Alka Koshire ¹, Rupesh Sinha ¹, Utkarsh S. Rayakar ¹

Affiliations
1 Department of Anaesthesiology at MVPS Dr. Vasantrao Pawar Medical College, Nasik, IN

Abstract

Introduction: Laparoscopic surgery is a boon for surgeons as it reduces tissue trauma, post–operative morbidity, hospital stay and healthcare costs. However, it is not possible to perform a laparoscopic procedure unless a proper anaesthetic procedure is available to combat the additional haemodynamic stress of pneumoperitoneum with CO₂ insufflation and the patient’s position^1,2. Use of an alpha–2 against tablets such as clonidine helps in blunting the adverse haemodynamic response during laparoscopy^3,4. Aims of this study were: To study haemodynamic response to oral clonidine tablet during endotracheal intubation in laparoscopic surgery. To study haemodynamic response to oral clonidine tablet in the intraoperative period in laparoscopic surgery. To study side–effects of clonidine. Materials and Methods: This prospective placebo controlled study was conducted in the Department of Anaesthesiology, in a tertiary health care centre attached to a medical college. A total of 60 patients scheduled for laparoscopic surgery in the age group of 18–60 years belonging to ASA grade 1 & 2 were included in the study. After appropriate preoperative evaluation they were divided into 2 groups. Group C (n = 30) received Tab. Clonidine 150 mcg orally. Group V (n = 30) received a placebo Vitamin tablet. After appropriate premedication, patients were given general anaesthesia. Various parameters like pulse rate, Non–Invasive Blood Pressure (NIBP) including systolic, diastolic and mean arterial pressure, ETCO₂ were measured pre–operatively, during intubation and at various points intraoperatively. Statistical analysis was done using statistical package for Social Sciences Ver. 18. The results was expressed in mean and standard deviation. Independent t–test was used to compare mean of the two groups. For the purpose of this study, 95% confidence limit was chosen and corresponding p–value < 0.05 was taken as statistically significant. Conclusion: We found that pre–medication with oral clonidine provides haemodynamic stability and protection against the stress response triggered by laryngoscopy, intubation and pneumoperitoneum with CO₂ in patients undergoing laparoscopic surgery. It also was found to reduce nausea, vomiting and shivering post–operatively.

Keywords

Clonidine, Haemodynamic, Laparoscopy

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Sunita Sankalecha ¹, Alka Koshire ¹, Mrinal Anand ¹, Bhooshan Gondse ¹

Affiliations
1 Department of Anaesthesia, Dr. Vasantrao Pawar Medical College, Nashik, IN

Abstract

A neonate with giant omphalocele was posted for repair on 3rd day of life. Anesthesia management was challenging as liver and intestines herniated through the anterior abdominal wall defect. Anticipating post-operative respiratory embarrassment, the child was kept on ventilatory support for two days, recovered fully.

Keywords

Gaint Omphalocele, Abdominal Wall Defects

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Sayali Patil ¹, Alka Koshire ¹

Affiliations
1 Department of Anaesthesia, Dr. Vasantrao Pawar Medical College Hospital & Research Centre, Nashik - 422003, Maharashtra, IN

Abstract

Introduction: Brachial plexus block has now evolved into valuable and safe alternative to general anesthesia for upper limb surgeries. The nerve stimulation technique make use of electric current to elicit motor stimulation of nerves and confirm the proximity of the needle to the nerve, thereby avoiding the discomfort caused due to paresthesia leading to good success rate, even when the pa-tient is uncooperative or uncommunicative. Aim and Objectives: To compare between paresthesia technique and use of nerve locator in performing supraclavicular brachial plexus block with respect to success and complication rate. Materials and Methods: A comparative study was conducted at department of Anesthesia of a tertiary care centre. A total of 100 patients undergoing upper limb elective surgery were included after satisfying inclusion and exclusion criteria. The anesthetic method employed was Brachial plexus block by Supraclavicular Approach: using paresthesia technique (Group A: 50 subjects) and; by using Nerve Stimulator technique (Group B: 50 subjects). Both the groups of patients were studied for performance time, sensory block, and motor block and for success rate. Statistical analysis was done using SPSS ver. 21. Results: Onset of sensory and motor block were significantly faster in nerve stimulator group as compared to paraesthesia group (p<0.05), also the duration of block was more in nerve stimulation group (7.28 vs 6.54 hrs; p-0.057). Failure of block was seen in 22% patients with paraesthesia technique as compared to 14% with nerve stimulation (p-0.44). No difference was observed between the groups on the basis of complication rate (10% vs 2%; p-0.2). Conclusion: Onset of sensory and motor block was shorter and duration of analgesia was longer with nerve stimulation group. Nerve stimulation was found more effective than paraesthesia with respect to degree of success and complication rate.

Keywords

Brachial Plexus Block, Nerve Stimulator, Paresthesia.

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Sagar Lokhande ¹, Alka Koshire ²

Affiliations
1 P.G. Resident, Department of Anesthesia, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
2 Professor and Head, Department of Anesthesiology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, Maharashtra, IN

Abstract

Introduction: Inhaled anaesthetics are the most widely used drugs for maintenance of general anaesthesia because of their ease of administration and predictable intraoperative and recovery characteristics. Newer inhalational agents such as Desflurane provide several advantages over the older inhalational agents. Desflurane has a very low blood-gas partition coefficient [about 30% less than Sevoflurane] and low oil-gas partition coefficient [about 64% less than Sevoflurane]. Objectives: Our main aim to conduct this study was to compare the hemodynamic parameters and recovery profiles after Desflurane vs. Sevoflurane anaesthesia in elective laparoscopic cholecystectomy patients. Materials and Methods: It was a comparative prospective randomized study conducted after consent from institutional ethical committee. Study included 80 ASA I-II patients aged between 20-60 years, of either sex scheduled for elective laparoscopic cholecystectomy. Patients were randomly divided into two groups of 40 patients each. Group ‘D’ received Desflurane as anesthetic agent and Group ‘S’ received Sevoflurane as anesthetic agent for maintenance of anesthesia. Hemodynamic parameters were observed perioperatively. Recovery profiles of patients were noted after giving reversal. Results were calculated using statistical tests. Results: Time required for eye opening, extubation, verbal response and to attain an Modified Aldrete score of ≥9 was significantly shorter in Group D as compared to Group S. Hemodynamic parameters [pulse, BP, SpO2] were comparable in both groups. Conclusion: Desflurane administration in patients undergoing Laparoscopic Cholecystectomy was associated with stable peri-operative hemodynamic parameters, faster early recovery and not significantly higher side effects.

Keywords

Desflurane, Laparoscopic Cholecystectomy, Sevoflurane.

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Alka Koshire ¹, Priyanka Satyanaryan Kandikatla ², Hemant Pawar ³

Affiliations
1 Professor and Head, Department of Anaesthesiology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, IN
2 Former PG Resident, Department of Anaesthesiology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, IN
3 Associate Professor, Department of Anaesthesiology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, IN

Abstract

Background: Laparoscopic cholecystectomy is one of the most commonly performed surgeries and has now being recognized as the gold standard for the treatment of cholelithiasis. It is known fact that laparoscopy has several advantages due to creation of pneumoperitoneum during the surgical procedure which is responsible for several deleterious haemodynamic and cardiorespiratory changes. Thus, our present study was designed tostudy of haemodynamic response to oral clonidine as pre medication in laparoscopic cholecystectomy. Methods: In this prospective comparative study, 128 patients between the age group of 18-60 years, belonging to ASA 1 and ASA 2 categories scheduled for elective laparoscopic cholecystectomy under general anaesthesia were categorized into 2 groups as Group C and Group NC with 64 patients in each group. Patients in Group C received premedication with oral clonidine 150μg 90 minutes prior to surgery and Group NC did not receive oral clonidine 150μg. The two groups were compared with respect to heart rate, systolic and diastolic blood pressure and post operative complications. Results: There was significant increase in all the haemodynamic variables in group C as compared to group NC where the variables remained close to baseline while the patients in Group C showed less post operative complications as compared to NC group. Conclusion: Oral premedication with clonidine helps in blunting the haemodynamic response to pneumoperitoneum and also has less post operative complications.

Keywords

Clonidine, General Anaesthesia, Haemodynamic Response, Laparoscopic Cholecystectomy

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