Comparison of the Effect of Pretreatment with Cisatracurium and Rocuronium on Succinylcholine Induced Fasciculation for Patients undergoing Surgery under General Anaesthesia: A Randomised Clinical Study

Introduction: Succinylcholine is the best agent for providing ideal intubating condition. Muscle fasciculation is common after succinylcholine administration and causes postoperative myalgia. Pretreatment with non depolarising muscle relaxant decreases fasciculation and myalgia after succinylcholine administration. Aim: To compare the efficacy between cisatracurium and rocuronium in preventing succinylcholine induced fasciculation in patients undergoing general anaesthesia and determining association between fasciculation and myalgia after succinylcholine use. Materials and Methods: The present study was a hospital-based, randomised, double-blinded clinical study conducted from January 2020 to July 2020. The study included 64 patients of American Society of Anaesthesiologists (ASA) grade I and II undergoing surgery under general anaesthesia which were randomly allocated in two groups. Group 1 (N=32) received intravenous (i.v.) cisatracurium (0.01 mg/kg) and group 2 (N=32) received i.v. rocuronium (0.06 mg/kg) as precurarising agent, three minutes before i.v. succinylcholine (1.5 mg/kg) administration. Incidence and intensity of fasciculation after succinylcholine injection was observed using a 4 point scale. Haemodynamic parameters were compared by measuring Mean Arterial Pressure (MAP) and Heart Rate (HR) before and after intubation. Patients were followed-up in Postanesthesia Care Unit (PACU) on Postoperative Day 1 (POD1) for myalgia. Observations in two groups were analysed using standard statistical test. Results: Fasciculation was significantly lower in group 2 (mean 0.2187±0.4200) than group 1 (mean 1.125±0.833, p-value <0.001). A significant association was found between fasciculation after succinylcholine injection and postoperative myalgia (p-value=0.007). Group 2 had less incidence of myalgia than group 1. However, the difference was not statistically significant. Conclusion: Rocuronium was more efficacious than cisatracurium in preventing succinylcholine induced fasciculation and rocuronium was more effective in preventing succinylcholine-related postoperative myalgia

Effects of Magnesium Sulphate, Dexmedetomidine and Lignocaine on Perioperative Haemodynamic and Postoperative Analgesia in Patients Undergoing Laparoscopic Abdominal Surgeries: A Randomised Clinical Study

Introduction: Laparoscopic surgeries currently represent the mainstay of surgical modalities. Pneumoperitoneum imposes significant intraoperative haemodynamic alterations, which are more pronounced in elderly patients and those with co-morbid conditions. Inadequate pain relief in the perioperative period may result in various physiological and psychological traumas. Aim: To investigate the effects of magnesium sulphate, dexmedetomidine, and lignocaine on the haemodynamic responses and postoperative analgesia in patients undergoing laparoscopic abdominal surgeries. Materials and Methods: This double-blinded, randomised clinical study was conducted in the general surgery operation theatre, Post-anaesthetic Care Unit (PACU), and the male and female surgery ward of RG Kar Medical College and Hospital, Kolkata, West Bengal, India from March 1, 2021, to March 1, 2022. The study involved 105 subjects assigned to Group-L, who received an injection of lignocaine as a loading dose of 1.5 mg/kg intravenously over 2-4 minutes before induction, followed by a continuous infusion of 2 mg/kg/hour throughout the surgery. Group-M received a loading dose of MgSO4 at 30 mg/kg over 15 minutes before induction, followed by 15 mg/kg/hour throughout the surgery, and Group-D received a loading dose of dexmedetomidine at 1 mcg/kg over 10 minutes before induction, followed by a continuous infusion of 0.5 mcg/kg/min throughout the surgery. Data on Heart Rate (HR), Mean Arterial Pressure (MAP), and the total dose of rescue analgesic administered in the postoperative 24 hours were recorded and analysed using Analysis of Variance (ANOVA) and Tukey’s Honestly Significant Difference (HSD) test, as well as the Chi-square test where applicable. A p-value of less than 0.05 was considered statistically significant. Results: The groups were comparable in terms of demographic variables and baseline haemodynamic status. The average age in Group-D was 39.13±9.48 years, in Group-M was 37.30±8.14 years, and in Group-L was 36.5±7.2 years (p=0.26). Group-D had 60% males, Group-M had 57% males, and Group-L had 60% males. The mean Body Mass Index (BMI) of Group-D was 25.9±2.03 (kg/m2), Group-L (Lignocaine) was 24.7±2.7, and Group-M (Magnesium Sulphate) was 23.8±3.2. Dexmedetomidine was found to be superior in maintaining haemodynamic stability throughout the perioperative period (Preinduction HR: Group-D=79.43, Group-L=79.06, Group-M=82.09; Postinduction HR: Group-D=86.49, Group-M=65.91, Group-L=72.69). There was a significant decrease in postintubation MAP, most pronounced in the Magnesium Sulphate and Dexmedetomidine groups. Post-pneumoperitoneum, the surge in MAP was most effectively prevented by Dexmedetomidine. The lowest amount of rescue analgesic (injection Diclofenac in mg) was used in the Dexmedetomidine group (55.86±5.05), followed by the Lignocaine group (126.43±17.69). Patients in the Magnesium group required the highest amount of rescue analgesic (156.43±7.91). The number of patients receiving rescue analgesia was significantly higher in the Lignocaine and Magnesium Sulphate groups (Group-D: 6.5±3.14565, Group-L: 14.75±7.36, Group-M: 18.25±8.057). Conclusion: Dexmedetomidine was more effective in maintaining haemodynamic stability throughout the perioperative period and exhibited superior postoperative analgesic properties. Magnesium Sulphate and lignocaine were more effective in preventing postintubation surges

Comparison of Digital and Bougie-aided Technique for Proseal Laryngeal Mask Airway Insertion in Mastoid Surgery: A Randomised Clinical Study

Introduction: While placing the Proseal-laryngeal Mask Airway (PLMA) using the digital technique, there may be failed insertion or inadequate ventilation. Therefore, a placement technique using the Gum Elastic Bougie (GEB)-aided placement was employed. Aim: To compare the clinical efficacy of Proseal Laryngeal Mask Airway (PLMA) insertion by two different techniques viz. Digital and Gum elastic bougie-aided, in mastoid surgery in adult patients done under General Anaesthesia. Materials and Methods: In this randomised clinical study conducted at the Department of Anaesthesiology, R.G. Kar Medical College, Kolkata, West Bengal, India from November 2016 to December 2022. A total of 88 patients of American Society of Anaesthesiologists (ASA) class I and II of either sex undergoing mastoid surgery using the PLMA as an airway management device were allocated to Digital (Group D) and gum elastic Bougie (Group B) techniques. Parameters studied included the percentage of successful insertion of PLMA on the first attempt, number of attempts required and time taken for successful insertion of PLMA and postoperative complications if any. The t-test was used to compare the groups regarding PLMA insertion time, while categorical data such as airway trauma was compared using Chi-square test or Fischer’s-exact test (whichever applicable). Results: In the present study 88 patients were included, with 44 patients in each of the two groups. The difference in Mallampati scoring of both groups was statistically insignificant. In the present study 68.18% patients in Gum elastic bougie group and 70.45% patients in Digital group were of ASA Grade I, showing no statistical significance between these two groups regarding ASA status. In Group B (GEB), PLMA was successfully inserted in 95.45% of cases on the first attempt, and in group D (digital) the corresponding figure was 77.27% and 22.72% of cases required a 2nd attempt, this difference was statistically significant (p-value<0.001). The difference of PLMA insertion mean time was statistically significant between the two groups (24.33±3.209 seconds in gum elastic bougie group whereas in digital group it was 13.42±3.228 seconds) (p-value <0.001). Conclusion: The GEB-aided Proseal-LMA insertion is more successful in the first attempt than in the digital technique. Although GEB-aided insertions of PLMA took longer, they helped achieve higher oropharyngeal leak pressure. With peak airway pressures less than 20 cm of H2O there was no audible leak from the drain tube and there were fewer failed insertions