Context:During induction of general anesthesia hypertension and tachycardia caused by tracheal intubation may lead to cardiac ischemia and arrhythmias. Dexmedetomidine attenuates the hemodynamic response to endotracheal intubation and reduces anesthetic requirement.Aims:The purpose of this study was to evaluate the effect of a single pre-induction intravenous dose of dexmedetomidine 1 μg/kg on cardiovascular response resulting from laryngoscopy and endotracheal intubation and need for anesthetic agent.Materials and Methods:Fifty patients scheduled for elective major surgery were randomized into two groups each having twenty five patients-dexmedetomidine group (Group 1) and control group (Group 2). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and Ramsay sedation score were recorded at 1, 2 and 5 min after completion of administration of study drug. Fentanyl 2 μg/kg was administered to all patients and propofol was given until loss of verbal contact. Intubation was facilitated with vecuronium 0.1 mg/kg i.v. Anesthesia was maintained with oxygen (O2) and nitrous oxide (N2O) 33%: 67% and isoflurane. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) was noted at 1 min, 2 min and 5 min after intubation.Statistical Analysis Used:For statistical analysis of the clinical data obtained, the analysis of variances (ANOVA) with paired t-test was used.Results:Pretreatment with dexmedetomidine 1 ug/kg attenuated, but did not totally abolish the cardiovascular and catecholamine responses to tracheal intubation after induction of anesthesia. In our present study, HR, SBP, DBP all increased after intubation at 1, 2, 3 and 5 min in both the groups, but the rise was significantly less in the dexmedetomidine group. Requirement of propofol was significantly less in the dexmedetomidine group.Conclusions:Preoperative administration of a single dose of dexmedetomidine blunted the hemodynamic responses during laryngoscopy, and reduced anesthetic requirements.

Background:Addition of clonidine to ropivacaine (0.2%) can potentially enhance analgesia without producing prolonged motor blockade. The aim of the present study was to compare the post-operative pain relieving quality of ropivacaine 0.2% and clonidine mixture to that of plain ropivacaine 0.2% following caudal administration in children.Methods:In a prospective, double-blinded, randomized controlled trial, 30 ASA 1 pediatric patients undergoing infraumbilical surgery were randomly allocated to receive a caudal injection of either plain ropivacaine 0.2% (1 ml/kg) (group A) or a mixture of ropivacaine 0.2% (1 ml/kg) with clonidine 2 μg/kg (group B). Objective pain score and need for supplemental analgesics were compared during the 1st 24 hours postoperatively. Residual post-operative sedation and motor blockade were also assessed.Results:Significantly prolonged duration of post-operative analgesia was observed in group B (P<0.0001). Heart rate and blood pressure were not different in 2 groups. Neither motor blockade nor post-operative sedation varied significantly between the groups.Conclusion:The combination of clonidine (2 μg/kg) and ropivacaine 0.2% was associated with an improved quality of post-operative analgesia compared to plain 0.2% ropivacaine. The improved analgesic quality of the clonidine-ropivacaine mixture was achieved without causing any significant degree of post-operative sedation or prolongation of motor blockade.

Background:Oxytocin is routinely administered during cesarean delivery for uterine contraction. Adverse effects are known to occur after intravenous oxytocin administration, notably tachycardia, hypotension, and electrokardiogram (EKG) changes, which can be deleterious in high-risk patients.Aims and Objectives:To compare the hemodynamic changes and uterotonic effect of equivalent dose of oxytocin administered as an intravenous bolus versus intravenous infusion.Study Design:Randomized, double-blind, active controlled trial.Materials and Methods:Eighty parturients undergoing elective cesarean delivery, under spinal anesthesia, were randomly allocated to receive 3 IU of oxytocin either as a bolus intravenous injection over 15 seconds (group B, n = 40) or as an intravenous infusion over 5 minutes (group I, n = 40). Uterine tone was assessed as adequate or inadequate by an obstetrician. Intraoperative heart rate, non-invasive blood pressure, and EKG changes were recorded. These data were compared between the groups. Any other adverse events like chest pain, nausea, vomiting, and flushing were noted.Results:There was significant rise in heart rate and significant decrease in mean arterial pressure in bolus group compared to infusion group. Three patients in bolus group had EKG changes in the form of ST-T depression and 5 patients complained of chest pain. No such complications were found in infusion group.Conclusion:Bolus oxytocin (at a dose of 3 IU over 15 seconds) and infusion of oxytocin (at a dose of 3 IU over 5 minutes) have comparable uterotonic effect. However, the bolus regime shows significantly more adverse cardiovascular events.

The intranasal route provides a good alternative for administration of fentanyl in pediatric surgical patients.