Evaluation of the merits of two drugs-dexmedetomidine and ketamine for day care hysteroscopic procedures

Background: The aim was to compare the hemodynamic changes intra operatively and to ascertain the superior efficacy of the study drugs Dexmedetomidine, a highly selective alpha-2-adrenoceptor agonist having sympatholytic, dose dependent sedation, analgesic properties, amnestic effect without respiratory depression and Ketamine, a n-methyl-d-aspartate receptor antagonist, a dissociative sedative hypnotic with potent analgesic properties and marked sympathomimetic effects, have been taken for day care (ambulatory) hysteroscopic procedures. The objectives are to evaluate the requirement of rescue sedative and /or analgesic during the procedure and any complication of the drugs per-operatively.Methods: About 25 patients in each group in the range of age 20 to 55 years, weight 40-60 kg, height 145-155 cm, ASA I and II were injected with dexmedetomidine (D) 100 µg IV or Ketamine (K) 75 mg IV both over 10 mins at the onset of the procedure. Maintenance of anaesthesia had been done on mask ventilation with 30% oxygen and 70% nitrous oxide.Results: The demographic data was statistically insignificant. The haemodynamics were stable in the group D, not in group K, ‘p’ value <0.0001. The request for rescue sedation propofol and rescue analgesic fentanyl and the number of top up doses were higher in the group K, p’ value <0.01, statistically highly significant. Group K had suffered more per-operative complications.Conclusions: Dexmedetomidine for day care hysteroscopic procedures can be the anaesthetic drug of choice

Response to low-dose intrathecal clonidine in septuagenarians undergoing sub-umbilical surgeries: A study

Clonidine, an alpha-2-adrenergic agonist, may have a clinically relevant analgesic action but also a hypotensive action, when administered spinally. Aim: To evaluate the analgesic and circulatory effects of low-dose intrathecal clonidine co-administered with hyperbaric bupivacaine in septuagenarian patients undergoing sub-umbilical surgeries. Materials and Methods: A total of 20 patients within the age group of 70-80 years of either sex, enrolled in this study, were randomly divided into groups of 10 each. Group I received clonidine 7.5 μg as an adjuvant to 15 mg of hyperbaric bupivacaine and Group II (control group) received 15 mg of bupivacaine with saline to make volume in the two solutions equal. Result: The level of subarachnoid block was comparable in the two groups. Duration of motor blockade was longer in the clonidine group (221.4 ± 35.92 min) compared with the control group (112.3 ± 12.45 min). Request for 1 st dose of analgesic was earlier in the control group (135.5 ± 28.52 min) than the clonidine group (295 ± 18.85 min). Mean arterial pressure (clonidine 77.67 ± 6.47 vs. control 93.87 ± 3.03, P = 0.0002) and heart rate (clonidine 65.2 ± 5.20 vs. control 77.4 ± 6.06, P = 0.003) were significantly lower (P < 0.05) in the clonidine group compared with the control group from 20 mins after the block to the end of 3 h. In the clonidine group, 3 patients had postoperative headache, 4 had intra-operative shivering. 2 patients in the clonidine group also developed hypotension and 1 bradycardia and 1 of them developed bradyapnea along with acute hypotension 5 min after shifting to the postoperative ward and later recovered on resuscitation. In the control group 2 patients had bradycardia, 6 had intra-operative shivering and 3 had postoperative headache. Conclusion: We conclude that addition of clonidine in the dose of 7.5 μg to bupivacaine significantly increases the duration of spinal analgesia with clinically insignificant influence on hemodynamic parameters

Hysteroscopic procedure as day care cases under TIVA with Dexmedetomidine vs Ketamine

Background: Day care surgery under total intravenous anaesthesia where the patient is discharged the same day has made hysteroscopy, a form of minimally invasive surgery, the most frequently performed gynaecological procedure. Aim and objective: Dexmedetomidine, a highly selective alpha-2-adrenoceptor agonist having dose dependent sedation, analgesic properties and Ketamine, a n-methyl-d-aspartate receptor antagonist, a dissociative sedative hypnotic with potent analgesic properties have been chosen to compare their efficacy, evaluate the requirement of rescue sedative and/or analgesic, haemodynamic changes and any complication per-operatively for day care hysteroscopic procedures. Methods: 25 patients in each group in the range of age 20 to 55yrs, weight 40-60kg, height 145-155cm, ASA I and II were administered dexmedetomidine (D) 100µg IV or Ketamine (K) 75mg IV both over 10 mins, at the onset of the procedure. Maintenance of anaesthetia had been done on mask ventilation with 30% oxygen and 70% nitrous oxide. Results: The demographic data was statistically insignificant. The haemodynamics were stable in the group D, not in group K, ‘p’ value &lt;0.0001. The requirement of rescue sedative propofol, midazolam and rescue analgesic fentanyl and the number of top up doses were higher in the group K, p value &lt;0.01, statistically highly significant. Group K had suffered more per-operative complications. Conclusion: Dexmedetomidine for day care hysteroscopic procedures can be the anaesthetic drug of choice.</jats:p

Evaluation of the merits of two drugs-dexmedetomidine and ketamine for day care hysteroscopic procedures

Background: The aim was to compare the hemodynamic changes intra operatively and to ascertain the superior efficacy of the study drugs Dexmedetomidine, a highly selective alpha-2-adrenoceptor agonist having sympatholytic, dose dependent sedation, analgesic properties, amnestic effect without respiratory depression and Ketamine, a n-methyl-d-aspartate receptor antagonist, a dissociative sedative hypnotic with potent analgesic properties and marked sympathomimetic effects, have been taken for day care (ambulatory) hysteroscopic procedures. The objectives are to evaluate the requirement of rescue sedative and /or analgesic during the procedure and any complication of the drugs per-operatively.Methods: About 25 patients in each group in the range of age 20 to 55 years, weight 40-60 kg, height 145-155 cm, ASA I and II were injected with dexmedetomidine (D) 100 µg IV or Ketamine (K) 75 mg IV both over 10 mins at the onset of the procedure. Maintenance of anaesthesia had been done on mask ventilation with 30% oxygen and 70% nitrous oxide.Results: The demographic data was statistically insignificant. The haemodynamics were stable in the group D, not in group K, ‘p’ value &lt;0.0001. The request for rescue sedation propofol and rescue analgesic fentanyl and the number of top up doses were higher in the group K, p’ value &lt;0.01, statistically highly significant. Group K had suffered more per-operative complications.Conclusions: Dexmedetomidine for day care hysteroscopic procedures can be the anaesthetic drug of choice.</jats:p

Non invasive Management of Post Dural Puncture Headache - A Comparison

Aim: To evaluate the efficacy of oral Theophylline for the management of post dural puncture headache (PDPH). Material and Method: Forty patients with PDPH, whose surgeries were done under spinal anaesthesia, were selected randomly and divided into two groups of 20 each. One group to receive conservative treatment and the other group Theophylline (400 mg) only orally. Intensity of headache was analysed using a visual analogue scale (VAS) of pain. Assessment was done immediately before (0 h) and at 8, 16 and 24th hr of drug administration. Result: Significantly better relief of PDPH was found in Theophylline (9.3±5.7) than the conservative group (56.7 ±10.2) (p&lt;0.001). Recurrence of headache was found in 2 patients (10 %) at 16th hr and 2 (10%) at 24th hr in the Theophylline group compared to 12 (60%) and 14 (70%) patients respectively in the other group. Conclusion: The study concludes that Theophylline in the management of post dural puncture headache may be considered the best choice over the conventional approach. DOI: http://dx.doi.org/10.3329/bjms.v13i2.18292 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.114-118</jats:p