Online ISSN: 2515-8260

Keywords : General Anesthesia


To compare the intraoperative haemodynamic parameters and cost effectiveness between sevoflurane (inhalational) anaesthesia and propofol (tiva) based anaesthesia

Dr Ravneet Singh Bhusari

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 6, Pages 445-450

Aim: To compare the intraoperative haemodynamic parameters and cost effectiveness between sevoflurane   (inhalational)   anaesthesia   and propofol (tiva) based anaesthesia
Methods: Following informed consent, hundred ASA I and II patients aged 19-63 years of either sex having general anaesthesia were randomly split into two groups of 50. Patients with an ASA of III or higher, major cardiovascular, renal, or pulmonary disease, a history of malignant hyperthermia, any documented allergy to the study agent, H/O any mental condition, or use of sedative medicines were excluded from the study. Sevoflurane was used in Group A, while Propofol was used in Group B.
Results: The Sevoflurane group (51.02±4.52) had a quicker induction time (sec) than the Propofol group (61.29±5.51), which was statistically significant (p<0.001). The recovery profile after the agents were withdrawn at the conclusion of surgery revealed a significant difference in spontaneous eye opening (9.5±1.3 min in Sevoflurane group and 13.4±1.4 min in Propofol group), verbal communication (11.5±1.9 min in Sevoflurane group and 14.6±1.9 min in Propofol group) and mental orientation (16.1±1.6 min Sevoflurane group and 20.3±2.1min Propofol group) (p<0.001), with Sevoflurane demonstrating the superior recovery profile.
Conclusion: In terms of quicker induction and rapid recovery characteristics, we discovered that Sevoflurane outperforms Propofol. The intraoperative hemodynamics of the two groups were equivalent, with no statistically significant difference. However, Sevoflurane-based anaesthesia is still more expensive than Propofol, which if addressed would serve as a good choice of anaesthesia in impoverished nations.

A COMPARISON OF PROPOFOL VERSUS KETOFOL PLUS FENTANYL AS INDUCTION AGENTS ON HEMODYNAMIC PARAMETERS IN PATIENTS UNDERGOING ELECTIVE SURGICAL PROCEDURES UNDER GENERAL ANESTHESIA

Krishna Reddy Pingili, Raghuveer Chinnapaka, Nandaraj Dubbaka, M. Sindhura

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2407-2417

Background: Propofol has gained a lot of popularity and is very commonly used in elective surgeries due to its solubility, rapid induction, quick recovery time along with its amnestic and antiepileptic properties make a potent anesthetic agent. Exclusive uses of propofol to provide LMA might be associated with some undesirable effects which are dose-dependent are like hypotension, respiratory depression, coughing, hiccups, laryngospasm, and movements. Forgoing studies reveled that a combination of ketamine and propofol decreased patients' use of propofol and opioids and improved hemodynamic and respiratory stability. The prime objective of our study is to substantiate the earlier results regarding whether the efficacy of the ketamine-Propofol-Fentanyl combination has more favorable hemodynamics than the gold standard prototypic induction drug (Propofol) in a cohort of healthy patients and to compare the additional post-operative analgesia requirements between the two groups.
Materials and Methods: The clinical prospective observational study was done on 240 individuals which were divided in to 2 equal groups (120 each group), the, Group A (Propofol) received 2.5 mg/kg Propofol for induction and the Group B (Ketamine-Fentanyl-Propofol) of 120 subjects, provided with 0.8mg/kg of ketamine + 0.2mg/kg fentanyl + 1mg/kg of Propofol. Patients in both - groups were maintained with O2, N2O, Sevoflurane and measurement of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) was done before induction and 10 minutes after induction before the surgical stimulus. Additional analgesia (0.2 mg/kg ketamine, 0.1mg/kg fentanyl and 0.3 mg/kg propofol, for a total of 1mg/kg ketamine, 0.3 mg/kg fentanyl and 1.3 mg/kg propofol) was supplied to all patients with a VAS > 3 who reported pain. Independent samples t-test and paired t-test were employed for analysis of the collected data.
Results: In Group B (KP), the systolic, diastolic, mean arterial blood pressure, and heart rate changes following LMA implantation were considerably greater than in Group A (P). Group B had longer recovery durations, lower VAS scores immediately following surgery, and less analgesic needs. There was no incidence of apnea, hypoventilation, or emerging responses.
Conclusion: Ketofol (0.8mg/kg ketamine and 1 mg/kg propofol) + 0.2mg/kg fentanyl has multiple advantages than relaying propofol (2.5mg/kg) alone Hemodynamic stability, absence of respiratory depression, rapid recovery, and potent postoperative analgesia. We thus advocate intravenous ketofol as an induction drug, particularly for patients undergoing short surgical operations.

TO EVALUATE THE INCIDENCE OF SPINAL ANESTHESIA FAILURE NECESSITATING CONVERSION TO GENERAL ANESTHESIA IN WOMEN PRESENTING FOR CAESAREAN SECTION

Dr Anjana Gupta, Dr Manmohan Shyam, Dr Udai Singh, Dr Anupam Narayan Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2418-2423

Aim: To evaluate the incidence of spinal anesthesia failure necessitating conversion to general anesthesia in women presenting for caesarean section.
Methods: This research included 120 women who were scheduled for a caesarean section under regional anaesthetic, as well as women who were weighed and had their heights measured. Women scheduled for general anaesthesia, women who refused to participate, and women whose height and weight could not be obtained were all excluded from the research.
Results: We discovered that the majority of the patients (70.33%) were between the ages of 25 and 35, with the average age of the patients being 32.552.58 years. The patients' mean BMI was 29.122.33kg/m2. There were 21 elective cases (17.5%) and 99 emergency cases (82.5%). The frequency of spinal anaesthesia failure necessitating conversion to general anaesthesia. We discovered that 10% of all patients were converted to general anaesthetic owing to spinal anaesthesia failure. The outcome was statistically significant (p<0.05).
Conclusion: As a result of the failure of spinal anaesthetic during the c-section operation, we found that 10% of the patients in our research group required a change to general anaesthetic.

Anaesthetic management of cases where Thoracic segmental spinal anesthesia a suitable alternative to general anesthesia

Dr.A Sagar, Dr. Manskuri Soujanya, Dr.Ramlal Porika, Dr Joshua Dhavanam Y

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 10286-10292

This manuscript describes six cases of thoracic spinal anaesthesia for patients with for
certain cases such as laparoscopic surgeries who are considered at high risk while under
general anesthesia. Anesthesiologists are hesitant to perform spinal anesthesia above the
termination of the conus medullaris due to fear of injuring the spinal cord. However,
thoracic spinal anesthesia has been demonstrated as a safe and effective method for
various surgeries. Although not routinely used, the procedure has been shown as
beneficial in maintaining hemodynamic stability for these patients and reducing side
effects encountered with general anesthesia. This activity describes the procedure of
thoracic segmental spinal anesthesia and explains the role of the interprofessional team
in managing patients who have undergone this procedure.

A PROSPECTIVE OBSERVATIONAL STUDY OF INTRA OPERATIVE AWARENESS AND RECALL DURING GENERAL ANESTHESIA

Dr. Minoti Baruah, Dr. Bandana Mahanta

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 1382-1389

Introduction: Awareness with recall (AWR), originally coined as intra-operative awareness, is a recognized risk of general anesthesia (GA). Based on individual factors, patients respond differently to GA. The safety of GA has increased drastically over the past 20 years; however, there is continued opportunity for assessment, evaluation and treatment of AWR. Gibbs, Gibbs and Lennox (1937) first identified AWR in 1937.
Materials and Methods: The Present study was conducted at the Department of Anaesthesiology and Critical Care, Tertiary care center, Guwahati, Assam. Which includes 50 patients who underwent different routine general surgeries and 50 patients from Emergency. Pre-anaesthetic evaluation was done and noted down. In the operating room IV line established, multichannel monitor attached and standard monitoring including baseline pulse, NIBP, SPO2 and ECG connected. Entropy and NM monitoring equipment was attached. The choice of inducing agent, neuromuscular blocker and maintenance for general anaesthesia was based on the patient and nature of surgical procedure.
Results: These 200 patients were interviewed as per the protocol in hospital on the day of surgery. Our study found that among these 200 patients, 2 patients reported remembering something between going to sleep and waking up from anaesthesia, thus 2 cases of awareness were identified. 7 patients reported dreaming and 6 cases of possible awareness were identified.
Conclusion: Awareness occurs despite the usual clinical monitoring of anaesthetic depth like BP, HR and even with the use of entropy. There is currently no evidence that awareness and recall could be prevented by monitoring consciousness with sophisticated methods such as BIS or entropy. If a patient has suffered from awareness and recalls this postoperatively, psychiatric consultation and followup is recommended

A clinical study of post-operative analgesia with intravenous paracetamol versus dexmedetomidine in patients undergoing laparoscopic cholecystectomy

Dr. Santosh Kumar, Dr. Nandini CV, Dr. Salim Iqbal M, Dr. Renita Lincia, Dr. Harsoor SS

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1431-1435

Pain management, stable hemodynamics and early post-operative recovery are the new challenges in ambulatory surgeries. The literature rates post-operative pain in laproscopic cholecystectomy as mild to severe pain. Our objective is to assess the post-operative analgesia with intravenous paracetamol versus dexmedetomidine in patients undergoing laproscopic cholecystectomy.
Methods: After ethical committee clearance, 60 patients were randomly allocated into two groups after informed consent. Patients between 18-50 years, ASA 1or 2 were included and those on opioids, any anti-inflammatory drugs, and hypersensitivity to study drugs were excluded. Group D received intravenous dexmedetomidine 1μg/kg as bolus over 10 min followed by dexmedetomidine infusion at 0.25ml/kg/h (0.25ml = 0.5μg). Group P received 1 g intravenous paracetamol in 100ml solution of normal saline over 10 min followed by infusion of 0.25ml/kg/h of normal saline.
Results: Demographic parameters were comparable between the groups. Time for first rescue analgesia, and total doses of analgesia in 24 h in group D was 225.33±29.12 and 2.73±0.64 and in group P was 143.33±28.96 and 4.23±0.77 respectively with p value 0.001 which was statistically significant.
Conclusion: Dexmedetomidine loading dose 1μg/kg and maintenance dose 0.5μg/kg is a good anesthetic adjuvant for general anesthesia to reduce post-operative requirement of analgesia in laparoscopic surgeries.

A Comparison of Ketamine-Propofol Versus Propofol as Induction Agents on Hemodynamic Parameters in Patients Undergoing Elective Surgical Procedures Under General Anesthesia

Prathap Sidda, Jhansi Gurram

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 5016-5028

Background:Propofol produces quick induction and recovery, depresses airway
reflexes, and is used for sedation and anaesthesia; nevertheless, it is associated with
dose-dependent hypotension and respiratory depression.It can produce coughing,
hiccups, laryngospasm, and movements when used as a sole agent to provide LMA.In
addition to its amnesic and analgesic effects, ketamine raises heart rate and blood
pressure through stimulating the sympathetic nervous system.It was shown that a
combination of ketamine and propofol decreased patients' use of propofol and opioids
and improved their hemodynamic and respiratory stability. Objectives:1. Determine
whether the ketamine-Propofol combination has more favourable hemodynamics than
the gold standard prototypic induction drug (Propofol) in a cohort of healthy patients.2.
To compare the additional post-operative analgesia requirements between the two
groups.
Materials and Methods: Group KP, the Ketamine-Propofol Group, provided 0.75mg/kg
of ketamine and 1.5mg/kg of Propofol to 60 patients with ASA status I who were
randomly divided into two groups. Group P – Propofol Group received 2 mg/kg
Propofol for induction. The airway is secured with LMA, and patients in both groups
were maintained with O2, N2O, and Sevoflurane. For the next 15 minutes, every three
minutes, the baseline hemodynamics, heart rate, NIBP, Spo2, and respiratory rate were
recorded. Pain scores were measured for each subject post-operatively. Additional
analgesia was supplied to all patients with a VAS > 3 who reported pain.
Results: In Group KP, the systolic, diastolic, mean arterial blood pressure, and heart
rate changes following LMA implantation were considerably greater than in Group P.
Group KP had longer recovery durations, lower VAS scores immediately following
surgery, and less analgesic needs. In neither group was there an occurrence of apnea,
hypoventilation, or emerging responses.
Conclusion: Ketofol is a mixture of ketamine and Propofol that has multiple
advantages.Hemodynamic stability, absence of respiratory depression, rapid recovery,
and potent postoperative analgesia. We thus advocate intravenous ketofol as an
induction drug, particularly for patients undergoing short surgical operations.

Evaluation of general anesthesia and sedation during dental treatment in emotionally immature children: A Randomized Clinical Trial

Dr. Arunkumar Sajjanar; Dr. Nilesh Rojekar; Dr. Pankaj Chavan; Dr. Milind Wasnik; Dr. Niharika Gahlod; Dr. Harshita Shukla

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 11, Pages 7645-7651

Background
Emotionally immature children are more likely to develop health problems, including dental
problems. Dental treatments require a good level of communication with the patient.
Therefore, in these patients, sedation and general anesthesia are an extremely humanistic
approach for comfortable and successful treatment. In such children, there is no standard
anesthetic approach due to varying clinical conditions. The aim of this study was to compare
general anesthesia and sedation during dental treatment of such children.
Methods
25 children with greater than 16 score on Rutters Child Behaviour Scale were treated under
general anesthesia or sedation. Demographic data, the American Society of Anesthesiologists
classification, Mallampati score, anesthesia duration, anesthesia type, anesthetic and
analgesic agents used, dental treatment performed, secondary diseases, and complications in
the perioperative period were recorded.

PARENTAL PREFERENCE FOR TREATMENT UNDER GENERAL ANAESTHESIA FOR CHILDREN BETWEEN 2-5 YEARS OF AGE

Niharika Kotian; Deepa Gurunathan; EMG Subramanian

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 1, Pages 1197-1203

Performing dental procedures on children is usually a challenge for dentists especially on those children who are anxious and lack the ability to cooperate. Depending on the child's emotional and psychological state of mind and the usual behavior management techniques may not help in carrying out the dental procedures effectively.In these circumstances, an alternative such as conscious sedation and general anesthesia may become necessary.This study was undertaken to assess dental treatment under general anaesthesia preferred by parents for their children.Data was collected from patient management software and analysed using SPSS software. Chi square test was done to check the association and a p value of < 0.05 was considered to be statistically significant. All children who underwent general anaesthesia from September 2019 to February 2020 were included in the study . Assessment for the reason of general anaesthesia was done. Parental preference for general anaesthesia was also assessed. It was observed that out of 80 children , parents of 53 children preferred treatment under general anaesthesia . Parents preferred treatment under general anesthesia more for male children as compared to female children. Parents preferred general anesthesia more in the age group of 2 to 3 years as compared to 4 to 5 years . Single visit treatment was the most preferred reason for general anaesthesia. We observed that parents preferred treatment under general anaesthesia for children between 2-5 years of age.