No abstract

Incidence of Atrial Septal Defect (ASD) in acyanotic congenital heart disease is about 10%. This condition is commonly diagnosed in childhood, although in some cases it is detected in later stages of life. Patients with ASD and Pulmonary Hypertension (PHT) pose a great challenge to anaesthetic management. Authors are presenting a case of general anaesthetic management of 39-year-old lady having ASD with mild to moderate PHT undergoing abdominal hysterectomy, a noncardiac surgery. The patient was induced with Inj. Propofol slow Intravenous (IV) and intubation was achieved with succinylcholine and maintenance was done with atracurium and isoflurane. The primary goal of general anaesthesia was to avoid increase in PHT and to maintain systemic vascular resistance.

Introduction: Nalbuphine and tramadol are opioids which have been used to control post-anaesthetic shivering. Aim: To compare the efficacy of nalbuphine and tramadol in the treatment of post-spinal anaesthesia shivering. Materials and Methods: This was a randomised clinical trial conducted on 60 patients of either gender (20-60 years age group) from January 2019 to June 2020, American Society of Anaesthesiologists (ASA) Grade I or II, having post-spinal anaesthesia shivering. The total sample was divided into two groups of 30 patients each. Group T received injection (Inj) tramadol 1 mg/kg intravenously (iv) and Group N received Inj. nalbuphine 0.1 mg/kg iv. Grade of shivering was assessed with a five point scale as Grade 0- no shivering; Grade 1; No visible muscle activity, but one or more of piloerection, peripheral vasoconstriction or peripheral cyanosis Grade 2; Muscular activity in only one muscle group; Grade 3: Moderate muscular activity in more than one muscle group, but not generalised shaking; Grade 4: Violent muscular activity that involves the entire body. The time taken for disappearance of shivering, assessment of improvement of shivering (complete- if grade of shivering becomes 0, partial- if grade of shivering deceased but not zero), recurrence rate and side-effects such as nausea, vomiting, deep sedation were noted. Independent t-test and Chi-square test were used to analyse the data. A p-value <0.05 were considered statistically significant. Results: The time taken for disappearance of shivering was shorter in group N than T (3.20±0.96 minutes and 6.43±0.97 minutes respectively, p=0.001). Significantly better sedation (p-value 0.04) was seen in nalbuphine group as grade 3 sedation were seen in 15 patients of nalbuphine group as compared to none in tramadol group. All the patients in group N had complete improvement of shivering and there was no recurrence, while in group T six patients had partial improvement in shivering and four (13%) had recurrence. Complications such as nausea (three patients) and vomiting (one patient) were seen in Group T while none were seen in Group N. Conclusion: The efficacy of nalbuphine is greater than tramadol in controlling post-spinal anaesthesia shivering, with minimal side-effects.

No abstract

To compare efficacy of intravenous dexmedetomidine versus butorphanol for balanced anaesthesia and postoperative analgesia in patients undergoing laparoscopic surgery under general anaesthesia. After obtaining institutional ethical committee approval & written informed consent 54 adults of either gender aged 18-60 years, of grade I & II ASA were divided into two equal groups; Group D received Inj. Dexmedetomidine 1 µg/kg i.v. & Group B, Inj. Butorphanol 10 µg/kg i.v., in 100ml NS over 10 minutes before induction. Standard general anaesthesia technique including propofol, succinylcholine/Atracurium, IPPV & Isoflurane/N20 was administered. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) & SPO2 were recorded at - baseline, after-drug administration, induction, at intubation & 1, 3 & 5 minutes after intubation, at  pneumoperitoneum & 15 minutes intervals upto 30 minutes after extubation. Postoperative Visual Analog Scale (VAS) Scores & Ramsay Sedation Score (RSS) were evaluated half hourly till score of >4 & <2 were recorded, respectively.