Academia Anesthesiologica International https://aijournals.com/index.php/aan <p><strong class="pull-left">Academia Anesthesiologica International </strong>is a double-blinded peer-reviewed, open access, Bi-annual, online journal that publishes original research articles, review articles, case reports, brief communications and clinical studies in all areas/advances of anesthesia, pain and intensive care. <br> <strong>Online ISSN: 2456-7388 | Print ISSN:&nbsp;2617-5479</strong></p> Society for Health Care & Research Development en-US Academia Anesthesiologica International 2617-5479 Reduction in Hemodynamic Changes during Direct Laryngoscopy and Intubation by Intravenous Clonidine or Nalbuphine Premedication - A Comparative Evaluation https://aijournals.com/index.php/aan/article/view/414 <p><strong>Background: </strong>Accentuated hemodynamic changes during direct laryngoscopy can be modified by appropriate premedication. The present study was aimed to comparatively evaluate the clinical efficacy of intravenous clonidine with nalbuphine premedication for reduction in hemodynamic changes during direct laryngoscopy and intubation. &nbsp;<strong>Subjects and Methods:</strong> Sixty adult consenting patients of ASA physical status I and II of either gender, were randomized into two equal groups of 30 patients each to receive either clonidine (2 µg/kg) Group I or nalbuphine (0.2 mg/kg) Group II, intravenously 10 minutes before induction. Anesthetic technique was standardised and direct laryngoscopy with intubation was facilitated with vecuronium bromide. Changes in heart rate, arterial blood pressure and ECG were recorded at baseline, after giving study drug, after laryngoscopy and intubation, then after at 1st, 2nd, 3rd, 5th, 10th, and 15th min of intubation and were noted as primary end points. Any side effects and complications were recorded as secondary end points. <strong>Results: </strong>After premedication in patients of comparable demographic profile, the fall in heart rate and blood pressure showed statistically significant difference between the groups. After laryngoscopy and intubation, the increase in mean heart rate and mean blood pressure occurred immediately in patients of both groups but persisted up to 5 to 7 min in patients of clonidine group and up to 10 minutes in patients of nalbuphine group with statistically significant difference between the groups. <strong>Conclusion: </strong>Intravenous clonidine premedication (2 µg/kg) could effectively reduce the hemodynamic changes during direct laryngoscopy and intubation when compared to intravenous nalbuphine (0.2 mg/kg), administered 10 min before induction.</p> Manoranjan Kumar Bansal Kumkum Gupta Abhishake Kumar Salony Agarwal Deepak Sharma Ans M Baseer ##submission.copyrightStatement## 2019-01-20 2019-01-20 3 2 1 6 Comparative Evaluation of Perioperative Haemodynamics and Emergence Profile Among Isoflurane, Sevoflurane and Desflurane in Patients Undergoing Elective Supratentorial Craniotomy for Space Occupying Lesion https://aijournals.com/index.php/aan/article/view/427 <p><strong>Background: </strong>Introduction of sevoflurane and desflurane had increased anaesthetic choices for maintenance of general anesthesia in neurosurgical cases after isoflurane. Aims: To compare emergence characteristics, intraoperative haemodynamic and intraoperative brain relaxation between isoflurane, sevoflurane and desflurane in patients undergoing elective supratentorial craniotomy. Settings and Design: Randomized, prospective and comparative study. &nbsp;<strong>Subjects and Methods:</strong> In this study, recruited patients were randomly allocated in three groups. Groups I, S, and D received Isoflurane, sevoflurane and desflurane in MAC (0.8-1.2) during maintenance of general anesthesia after endotracheal intubation till skin closure. Emergence time, extubation time, perioperative hypertension and intraoperative brain relaxation were compared between 3 groups across different time period. Statistical Analysis: Mean and standard deviation were calculated. Test of analysis between two groups was done by t-test and among three groups by analysis of variance, and then P value was calculated. <strong>Results: </strong>Significantly lesser emergence time and extubation time was found in group D compared to group I and group S (7.53±2.11 vs 15.10±1.74 vs 10.50±1.19 and 10.87±1.961 vs 18.20±1.92 vs 14.00±2.068). Incidence of emergence hypertension and post-operative complication were found to be similar among 3 groups. <strong>Conclusion: </strong>It is concluded that although all 3 inhalational agents can be used in patients undergoing supratentorial surgeries, desflurane has added advantage of faster post-operative recovery and emergence characteristics.</p> Rakesh K Dubey Jitendra S Chahar Deepak Malviya Virendra Kumar Manoj Tripathi ##submission.copyrightStatement## 2019-01-20 2019-01-20 3 2 7 12 Intrathecal Low Dose Bupivacaine with Fentanyl or Clonidine in TURP Surgery: A Prospective Randomized Double Blind Study https://aijournals.com/index.php/aan/article/view/428 <p><strong>Background: </strong>Present study was designed to compare the effect of intrathecal clonidine and fentanyl in combination with low doses of bupivacaine in TURP surgery on the hemodynamics, quality of sensory and motor block as well as the duration of analgesia and motor block. &nbsp;<strong>Subjects and Methods:</strong> 120 patients scheduled to undergo TURP surgery were randomized into four groups. Group I and II received hyperbaric bupivacaine 5 mg and 7.5 mg respectively with fentanyl 25 μg whereas Group III and IV received Bupivacaine 5 mg and 7.5 mg respectively with clonidine 30 μg in subarachnoid space. Hemodynamic parameters (heart rate, systolic blood pressure, diastolic blood pressure) were recorded at regular intervals. Intensity of motor block was recorded at L2 to S1 myotomes and a myotome score was calculated for each limb. Measurement of level of pinprick analgesia and intensity of motor block were recorded at 0,2,4,8 and 10 minutes. Time to return of pain sensation and complete motor recovery was also noted. <strong>Results: </strong>There was statistically significant difference in occurance of bradycardia from baseline in group I at 10 and 20 minutes (p&lt;0.05,p&lt;0.001). In group IV there was significant fall in heart rate at 10, 20 and 30 minutes (p&lt;0.05,p&lt;0.05,p&lt;0.001). In group II and III there was no significant fall in heart rate. In group I there is significant fall in SBP at 10, 20 and 30 minutes (p&lt;0.05). In group II there is significant fall in SBP at 10 and 20 minute (p&lt;0.05). In group III and IV, there is significant fall in SBP at 10, 20 and 30 minutes (p&lt;0.05,p&lt;0.05,p&lt;0.001). The maximum level of sensory block was comparable in all the groups (T10.21±0.99, T10.30±0.75, T10.33±1.12, T10.13±1.11 in groups I,II,III and IV respectively). There is no statistical significant difference in achieving level of motor block on comparing group I/II and group III/IV but there is highly significant (p&lt;0.001) difference in group I/III, group I/IV, group II/III, group II/IV at 10 minutes after onset of&nbsp; block. There was no statistical significant difference in return of pain sensation in all groups (91.60±18.95, 86.07±10.84, 85.37±17.39, 85.50±22.22 in groups I,II,III and IV respectively). Complete return of motor power (modified Bromage score =0) was seen at 158.17±18.17 min, 154 ± 18.50 min, 146.53 ± 16.54 min and 154.83 ± 21.27 min in group I,II,III and IV respectively.&nbsp; There is significant difference (p&lt;0.05) in return of motor power on comparing group I with III, otherwise all groups are comparable. <strong>Conclusion: </strong>The addition of fentanyl or clonidine to intrathecal bupivacaine for TURP does not result in any significant difference in the quality and&nbsp; intensity of sensory block. Clonidine causes a greater degree of motor block when compared to fentanyl. Both clonidine and fentanyl causes bradycardia and hypotension although the degree and duration of hypotension is greater with clonidine.</p> Lalit K. Raiger Sandeep Sharma Pramod Jain Shailendra Pareek ##submission.copyrightStatement## 2019-01-20 2019-01-20 3 2 13 17 Effects of Single Dose of Intravenous Dexmedetomidine on Hyperbaric Bupivacaine Spinal Anaesthesia: A Randomized Study https://aijournals.com/index.php/aan/article/view/439 <p><strong>Background: </strong>The present study is designed to evaluate the effect of intravenous dexmedetomidine on spinal anesthesia with 0.5% of hyperbaric bupivacaine. Objective: To evaluate the effect of intravenous dexmedetomidine on sensory regression, hemodynamic profile, level of sedation and postoperative analgesia. &nbsp;<strong>Subjects and Methods:</strong> Sixty patients of American Society of Anaesthesiologists (ASA) physical status I/II patients undergoing elective surgeries under spinal anaesthesia were randomized into two groups of 30 each. Immediately after subarachnoid block with 3 ml of 0.5% hyperbaric bupivacaine, patients in group D received a loading dose of 0.5 μg/kg of dexmedetomidine intravenously over a period of ten minutes, whereas, patients in group C received an equivalent quantity of normal saline. <strong>Results: </strong>Total number of doses of analgesic given as injection diclofenac sodium 75 mg (IM), in Group D was 2 ± 0.000 doses and in Group C was 2.85 ± 0.301 doses, which was highly significant as&nbsp; P=0.00001 &lt; 0.01&nbsp;&nbsp; (t-test at 1% level of significance). <strong>Conclusion: </strong>Single dose IV dexmedetomidine of 0.5 mcg/kg prolongs the duration of sensory blockade and analgesia and reduces the requirement of analgesics with lesser incidence of bradycardia and hypotension introperatively as well as postoperatively.</p> Pradeep Pendyala ##submission.copyrightStatement## 2019-01-20 2019-01-20 3 2 18 21 A Comparison of Emergence Characteristics, Intraoperative Haemodynamics and Intraoperative Brain Relaxation between Isoflurane and Desflurane in Patients Undergoing Craniotomy for Supratentorial Lesions. https://aijournals.com/index.php/aan/article/view/440 <p><strong>Background: </strong>Desflurane had increased anaesthetic armamentarium for maintenance of general anesthesia in neurosurgical cases. Few studies have compared isoflurane and desflurane for patients undergoing elective supratentorial craniotomy. Aims: The aim of this study is to compare emergence characteristics, intraoperative haemodynamic and intraoperative brain relaxation between isoflurane and desflurane in patients undergoing craniotomy for supratentorial lesions. Settings and Design: Prospective randomized and comparative study. &nbsp;<strong>Subjects and Methods:</strong> In this study, patients were randomly allocated in two groups. Groups I and D received Isoflurane and desflurane in MAC (0.8-1.2) during maintenance of general anesthesia after endotracheal intubation till skin closure. Emergence time, Extubation time, perioperative hypertension and intraoperative brain relaxation was compared between 2 groups across different time period. Statistical Analysis: Mean and standard deviation were calculated. Test of analysis between two groups was done by t-test and then P value was calculated. <strong>Results: </strong>Significantly lesser emergence time and extubation time in group D compared to group I (7.53±2.11 vs 15.10±1.7 and 10.87±1.961 vs 18.20±1.92).&nbsp; Perioperative haemodynamics were among comparable between both groups. Intraoperative brain relaxation was also comparable between 2 groups with more patients in desflurane group having grade 1 relaxation. Incidence of emergence hypertension and post-operative complication were also similar with 2 groups. <strong>Conclusion: </strong>It is concluded from the study that both inhalational agents isoflurane and desflurane can be used in patients undergoing supratentorial surgeries, desflurane has added advantage of faster post-operative recovery and intraoperative brain relaxation and emergence characteristics.</p> Jitendra S Chahar Rakesh K Dubey Ravi Ranjan Subhransu S Padhy Vaishali Agarwal ##submission.copyrightStatement## 2019-01-20 2019-01-20 3 2 22 26