Awareness about anaesthesia in India: a survey in southern India

Background: Anaesthesia has achieved great heights and made advances. Patients are more concerned about operative aspect of his/ her treatment. A section of society still thinks anaesthesia to be a part of surgery. Anaesthesiologists have developed great skills but do not take effort to convey skills to lay persons.Methods: This study was conducted in Telangana (southern India). 500 persons were given a questionnaire in local language. Study was done on two group of people on urban and rural population.Results: In both groups 60- 65% are afraid of postoperative pain.  Awareness about nausea and vomiting is 15%- 25% in both groups. 90% of population is not worried about regaining consciousness after surgery.Anaesthesiologist- Urban (90%) and rural (76%) population thinks  anaesthesia is given by anaesthesiologist but 35% of urban and 60% of rural thinks anaesthesiologist is less important than surgeon.Consent- 91% of urban and 78% of rural knows regarding high risk consent. Only 56% of urban and 22% of rural knows that the risk is explained by anaesthesiologist and the rest think that it is explained by surgeon, nurse or assistant. NBM-It is disappointing to know that only 20% urban 45%rural is aware of 8 hours NBM before surgery.Conclusions: According to this study 1/3rd of urban population has limited knowledge about importance of anaesthesia as part of their treatment. Risk is explained by person other than anaesthesiologist. Knowledge about fasting before surgery is extremely low in urban population. Hence anaesthesiologist must make efforts to improvise in above mentioned fields.

Comparative study on Haemodynamic response to extubation: Attenuation with Lignocaine, Esmolol, Propofol

Background: Endotracheal extubation is an unpredictable and tricky part of anaesthetic management. Elevation in blood pressure and heart rate due to extubation are brief but may have detrimental effects. Hence there should be an effective means of attenuating sympathetic responses to tracheal extubation. Many strategies have been advocated to minimize these hemodynamic adverse responses. Among the recommended procedures i.v. lignocaine, fentanyl and esmolol appear to fulfil the above mentioned criteria.Methods: This prospective randomized study was done on 90 patients to evaluate haemodynamic effects of intravenous Propofol, Lignocaine, Esmolol given two minutes prior to extubation.Results: Heart rate, Systolic, Diastolic and Mean blood pressure decreased significantly to Esmolol 1.5mg/kg and propofol 0.5 mg/kg 2 minutes prior to extubation. With lignocaine there was an initial rise in blood pressure. Lignocaine, Esmolol and Propofol were able to attenuate cough and strain of extubation in > 90% of the patients.Regarding Esmolol, our study coincided with similar studies done by different authors but we found that esmolol in doses of 1.5mg/kg showed better results to control haemodynamic response during extubation.  Sedation score was a little high in Propofol group. Extubation scoring was good with all the three drugs.Conclusions: Esmolol IV is preferred for attenuation of haemodynamic responses when compared with IV propofol 0.5 mg/kg and IV lignocaine (2%) 1 mg/kg as the attenuation effect is elicited immediately.

Effect of intravenous dexmedetomidine (1µg/kg) in obtunding the pressor response to laryngoscopy and tracheal intubation compared to intravenous preservative free 2% lignocaine (1.5mg/kg)

Background: Haemodynamic variation during layngoscopy/intubation is always a matter of concern for Anesthesiologists. A stable circulatory system is the wish of all performing general anaesthesia. Hence an acceptable and easy method needs to be established to prevent the haemodynamic variations. Our aim was to evaluate the effect of intravenous Dexmedetomidine (1µg/kg) infusion in obtunding the pressor response to laryngoscopy and tracheal intubation compared to intravenous preservative free 2% Lignocaine (1.5mg/kg).Methods: In this study, 60 patients, aged between 18-60 years belonging to ASA I and II are included. They were randomly divided into 2 groups, each comprising of 30. In group D, patients were given Dexmedetomidine 1µg/kg IV infusion over 10min and in group L, patient were given Lignocaine 1.5mg/kg IV.Results: In group D, the systolic, diastolic, mean arterial pressure and heart rate decreased significantly, from baseline, at first, second, third, fourth and fifth minute post intubation. In group L, the systolic, diastolic, mean arterial pressure and heart rate increased from baseline at first and second minute and then decreased at third, fourth and fifth minute post intubation.Conclusions: When compared between the two groups all the hemodynamic parameters showed statistical significance. There are no significant side effects and severe haemodynamic variability like hypotension and bradycardia. Therefore we concluded that Dexmedetomidine is superior to lignocaine in blunting the hemodynamic response to laryngoscopy and endotracheal intubation without any significant side effects.

Comparative study on Haemodynamic response to extubation: Attenuation with Lignocaine, Esmolol, Propofol

Background: Endotracheal extubation is an unpredictable and tricky part of anaesthetic management. Elevation in blood pressure and heart rate due to extubation are brief but may have detrimental effects. Hence there should be an effective means of attenuating sympathetic responses to tracheal extubation. Many strategies have been advocated to minimize these hemodynamic adverse responses. Among the recommended procedures i.v. lignocaine, fentanyl and esmolol appear to fulfil the above mentioned criteria.Methods: This prospective randomized study was done on 90 patients to evaluate haemodynamic effects of intravenous Propofol, Lignocaine, Esmolol given two minutes prior to extubation.Results: Heart rate, Systolic, Diastolic and Mean blood pressure decreased significantly to Esmolol 1.5mg/kg and propofol 0.5 mg/kg 2 minutes prior to extubation. With lignocaine there was an initial rise in blood pressure. Lignocaine, Esmolol and Propofol were able to attenuate cough and strain of extubation in > 90% of the patients.Regarding Esmolol, our study coincided with similar studies done by different authors but we found that esmolol in doses of 1.5mg/kg showed better results to control haemodynamic response during extubation.  Sedation score was a little high in Propofol group. Extubation scoring was good with all the three drugs.Conclusions: Esmolol IV is preferred for attenuation of haemodynamic responses when compared with IV propofol 0.5 mg/kg and IV lignocaine (2%) 1 mg/kg as the attenuation effect is elicited immediately.