European Journal of Molecular & Clinical Medicine

The onset of action of bupivacaine is between 4 and 6 minutes, and maximum anaesthesia is obtained between 15 to 20 minutes. The duration of anaesthesia varies according to the block; the average duration of peridural block is about 3.5 to 5 hours and for nerve blocks, it is about 5 to 6 hours. The short duration of action of fentanyl is associated with decrease in the concentration of the drug due to its rapid redistribution to inactive sites such as fat and skeletal muscles.86% is protein bound. High volume of distribution of 3 to 6 L/Kg. Context sensitivity half time is 260 minutes after a 4 hour infusion. Patients were prospectively randomized in to two groups with 30 patients in each group. All Patients were kept nil by mouth for overnight before surgery. To ensure that all the patients received the same medications before and during the surgery, a standardized anesthetic protocol and technique were used. In the operating room standard anesthesia monitors were attached to the patient to monitor: Heart rate, ECG, peripheral oxygen saturation, blood pressure. Intravenous access was obtained using a 20G/18G IV cannula. The minute to minute variation of averages of SBP was more pronounced in Group A, whereas the average SBP was more consistent in Group B. The minute to minute variation of averages of HR was very much higher in Group A, than in Group B.
Conventional dose of bupivacaine, low dose bupivacaine along with fentanyl, hemodynamic changes
 

Background: During general anesthesia laryngoscopy, tracheal intubation and extubation are the critical events provoking transient, but marked sympathoadrenal response manifesting as hypertension and tachycardia. In addition, in laparoscopic surgery, CO2 is routinely used to create pneumoperitoneum, which causes increased plasma level of catecholamine and vasopressin. Aim & Objective: 1. To compare the hemodynamic changes- heart rate and mean arterial pressure. 2.To study the postoperative emergence and recovery.3. To study the postoperative nausea and vomiting incidence. Methods: Study design:  Randomized comparative study.  Study setting: Department of Anaesthesia, Kamineni Institute of Medical Sciences, Sreepuram Narketpally, India. Study duration: From January 2021 to January 2022 (1 year) Sample size: 56. Results: There was a statistically significant difference in mean SBP at pre operative of subjects between group (i.e, p=0.024). There was no statistically significant difference in mean SBP after bolus of subjects between group. There was a statistically significant difference in mean SBP At 2 hour of subjects between group (i.e, p=0.012). There was a statistically significant difference in mean DBP at pre operative of subjects between group. There was a statistically significant association between other side effects and group (p=0.033) and strength of association was 0.290. Conclusion: The addition of dexmedetomidine provides better hemodynamic stability

Background: brachial plexus block is a common technique instead of general anaesthesia. This type of anaesthesia primarily assists in achieving the best possible operating conditions by causing muscular relaxation, maintaining a stable intraoperative hemodynamic condition, and inducing sympathetic block, which lessens postoperative discomfort, vasospasm, and edoema. Aim & Objective:1. To compare the duration of post operative analgesia 2. To compare the onset & duration of sensory and motor block, hemodynamic changes and adverse effects. Methods: Study design:  Randomized comparative study.  Study setting: Department of Anaesthesia, Kamineni Institute of Medical Sciences, Sreepuram Narketpally, India. Study duration: From January 2021 to July 2022 (1.5 year). Study population: All patients undergoing upper limb surgeries (below shoulder) under brachial plexus block by supraclavicular approach. Sample size: 105. Results: Age distribution across groups was found statistically significant (p=0.033). This infers that age has a significant impact in causing the variation in results across various groups. mean duration of sensory block measured by return of pin prick sensation was 11.537 hours, 7.81 hours and 10.048 hours in groups A, B and C respectively. p-value was statistically significant (<0.001). mean duration of motor blockade was 9.784 hours, 7.05 hours and 8.774 hours in groups A, B and C respectively. p-value was statistically significant (<0.001). mean duration of effective analgesia (VAS>4) was 14.221 hours, 9.583 hours and 12.299 hours in groups A, B and C respectively. p-value was statistically significant (<0.001). mean duration of complete analgesia (VAS>0) was 11.537 hours, 7.81 hours and 10.048 hours in groups A, B and C respectively. p-value was statistically significant (<0.001). Conclusion: dexmedetomidine is a better option than fentanyl when used for supraclavicular block techniques along with bupivacaine and lignocaine.

Background: Femur fracture causes moderate to severe pain which requires effective analgesia both preoperatively and postoperatively. Multimodal analgesic regimens which includes non-steroidal anti-inflammatory drugs, opioids and regional analgesic techniques have been used in femur fracture patients so far. Peripheral blocks was initially done with either paresthesia technique or nerve stimulation-based technique. Ultrasound guided needle &catheter placement is observed to be technically superior, more accurate, being placed in peripheral location probably increases the safety of USG guided compared with other techniques.
Aim & Objective:

To study USG guided femoral nerve block for positioning of femur fracture patient for subarachnoid block.
To evaluate the efficacy of ultrasonography guided femoral nerve block for pain relief in femur fracture patients.
To study VAS (visual analogue scale) before and after block.
Study of hemodynamic changes before and after block.

Methods:
Study design: Prospective Observational Study.
Study setting: Anesthesia department of tertiary care centre.
Study duration: 2 years (from…. to….).
Study population: The study population included all the cases with Surgeries involving lower limbs admitted at a tertiary care center.
Sample size: 40.
Results: Our study was done on 40 patients which included 13 females and 27 male patients. There were 9 (22.5%) patients between age of 20-40 years,13 (32.5%) patients between age
 
 
 
of 40-60 years and 18(45%) patients between 60-80 years. The youngest patient in our study was 22 years and oldest patient was 80 years. ASA distribution with 21 (52.5%) ASA 1 patients and 19 (47.5%) ASA 2 patients. there were 44% patients having intertrochanteric fracture of femur, 28% patients having femur shaft fractures and 28% patients having neck of femur fracture. VAS score 26 patients had no pain and 14 patients had mild pain. the FEMORAL block had a fall in systolic and diastolic bp up to 20 mins after the block, but there was no major hemodynamic change after the block. No patients during the study had hypotension or hypertension after the femoral block. Among the study population, 98% USG guided femoral nerve block were successful with 2% failure rate as in this study we calculated success rate from percent of successful blocks to supplemental analgesia for patient positioning.
Conclusions: USG guided femoral nerve block with 0.25% bupivacaine is a better choice for pre-operative pain relief of pain in femur fracture patients with high success rate and good post-operative analgesia with no complication

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.

Introduction: Supraglottic airway devices (SADs) are used to keep the upper airway
open to provide unobstructed ventilation. I-gel is a second generation extraglottic
airway device. SADs now provide successful rescue ventilation in > 90% of patients in
whom mask ventilation or tracheal intubation is found to be impossible.The present
study was carried to observe the hemodynamic changes following insertion of I-gel and
to evaluate any incidence of post – operative sore throat or any other side effects.
Material and Methods: A prospective randomized controlled study was conducted on 40
patients scheduled for elective surgical procedures and requiring controlled ventilation.
Patients were induced with thiopentone 4-6 mg/kg. Size 3 I-gel was used in patients
weighing 30-60 kg and size 4 I-gel was used in patients weighing 60-90 kg. Correct I-gel
insertion was assessed clinically by subjective assessment of appropriate length of
airway tube outside the mouth, gastric insufflation and adequacy of manual ventilation
which was assessed by proper chest expansion and presence of CO2 waveform.
Results: Slight rise in MAP of 97.58±9.29 mmHg from BL value of 93.13±9.03 was
observed (p=0.836). The mean %age rise was 4.66±2.83 after insertion of the I-gel in
comparison with the base line value. It was found to be statistically insignificant.
Oxygen saturation was maintained between 99-100% for all the patients till the end of
the surgery. There was not any significant change in the ETCO2 after I-gel insertion. As
revealed from the data there was very less incidence of post-operative complications.
Two patients complained of sore throat at 6 hours and 24 hours post-operatively.

In laparoscopic surgeries, marked hemodynamic changes occur due to the effect of absorption, positioning of the patient, anesthetic agents and pneumoperitoneum. When the intra-abdominal pressure is < 10mmHg, hemodynamic alteration is not significant. Significant alteration in hemodynamics occurs, when the intra-abdominal pressure is > 10 mmHg after insufflation. When the intra-abdominal pressure is >10mmhg, it will cause inferior vena cava compression and pooling of blood in the lower extremities, which decreases the venous return to the heart thereby reducing the cardiac output. On receiving patient in operating room, the patient monitoring included electrocardiogram (ECG), noninvasive blood pressure (NIBP), heart rate (HR), oxygen saturation (SPO2). The baseline HR, NIBP, SpO2 scores were recorded. The hemodynamic parameters taken into consideration were the heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure. Mean values of these parameters were analyzed from the baseline, every minute for the first 10 min thereafter for every 5 min till the end of surgery. The heart rate was significantly lower in dexmedetomidine group during the initial 10 min during infusion, lowest mean of 79.53±13.08, none of the patients from either group had bradycardia requiring atropine. Mean value of HR was higher in paracetamol group compared to dexmedetomidine group till 1 h postoperatively. Using preanesthetic dexmedetomidine 1μg/kg infusion followed by 0.5 μg/kg/h showed there was no difference in MAP between the groups, but heart rate of dexmedetomidine group was lower compared to the control group.

Aim: To compare the hemodynamic response to anaesthetic induction with thiopentone sodium or
etomidate in adult treated hypertensive patients posted for elective surgeries.
Materials and methods:A prospective randomised blind clinical study conducted in 60 adult treated
hypertensive patients(29-61 years) of ASA II posted for elective surgeries under general anaesthesia.
Patients were randomly allocated to two groups of 30 each. Group T-Thiopentone sodium 5mg/kg
body weight Group E-Etomidate 0.3mg/kg body weight. Pulse,systolic blood pressure, diastolic
blood pressure and mean arterial pressure were noted down every minute for five minutes post
induction.
Results: Both groups were comparable statistically for age, gender and weight.There was no
statistically significant variation in the extent of over all change in heart rate, systolic, diastolic and
mean arterial pressures between the two group of patients (p >0.05).All the studied hemodynamic
variations with respect to HR,SBP,DBPand MAP in the two groups were self corrective and did not
require any treatment. Patients in both groups did not have any side effects perioperatively and for 24
hours post operatively except for vomiting in one patient in group E.
Conclusion: Both thiopentone (5mg/kg) and etomidate (0.3mg/kg) have similar hemodynamic effects
when used for induction of anaesthesia in adult treated hypertensive patients and can be safely used in
them. However thiopentone comparatively has better cost effectiveness and ease of availability.

Bupivacaine hydrochloride is 2-piperidenecarboxamide-1-butyl-N-(2, 6 dimethyl phenyl) monochloride, a monohydrate is a white crystalline powder that is freely soluble in 95% ethanol, soluble in water, and slightly soluble in chloroform or acetone. Local anesthetics mainly work on the cell membrane of the axon. The considerable transient rise in sodium ion permeability that's also required for impulse transmission is inhibited. Depolarization in response to the stimulus is thereby blocked, and the resting membrane potential is preserved. A pre-anesthetic check-up was done one day before the surgery. Patients were evaluated for any systemic diseases and laboratory investigations were recorded. The procedure of SAB was explained to the patients and written consent was obtained. The preparation of patients included a period of overnight fasting. Hemodynamics during the operative period was similar in the 30 mcg group and 60 mcg, but for the 90 mcg group incidence of hypotension and respiratory depression was observed for a few cases.

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.

Laryngoscopy and endotracheal intubation result in pressor and sympathoadrenal responses. Certain agents such as Lignocaine and Labetalol can be given to prevent these hemodynamic changes prior to intubation.
Materials and Methods: 60 patients of ASA grade I, scheduled for various surgeries under general anaesthesia were divided into 2 Groups. Patients in Group A were given 2% Inj. Lignocaine hydrochloride (preservative free) intravenously at 1.5mg/kg over 10 seconds, 90 seconds before laryngoscopy. Patients in Group B were administered 0.5 mg/kg Inj. Labetalol IV, 10 minutes before intubation. Laryngoscopy and endotracheal intubation were performed after induction. Heart rate, systolic, diastolic and the mean arterial blood pressure were recorded before induction, after induction, during intubation and at 1, 3 and 5 minutes post intubation.
Results: Heart rate, systolic and diastolic blood pressures and the mean arterial pressures were significantly lower in the Labetalol group when compared to the Lignocaine group, with the mean arterial pressure and the heart rate attaining the basal value in the Labetalol group after 5 minutes of intubation, while it was still higher in the Lignocaine group.
Conclusion: Labetalol is a better drug for the attenuation of the hemodynamic changes that take place during intubation compared to Lignocaine.

The myelinated A δ (sharp pain, first pain) peripheral nociceptors and unmyelinated C
nociceptors (delayed pain, second pain) respond to strong mechanical, thermal, chemical
stimuli that act as transducers, converting chemical, mechanical or thermal energy at the site
of stimulus to electrical activity, which are conducted to the dorsal horn of CNS. Based on
previous study by Usha Bafna et al., sample size was calculated to be 30 patients, to be
randomly included in each group to demonstrate a 40% difference in duration of analgesia
with a power of 0.8 and type-1 error of 0.05. To allow for study error and attrition, 35 patients
were included in each group. In Group A, 3 (8.57%) patients and in Group B, 4 (11.42%)
showed hypotension that is mean SBP was less than 20% of the base line, were as none of
patients in either group showed hypertension that is more than 20% of the baseline SBP
(intraop and postop). There was no statistically significant difference between two groups P
value (0.6903).