively stable hemodynamic profiles. Limited data comparing these medications in the air medical setting exist. Compare administration of ketamine and etomidate on peri-intubation hemodynamics. A retrospective chart review of intubations performed by a HEMS program over 69 months was completed. Heart rate (HR) change, systolic blood pressure (SBP) change, and hypotension with etomidate or ketamine use were measured. There were 258 patients induced with etomidate and 48 with ketamine. Etomidate patients showed a +1.161% change in HR (SD ± 22.7) and -0.49% change in SBP (SD ± 25.0). Ketamine patients showed a -4.7% change in HR (SD ± 16.7) and 17.2% change in SBP (SD ± 43.4). The p-values for percentage change in HR and SBP between etomidate and ketamine were 0.0830 and 0.0018, respectively. Twenty-five episodes of postadministration hypotension occurred with etomidate, and two with ketamine (p=0.028). Both ketamine and etomidate are appropriate for intubation of HEMS patients. Ketamine was preferentially selected for hypotensive patients with statistically significant improvement in SBP. Although statistically significant, both ketamine and etomidate had relative low incidences of hypotension.

Сучасні підходи до інфузійної терапії прееклампсії та еклампсії

Дослідження проведено за участю 78 пацієнток віком 19–35 років (у середньому 27,1 ± 0,5 року) із прееклампсією тяжкого ступеня при терміні гестації 38,50 ± 0,15 тижня. Усім пацієнткам у допологовому періоді проводили корекцію гіповолемічних порушень Гекотоном («Юрія-Фарм»): 4–6 мл/кг протягом 1–1,5 години. Дослідження здійснювали в 4 етапи: I — до інфузії, II — через 60 хв після закінчення інфузії Гекотоном, III — через 6 годин і IV — до кінця першої доби. Початковий стан гемодинаміки в пацієнток із прееклампсією характеризувався гіпертензивно-гіподинамічною дисоціацією з проявом систолодіастолічної дисфункції. Включення в інфузійну програму Гекотону забезпечувало стабільний гемодинамічний профіль, ліквідацію систолічної та діастолічної дисфункції лівого шлуночка, сприяло швидкому переходу позаклітинної рідини у внутрішньосудинний простір, зберігаючи досягнуте збільшення внутрішньосудинного об’єму за рахунок високої здатності гідроксіетилкрохмалю 130/0,4 пов’язувати воду, що й забезпечувало тривалий ефект препарату.

COMPARATIVE STUDY BETWEEN OXYTOCIN VERSUS TRANEXAMIC ACID AND ETHAMSYLATE COMBINATION IN REDUCING INTRAOPERATIVE BLOOD LOSS IN MYOMECTOMY

Background: Fibroids are the most common benign pelvic tumors affecting about 20% of women above 35 years of age. The diverse symptomatology of fibroids can be attributed to size, number and location of the tumors. The common symptoms include menorrhagia, infertility, abdominal mass and pressure effects. Objective: To compare the efficacy of tranexamic acid and ethamsylate versus IV oxytocin infusion in reducing blood loss during abdominal myomectomy. Patients and Methods: This study involved ninety women undergoing abdominal myomectomy for symptomatic uterine myoma divided randomly into three equal groups: Group A (Tranexamic acid and ethamsylate group) received 1 g tranexamic acid (2 ampoules of kapron 500 mg) and (1 ampoule of dicynone) IV just before skin incision, Group B (Oxytocin group) received 30 IU of oxytocin in 500 ml normal saline will be administered during myomectomy, and Group C (Saline group) received 110 ml normal saline IV just before skin incision. This study was conducted in Sayed Galal Al-Azhar University Hospital and El-Galaa Teaching Hospital during period time from December 2018 to December 2019. Results: Using 1 g tranexamic acid and 1 ampoule of dicynone in abdominal myomectomy resulted in a significant reduction of blood loss than using 30 IU oxytocin in 500 ml normal saline immediately before the start of the surgery (509.24±57.28 ml in Tranexamic acid and ethamsylate group vs. 720.13±112.62 ml in oxytocin group). Conclusion: Tranexamic acid and ethamsylate are more effective in reducing the transfusion requirement than oxytocin with more stable hematological and hemodynamic profile.

Comparison of Propofol and Ketofol on Transcranial Motor Evoked Potentials in Patients Undergoing Thoracolumbar Spine Surgery.

Study DesignThis was a double-blind randomized study.PurposeThe primary purpose was to compare the effects of propofol and ketofol on amplitudes and latencies of transcranial motor evoked potentials (TcMEPs) during thoracolumbar spine surgery. In addition, intraoperative hemodynamics and muscle power were compared.Overview of LiteraturePropofol is commonly used during intraoperative TcMEP monitoring. However, propofol inhibits TcMEP amplitudes and causes hypotension in a dose-dependent fashion.MethodsAmplitude and latency of TcMEPs were recorded bilaterally from the abductor pollicis brevis (APB) and abductor hallucis (AH) muscles in 38 adult American Society of Anesthesiologists I and II patients undergoing thoracolumbar spine surgery. Baseline recordings of TcMEPs in both groups were recorded under propofol infusion. Group X patients then received propofol and fentanyl (1 mcg/kg/hr), and group Y patients received ketofol and fentanyl (1 mcg/kg/hr). Bispectral index was maintained at 40–60 in both groups. Amplitude and latency were recorded at 30 minutes intervals for 2 hours.ResultsPropofol caused no significant changes in amplitude and latency in any muscle. In contrast, amplitude increased significantly at all time points in the bilateral APB muscles and 60, 90, and 120 minutes in the left AH muscle without changes in latency in response to ketofol. When the two groups were compared, ketofol induced significantly higher amplitudes at 60, 90, and 120 minutes in the (left) APB, at all time points in the (right) APB, and at 120 minutes in both AH muscles, compared with propofol. Blood pressures were lower and fluid and vasopressor requirements were higher in group X. Muscle power was similar between the two groups.ConclusionsKetofol facilitates TcMEP amplitudes without affecting latency. Use of ketofol resulted in a better and more stable hemodynamic profile than did use of propofol.

A prospective randomized study to see the effects of combined administration of dexmedetomidine plus propofol versus propofol alone in cardiac surgical patients.

Objective: To compare the hemodynamics changes, intraoperative awareness and postoperative delirium after combined administration of dexmedetomidine plus propofol versus propofol alone in cardiac surgical patients. Study Design: Randomized Clinical Trial. Setting: Cardiac Center, Bahawal Victoria Hospital, Bahawalpur. Period: 1st December 2018 to January 2020. Material &amp; Methods: Sixty-two (62) patients who underwent different cardiac surgical procedures were included in the study. Patients were randomly divided in group 1 {Dexmedetomidine (DEX) +Propofol} and group 2 {propofol alone}. Induction in group 1 was done by loading dose of DEX (0.7 microgram/kg) while induction in group 2 was done by Lignocaine 1.5 mg/kg. Heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP) and mean arterial pressure (MAP) were recorded at different time intervals. Intraoperative awareness and post-operative delirium was also assessed. Results: All hemodynamic parameters (HR, SAP, DAP, MAP) were statistically significant lower in group 1 in comparison to group 2 at different intervals indicating a more stable hemodynamic profile in group 1. End tidal CO2, pH, and peak airway pressures were not statistically significant between both groups. Intra-operative awareness was diagnosed in 1 (3.2%) patients in group 1 and in 5 (16.1%) patients in group 2 (p-value 0.08). Delirium was diagnosed in 3 (9.6%) patients in group 1 and in only 1 (3.2%) patients in group 2 (p-value 0.30). Conclusion: Combined administration of DEX and propofol produces more stable hemodynamics, less intraoperative awareness but more incidence of delirium as compared to propofol alone in cardiac surgical patients.