Clinical efficacy of clonidine versus nalbuphine as intrathecal adjuvants to 0.5% hyperbaric bupivacaine for subarachnoid block during gynaecological procedures: a double blind study

Background: Regional anesthesia techniques for gynaecological procedures are on increasing trends due to their advantage of postoperative analgesia owing to intrathecal adjuvants. The present study was aimed to comparatively evaluate the clinical efficacy of clonidine with nalbuphine when co-administered intrathecally with 0.5% hyperbaric bupivacaine for gynaecological procedures.Methods: Regional anesthesia techniques for gynaecological procedures are on increasing trends due to their advantage of postoperative analgesia owing to intrathecal adjuvants. The present study was aimed to comparatively evaluate the clinical efficacy of clonidine with nalbuphine when co-administered intrathecally with 0.5% hyperbaric bupivacaine for gynaecological procedures.Results: The onset of sensory block was earlier in patients of Group BN (3.91±2.25 min vs 4.30±0.87 min, p=0.039). The onset of motor block was also earlier in patients of Group BN (p=0.042). The time to first rescue analgesia in patients receiving intrathecal clonidine was significantly delayed (283±14.18 min vs 231.50±26.18 min, p=0.001). Intraoperative hemodynamic changes were comparable and none of the patient suffered from respiratory depression, shivering, nausea or vomiting.Conclusions: Intrathecal clonidine as adjuvant to bupivacaine provided was clinically more effective than nalbuphine for prolonging the duration of analgesia for gynaecological procedures

Comparative evaluation of dexmedetomidine with clonidine as premedication for attenuation of hemodynamic responses during laryngoscopy and endotracheal intubation under general anesthesia

Background: Direct laryngoscopy and tracheal intubation predictably leads to tachyarrhythmia and hypertension which are usually transient and variable, but these changes may be fatal in high risk patients. These hemodynamic responses can be attenuated by appropriate premedication. Dexmedetomidine and clonidine, alpha- 2 adrenergic agonist, might do so. The present study was aimed to compare these drugs for attenuation of hemodynamic responses. Methods: Sixty adult consented patients of ASA grade I and II between 18-58 yrs of age of either sex were randomly allocated into two equal groups of 30 patients each by computer generated random number table. They were administered either dexmedetomidine (Group A) or clonidine (Group B) in dose of 1μg.kg-1 intravenously as premedication. Hemodynamic changes during laryngoscopy and intubation were primary end points and any side effects due to drugs were observed as secondary end points.Results: After propofol induction there was more fall in heart rate in patients of dexmedetomidine group  as compared to clonidine group but with statistically non-significant difference (p value>0.05). After laryngoscopy and intubation, hemodynamic variations were more in patients of clonidine group than in dexmedetomidine group with statistically significant difference (p value<0.05). Bradycardia (HR<50/min) was observed in one patient of dexmedetomidine group and two patients in clonidine group, five minutes after intubation. Intraoperative hypotension was observed in one patient of dexmedetomidine group and in two patients of clonidine group.Conclusions: Dexmedetomidine premedication in dose of 1 μg.kg-1 provided more stable hemodynamics during induction with propofol and following laryngoscopy and intubation as compared to clonidine.

Clonidine versus fentanyl as adjuvant to 0.75% ropivacaine for epidural anesthesia for lower limb surgeries: a comparative evaluation

Background: Epidural adjuvants to local anaesthetic are used to enhance the quality and duration of surgical anaesthesia. The present study was aimed to compare the clinical efficacy of clonidine with fentanyl as adjuvant to epidural ropivacaine for block characteristics and hemodynamic changes during lower limb surgeries.Methods: Sixty adult consenting patients of both gender of ASA physical status I and II scheduled for lower limb surgeries under epidural anaesthesia, were randomized into   two groups of 30 patients each to receive either 15 ml of 0.75% ropivacaine with 1 ml of clonidine, 50 µg (Group RC) or with 1 ml of fentanyl 50 µg (Group RF). All patients were assessed for onset and duration of sensory and motor blockade and time to first rescue analgesia as primary end points. The hemodynamic variations, sedation, pruritus, respiratory depression or any other adverse events were recorded as secondary end points.Results: Onset of sensory block to T10 was comparable between the groups. Time to achieve maximum sensory level at T6-7 and maximum motor block was faster when fentanyl was used as compared to clonidine with statistically significant difference between the group (p<0.05). Duration of sensory analgesia was enhanced with epidural clonidine, delaying the need for rescue analgesia. In clonidine group, side effects of sedation, bradycardia and hypotension were also observed. Only 5 patients of fentanyl group suffered from pruritus.Conclusions: Clonidine was more effective than fentanyl as epidural adjuvant to 0.75% ropivacaine for prolonging the duration of analgesia with fewer manageable side effects.

Comparative efficacy of intravenous premedication of clonidine versus nalbuphine on intraoperative hemodynamic profile of patients during surgery under general anesthesia: a randomized study

Background: Airway manipulation and surgical stimulation lead to variable changes in hemodynamic profile due to increase in plasma catecholamine levels, but these changes can be attenuated by appropriate premedication. The present study was designed to compare the clinical efficacy of intravenous premedication of clonidine with nalbuphine on intraoperative hemodynamic profile of patients during surgery under general anaesthesia.Methods: Sixty adult consenting patients of ASA physical status I and II of either gender were randomized into two groups of 30 patients each, to receive either intravenous clonidine (2 μg/kg) or nalbuphine (0.2 mg/kg), 10 min before induction with propofol. Direct laryngoscopy and intubation were facilitated with vecuronium bromide. Changes in heart rate, blood pressure and electrocardiogram were recorded at specific time intervals and were noted as primary variable. Any adverse effects and complications were recorded as secondary outcomes.Results: After laryngoscopy and intubation, the increase in mean heart rate and mean blood pressure occurred immediately in patients of both groups, but persisted up to 6 to 10 min in patients of clonidine group, thereafter the changes returned back to baseline values, while in patients of nalbuphine group, this increase persisted up to 8 to 10 min. The differences in hemodynamic changes between the groups were statistically significant throughout the surgery and post extubation.Conclusions: Intravenous clonidine was more effective than nalbuphine to attenuate the hemodynamics changes during stressful period of laryngoscopy, intubation and surgery

Clinical efficacy of dexmedetomidine in two different doses to attenuate the hemodynamic changes during laparoscopic cholecystectomy

Background: Laryngoscopy and laparoscopy lead to predictable hemodynamic changes. Dexmedetomidine is selective 2 agonist with dose dependent sedation, sympatholysis and analgesia, hence could provide stable hemodynamics during laparoscopic surgeries. The present study was aimed to compare the clinical efficacy of dexmedetomidine infusion in two different doses to attenuate the hemodynamic variations during laparoscopic cholecystectomy.Methods: Total 60 adult patients of ASA physical status I and II of both gender, scheduled for elective laparoscopic cholecystectomy, were randomly allocated into two groups of 30 patients. All patients were infused with loading dose of dexmedetomidine (1µg/kg) before induction. Patients of Group 1 received maintenance infusion of dexmedetomidine in doses of 0.3µg/kg/h and patients of Group 2 received maintenance infusion of dexmedetomidine in doses of 0.6µg/kg/h, continued till the end of surgery. Heart rate and blood pressure were recorded preoperatively, after dexmedetomidine administration, after induction, intubation, after creation of pneumoperitoneum and postoperatively. Intraoperative changes in heart rate and blood pressure were noted as primary variables and dexmedetomidine related side effects were noted as secondary outcomes, for statistical analysis.Results: The hemodynamic responses were attenuated in patients of both groups after laryngoscopy, intubation and creation of pneumoperitoneum but patients of Group 2 (0.6µg/kg/h) showed more stability in hemodynamics. The difference between the group was statistically significant (p value=0.001). No any evident complication or side effects occurred.Conclusions: Dexmedetomidine infusion was effective for attenuating the hemodynamic changes due to laryngoscopy and laparoscopy but were better with maintenance infusion of dexmedetomidine in dose of 0.6µg/kg/h.

Clinical efficacy of Esmolol, Lignocaine and Diltiazem as premedicant for attenuation of hemodynamic responses of laryngoscopy and endotracheal intubation- a comparative evaluation

Background: Direct laryngoscopy and endotracheal intubation after induction of anesthesia is almost always associated with hemodynamic stress response. The aim of this study was to compare esmolol, lignocaine and diltiazem for suppression of laryngoscopy and intubation response.Methods: This randomized prospective double-blind control study was performed on 120 patients of either sex, aged between 18 and 58 years of ASA physical status I and II with Mallampatti grade I and II, undergoing elective surgeries under general anesthesia with endotracheal intubation. Patients were randomized in four groups, Group N (normal saline), Group E (esmolol) 1.5mg/kg I.V, Group D (diltiazem) 0.2mg/kg I.V, and Group L (lignocaine) 1.5mg/kg I.V with 30 patients in each group. Hemodynamic parameters were recorded during the basal period, preinduction, during intubation and at specified intervals.Results: There was significant increase in systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate in the control group (Group N) in association with tracheal intubation. The heart rate was significantly lower in Group E (Esmolol group), followed by Group D (Diltiazem group) and Group L (Lignocaine group). Rate pressure product was significantly lower in group E as compared to other groups, followed by group D and group L. Maximum increase in rate pressure product (RPP) just after laryngoscopy and intubation was ±74.29% in group N, ±16.11% in group E, 25.38% in group D and 38.77%in group L.Conclusions: Esmolol was better than diltiazem and they both were better than lignocaine for preventing the hemodynamic response after laryngoscopy and intubation

Changes in morphology of white blood cells on peripheral smear in COVID-19 infection

Background: COVID-19 is an infectious disease caused by a newly discovered coronavirus, and has spread around the world in a deadly pandemic. The first case of COVID-19 was reported from Wuhan, China in December 2019. This is also called as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) because of its homology with SARS virus. The most common hematological manifestation of coronavirus is lymphopenia which is due to depletion of lymphocytes by coronavirus infection. Other manifestations are neutrophilia and mild thrombocytopenia. Literature is full of quantitative hematological parameters but the researches on morphology of white blood cells is still ongoing. We at our institute done study on 60 confirmed positive cases of COVID-19, and analyzed those peripheral smears in terms of morphology of white blood cells.Methods: The study was done using peripheral smear staining with methylene blue stain and was screened for various changes in white blood cells in peripheral smear.Results: Changes in the white blood cells were examined in the peripheral smear and findings were made in the tabular form.Conclusions: To conclude that all these changes are due to the virus infecting them or are secondary to pathogenesis of COVID disease, needs to be evaluated by larger studies

Dexmedetomidine infusion during middle ear surgery under general anaesthesia to provide oligaemic surgical field: A prospective study

Background and Aims: Middle ear surgery requires bloodless surgical field for better operating conditions, deep level of anaesthesia and rapid emergence. Recent studies suggest that α2 agonists could provide desired surgical field, sedation and analgesia. The present study was aimed to evaluate the clinical effects of dexmedetomidine infusion as anaesthetic adjuvant during middle ear surgery using operating microscope. Methods: Sixty four adult patients aged 18-58 years, American Society of Anaesthesiologists Grades I and II, of both gender were randomised into two comparable equal groups of 32 patients each for middle ear surgery under general anaesthesia with standard anaesthetic technique. After induction of general anaesthesia, patients of Group I were given dexmedetomidine infusion of 0.5 μg/kg/h and patients of Group II were given placebo infusion of normal saline. Isoflurane concentration was titrated to achieve a systolic blood pressure 30% below the baseline value. All patients were assessed intra-operatively for bleeding at surgical field, haemodynamic changes, awakening time and post-operative recovery. Results: Statistically significant reduction was observed in the required percentage of isoflurane (0.8 ± 0.6%) to maintain the systolic blood pressure 30% below the baseline values in patients receiving dexmedetomidine infusion when compared to those receiving placebo infusion (1.6 ± 0.7%). Patients receiving dexmedetomidine infusion had statistically significant lesser bleeding at surgical field (P < 0.05). The mean awakening time and recovery from anaesthesia did not show any significant difference between the groups. Conclusion: Dexmedetomidine infusion can be safely used to provide oligaemic surgical field for better visualization using operating microscope for middle ear surgery

Clinical efficacy of oral gabapentin versus clonidine for preemptive analgesia in knee arthroplasty under epidural anesthesia with 0.75% Ropivacaine – A comparative study

Background: The preemptive analgesia for knee arthroscopic repair may reduce the postoperative pain without affecting the mobility of patients. The present study was designed to compare the clinical efficacy of oral gabapentin with clonidine as preemptive analgesic to epidural ropivacaine (0.75%) for knee arthroscopic repair, done under epidural anesthesia. Patients and Methods: Sixty adult patients of both genders of the American Society of Anesthesiologists physical status I and II aged 20–58 years, scheduled for knee arthroscopic repair under epidural anesthesia, were randomized into two groups of 30 patients each. Patients of Group RG were given oral gabapentin 300 mg, and patients of Group RC received oral clonidine 100 μg, 90 min before surgery with sip of water. All patients received epidural anesthesia with 15 ml of 0.75% ropivacaine. Groups were compared for onset and duration of sensory and motor blockade and postoperative analgesia as primary end points. Intraoperative hemodynamic changes, sedation score, or any side effects were evaluated as secondary end points. Results: The onset of complete sensory block to T10 (15.4 ± 4.7 vs. 17.5 ± 3.8 min) and time to achieve complete motor block (23.7 ± 3.3 vs. 26.9 ± 1.4 min) was earlier in patients of Group RC. Postoperative analgesia was prolonged in patients of Group RG (248.17 ± 19.6 vs. 217.36 ± 12.3 min). Intraoperative hemodynamic changes showed no significant difference. There was an increased incidence of nausea and vomiting in clonidine group. Conclusion: Oral gabapentin proved to be better as preemptive adjuvant for providing postoperative analgesia and good sedation during knee arthroscopic repair