EFFECT OF DEXMEDETOMIDINE ON DOSE REQUIREMENT OF PROPOFOL AND THIOPENTONE INDUCTION IN PATIENTS UNDER GENERAL ENDOTRACHEAL ANESTHESIA

Objectives: The present study was undertaken to assess the effect of dexmedetomidine as a premedicant on dose requirement of induction agents, thiopentone and propofol in patients undergoing various surgeries under general endotracheal anesthesia under the bispectral index (BIS) guidance.Methods: A double-blinded randomized controlled study was conducted during the year 2014–2015 among 120 patients aged 18–55 years with American Society of Anesthesiologists' physical status Score I or II and Mallampati Grades I and II. After obtaining informed consent, all the eligible patients were randomly assigned to one of the four groups each containing 30 patients: Group SP (control group) - saline infusion before induction with propofol, group DP - dexmedetomidine infusion before induction with propofol, group ST (control group) - saline infusion before induction with thiopentone, and group DT - dexmedetomidine infusion before induction with thiopentone.Results: The mean dose of propofol required was 95.0±6.15 mg and 55.0±7.0 mg in group SP and DP, respectively, whereas the requirement of thiopentone was 6.6±0.93 mg/kg in group ST as opposed to 4.8±0.58 mg/kg in group DT. The decrease in the dose requirement in dexmedetomidine groups than the control groups was statistically significant and also dose reduction in dexmedetomidine was more in DP group compared to that in DT group (p<0.001).Conclusion: Dexmedetomidine as a preanesthetic medication significantly decreases intraoperative anesthetic requirement of thiopentone and propofol, and dose requirement is significantly less in case of propofol as compared to thiopentone

EFFECT OF DEXMEDETOMIDINE ON DOSE REQUIREMENT OF PROPOFOL AND THIOPENTONE INDUCTION IN PATIENTS UNDER GENERAL ENDOTRACHEAL ANESTHESIA

Objectives: The present study was undertaken to assess the effect of dexmedetomidine as a premedicant on dose requirement of induction agents, thiopentone and propofol in patients undergoing various surgeries under general endotracheal anesthesia under the bispectral index (BIS) guidance.Methods: A double-blinded randomized controlled study was conducted during the year 2014–2015 among 120 patients aged 18–55 years with American Society of Anesthesiologists' physical status Score I or II and Mallampati Grades I and II. After obtaining informed consent, all the eligible patients were randomly assigned to one of the four groups each containing 30 patients: Group SP (control group) - saline infusion before induction with propofol, group DP - dexmedetomidine infusion before induction with propofol, group ST (control group) - saline infusion before induction with thiopentone, and group DT - dexmedetomidine infusion before induction with thiopentone.Results: The mean dose of propofol required was 95.0±6.15 mg and 55.0±7.0 mg in group SP and DP, respectively, whereas the requirement of thiopentone was 6.6±0.93 mg/kg in group ST as opposed to 4.8±0.58 mg/kg in group DT. The decrease in the dose requirement in dexmedetomidine groups than the control groups was statistically significant and also dose reduction in dexmedetomidine was more in DP group compared to that in DT group (p<0.001).Conclusion: Dexmedetomidine as a preanesthetic medication significantly decreases intraoperative anesthetic requirement of thiopentone and propofol, and dose requirement is significantly less in case of propofol as compared to thiopentone

EFFECT OF INTRAVENOUS VERSUS INTRATHECAL DEXMEDETOMIDINE ON CHARACTERISTICS OF HYPERBARIC BUPIVACAINE SPINAL ANESTHESIA IN LOWER LIMB SURGERY

Objectives: Dexmedetomidine was shown to prolong the duration of spinal anesthesia and enhance post-operative analgesia. The aim of the study was to compare the effect of intravenous (IV) versus intrathecal (IT) administration of dexmedetomidine on bupivacaine spinal anesthesia in patients undergoing lower limb surgery.Methods: A prospective randomized controlled study was conducted during the year 2014–15. 60 American Society of Anesthesiologists physical status I–II aged 18–60 years scheduled for lower limb surgery under spinal anesthesia were assigned randomly to two groups: (1) IT group (IT group) (n=30) patients received 3 ml of 0.5% hyperbaric bupivacaine and 5 μg of dexmedetomidine intrathecally (100 μg/1 ml ampoule drawn in 40 IU/ml insulin syringe making 5 μg=2 IU=0.05 ml) and (2) IV group (IV group) (n=30) received 3 ml of 0.5% hyperbaric bupivacaine and 0.05 ml of normal saline intrathecally followed 5 min later by IV dexmedetomidine 0.5 μg/kg by infusion pump over 10 min as a single dose.Results: The IT group had a statistically significantly earlier sensory onset to T10 and shorter time from injection to highest sensory level (p<0.001). The regression times of two dermatomes, regression time to S1 dermatome and time to reach Bromage 3 motor block were significantly less in the IT group, whereas regression time to Bromage 0 was prolonged (p<0.001). The IT group showed a significantly longer time to the use of rescue analgesia and less analgesic consumption in first 24 h than the IV group (p<0.001). Furthermore, the intensity of pain was significantly less in the IT group as compared to IV group (p<0.001). Compared with IV group, the IT group had low sedation score, fewer overall side effects, which was statistically not significant (p>0.05).Conclusion: In bupivacaine spinal anesthesia for limb surgeries, dexmedetomidine, when administered intrathecally, has greater augmentation to sensory and motor block, more hemodynamic stability, better analgesic properties, and fewer overall side effects compared to the IV route of administration

Comparative evaluation of bupivacaine with magnesium sulphate and dexamethasone as adjuvants in ultrasound-guided transversus abdominis plane block for open unilateral inguinal hernia surgeries: A randomised controlled trial

Background and Aims: Inguinal hernia repair is associated with moderate to severe pain that is most extreme in the first 24 hours. The aim of this study was to compare the efficacy of dexamethasone versus magnesium sulphate (MgSO4) with bupivacaine in ultrasound-guided transversus abdominis plane (TAP) block for patients undergoing unilateral inguinal hernioplasty. Methods: Eighty patients were randomly allocated to two groups to receive ultrasound-guided TAP block postoperatively with either 20 ml of 0.25% bupivacaine with 8 mg of dexamethasone (Group BD) or 20 ml of 0.25% bupivacaine with 250 mg of MgSO4 (Group BM). Patients were assessed for the first 24 hours after surgery for pain at rest and movement using a numerical rating scale (NRS). Two mg/kg of tramadol was administered as rescue analgesia. The time to first demand tramadol, total consumption of tramadol, patient satisfaction score and side effects were evaluated. Results: The time to the first dose of rescue analgesia was significantly longer in BD group (596.13 ± 57.93 min) than in the BM group (422.50 ± 51.95 min). The NRS scores in the BD group were significantly lower compared to the BM group both at rest and on movement. The total requirement of tramadol was significantly less in the BD group (154.55 ± 59.11 mg) compared to the BM group (270.25 ± 105.72 mg). The incidence of side effects was lower and patient satisfaction was higher in BD group compared to BM group. Conclusion: Bupivacaine with dexamethasone in TAP block after unilateral open inguinal hernioplasty provides increased duration of analgesia and decreased requirement for rescue analgesics compared to magnesium sulphate, with lesser side effects and better patient satisfaction