COMPARISION OF ORAL PREGABALIN VERSUS BOLUS DOSE OF INTRAVENOUS DEXMEDETOMIDINE IN ATTENUATING THE HEMODYNAMIC RESPONSES DURING LARYNGOSCOPY, INTUBATION AND PNEUMOPERITONIZATION IN LAPROSCOPIC CHOLECYSTECTOMY: A RANDOMIZED STUDY

2021 ◽  
pp. 74-77
Author(s):  
Jyoti Rani ◽  
Meenaxi Sharma ◽  
Deepak Kumar ◽  
Anumeha Jain
Keyword(s):  
Blood Pressure ◽  
Normal Saline ◽  
Bolus Dose ◽  
Pressor Response ◽  
Randomized Study ◽  
Intravenous Bolus ◽  
Hemodynamic Parameters ◽  
Randomised Study ◽  
Placebo Tablet ◽  
Group D

Background: Laryngoscopy, intubation and pneumoperitoneum during general anaesthesia are severe noxiousstimuli that can produce many adverse effects. Aim of the study was to compare the efcacy of oral pregabalin versus intravenous bolus dose of dexmedetomidine as premedication for attenuating the haemodynamic pressor response during intubation, pneumoperitonization and extubation as well as perioperative stability and requirement of postoperative analgesics. Methods: A Randomised study was conducted in 100 patients undergoing Laparoscopic Cholecystectomy. Participants were divided into two groups in which group P (n=50) received oral pregabalin 150mg with sips of water 1 hour prior to surgery and intravenous normal saline (0.9%) 10ml, 10 mins prior to induction over 10 minutes and those in group D (n=50) received oral placebo tablet with sips of water 1 hour prior to surgery and intravenous dexmedetomidine at 1mcg/kg diluted with normal saline (total volume 10ml), 10 minutes prior to induction over 10 minutes. Hemodynamic parameters like heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), oxygen saturation (SPO2) and ETCO2 were noted before premedication and induction (baseline), at the end of induction and at laryngoscopy and intubation (I0) and then at 1,3,5,10 minutes after intubation as well as atstart of pneumoperitoneum and then after every 10 minutesinterval till the deation of CO2 and also at the time of extubation and 10 minutes thereafte

scholarly journals Comparison of Pethidine and Dexmedetomidine for the Control of Intraoperative Shivering Under Spinal Anesthesia

2020 ◽  
Vol 5 (1) ◽  
pp. 96-99
Author(s):  
Viral Prakashkumar Patel ◽  
Shital Hardik Halvadia
Keyword(s):  
Spinal Anesthesia ◽  
Statistical Difference ◽  
Bolus Dose ◽  
Randomized Study ◽  
Study Groups ◽  
Sedation Score ◽  
Intravenous Bolus ◽  
Grade 3 ◽  
Time Required ◽  
Group D

Background: Spinal anesthesia significantly impairs the thermoregulation system by inhibiting tonic vasoconstriction, which plays a significant role in temperature regulation. Various non-pharmacological and pharmacological methods are available for the control of shivering during anesthesia. The present study was done with an aim to compare the two drugs Pethidine and Dexmedetomidine for the control of intraoperative shivering under spinal anesthesia.Subjects and Methods:A prospective randomized study was carried out in the Department of Anaesthesiology, on 100 patients who developed intra-operative shivering following spinal anesthesia for numerous surgical procedures. When patients developed shivering of higher than mentioned grades, they were randomly assigned to one of the 2 study groups: Group D- Dexmedetomidine group receiving single intravenous bolus dose of 0.5mcg/kg over 5 min.  Group P: Pethidine group patients receiving 0.5mg/kg Pethidine IV over 5 min. Patients were intently monitored for the failure of the drug, Recurrence of shivering and side effects like nausea, vomiting, bradycardia (< 50/min), hypotension (>20% of baseline), giddiness and sedation score were recorded.Results:We found the Pethidine group had 62.5% and Dexmedetomidine had 67.5% of grade 3 shivering. The grades of shivering were comparable between the two groups with no statistical difference. We found the dexmedetomidine group had a significant reduction in time required to control shivering and vanishing of shivering after drug.Conclusion:Both dexmedetomidine (0.5mcg/kg) and Pethidine (0.5mg/kg) are effective in treating patients with post-spinal anesthesia shivering but the time taken for control of shivering was shorter with Dexmedetomidine as compared to Pethidine.

scholarly journals Intravenous dexmedetomidine 1µg/kg as premedication to attenuate hemodynamic response to laryngoscopy and endotracheal intubation in surgeries under general anesthesia

2017 ◽  
Vol 4 (6) ◽  
pp. 1884
Author(s):  
Dixitkumar B. Modh ◽  
Pratiti Gohil ◽  
Manthan Parmar
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Endotracheal Intubation ◽  
Normal Saline ◽  
Induction Agent ◽  
Hemodynamic Parameters ◽  
Hemodynamic Changes ◽  
Dose Requirement ◽  
Hemodynamic Stability ◽  
Induction Dose

Background: Choice of premedication and hemodynamic stability are always remain important concerns during laryngoscopy and endotracheal intubation for Anesthesiologists. Dexmedetomidine offers anxiolytic, sedation, hypnosis, analgesia, antisialagogue action as well as sympatholysis which make most suitable drug as premedication. Our aims for this study to evaluate efficacy of Injection Dexmedetomidine 1µg/kg intravenously as premedication on attenuation of hemodynamic changes to laryngoscopy and intubation as well as requirement of injection Propofol as an induction agent.Methods: In Present study, 60 patients of ASA I, II of age 18 to 45 years were randomly divided in to two groups of 30 each. In group NS, 10 ml normal saline and in group D1 injection Dexmedetomidine 1µg/kg diluted in 10 ml of normal saline was used. In both groups study solutions administered over 10 minutes. Both the groups were administered standard general anaesthesia and requirement of Propofol was noted as an induction agent. Heart rate, blood pressure (systolic, diastolic and mean arterial pressure) were compared at baseline, 2 min, 5 min, 10 minutes (SD2, SD5, SD10) after study drugs administration, before induction (BI), after induction (AI), 1 minute (T1), 2 minutes (T2), 5 minutes (T5) and 10 minutes (T10) after laryngoscopy and intubation in both groups.Results: HR, SBP, DBP and MAP highly significantly reduced at 2 min, 5 min and 10 minutes after infusion of Dexmedetomidine in group D1 as compared to group NS. (P<0.01). After induction values are highly significant in group D1 than group NS from baseline (P<0.01). Highly significant mean rise in hemodynamic parameters (HR, SBP, DBP and MAP) from baseline were observed in group NS compared to group D1 after laryngoscopy and intubation (P<0.01). Induction dose requirement of inj. Propofol significantly reduced in group D1 compared to other group (P<0.01).Conclusions: Injection Dexmedetomidine 1µg/kg provides effective and complete attenuation of pressure response to laryngoscopy and endotracheal intubation as premedication with decreased requirement of inj. Propofol for induction without any side effects.

scholarly journals Effect of Dexmedetomidine on Perioperative Haemodynamic Fluctuations in Untreated Stage 1 Hypertensive Patients Undergoing Laparoscopic Cholecystectomy- A Randomised Controlled Trial

2021 ◽  
Author(s):  
Anish Kumar Singh ◽  
Sanjay Johar ◽  
Sudesh Kumar ◽  
Mamta Jain ◽  
Kiranpreet Kaur ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Laparoscopic Cholecystectomy ◽  
Pulse Rate ◽  
Normal Saline ◽  
Double Blind Study ◽  
Rescue Analgesia ◽  
Extubation Time ◽  
Sedation Scores ◽  
Stage 1 ◽  
Group D

Introduction: Eighth Joint National Committee (JNC 8) has reclassified earlier prehypertension {Systolic Blood Pressure (SBP) 130-139 mm of Hg and/or Diastolic Blood Pressure (DBP) 80-89 mmHg} as stage 1 HTN. These patients may be at greater risk of perioperative haemodynamic instability, more so in case of laparoscopic surgeries and alpha-2 agonists premedication may be useful in such patients. Aim: To assess perioperative haemodynamic fluctuations in untreated stage 1 hypertension (HTN) patients and the role of Dexmedetomidine (Dexmed) in it. Materials and Methods: This prospective, randomised, double blind study was conducted at Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India from March 2019 to September 2020. Sixty-five patients with stage 1 HTN not on any anti-hypertensive drugs undergoing laparoscopic cholecystectomy were enrolled and randomly divided into group D (dexmedetomidine) and group NS (Normal Saline). Group D received Dexmed 1 μg/kg over 10 minutes before induction, followed by continuous infusion of Dexmed at 0.2 μg/ kg/h and Group NS received similar volume of normal saline. Serial recording of pulse rate, Mean Arterial Pressure (MAP) and oxygen saturation was done. Postoperative sedation scores, extubation time and time to first rescue analgesia were also assessed. For analysis, quantitative variables were expressed as mean±SD and compared using unpaired and paired t-test. Mann-Whitney test was used for quantitative data that did not follow a normal distribution. Qualitative variables were expressed as frequencies/percentages and compared using Chi-square test. A p-value <0.05 was considered statistically significant. Results: A total of 60 patients (30 in group NS, mean age 38.40±10.32 years and 30 in group D, mean age 42.5±11.72 years) were analysed in the present study. In NS group, haemodynamic variations were seen at induction, Laryngoscopy and Intubation (L&I), creation and release of Pneumoperitoneum (PNP) and extubation but actual changes were within 10-12% of baseline value, whereas in group D, pulse rate and MAP remained stable and moderately lower than baseline throughout the perioperative period. An increase in extubation time was observed in group D (15.57±3.16 vs.9.15±1.60 min). Group D also had significantly higher sedation scores postextubation. Group NS patients demanded rescue analgesia early (18.33±7.46 min vs.43.53±8.57 min) (p=0.001). Conclusion: It was concluded that the administration of i.v. Dexmed 1 μg/kg over 10 minutes followed by infusion at 0.2 μg/Kg/h results in haemodynamic stability during surgical stress, slightly delayed but smooth extubation, delayed demand of postoperative rescue analgesia and mild sedation of short duration. Dexmed induced effects help in improving the recovery profile of the patient and keeping the patient more comfortable in the postoperative period.

scholarly journals The Effects of Magnesium Sulfate with Lidocaine for Infraclavicular Brachial Plexus Block for Upper Extremity Surgeries

2020 ◽  
Vol 15 (01) ◽  
pp. e33-e39 ◽  
Author(s):  
Siavash Beiranvand ◽  
Arash Karimi ◽  
Majid Haghighat Shoar ◽  
Maryam Baghizadeh Baghdashti
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Postoperative Pain ◽  
Magnesium Sulfate ◽  
Normal Saline ◽  
Motor Block ◽  
Control Group ◽  
Case Group ◽  
Hemodynamic Parameters ◽  
Infraclavicular Block

Abstract Background An addition of analgesic to anesthetic agents is likely to increase the effects of anesthesia and reduce associated adverse outcomes. Several adjuvants are studied in this regard. The aim of this study is to investigate the effects of adding a magnesium adjunct to lidocaine for the induction of infraclavicular block. Methods Patients referred to Shohada Ashayer Hospital, Khorramabad, for wrist and hand surgery were enrolled in this study. The intervention/case group included patients who received 18 mL lidocaine (2%) + 2 mL magnesium sulfate (50%), 10 mL normal saline; control group: 18 mL lidocaine (2%) + 12 mL of normal saline. After the induction of ultrasound-guided infraclavicular block, parameters such as duration of reach with respect to complete sensory and motor block, hemodynamic parameters (hypotension and bradycardia), and postoperative pain, using visual analogue scale criteria, were measured. The obtained data were analyzed using a Bayesian path analysis model. Results A total of 30 patients were included in each group. In the case group, sensory and motor block was achieved for 12.136 ± 4.96 and 13 ± 3.589 minutes more than those in the control group. The duration of sedation and immobilization was 2.57 ± 0.764 minute and 4.66 ± 0.909 minutes lengthier in the case group. Regarding the hemodynamic parameters, blood pressure was 0.217 ± 5.031 and 1.59 ± 5.14 units lower in the case group, immediately following the block and the surgery. Similarly, heart rate was 0.776 ± 4.548 and 0.39 ± 3.987 units higher in the case group, after 30 minutes and 2 hours of the procedure. A decrease in the pain was seen at 8, 10, and 12 hours after the surgery, as compared with the control group. An addition of magnesium to lidocaine for infraclavicular block resulted in a significantly longer sedation and immobilization period and decreased postoperative pain at 12 hours. Conclusion Heart rate and blood pressure did not decrease significantly in the case group. It can be concluded that addition of magnesium sulfate to lidocaine can produce better anesthetic and analgesic outcomes with low-to-no adverse effects.

scholarly journals “EVALUATION OF DEXMEDETOMIDINE ON HEMODYNAMICS IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY”

2021 ◽  
pp. 1-2
Author(s):  
D.V.Rama Siva Naik ◽  
J.Sudheer Kumar
Keyword(s):  
Blood Pressure ◽  
Laparoscopic Cholecystectomy ◽  
Normal Saline ◽  
Surgical Stress ◽  
Saline Group ◽  
Normal Saline Group ◽  
Sympathetic Response ◽  
Adrenoceptor Agonist ◽  
Elective Laparoscopic Cholecystectomy ◽  
Group D

The physiological response to surgical stress and anaesthesia is well documented. Laparoscopic surgery which involves insufflation with carbon dioxideproduces undesirable responses like hypertension, tachycardia and dysrhythmias. Introduction of Dexmedetomidine which is highly specific and selectiveα2 adrenoceptor agonist has been tried in various studies to modify the stress response to surgery and to have a pleasant anaesthetic outcome with minimal cardiovascular changes. In our present study we have taken the pharmacological advantage of Dexmedetomidine to study the various cardiovascular parameters at different periods during the laparoscopic procedure. The aim is to studythe effectiveness of Dexmedetomidineinattenuating the sympathetic response tolaryngoscopy and endotracheal intubation and in maintaining the hemodynamic stability in laparoscopic cholecystectomy. Materials & Methods: 30 ASA I and II patients of either sex, scheduled for elective Laparoscopic Cholecystectomy under General anaesthesia were randomly allocated to receive either 1mcg/kg of Dexmedetomidine in 100ml of 0.9% normal saline (Group D,n=30) or 100ml of 0.9% normal saline(Group S, n=30) 30min beforeinduction. Results: In patients who received Dexmedetomidine there was a statistically significant differencein heartrate, systolic blood pressure, diastolic blood pressure and meanarterial pressures during Laparoscopy and Intubation. Conclusion: Dexmedetomidine when given as a premedication before Laparoscopic Cholecystectomy attenuates the sympathetic response to laryngoscopy and intubation and provides stable intra operative hemodynamics.

Randomised Study Comparing the use of Propofol Versus Dexmedetomidine as a Sedative Agent for Patients Presenting for Lower Gastrointestinal Endoscopy

2020 ◽  
Vol 15 (1) ◽  
pp. 61-66
Author(s):  
Sameh A. Ahmed ◽  
Nehad Hawash ◽  
Fatma H. Rizk ◽  
Mahmoud Elkadeem ◽  
Mohamed Elbahnasawy ◽  
...  
Keyword(s):  
Maintenance Dose ◽  
Demographic Data ◽  
Loading Dose ◽  
Hemodynamic Parameters ◽  
Traditional Use ◽  
Randomised Study ◽  
Sedative Agent ◽  
Significant Difference ◽  
Group D ◽  
Positive Effect

Objectives:: Dexmedetomidine, the alpha 2 agonist sedative and an analgesic agent may be beneficial in sedation for endoscopic intervention. Our aim was to compare the use of dexmedetomidine versus the traditional use of propofol as a sedative agent for colonoscopies. Methods:: This study included 100 patients presenting for elective colonoscopy under sedation with random and equal allocation of patients into two groups; group P, in which patients received propofol in a loading dose of 1.5 mg/kg and maintenance dose of 0.5 mg/kg/hr, and group D, in which patients received dexmedetomidine at a loading dose of 1ug/kg and maintenance dose of 0.5 ug/kg/hr. In addition to the demographic data, time to recovery, time of discharge, and endoscopist rating were measured. Also, the hemodynamic parameters were recorded, and also the incidence of postoperative complications. Results:: The basic patients' characteristics, time to recovery, and time of discharge were comparable between the two groups. Moreover, the endoscopist did not significantly report more convenient procedure with one group over the other. Also, there was no significant difference in hemodynamic parameters or in the incidence of complications between the two studied groups. However the use of dexmedetomidine decreased the incidence of hypoxemia. Conclusion:: The use of dexmedetomidine seems to have a similar effect to the use of propofol as a sedative agent for lower GIT endoscopy with the positive effect of dexmedetomidine in decreasing the incidence of perioperative hypoxemia.

scholarly journals A randomized study of comparison of intravenous dexmedetomidine and intravenous esmolol to attenuate the cardiovascular responses to laryngoscopy and endotracheal intubation

2020 ◽  
Vol 8 (9) ◽  
pp. 3239
Author(s):  
Ninad Deepak Chodankar ◽  
Bhagyashree Shivde
Keyword(s):  
Blood Pressure ◽  
Endotracheal Intubation ◽  
Elective Surgery ◽  
Randomized Study ◽  
Cardiovascular Responses ◽  
Pressor Responses ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Group D ◽  
Dexmedetomidine Infusion

Background: The objective of this study was to compare the efficacy of intravenous dexmedetomidine and esmolol in attenuating the cardiovascular pressor responses to laryngoscopy and endotracheal intubation.Method: Study was done on 60 adults, American society of anesthesiologists (ASA) grade I or II normotensive patients, undergoing elective surgery under general anesthesia and willing to participate. These patients were randomly allocated to either group E (esmolol) or D (dexmedetomidine). Group ‘D’, patients were given intravenous dexmedetomidine infusion 1 mcg/kg over 10 minutes, 3 minutes before start of laryngoscopy. Group ‘E’, patients were given intravenous esmolol 1.5 mg/kg 2 minutes before start of laryngoscopy. All patients were premedicated, induced and intubated using thiopentone and succinyl choline as per the protocol. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded at baseline (taken half an hour prior to anesthesia), before sedation, after induction but before intubation, immediately after endotracheal intubation and thereafter at 1, 2, 3, 4, 5 and 10 minutes.Results: Immediately after intubation, HR was similar in group D and group E, thereafter HR remained higher in group E as compared to group D, and difference was statistically significant. SBP, DBP and MAP recorded was higher in group E as compared to group D, and difference was statistically significant.Conclusion: Authors conclude that intravenous dexmedetomidine 1 ug/kg is better drug to attenuate hemodynamic response to laryngoscopy and intubation as compared to intravenous esmolol 1.5 mg/kg.

scholarly journals Effects of Dexmedetomidine Infusions on Hemodynamic Stability in Patients undergoing Laparoscopic Cholecystectomy

2018 ◽  
Vol 04 (01) ◽  
pp. 010-014
Author(s):  
Himanshu Dodeja ◽  
Vinaya Udaybhaskar ◽  
Amol Singam
Keyword(s):  
Blood Pressure ◽  
Laparoscopic Cholecystectomy ◽  
Cardiovascular System ◽  
Normal Saline ◽  
Pressor Response ◽  
Hemodynamic Instability ◽  
System Stability ◽  
Plasma Catecholamine ◽  
Hemodynamic Stability ◽  
Inhalation Agent

Abstract Objectives: In laparoscopic cholecystectomy, there has been emphasis on maintaining hemodynamic stability by avoiding hypertension, hypotension, or tachycardia. The hemodynamic instability is persistent during the duration of pneumoperitoneum (PNP), namely, CO2 insufflations. This study helps us to find out the efficacy of dexmedetomidine on cardiovascular system stability in patients undergoing laparoscopic cholecystectomy. Materials and methods: Thirty patients were randomized into two groups of 15 members each: group P (placebo group) and group D (dexmedetomidine group). In the former, patients received 0.9% 20 mL normal saline, while in the latter, patients received 0.4 μg/kg/hr of injection dexmedetomidine in 0.9% normal saline. In all patients, age, weight, height, systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded. Results: Dexmedetomidine being a highly selective and potent and specific alpha 2 agonist attenuates the hemodynamic response to tracheal intubation, decreases plasma catecholamine concentration during anesthesia, and decreases perioperative requirements of inhaled anesthetics. We found that dexmedetomidine helped in blunting the pressor response during the intubation, kept the HR and mean arterial pressure stable intraoperatively, and there was faster recovery as the requirement of inhalation agent was decreased intraoperatively. Conclusion: The drug dexmedetomidine maintained cardiovascular stability during laparoscopic cholecystectomy. The inhalational agent (isoflurane) requirement was found to be considerably lower. Also, the mean recovery time as indicated by the ability to vocalize following extubation was found to be significantly less. Hence, it can be recommended in laparoscopic cholecystectomy for maintaining cardiovascular system stability.

scholarly journals “EVALUATION OF DEXMEDETOMIDINE ON HEMODYNAMICS IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY

2021 ◽  
pp. 1-2
Author(s):  
D.V.Rama Siva Naik ◽  
J.Sudheer Kumar
Keyword(s):  
Blood Pressure ◽  
Laparoscopic Cholecystectomy ◽  
Normal Saline ◽  
Surgical Stress ◽  
Saline Group ◽  
Normal Saline Group ◽  
Sympathetic Response ◽  
Adrenoceptor Agonist ◽  
Elective Laparoscopic Cholecystectomy ◽  
Group D

Background: The physiological response to surgical stress and anaesthesia is well documented. Laparoscopic surgery which involves insufflation with carbon dioxideproduces undesirable responses like hypertension, tachycardia and dysrhythmias. Introduction of Dexmedetomidine which is highly specific and selectiveα2 adrenoceptor agonist has been tried in various studies to modify the stress response to surgery and to have a pleasant anaesthetic outcome with minimal cardiovascular changes. In our present study we have taken the pharmacological advantage of Dexmedetomidine to study the various cardiovascular parameters at different periods during the laparoscopic procedure. The aim is to studythe effectiveness of Dexmedetomidineinattenuating the sympathetic response tolaryngoscopy and endotracheal intubation and in maintaining the hemodynamic stability in laparoscopic cholecystectomy. Materials & Methods: 30 ASA I and II patients of either sex, scheduled for elective Laparoscopic Cholecystectomy under General anaesthesia were randomly allocated to receive either 1mcg/kg of Dexmedetomidine in 100ml of 0.9% normal saline (Group D,n=30) or 100ml of 0.9% normal saline(Group S, n=30) 30min beforeinduction. Results: In patients who received Dexmedetomidine there was a statistically significant differencein heartrate, systolic blood pressure, diastolic blood pressure and meanarterial pressures during Laparoscopy and Intubation. Conclusion: Dexmedetomidine when given as a premedication before Laparoscopic Cholecystectomy attenuates the sympathetic response to laryngoscopy and intubation and provides stable intra operative hemodynamics.

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