Background: In spine surgery rapid emergence and extubation with haemodynamic stability is crucial for early neurological examination. Here, we have studied the effect of α2 agonist – dexmedetomidine intravenous (IV) and lignocaine spray instilled into the endotracheal tube at the end of the procedure to attenuate the extubation responses. Methods: A total of 45 patients undergoing spine surgery were randomly allocated in three groups. After the return of spontaneous respiration, Group-D: Dexmedetomidine 0.3 mcg/kg IV, Group-L: 10% lignocaine spray 1.5 mg/kg through endotracheal route and Group-P: Normal saline IV given over 60 s. Haemodynamic responses (systolic blood pressure, diastolic blood pressure, mean arterial pressure [MAP], heart rate [HR] and SpO2) were recorded before and after administration of drugs and also duration of emergence, extubation, quality of extubation and post-operative sedation level were evaluated. Results: The increase in MAP and HR during extubation was significantly less in Group-D than Group-L and Group-P, 2 min after administration of the respective drugs (P < 0.05). There were no significant differences in the grade of a cough after extubation and post-operative sedation level. Conclusion: Dexmedetomidine (0.3 mcg/kg) attenuates haemodynamic response better than lignocaine spray (1.5 mg/kg) during emergence and extubation. It also provides smooth extubation and easy recovery without any post-operative sedative effect.

No abstract

Ibutilideis less frequently used drug for atrial fibrillation (AF) in postoperative coronary artery bypass grafting (CABG) patients as compare to amiodarone. We therefore investigated the comparative efficacy of ibutilde and amiodarone for cardioversion in atrial fibrillation after CABG.To compare the efficacy of ibutilide and amiodarone for cardioversion of AF in post CABG patients. Narayana Multispeciality Hospital, Jaipur. Single center, randomized, double blind, comparative prospective study.Total 80 post CABG patients who developed AF were divided into two groups (Group A) Ibutilde and (Group B) Amiodarone respectively. The cardioversion time and cardioversion rate were measured. Unpaired t-test, Paired t-test, Chi square test / Fisher exact test. P value &#60;0.05 The cardioversion rate at 4hrs in group A was 42.5% and in group B was 50% (p value &#62; 0.001). At 24 hrs cardioversion rate in group A was 95% and in group B was 87.5% (p value &#62; 0.001). The mean time of conversion to sinus rhythm in group A was 382.85 minutes and in group B was 492.30 minutes. (p value= 0.235)Ibutilide was as effective as amiodarone for restoration of sinus rhythm in postoperative coronary bypass grafting patients who developed atrial fibrillation in their postoperative intensive care unit stay. Ibutilide may be superior to amiodarone in terms of hemodynamics and systemic side effects.

Background: Device like fibreoptic bronchoscope is gold standard for difficult intubation situations. It can be performed by both orotracheal and nasotracheal route. But, through nasal route there are more chances of nasal bleeding and pressure necrosis while through oral route there is only one problem, which is clearing of upper airway for bronchoscope. Manoeuvres like jaw thrust and chin lift are very useful in clearing upper airway for bronchoscope. The aim of this study was to compare ease of oral intubation using flexible fibreoptic bronchoscope with or without rigid cervical collar, in terms of need of manoeuvres: Jaw thrust and Chin lift. Materials and Methods: 25 patients in age range 20-50 years, of ASA ? - II, and of either sex undergoing elective surgery under general anaesthesia were randomly allocated into each group. There were two groups: Group A (Rigid Cervical Collar) and group B (Without Collar). Intubating condition was assessed in between these groups with need of manoeuvres like jaw thrust and chin lift. Quantitative data i.e. age, weight, thyromental distance and sternomental distance were presented as mean value and standard deviation. Intergroup comparison of quantitative data was done by t-test and probability was considered to be significant if less than <0.05. Categorical data i.e. sex, ASA grade, Mallampati grade and need of manoeuvres were presented as number and were compared among groups using Chi-square test. P < 0.05 was considered statistically significant. Results: There was significant (P < 0.05) difference between group A and group B in terms of use of manoeuvres for ease of intubation and clearing upper airway. In group B, need of jaw thrust and chin lift for clearing airway is significantly (P < 0.05) higher than collar group. Conclusion: We concluded that as far as the oral intubation with flexible fibreoptic bronchoscope is concerned, rigid cervical collar is very useful tool for making intubation easier.

This study aims to compare the hemodynamic response of two commonly used induction agents Propofol and Etomidate in patients with left ventricular ejection fraction ≤40% undergoing Coronary Artery Bypass Grafting surgery. To compare the effects of Propofol and Etomidate on hemodynamics in terms of heart rate, rhythm, blood pressure, and central venous pressure. Narayana Multispeciality Hospital, Jaipur. Prospective, double-blinded, randomized, hospital based study.100 patients with LVEF≤40% scheduled for elective CABG, were randomly assigned to one of the two groups receiving either of the inducing agents, group A (PROPOFOL 2mg/kg) and group B (ETOMIDATE 0.2mg/kg). Unpaired t-test and Chi square test/Fisher exact test, p&#60;0.05 was taken as significant. HR, SBP, DBP and MAP decreased from post induction 1 min. to post induction 3 min. (fall greater in propofol, p&#62;0.005) then increased from post intubation 1 min. to post intubation 5 min. in both the groups (rise greater in etomidate group, p&#60;0.005). Need of drugs to control hypotension (62% and 26%, p=0.001) and to control pressor response (10% and 38%, p=0.002) was observed in both the groups. Etomidate is superior to propofol in providing hemodynamic stability before and after laryngoscopy and intubation, but less effective in controlling the pressor response to intubation. Therefore, Etomidate can be used as an induction agent with suitable adjuvants to control pressor response to tracheal intubation in patients undergoing CABG with low LVEF.