European Journal of Molecular & Clinical Medicine

Introduction: Sevoflurane is one of the general anesthetic having  a  rapid  onset and offset of action. Hence anesthetist can control the depth of anesthesia rapidly. Intravenous propofol with rapid induction and  recovery  is a  popular  induction  agent nowadays for surgical anesthesia. Objectives: To compare the effect of sevoflurane and propofol for inducing anesthesia in short elective surgeries. Methods: The study was conducted at Government Medical College,Nizamabad,Telangana,India. Hundred patients prepared for elective short surgery were taken into the study. After pre-anesthetic medication, one group of patients were induced with : O2:N2O  (50:50)  +  Sevoflurane  3-4%  and the other group induced with:  O2:N20  (50:50)  +Propofol 3-5 mg/kg.Parameters like relavant intra-op details, ease of procedure, hemodynamic changes, recovery, and complication rate were compared between both groups.Results: Parameters like jaw opening, attempts for LMA and ease of insertion was comparable in both the groups . Time to loss of consciousness and time  to  LMA insertion was significantly shorter with Propofol. Mean pulse rate and MAP was significantly higher in Sevoflurane group.  Conclusion:  Inhaled Sevoflurane is better for LMA insertion and intra-operative hemodynamic profile during anesthesia was stable.Sevoflurane can be considered as an alternative induction agent when inhalational induction is required. We should keep in mind that  caution  still needs to be continued when sevoflurane is used.

 Background: In critically ill patients, Pain is a major problem; efficient pain management depends on a systematic, comprehensive assessment of pain. Hemodynamic parameters change with simple non-invasive procedures. Monitoring of the change will help in determining the better systematic way to carry out the procedures for quality care.
 Aim: The study aimed to review and synthesize current evidence on the impact of a systematic approach to pain assessment and hemodynamic monitoring on critically ill patient outcomes.
 Methods: A comprehensive search for primary research articles was conducted using the Medline and PubMed, Eric, Cochrane and google scholar databases, using the keywords ‘assessment of pain in mechanically ventilated patient’, ‘changes in hemodynamic parameter during nursing procedures’, ‘impact of nursing procedures on mechanically ventilated patients’ were entered into a search engine. A number of highly pertinent papers relevant to the aims of the review were identified, only those papers, which satisfied the inclusion criteria, were selected for inclusion in this review.
 Discussion: In the study all the reviews were able to produce significant results with regard to pain and hemodynamic parameters. Assessment of pain behaviours’ was common, these assessments were observed and documented with the use of is widely accepted that the use of reliable behavioural pain assessment tool can assist health care providers in early identification of pain in critical ill patients and subsequently in the prompt of efficient management of pain. An assessment tool for hemodynamic parameters was not developed in the above studies which might help the nurses to identify the patient’s discomfort.
 Conclusion: The nursing procedures such as suctioning, positioning, oral care   and changing of the dressing did bring change in hemodynamic parameters and as well induced pain to the patient. The procedures cannot be withheld instead it can be deliberately planned so as to provide comfort and quality care to the patient.

Background: When used in conjunction with bupivacaine to block the supraclavicular brachial plexus (SCBP), dexamethasone prolongs the motor and sensory blockade. The effect of dexamethasone (8 mg) when combined with levobupivacaine, on the other hand, has not been well investigated.
Aim: To determine the role of dexamethasone as an adjuvant to levobupivacaine in ultrasound guided SCBP block.
Materials and methods: Comparison of efficacy of levobupivacaine and levobupivacaine with dexamethasone in supraclavicular brachial plexus block was undertaken to compare duration of analgesia, requirement of rescue analgesics and the onset and duration of sensory and motor block among 2 groups. Patients in age group 18 to 60 years belonging to either sex of ASA class 1 or 2 posted for upper limb surgeries were divided into 2 groups of 30 patients each. Group S: 25 ml of 0.5% Levobupivacaine + 2ml Normal Saline Group D: 25 ml of 0.5%Ropivacaine + 2ml (8mg) Dexamethasone.
Results: There was no statistically significant difference in demographic data, duration of surgery, and hemodynamic parameters between the study groups. There was statistically highly significant difference in between the groups in terms of onset and duration of sensory and motor block and duration of analgesia (time to first rescue analgesia) and total number of rescue analgesics used.
Conclusion: Addition of dexamethasone to 0.5% levobupivacaine shortens the onset of sensory and motor block and increases the duration of sensory and motor block as well duration of analgesia in comparison to levobupivacaine alone in Supraclavicular Brachial Plexus Block for upper limb surgeries.

Background:This clinical study was undertaken to compare the effects of intrathecal
midazolam and fentanyl as additives to intrathecal bupivacaine 0.5 % for spinal
anaesthesia.
Materials and Methods: This prospective, randomized, comparative study was
conducted on 100 adult patients of ASA physical status 1 & 2 in the age group of 18
years to 60 years, at MAMATA GENERAL HOSPITAL, KHAMMAM. on patients
admitted for elective surgery from the period october 2017 - september 2019. Patients
belonging to Group A received 3 ml (15 mg) of hyperbaric bupivacaine (0.5 %) + 0.2 ml
(1 mg) of preservative free midazolam + 0.3 ml of normal saline and Group B received 3
ml (15 mg) of hyperbaric bupivacaine (0.5 %) + 0.5 ml (25 μg) of fentanyl. Patients were
preloaded with intravenous Ringer’s lactate solution 15 ml / kg just before
administering subarachnoid block. Subarachnoid block was administered in L3-L4
intervertebral space with 25G Quincke’s needle. Standard monitoring was carried out
in the form of pulse oximetry, ECG and non-invasive arterial blood pressure
monitoring. Pulse rate, respiratory rate, arterial blood pressure and oxygen saturation
were recorded every 5mins for first 10mins, every 10mins for next half an hour and
then every 15mins intra operatively. The following parameters were observed - onset
and duration of sensory blockade, maximum level of sensory blockade achieved, two
segment regression, onset and duration of motor blockade, duration of effective
analgesia and any side effects associated with these drugs like nausea, vomiting,
pruritis, bradycardia, and hypotension. Computer generated randomization was used
to allocate patients into two groups. Statistical analysis was done using T-test and
fischers exact test. P value of less than 0.05 was considered to be significant
Results: The present study concludes that there were no differences in the onset of
sensory and motor blockade, maximum level of sensory blockade achieved, and time for
two segment regression. 25μg intrathecal fentanyl was found to provide a longer
duration of sensory and motor blockade and prolonged the time for first rescue
analgesia as compared to 1mg intrathecal midazolam. There was no significant
difference between the two groups with respect to the occurrence of side effects.
Conclusion: Hence, we suggest that addition of intrathecal fentanyl is excellent additive
to Bupivacaine for prolongation of duration of anaesthesia without any deleterious
effects.

Introduction:The subarachnoid block is a safe and time-tested technique for
administering anesthesia for cesarean section due to its rapid onset and effective
sensory and motor blockade. Bupivacaine is available as a racemic mixture of its
enantiomers, dextrobupivacaine and levobupivacaine [1] and is the most frequently used
anesthetic agent for cesarean section.
Aims: This study was performed to compare the anaesthetic efficacy and safety of two
local anaesthetic agents: Hyperbaric Bupivacaine and Isobaric Levobupivacaine, in
patients undergoing elective caesarean section.
Methods and materials: It is prospective study in 100 patients, ASA I-II, were
randomized to receive an intrathecal injection of Hyperbaric Bupivacaine or Isobaric
Levobupivacaine. Group B (n = 50) received 2 ml of Hyperbaric Bupivacaine 5 mg/ml
(10 mg). Group L (n = 50) received 2 ml of Isobaric Levobupivacaine 5 mg/ml (10 mg).
The onset and duration of sensory and motor blockade, recovery parameters,
hemodynamic changes and side effects for the two agents were compared.
Results: The time of onset of sensory block was faster in Group B (1.80 ± 0.404) when
compared with Group L (2.02 ± 0.473). In Group B the time to two segment regression
was prolonged (74.68 ± 12.916) when compared with Group L (69.08 ± 3.349) and it is
statistically significant. Duration of motor blockade was prolonged in Group B (135.52
± 4.781) when compared with Group L (100.04 ± 9.165). Hemodynamic variables were
more stable in Group L than Group B. Twenty patients in Group B had adverse effects
when compared with ten patients in Group L.
Conclusion: 0.5% Isobaric Levobupivacaine 10mg for intrathecal injection of caesarean
section produces adequate sensory and motor blockade and stable hemodynamic
parameters with minimum adverse effects than 0.5% Hyperbaric Bupivacaine 10mg.
We concluded that Isobaric Levobupivacaine is a better alternative for caesarean
section.