European Journal of Molecular & Clinical Medicine

Background: Emergence agitation has potential to harm both patients and caregivers. This is more often witnessed in patient undergoing otolaryngology operations under general anesthesia with volatile anesthetic used for maintenance.
Aim: We investigated the effects of intra-operative dexmedetomidine infusion on emergence agitation and quality of recovery after functional endoscopic sinus surgery in adult patients.
Materials and Methods: One hundred patients undergoing functional endoscopic sinus surgery were randomized into two groups. The dexmedetomidine group (Group D, n = 50) received dexmedetomidine infusion at a rate of 0.4 mcg/kg/hr from induction of anaesthesia until extubation, while the control group (Group C, n = 50) received volume-matched normal saline infusion as placebo. Propofol (2 mg/kg) and fentanyl (2 mcg/kg) were used for induction of anaesthesia, and sevoflurane was used for maintenance of anaesthesia. The incidence of agitation, haemodynamic parameters, and recovery characteristics were evaluated during emergence. A 40-item quality-of-recovery questionnaire (QoR-40) was provided to patients 24 hours after surgery.
Results: The incidence of agitation was lower in Group D than Group C (28 vs 56 %, P = 0.018). Mean arterial pressure and heart rate were more stable intra-operatively and during emergence in Group D than in Group C (P < 0.05). Time to extubation, nausea and vomiting, and pain scores were similar between the groups. Global QoR-40 score at 24 hours after surgery was higher in Group D (mean 174.7 ± 6.99) compared with Group C (mean 169.4 ± 9.91) (P < 0.05).
Conclusion: Intra-operative infusion of dexmedetomidine provided smooth and hemodynamically stable emergence. It also improved quality of recovery after nasal surgery.

Introduction: Coronary artery disease (CAD) obstructs the supply of blood to the heart muscle through the coronary arteries. Atherosclerosis is main cause of CAD. Patient history: The male patient 54 year old who was apparently admitted in AVBRH on date 22/08/2019 with chief complaint was severe chest pain which is radiating to shoulder and also complaint f shortness of breath and sweating. Excessive palpitation since in 1 month. After admitted in the ward all investigation done like X-ray, ECG, 2 Day echo, CBC, Lipid profile, cardiac stress test, and coronary angiography, PT or PT-INR Test etc. All over investigation observe then final diagnosis is conforming by coronary artery diseases. Past history: Patient was having the history of hypertension since 7 year. He is known case of hypertension. He was come with the complaint of chest pain in the hospital in 2018 one year back diagnosed he was myocardial infarction. Clinical finding: The patient has been undergone with various investigations like physical examination, cholesterol and triglyceride are often elevated in patients with atherosclerosis, cardiac examination, X-ray, ECG, 2 Day echo, CBC, Lipid profile, cardiac stress test, and coronary angiography, PT or PT-INR Test etc. Pharmacology: Patient was treated with anti-angina agent and antihypertensive drug Medical Management: Tablet- amlo 5mg, Tablet- flavedon 35 mg, Tablet- ecosprin 150mg, Tablet- pan 40 mg, Tablet-ranolazine 500mg. Nursing management: Monitor the vital sign, Maintain O2 level and intake and output. Incision side is observed like any complication. Patient assessed for anxiety, depression and anger. Conclusion: Patient was admitted to hospital with the with chief complaint was severe chest pain, shortness of breath, excessive palpitation, sweating since in 1 months and his condition was very critical and patient was admitted in AVBR Hospital, immediate treatment was started by health team member and all possible treatment were given and now the patient condition is satisfactory.