Search

Background & objective: The anesthesiologists have been trying various strategies to lessen the adverse effects of endotracheal intubation on hemodynamic parameters. The aim of this study was to explore a better and safer drug to attenuate the pressor response to laryngoscopy and intubation by comparing dexmedetomidine (Precedex; Brookes Pharma), fentanyl (Fentra; Brookes Pharma), and lidocaine (Xylocaine; Barret Hodgson). Methodology: In this double-blind, randomized controlled trial, a total of 90 patients of ASA physical status I and II, undergoing laparoscopic cholecystectomy under general anesthesia were included. Sample size was calculated using OPEN EPI sample size calculator. Patients were randomized into three groups by sealed envelope method. Patients in Group D received intravenous dexmedetomidine 0.6 μg/kg, Group F received intravenous fentanyl 2 μg/kg and Group L received intravenous lidocaine 1.5 mg/kg over 10 min before induction. Hemodynamic variables were recorded at baseline, at laryngoscopy, 1, 3, 5 and 10 min after intubation. Perioperative complications and postoperative sedation and recovery were also noted at 0 and 10 min in Post Anesthesia Care Unit (PACU). Results: As compared to dexmedetomidine, there was no significant impact of lidocaine (P = 0.774) and fentanyl (P = 0.992) in managing the heart rate (HR) of patients, while time had a significant impact on the HR. There was no substantial effect of fentanyl (P = 0.123) or lidocaine (P = 0.616) in managing SBP and no effect of fentanyl (P = 0.580) or lidocaine (P = 0.752) in managing DBP, in contrast to dexmedetomidine. Although statistically significant reduction in HR, SBP and DBP was observed in Group D, soon after study drug infusion, but overall long-term stability was noticed. Ramsey sedation scores were significantly higher in the Group D at arrival in PACU, but after 10 min all three study groups showed almost similar results. Aldrete score was statistically significant in the fentanyl group compared to Group D and L in PACU, both at arrival and after 10 min (P = 0.001 and 0.010 respectively). Conclusion: We conclude that intravenous dexmedetomidine demonstrated better attenuation of hemodynamic response to laryngoscopy and intubation in patients undergoing laparoscopic cholecystectomy by controlling rise in heart rate and by providing long-term stability in systolic and diastolic blood pressure. Fentanyl and lidocaine showed inconsistencies in heart rate, systolic and diastolic blood pressure over time. Fentanyl showed better hemodynamic profile compared to lidocaine. Patients included in fentanyl group exhibited early recovery than dexmedetomidine and lidocaine. [ABSTRACT FROM AUTHOR]

Background & objectives: Spinal anesthesia is the preferred technique for obstetric patients as it is economical, simple to perform, has a rapid onset and provides complete muscle relaxation. A variety of adjuvants have been used to enhance or prolong its effects. We compared the effects of dexmedetomidine and fentanyl on the onset and recovery times of sensory and motor blockade as well as on hemodynamics, postoperative complications and duration of postoperative analgesia in parturients undergoing lower segment cesarean section (LSCS). Methodology: It was a prospective, double blind, randomized controlled trial. Sixty healthy parturients having cesarean delivery under spinal anesthesia were randomly divided into two equal groups. Group BD was given 10 mg bupivacaine plus 5 μg of dexmedetomidine and Group BF was given 10 mg bupivacaine plus 10 μg of fentanyl. Parturients was then observed for the onset and recovery times of sensorimotor blockade, hemodynamics, postoperative complications and postoperative analgesia. Results: There was no statistically significant difference in the onset of sensorimotor block between the groups. The time to complete sensory and motor recovery was significantly prolonged in Group BD (P = 0.01 and P = 0.0001 respectively) as compared to Group BF. Both groups did not show significant differences in hemodynamic changes, but there was a reduction in systolic and diastolic blood pressures ≥ 20% from baseline intraoperative. The VAS at 3 and 4 h postoperatively in the Group BD was significantly lower (P = 0.02 and P = 0.01 respectively). The incidence of complications was found comparable in two groups, except incidence of hypotension and nausea was more in the Group BD compared to Group BF (P = 0.006 and 0.002 respectively). Conclusion: Although intrathecal dexmedetomidine prolongs the duration of sensory block, with comparable hemodynamic changes and good postoperative analgesia, prolonged motor block due to it, compared to intrathecal fentanyl, is not a desirable outcome particularly in short duration surgeries like LSCS, which can increase discharge time from post anesthesia care unit (PACU) to the ward. [ABSTRACT FROM AUTHOR]