Haemodynamic changes during laparoscopic cholccystectomy: Effect of clonidine premedication

Clonidine has been shown to reduce perioperative haemodynamic instability. The aim of the study was to investigate the clinical efficiency of oral clonidine premedication in prevention of haemodynamic response associated with pneumoperitoneum. Sixty adult patients of ASA physical status I& II, scheduled for elective laparoscopic cholecystectomy were recruited for a prospective randomized, double-blinded comparative study. They were randomly allocated to one of the two groups to receive either oral clonidine 150 gg (Group C) or ranitidine 150 mg (Group P), 90 minute before induction of anaesthesia. Significant rise in heart rate was observed following pneumoperitoneum in Group P as compared to Group C (99.23±14.02 Vs 81.26±8.40 bpm). Similarly, rise in systolic arterial pressure (143.63±19.60 Vs 119.6±10.06 mm Hg), diastolic arterial pressure (99.23±14.02 Vs 81.26±8.40 mm Hg) and mean arterial pressure (114.13±16.57 Vs 93.83±8.107 mm Hg) was more in Group P following pneumoperitoneum. Nitroglycerine drip was started in 33.3% patients in Group P to control intraoperative hypertension. Incidence of postopera-tive nausea-vomiting and shivering was also less in Group C. To conclude, clonidine premedication provides perioperative haemodynamic stability, hence it can be recommended as a routine premedication for laparoscopic procedure

Anaesthetic concerns in post-COVID mucormycosis at a tertiary care hospital in India: An observational study

Administration of anaesthesia in post-COVID mucormycosis patients is a real challenge due to complications such as dyselectrolytemia, renal failure, multi-organ failure, and sepsis. The aim of this study was to evaluate the challenges and perioperative complications of administration of anaesthesia in terms of morbidity and mortality in patients undergoing surgical resection of post-COVID rhino-orbito-cerebral mucormycosis (ROCM). The present study was a case series, which was carried out on 30 post-COVID, biopsy-proven mucormycosis patients enrolled for ROCM resection under general anaesthesia, and all data were collected retrospectively for this series. The post-COVID mucormycosis patients had diabetes mellitus as the most common comorbidity (96.6%), and difficult airway was a common feature (60%) among them. Anaesthetic management of post-COVID mucormycosis patients is a real challenge due to associated comorbidities

Bedside prediction of airway length by measuring upper incisor manubrio-sternal joint length

Background: Malpositioning of endotracheal tube may lead to serious complications like endobronchial intubation or accidental extubation. Using anatomical measurements for prediction of airway length would be more practical in resource constrained settings. Materials and Methods: One hundred adult patients of American Society of Anesthesiologists (ASA) grade 1 or 2, without any evidence of difficult airway, were randomly allocated to two cohorts - a model cohort of 70 (50 males) and test cohort of 30 (20 males) subjects. Height, the straight length from the upper incisor to manubrio-sternal joint in fully extended head position (IncManustL), the length from upper incisor to the carina in neutral head position (IncCarinaL), and degree of neck extension were measured in all subjects. Relationship between the two lengths in the model cohort was explored by Pearson′s coefficient (r). Predictions were made for subjects in the test cohort and actual and predicted values assessed for agreement using intra-class correlation coefficient (ICC). Results: Good agreement was found between IncManustL and IncCarinaL for both male (r = 0.69) and female (r = 0.54) subjects. Multiple regression analysis suggested height to be another significant predictor, unlike age, weight, and neck extension. The gender-specific regression equations were used to predict IncCarinaL for the test cohort. ICC for absolute agreement between the actual and predicted values was 0.723 (95% CI 0.495-0.858). Conclusions: It is possible to predict airway length in adult Indian subjects by making two simple anatomical measurements, namely stature and incisor manubrio-sternal joint length

Effects of progressive muscle relaxation on postmenopausal stress

Background: Menopause increases stress level among females and this may be a contributing factor in developing metabolic syndrome. Objectives: The objective of this study is to study the effects of progressive muscle relaxation on cardiorespiratory efficiency and autonomic functions in over weight and obese working stressed postmenopausal females. Materials and Methods: A total of 30 postmenopausal overweight or obese (body mass index [BMI]: 24.97 ± 1.28) females belonging to the age group 50-55 years were included. Stress level in the subjects was assessed according to the presumptive life event stress scale. The perceived stress scale (PSS) of Sheldon Cohen was used for measuring the perception of stress. Fasting blood samples were collected to exclude diabetic subjects and analyze lipid profile. BMI and waist/hip ratio were calculated. Resting pulse rate and blood pressure, respiratory rate were measured. VO 2 max, physical fitness index, breath holding time and 40 mm endurance test time were calculated for estimation of cardiopulmonary efficiency. Autonomic function tests were carried. Subjects were given progressive muscle relaxation training for 3 months and all parameters were reevaluated. Data was analyzed using SPSS version 16 (SPSS Inc., Chicago, USA). Results: PSS in pre-training session was 26.16 ± 1.7 and in post-training session was 14.33 ± 2.01 and the difference was statistically significant. There was a significant decrease in pulse rate, blood pressure, BMI, waist/hip ratio, cholesterol, low-density lipoprotein following preventive medicine residency training. Results of autonomic function tests and cardiopulmonary efficiency test improved significantly following relaxation training. Conclusions: Increased stress levels may increase BMI and waist/hip ratio, dyslipidemia and lead to autonomic dysfunctions and increase incidence of cardiovascular disease in postmenopausal females. Lifestyle modification with relaxation exercises decreases stress levels and improves autonomic functions, cardiopulmonary efficiency, and lipid profile

Cardio-respiratory response of young adult Indian male subjects to stress: Effects of progressive muscle relaxation

Background: Stress and anxiety have become an integral part of our lives. Of late, this has resulted in the increase in incidence of hypertension and coronary heart disease. Objectives: To assess the effect of progressive muscle relaxation (PMR) on young adult males and its role in the modulation of cardio-respiratory response on exposure to stress. Materials and Methods: This prospective cross-sectional study was conducted in a tertiary care referral hospital. Undergraduate male students under stress were chosen for the study. Fasting blood samples were drawn to analyze sugar and lipid profile, followed by anthropometric measurements and ECG. In the resting condition, blood pressure, pulse rate, and spirometric parameters; forced vital capacities (FVC), and forced expiratory volume in 1 sec (FEV 1 %) were measured. Then, they were made to exercise with bicycle ergometer and post exercise, the vital parameters were recorded. All subjects were given a training of Jacobson′s Progressive Muscular Relaxation and asked to practice this technique for 3 months. All parameters were re-evaluated. Results: Significant decreases in resting heart rate, systolic blood pressure and diastolic blood pressure, total cholesterol, triglyceride, and low density lipoprotein (LDL) cholesterol levels of subjects were seen after PMR training. Exercise-induced rise in heart rate and blood pressure were also significantly less in subjects following PMR training. Conclusion: Progressive muscle relaxation helps in modulation of heart rate, blood pressure, and lipid profile in healthy normal adult male individuals

Parkinson′s Disease and Anaesthesia

Parkinson′s disease is a debilitating neurodegenerative disorder due to death of dopaminergic neurons of the substantia nigra that leads to resting tremor, muscle rigidity, and bradykinesia. Parkinson′s disease is a common disease of elderly patients who present a particular anaesthetic challenge. Good number of patients are newly diagnosed at the time of preanaesthetic examinations. Variety of drugs may be used for symptomatic treatment. Controversies surrounding the use of the newer drugs and possible advances in neurosurgical interventions are discussed. Particular anaesthetic problems in Parkinson′s disease include respiratory, cardiovascular, and neurological. Potential drug interactions are described and recommendations are made about suitable anaesthetic technique