Introduction: Laparoscopic surgeries are known to be associated with a higher incidence of postoperative nausea and vomiting (PONV). Prophylaxis of PONV is usually achieved with a singledose antiemetic drug administered during the surgical procedure. The aim of this study was to compare the antiemetic efficacy of two different 5-hydroxytryptamine-3 (5HT3) receptor antagonists, ondansetron and granisetron when given prophylactically to patients undergoing laparoscopic cholecystectomy.Methods: It was a randomized, double blind study, conducted in 90 patients. Patients were divided into two groups: Group A and Group B with 45 patients in each group. Patients in groupA were given 100 microgram/kg ondansetron intravenously (IV), and patients in Group B were given 40 microgram/kg granisetron. Both the drugs were diluted in 10 ml of 0.9% NaCl and were given at the end of surgery. The standard general anesthetic technique was administered to all the patients. Episodes of nausea, retching and vomiting were assessed during the first 24 hours after anesthesia. results:There was no statistically significant difference for demographic data and duration of surgery among the two groups (P>0.05). Evaluated nausea and vomiting scores in the first 3 hours period revealed that each of the drugs had a similar antiemetic effect (P>0.05). Between 4-12 hours also the episodes of nausea, retching as well as vomiting were statistically insignificant in both the groups. In the last 12 hours, episodes of nausea, retching and vomiting were significantly higher in ondansetron group. conclusions: Granisetron, when given prophylactically, resulted in a significantly lower incidence of PONV than ondansetron in the first 24 hours.
Background: The aim of the study is to evaluate the efficacy of Ketamine-Propofol compared to Fentanyl-Propofol combination during induction and maintenance of total intravenous anesthesia for short surgical procedures at moderate elevation. Methods: A prospective pilot study was done comparing between Fentanyl (1.2 mcg/kg)- Propofol and Ketamine (0.5mg/kg)-Propofol with 30 in each group at moderate altitude of approximately 2514 meters for the requirement of positive pressure ventilation, changes in heart rate and mean arterial pressure intraoperatively, total Propofol consumption and time to attain Modified Steward Score of 6.Results: Requirement for positive pressure ventilation was significantly high in Fentanyl-Propofol group 18 (60%) compared to Ketamine-Propofol 1 (0.03%) [P = 0.00]. Fall in oxygen saturation was significant at 2 minute of Ketamine or Fentanyl [95% CI, 3.10-5.76, P = 0.00], after induction with Propofol [95% CI, 2.30-4.03, P = 0.00], 5 minute [95% CI, 1.66-3.54, P = 0.00], 10 minutes [95% CI, 0.55-2.32, P = 0.02], 15 minutes [95% CI, 0.50-2.09, P = 0.00] and 20 minutes [95% CI, 0.43-2.23, P = 0.00] respectively after study drug between the groups. Total Propofol consumption was significantly higher [95% CI, 0.19-0.43, P = 0.00] in KP (1.55±0.27mg/kg) compared to FP (1.23±0.16 mg/kg). Conclusions: At moderate elevations of 2514 meters, during the induction and maintenance of intravenous anesthesia, Ketamine-Propofol causes significantly less fall in oxygen saturation in the first 20 minutes requiring lesser need of positive pressure ventilation with comparable least fall in heart rate and mean arterial pressure with higher total Propofol consumption when compared to Fentanyl-Propofol. It took a significantly longer time to recovery with Modified steward score of maximum 6 with Ketamine-Propofol.Keywords: Fentanyl; intravenous anesthesia; ketamine; moderate altitude; propofol
IntroductionLaparoscopic cholecystectomy has higher incidence of postoperative nausea and vomiting (PONV). In routine practice single dose of drug is given prophylactically during the surgery.ObjectiveThis study aimed to compare the antiemetic efficacy of two different 5-hydroxytryptamine-3 (5HT3) receptor antagonists, Ondansetron and Granisetron when given prophylactically to patients undergoing laparoscopic cholecystectomy.MethodologyIt was a randomized, single blind study, conducted in 75 patients undergoing laparoscopic cholecystectomy. Patients were divided into two groups: Group O and Group G. Patients in group O were given 0.1 mg/kg Ondansetron intravenously (IV) and patients in Group G were given 0.04 mg/kg Granisetron. The standard general anesthetic technique was administered to all the patients. Episodes of nausea, retching and vomiting were assessed during the first 24 hours after anesthesia. Collected data was applied with appropriate test in SPSS 16 and overall significance level was considered at 95% confidence interval (p ≤ 0.05).ResultsThere was no statistically significant difference for demographic data among the two groups (P>0.05). Both drugs were similarly effective in first four hours (P>0.05). Between 4–12 hours and 12-24 hours, episodes of nausea and vomiting were higher in Ondansetron group.ConclusionThe incidence of PONV was significantly high in Ondansetron than in Granisetron given prophylactically in laparoscopic cholecystectomy. Birat Journal of Health SciencesVol.2/No.1/Issue 2/ Jan - April 2017, page: 175-178
Introduction: Spinal anesthesia induced hypotension frequently complicates Cesarean delivery. This is usually due to sudden sympatholysis causing decreased venous return which can be aggravated by physiological changes of pregnancy leading to change in baseline peripheral vascular tone. Strategies to prevent hypotensive episodes should be the primary aim of anesthetic management. A simple noninvasive measurement of perfusion index derived from pulse oximeter predicting hypotension during the routine intraoperative course could provide a new dynamism to the management and improving the safe execution of anesthesia. Objectives: The primary objective of this study was to compare incidence of hypotension following SAB for LSCS in patients with baseline PI ≤ 3.5 to those with PI > 3.5. The secondary objectives were to compare PI, HR, SBP, MAP at various time intervals and also to study the side effects between the two groups. Methodology: This prospective observational study was conducted at Nobel Medical College Teaching Hospital from to July 2019 to October 2019. 73 Term parturients presenting for elective cesarean delivery were included for the study. Upon arrival in the operation room, standard monitors were attached and baseline HR, SBP, DBP, MAP, PI and SPO2 were recorded in supine position. The patients with baseline PI ≤ 3.5 were enrolled into Group I and those with a PI > 3.5 were enrolled into Group II. Spinal Anesthesia with 10mg of 0.5% heavy Bupivacaine and 20mcg Fentanyl ( total 2.4ml) was given at L3-L4 interspace in sitting position using midline approach. Patient was then returned to supine position with left lateral tilt of 15 degrees to facilitate left uterine displacement. Upper sensory level was checked at 5 minutes using alcohol swab. Once T-6 level was reached, surgery was started. Maternal SBP, DBP, MAP, HR and PI were recorded at 1 minute intervals between spinal injection and delivery and then 3 minutes until end of surgery. Clinically relevant hypotension was defined as the decrease in MAP by 20% or more from baseline value. Results: The incidence of hypotension in Group I was 18.8% (6/30) compared to 81.3% (26/38). This was clinically and statistically highly significant (P = 0.000, odds ratio 0.11). On Spearman’s rank correlation we found highly significant correlation between baseline PI >3.5 and number of episodes of hypotension (rs 0.482, P = 0.000). The sensitivity and specificity of baseline PI with cut-off 3.5 for predicting hypotension were 81.3% and 66.7% respectively. The ROC curve analysis showed 3.53 as appropriate cut‑off for our findings. The area under the ROC curve (AUC) was 0.734 [Figure 6](Lower bound 0.608 and upper bound 0.861, P=0.001). Conclusion : This study demonstrates that baseline PI of > 3.5 correlates with incidence of hypotension after spinal anesthesia for cesarean delivery in healthy parturients compared to a baseline PI of < 3.5.
Background: General anesthesia for cesarean section is being less popular for cesarean section in present days but sometime general anesthesia is inevitable. The aim of the study is to assess the trends of general anesthesia, indications, clinical outcome in mother and fetus in high altitude setting of tertiary care center of Nepal. Methods: We conducted descriptive cross-sectional study all cases of cesarean section in Karnali Academy of health Sciences (KAHS) located at high altitude over three years period in our institute. Data were retrieved from the hospital records during three fiscal year (Jan 1st 2017 to Jan Dec 31st 2019). The record of all the patients who underwent cesarean section under general anesthesia was reviewed for demographic details, indication of general anesthesia, trends for general and spinal anesthesia and maternal and neonatal outcome. Results: Out of total deliveries 2175, 309 (14.2%) cases account for cesarean section. Among them, 52 (17%) required general anesthesia . Eclampsia 19(36%) remain the major indication for General Anesthesia in cesarean section followed by failure of spinal anesthesia number 14 (26%) , cord prolapse six (12%), antepartam haemorrhage five (10%), spinal site infection four (8%), Khiphoscoliosis two(4%), Patients request two (4%). Use for general anesthesia technique was consistent for three years with slow rise in use of spinal anesthesia . There was no any anesthesia related maternal mortality and nine intraoperative neonatal Conclusions: General anesthesia practices are consistently required in rural high-altitude setup. Eclampsia is the commonest indication followed by failure of spinal anesthesia and cord prolapse. Neonatal outcome is still not good.
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