Prof. Minnu Panditrao shares her own ideas about the use dexmedetomidine for various indications i.e. for sedation, intra and post operative analgesia.
Dexmedetomidine why should i make it a part of my anaesthetic practice: Prof....Prof. Mridul Panditrao
Prof. Mridul M. panditrao gives detailed pharmacodynamics/ kinetics of alpha 2 agonists, centrally action. especially when given via variuos routes, withb help of evidence in the terms of his own conducted trials.
Dexmedetomidine why should i make it a part of my anaesthetic practice: Prof....Prof. Mridul Panditrao
Prof. Mridul M. panditrao gives detailed pharmacodynamics/ kinetics of alpha 2 agonists, centrally action. especially when given via variuos routes, withb help of evidence in the terms of his own conducted trials.
BUPIVACAINE epidural effectiveness has a clearly scientific evidence for perioperative analgesia
Bupivacaine epidural still safe in a wide range dose to cause systemic toxicity
We always reduce the risk of LA toxicity by our usually practice procedures
Short description about awake craniotomy, its indications, contraindications, complications,various techniques of providing awake craniotomy and drugs used.
Scalp block is simple and easy to perform. It has the advantages of minimizing cardiovascular effects and decreasing intraoperative analgesia requirements.
New GCS, the GCS-P was adopted in 2018 by the same person who proposed GCS. It gives better prognosticate outcomes compared to GCS.
The transversus abdominis plane, more commonly referred to as the TAP block,
Places local anesthetic in the lateral abdominal wall in a plane between the internal oblique and the transversus abdominis muscles.
Here, the local anesthetic block can block many of the abdominal nerves as they pass to the abdominal structures.
new technique for pain management ,described by dr forero ,it can replace epidural anesthesia,paravertebral anesthesia and other regional blocks.it can be used for both acute and chronic painful conditions
BUPIVACAINE epidural effectiveness has a clearly scientific evidence for perioperative analgesia
Bupivacaine epidural still safe in a wide range dose to cause systemic toxicity
We always reduce the risk of LA toxicity by our usually practice procedures
Short description about awake craniotomy, its indications, contraindications, complications,various techniques of providing awake craniotomy and drugs used.
Scalp block is simple and easy to perform. It has the advantages of minimizing cardiovascular effects and decreasing intraoperative analgesia requirements.
New GCS, the GCS-P was adopted in 2018 by the same person who proposed GCS. It gives better prognosticate outcomes compared to GCS.
The transversus abdominis plane, more commonly referred to as the TAP block,
Places local anesthetic in the lateral abdominal wall in a plane between the internal oblique and the transversus abdominis muscles.
Here, the local anesthetic block can block many of the abdominal nerves as they pass to the abdominal structures.
new technique for pain management ,described by dr forero ,it can replace epidural anesthesia,paravertebral anesthesia and other regional blocks.it can be used for both acute and chronic painful conditions
“Hemodynamic and recovery profile with Dexmedetomidine and Fentanyl in intrac...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Evaluation of Effect of Low Dose Fentanyl, Dexmedetomidine and Clonidine in S...iosrjce
In the present study effect of intrathecal hyperbaric Bupivacaine 0.5% with low doses of Clonidine
or Fentanyl or Dexmedetomidine were compared in elective lower abdominal surgeries. This was a prospective
randomized control trial. 90 patients belonging to ASA 1 &II, aged between 20-50 years were allocated into
three groups. Group-C: Clonidine 30µg, Group-D: Dexmedetomidine 5 µg, Group-F: Fentanyl 25 µg. The
onset of sensory blockade was comparable in all the three groups. The onset of motor blockade was earlier by
about 1.3 mins in Dexmedetomidine group when compared to Clonidine and Fentanyl group. Duration of
sensory blockade was prolonged in Dexmedetomidine group (346mins) when compared to Clonidine (300mins)
and Fentanyl (302mins) group. Time duration of motor blockade was prolonged in Dexmedetomidine group
(269mins) when compared to Clonidine (223mins) and Fentanyl (220mins) group. The haemodynamic
parameters were clinically and statistically insignificant The time of first request for analgesics by the patients
was more in Dexmedetomidine group (250mins) when compared to Clonidine (194mins) and Fentanyl
(189mins) group. The use of intrathecal Dexmedetomidine as an adjuvant to Bupivacaine is an attractive
alternative to Fentanyl or Clonidine for long duration surgical procedures due to its profound intrathecal
anesthetic and analgesic properties combined with minimal side effects.
Dr. Niranjan Kumar Verma¹*, Dr. Mahesh Kumar²
¹Professor, Department of Anaesthesiology, JLN Medical College & Hospital, Bhagalpur, India
²Assistant Professor, Department of Anaesthesiology, JLN Medical College & Hospital, Bhagalpur, India
*Address for Correspondence: Dr. Niranjan Kumar Verma, Professor, Department of Anaesthesiology, JLN Medical
College & Hospital, Bhagalpur, India
Received: 04 Sept 2016/Revised: 28 Sept 2016/Accepted: 18 Oct 2016
ABSTRACT- BACKGROUND & OBJECTIVES: Control of post spinal shivering is essential for optimal
peri-operative care as shivering is a cause of discomfort and dissatisfaction in patients undergoing operations under spinal
anaesthesia. The aim of the study is to assess the efficacy and safety of intravenous Clonidine, Dexmedetomidine and
Tramadol in the treatment of post spinal intra-operative shivering.
MATERIALS AND METHODS: In this prospective, double blind, randomized study, 90 ASA grade I and II patients of
patients aged 18 – 50 rears, scheduled for various routine surgical procedures under spinal anaesthesia with hyperbaric
Bupivacaine and who developed shivering were selected. The patients were divided into three groups of 30 each.
Group- C (n=30) comprised of the patients who received Clonidine 0.5mcg/kg intravenously, Group-D (n=30) who
received Dexmedetomidine 0.5mcg/kg IV and Group T (n=30) receiving Tramadol 2 mg/kg (maximum 100mg) IV. The
efficacy and response rate of the study drugs were evaluated and recorded. Side effects like, nausea, vomiting,
hypotension, bradycardia, sedation and headache, if present, were recorded. All data were analyzed using Chi-square test
and student-t test and expressed in >0.05, (which is insignificant) and < 0.05, (which is significant differences).
RESULTS: There were significant differences in the total response rate between the drugs (p > 0.05), Tramadol showing
the highest response rate (100%). Time taken from the start of treatment to cessation of shivering was significantly less
(p<0.05) in Dexmedetomidine group, but Tramadol group shows complete control of post spinal shivering with none or
lesser and mild degree of side effects with a single dose.
CONCLUSION: Complete control of post spinal intra-operative shivering with less or no severe side effects could be
achieved with Tramadol in comparisons to clonidine and Dexmedetomidine.
Key-words- Post spinal Shivering, Clonidine, Dexmedetomidine, Tramadol
Effect of Intravenous Dexmedetomidine on Prolongation of Intrathecal Spinal A...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Effectiveness of intra-articular dexmedetomidine as postoperative analgesia i...iosrphr_editor
Background And Objectives: To study the effect of inj.Ropivacaine (0.25%) 2mg/kg with and without Inj.Dexmedetomidine (1-2μg/kg) intraarticularly for postoperative analgesia in arthroscopic knee surgery.1:To Evaluate Onset, Duration and analgesic efficacy of Intraarticular Dexmedetomidine2: To monitor the safety of Dexmedetomidine and Ropivacaine.
Methods: A prospective randomized double blind study, was conducted in 50 patients undergoing elective arthroscopy of knee joint under spinal anaesthesia. At the completion of the surgery, all patients were divied into two groups;GroupP(n=25):received Inj. Ropivacaine 0.25% and GroupD(n=25):received Inj.Ropivacaine(0.25%)+Inj. Dexmedetomidine(1μg/kg) total volume 20 ml was deposited intra-articularly.Patients were monitored in the postoperative ward for the hemodynamic parameters and their Sedation score was assessed.. The efficacy of the drug was determined by improvement in VAS score, duration of analgesia and total number of rescue analgesics during 24 hr in post operative period.
Results: There was no statistically significant differences observed in heart rate except changes at 6 and 8 hr. At 6 and 8 hr in group P pulse (82.48 ± 7.49, 81.44 ± 8.78) as compared to group D (75.38 ± 6.52, 74.96 ± 5.70),because of duration of action of ropivacaine with or without dexmedetomidine.There was no statistically significant difference in blood pressure was found, except at 12 hour and 24 hour (p=0.018), because of longer duration of action of intrarticular dexmedetomidine with ropivacaine in group D.At 6 hrs patients in Group P had a mean VAS score of 3.2 as compared to VAS score values of 1.8 in Group D which is statistically significant..At 2 , 4, 6 and 8 hour VAS score in P group was 1.64, 2.44, 3.24, 2.84 respectively. As compared to group P, in group D VAS score at 2, 4, 6 and 8 hour was 0.92, 1.04, 1.79 and 2.08 respectively. So VAS score lower in group D as compared to group P at 2, 4, 6 and 8 hrs.
Does scorpion bite lead to resistance to action of local anaesthetic agentsby...Minnu Panditrao
Professor Minnu M. Panditrao gives her award winning (SAARC Bengaluru 2011) and recently published paper in Inidan Journal of Anaesthesia 56, 6 Nov.dec 2012, 575-78, paper where she explains the peculear responswe seen by herself and her team, about the developement of resistance to the local anaesthetic agents given via various routes, inpatients who give history of old single/ or usually multiple scorpion bites.
Delayed recovery from anaesthesia by prof. minnu m. panditraoMinnu Panditrao
Prof. Minnu M. Panditrao analyses the very common and potentially dangerous problem/s of the Delayed post-ooperative/ anaesthetic recovery and how to overcome the problem
Jehowah's witnesses and blood conservation strategies by Dr.Minnu M. PanditraoMinnu Panditrao
dr. Mrs. Minnu M. Panditrao explains the problems faced by anesthesiologists in anesthetising the Jehowah's Witness patients because of their beliefs. Ina ddition she also discribes various strategies of Blood conservation.
Nalbuphine given intrathecally as an adjuvant to LAAsMinnu Panditrao
Dr. Minnu M. Panditrao, shares her own experience of adding nalbuphine, a newer, agonist- antagonist to bupivacaine as an adjuvant in elderly males coming for lower limb surgeries
Deep Vein Thrombosis and Pulmonary Embolism, by Prof. Minnu M. PanditraoMinnu Panditrao
Dr. Mrs. Minnu Panditrao, goes in depth with the very important topic of Deep Vein Thrombosis, Pulmonary embolism, aetio patheogenesis, clinical features, management etc.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. Dr. Mrs. Minnu M. Panditrao
CONSULTANT
DEPARTMENT OF ANESTHESIOLOGY &
INTENSIVE CARE
Public Hospital Authority’s
RAND MEMORIAL HOSPITAL
FREEPORT, GRAND BAHAMA
COMMONWEALTH OF THE BAHAMAS
4. alpha 2 Adrenergic Receptor Agonists
• Imidazole class of drugs
• Older drugs : xylazine
detomidine
medetomidine
in veterinary medicine!
• Clonidine : first agent ( in humans)
•Clarke KW, Hall LW. “Xylazine” a new sedative for horse and cattle. Vet rec1969; 85: 512-517
•Tamsent A, Gordh T. Epidural clonidine produces analgesia, Lancet1984; 2:231-232
5. alpha 2 Adrenergic Receptor Agonists
Dexmedetomidine
What is so special about it?
6. Dexmedetomidine
• a D – enantiomer of medetomidine
• New Entrant in this class
• approved in 1999 by FDA for clinical
application in humans
• Structure:
7.
8. Actions
• Central
Sedation, anxiolysis and analgesia
Bradycardia and hypotension
• Peripheral
Decreased GI secretions, inclusive of saliva
Decreased GI motility
Inhibition of rennin-Angiotensin (RA) system and
decreased release of rennin
Increased Glomerular Filtration Rate (GFR),
Increased excretion of Na, water and thus diuresis
Decreased intra-ocular pressure
Decreased insulin release
9. MECHANISM
CLINICAL (CNS) EFFECTS
• neither the nerve/ terminal is allowed to get
stimulated, nor it can transmit/ propagate the
signal forwards.
• at supra-spinal level as well as at spinal level
Supra-spinal: Locus coeruleus:
– Brainstem center - modulates wakefulness
– Major site for hypnotic actions (sedation,
anxiolysis)
– Mediated via various efferent pathways:
• Thalamus and subthalamus cortex
• Nociceptive transmission via descending spinal tracts
• Vasomotor center and reticular formation
10.
11. MECHANISM
CLINICAL (CNS) EFFECTS
• Spinal: Spinal cord
Binding to 2 receptors analgesia
At Substantia gelatinosa (Lamina II),
closing the gate at the dorsal horn to
stimuli coming from Aδ and C fibers
Inhibit release of nociceptive humoral
transmitters like Substance P
release of substance P
•Kuraishi Y, Hirota N, Sato Y, et al Noradrenergic inhibition of the release of Substance P from the primary afferents in the rabbit spinal
cord dorsal horn. Brain res.1985; 309: 177- 182
14. CNS ACTIONS
• Sedation, resembles the physiologic sleep
with less prominent respiratory depression
• Action is supposed to be mediated through
α2A subset of receptors and is very specific
for dexmedetomidine as compared to
clonidine
• Are easily arousable and additional sedative/
adjuvant is not needed to maintain the
sedation
•Hunter JC, Fontana DJ, Hedley LR et al. Assessment of the role of alpha 2 adrenoceptor subtypes in anti nociceptive , sedative and
hypothermic action of dexmedetomidine in transgenic mice Br J Pharmacol1997; 122: 1339-1344
•Venn RM, Bradshaw CJ, Spencer R et al. Preliminary UK experience of dexmedetomidine, a novel agent for post operative sedation
in intensive care unit. Anaesthesia 199; 54: 1136-1142
15. Actions on Cardio-Vascular system
• Totally devoid of any direct effects on
myocardium
• Transient increase in BP : attributable to
peripheral vasoconstriction due to
stimulation of α2B adrenoreceptors in
peripheral vascular smooth muscles.
• Significant bradycardia & Hypotension
secondary to central inhibitory α2A agonist
effect
• All these effects can be offset or overcome
with use of atropine, ephedrine or volume
loading
16. Clinical Uses of Dexmedetomidine
• Craniotomy:
aneurysm, AVM
• Cervical spine
surgery
• Conventional CABG
• Off-pump CABG
• Vascular surgery
• Thoracic surgery
• Bariatric surgery
• Back surgery, evoked
potentials
• Head injury
• Burn
• Trauma
• Awake intubation
17. Clinical Uses of Dexmedetomidine
Sedation in CT and MRI imaging studies
Mason K, Ped Anesth 2008
Koroglu A, Anesth Analg 2006
Outpatient third molar surgery
Ustin Y, J Oral Maxilfac Surg 2006
Cheung C, Anaesthesia 2007
Cataract surgery
Alhashemi J, Br J Anaest 2006
Cardiac catheterization
Tosun Z, J Card Vasc Anesth 2006
Mester R, Am J Therap 2008
GI Procedures
Demiraran Y, Can J Gastroenter 2007
Dex may be a good alternative to midazolam for upper
endoscopy
18. Dex: Use in Coronary Artery Surgery
Coronary Artery Surgery Patients
Dexmedetomidine : Herr study, n=300: Dex vs. controls [propofol]
• Faster time to extub in dex gp - by 1 hr
• 70% did not require morphine vs. 34% controls
• Dex pts had less Afib (7 vs 12 pts)
Herr DL: Crit Care Med 2000;28:M248. Washington Hospital
CABG and Lung Disease
• RCT, n= 20. Dex started at end of surgery, 0.2 to 0.7 ug/kg/hr, + continued 6
hr after extubation vs. controls (propofol)
Dexmedetomidine
• Faster time to extub: 7.8 + 4.6 h v. 16.5 + 11.8 h
• No difference in PaCO2 between gps 30 min after extub: 37.9 v. 34.9 mmHg
Sumping ST: CCM 2000;28:M249. Duke
19. Dex: Use in Thoracotomy + Thoracoscopy
Thoracotomy + thoracoscopy patients
• COPD, pleural effusion, marginal pulmonary function, pCO2 + pO2 with opioids
• Thoracic epidural: mainly for thoracotomy, Dex: mainly for thoracoscopy
Dexmedetomidine
• Patients are arousable, but sedated
• Does not ventilatory drive
• Greatly need for opioids
• Alternative to thoracic epidural
• Continue after extubation
Vascular surgery
• Usually at risk for CAD, ischemia, HTN, tachycardia
• Dex attenuates periop stress response
• Dex attenuates BP w AXC, especially thoracic aorta
Dexmedetomidine: RCT, n=41. Dex continued 48 hr postop
• HR in dex gp at emergence- 73 + 11 v. 83 + 20 bpm
• Better control of HR, Plasma NE levels in dex group
Talke et al: Anesth Analg 2000;90:834. Multicenter
20. Dex: Use in Other Surgical Procedures
Abdominal surgery
• Dexmedetomidine provides analgesia without respiratory depression
• Especially useful in elderly undergoing colon resections, TAH, + other stressful
procedures
Bariatric surgery
• Dexmedetomidine Improves Postop Pain Mgt after Bariatric Surgery
• Morphine use in dex gp
• Pain score better in dex gp: 1.8 vs 3.4 , % time pain free in PACU in dex gp: 44% vs 0
• Better control of HR in dex gp
Neck + back surgery
• Dex causes minimal effect on SSEP monitoring
• Smooth emergence, especially cervical spine
• Easy to evaluate neuro function prior to + after extubation
Ramsay MA, et al: Anesthesiology, 2002: A-910 and A-165. Baylor
21. Dex: Use in Other Surgical Procedures
Burns patients
• 2 agonist effect assists in the management of burn patients; blunts
catecholamine surge
•Use in intubated and non-intubated burn patients
•Outpatient dressing changes instead of ketamine
Trauma and Alcohol withdrawal patients
•Benzodiazepines typically used- Intubation and ventilation often
required if extreme agitation
•Dexmedetomidine is an alternative to BZD- Spontaneous breathing,
Hemodynamic stability, Adequate sedation, Prevention of autonomic
effects of withdrawal, Pain control
22. Dex: Use in Neuro anesthesia
Effect of Dexmedetomidine on Cerebral Blood Flow
• Animal models
– Dex causes a reduction in CBF up to 45%
– Dex has no effect on the CMRO2
– Dex produces the concentration-dependent constriction of pial arteries and veins
– Dex limits hypercapnea- and hypoxia-induced cerebral vasodilation
Zornow MH et al, Anesth Analg; 1990
Fale A et al, Anesth Analg; 1994
Karlsson et al, Anesth Analg; 1991
• Human study (TCD)
– Mean CBF velocity decreased with an increase in plasma concentration of Dex
– Pulsatility index increased at higher level of Dex (indicates an increase in CVR)
Zornow MH et al, J Cereb Blood Flow Metab; 1993
Cognitive Function
• There is strong evidence that a2 – agonists improve prefrontal cortical function (PFC)
Arnstein et el. Arch Gen Psychiatry 1996
23. Dex: Use in Neuro anesthesia
Effect on ICP
• Animal model
– ICP was unchanged despite an increase in systemic blood pressure
in rabbits
– ICP was decreased in the presence of intracranial hypertension
Zornow MH et al, Anesth Analg 1992
• Human study
– Dex has no effect on lumbar CSF pressure in patients undergoing
transphenoidal pituitary tumor resection
Talke P et al. Anesth Analg 1997
Effect on SSEPs and AEP
• There is a lack of effect on cortical AEP
• Dex does not affect cortical (P25-N35) response
• Dex depresses median nerve P15-N20 amplitudes
Thornton C et al. Br J Anaesth 1999
24. Dex: Use in Neuro anesthesia
Antinociception
· a2 – Agonists attenuate hemodynamic responses to laryngoscopy and intubation
Lawrence CJ et al Anaesthesia 1997
· a2 – Agonists decrease peri operative oxygen consumption Taittonen MT Br J Anaesth
1997
• Dex reduces NE level during emergence from anesthesia (2 to 3 times lower than placebo)
Talke P et al. Anesth Analg 2000
Effect on BIS
• BIS values after Dex infusion for 1 hour were: 65 at 0.2 mg/kg/hr, 60 at 0.6 mg/kg/hr
• Volunteers readily awakened from hypnosis by talking ; BIS returned to awake level
BIS before and after subjects were asked to perform various tasks
Hall JE et al. Anesth Analg 2000
25. Dex: Use in Neuro anesthesia- Neuro protective effects
• Inhibition of ischemia induced NE release may be associated with
neuroprotection
• Dex prevents delayed neuronal death after focal ischemia
• Dex decreased total ischemic volume by 40% compared to placebo
Jolkkonen J et al. Euro J Pharm 1999
Hoffman WE et al Anesthesiology 1991
• Dex enhances glutamine disposal by oxidative metabolism in
astrocytes
Huang R et al. J Cereb Blood Metab 2000
26. Dexmedetomidine: Use in Craniotomy
Craniotomy for Aneurysm / AVM
Anesthesia considerations
• Smooth induction + emergence, Prevent rupture
• Avoid cerebral ischemia, Hypothermia (33 oC) CMRO2, CBF, CBV, CSF, ICP
Dexmedetomodine
• sympathetic stimulation
• or no change in ICP
• shivering w/o respiratory depression
• Preserved cognitive function- reliable serial neuro exams
Doufas AG et al: Stroke 2003;34. Louisville, KY
Craniotomy
• Postoperative infusion of Dex in patients recovering from transphenoidal
hypophysectomy reduced plasma catecholamines by 70%
Talke P et al Anesth Analg 1997
27. Dex Use in Neuro: Clinical Experience
Spinal Fusion
• Intraoperative switching from a propofol infusion to Dex in patients undergoing
cervical fusion resulted in:
– A neurological examination that was successfully performed in the OR on an
intubated patient
– Clinically insignificant hemodynamic changes during and after the switchover
Bloom M et al J Neurosurg Anesth 2001
28. Dex Use in Neuro: Clinical Experience
Carotid Endartrectomy
• A combination of superficial and deep cervical plexus blocks is the most
common regional anesthetic technique in the NYU medical center
• Sedation with dexmedetomidine (0.2-0.4 mcg/kg/hr) offers a comfortable
and cooperative patient during the operation
• Less agitation and respiratory depression than with a continuous infusion
of propofol or repeated doses of fentanyl and/or midazolam
Functional Neurosurgery
• Dex infusion at 0.1 – 0.2 mcg/kg/hr allowed us to achieve a tranquil state
sufficient to complete neuropsychiatric testing required for mapping of the
cortical speech area, as well as to perform an awake tumor resection
• A lack of respiratory depression offers an advantage over other technique
Bekker A et al. Anesth Analg 2001
29. Dex Use in Ophthalmology:
Effect of dexmedetomidine premedication on the intraocular pressure
changes after succinylcholine and intubation: BJA
British Journal of Anaesthesia 100 (4): 485–9 (2008) February 19, 2008
Details - 40 patients with no pre-existing eye disease undergoing GA, Random
premedication with Dex 0.6 mcg/kg or saline, HR, MAP, and IOP measured
• IOP- Succinylcholine and intubation increased IOP in both groups.
However, in the Dex group, the IOP rise was not different from the baseline
value and was significantly lower than in the saline group .
• MAP- After intubation, the MAP in the control group was higher than that
in the dex group and exceeded the baseline value
• HR- HR also showed less fluctuation in the dex group than in the saline
group
Result:
• Premedication with a dose dex 0.6 mg/kg over 10 min blunted the ↑IOP
caused by succinylcholine & intubation
• Attenuated the hemodynamic response to laryngoscopy & intubation.
30. Dex Use in Ophthalmology: Conclusion
of IOP with succinylcholine & endotracheal intubation can be
blunted with i.v. dexmedetomidine premedication.
Hemodynamic stability is an additional advantage
Dex could be a beneficial premedication in open globe injuries
Single i.v. dose of dexmedetomidine 0.6 mcg/kg IOP by 34%
The present study (0.6 mcg/kg) was based on a previous clinical study,
where the selected dose resulted in a significant IOP and prevented
IOP response to intubation
Dexmedetomidine attenuates sympathoadrenal responses to tracheal intubation. Br J Anaesth 1992; 68: 126–31
31. PROCEDURAL SEDATION
• Koroglu A, Br J Anaesth 2005;94:821
– Dex vs midazolam for MRI sedation
– 80 patients, 1-7 yrs
– Dex: 1ug/kg bolus, then 0.5 ug/kg/hr
– Midazolam: 0.2 mg/kg, then 0.36 mg/kg/hr
– Efficacy: 32/40 (dex) vs 8/40 (midazolam)
– Onset: 19 min (dex) vs 35 min (midazolam)
– Similar CV effects - nothing significant
• Concl: dex > efficacy vs midazolam
• Problem – midaz rarely sole agent for MRI
32. PROCEDURAL SEDATION
• Koroglu A, Anesth Analg 2006;103:63
– Dex vs propofol for MRI sedation
– 60 patients aged 1-7 yrs
– Dex: 1ug/kg bolus, then 0.5 ug/kg/hr
– Propofol: 3 mg/kg bolus, then 6 mg/kg/min
– Efficacy similar: 83% (dex) vs 90% (propofol)
– Onset – 11 min (dex) vs 4 min (propofol)
– rec time with dex (27 vs 18 min)
– hypoxia with dex (0% vs 13%)
• Concl: Consider as alternative to propofol
33. Dex Use in MRI
• 80 children aged 1-7 years
• Randomly assigned to either
dexmedetomidine or midazolam
– 10-minute loading doses:
1 mcg/kg dexmedetomidine,
0.2 mg/kg midazolam
– Infusions: 0.5 mcg/kg/h
dexmedetomidine,
6 mcg/kg/h midazolam1
• The quality of MRI was
significantly better (P<.001) and
the rate of adequate sedation was
significantly higher (P<.001) with
dexmedetomidine
Quality of MRI
0
10
20
30
40
1 2 3
NumberofPatients
Midazolam
Dexmedetomidine
34. Clinical Administration
• Onset of 30 minutes as compared to that of
midazolam 3-5 minutes and that of propofol
30-50 seconds
can be decreased by infusion of standard
loading dose of 1µg/kg, over 10 minutes
• Offset of sedative action in 5 minutes, while
midazolam has about 2 to 6 hours and
propofol has 3-8 minutes.
• Duration of analgesic action of about 4 hours
as compared to that of Fentanyl up to 60-80
minutes
35. Indications & Dosage
• A pre-anaesthetic medication and as a
psychosedation in short outpatient surgical
procedures
• initial loading dose of intra venous infusion
of dexmedetomidine 1- 6 µg / kg for 10
minutes till 3 on Mackenzie’s Sedation
assessment score (till the patient showed
awakening responses to calling in spite of
closed eyes) and maintained on
0.4 µg/kg/hr
•Taniyama K, Oda H, Okawa K et al. Psychosedation with dexmedetomidine hydrochloride during
minor oral surgery. Anesth Prog 2009; 56:n75-80
36. Indications & Dosage
• In the dose of 0.2 to 0.7 µg/kg/hr, found to
attenuate the stress induced sympatho
adrenal responses to laryngoscopy,
endotracheal intubation, surgical stimulation
and provide overall increased hemodynamic
stability & as an adjuvant to other
anaesthetic agents, including inhalational
agents like isoflurane
Bhatia P. Dexmedetomidine: a New agent in Anaesthesia & Critical care Practice. http://dexmedtomidine.com
Aanta R, Jaakola ML, Kallio A, Kanto J. Reduction of minimum alveolar concentration of isoflurane by dexmedetomidine
.Anesthesiology 1997;80 : 1055-1060
37. Indications & Dosage
• Can be used to obtund the autonomic
pressor response due to laryngoscopy and
endotracheal intubation
• In the dose of 1 µg / kg diluted in 100ml of
saline solution, infused over 15 minutes
• After a stabilization period of 5 minutes
• Suitably induced, relaxed & trachea
intubated
38. Indications & Dosage
• an intra-operative analgesic in GA as an
alternative to opioids
• Infusion of standard loading dose of 1µg/kg,
over 10 minutes followed by maintenance of 0.2-
0.7 µg/kg/hr. diluted in 0.9 % normal saline
Scheinin B, Lindgren L, Bandel T, Scheinin H, Scheinin M. Dexmedomidine attenuates sympatho adrenal responses to
tracheal intubation and reduces need for thiopentone and peri-operative fentanyl Br J Anaesth 1992; 68: 126-131
Menda F, Koner O, Sayin M, Ture H et al. Dexmedetomidine as an adjunct to anaesthetic induction to attenuate
hemodynamic response to endotracheal intubation in patients undergoing fast track CABG. Ann Can J Anaesth 2010’
13: 16-21
39. Indications & Dosage
• It has been found to provide neuro-
protective effect by decreasing cerebral
blood flow without increasing either with
cerebral metabolic rate (CMRO2) or intra
cranial pressure (ICP)
• sole sedating agent with local anesthetic
agents in a high risk patient
• used as anti-shivering and for
thermoregulation
•Zornov MH, Maze M, Dyek JB. Shafer SL. Dexmedetomidine decreases cerebral blood flow velocity in humans J
Cereb Blood Flow Metab 1993; 13: 350-352
•Rich JM. Dexmedetomidine as a sole sedating agent with local anesthesia in a high risk patient for axillo-femoral
bypass graft: a case report. AANA Journal2005; 73:357-360
40. alpha 2 Adrenergic Receptor
Antagonist
Atipamezole
• Effectively reverses Psychomotor side-
effects
• Reverses Sedation & Sympatholysis
• Reverses Analgesia
• t ½ is 1 ½ - 2 hours.
41. To compare the efficacy of
Dexmedetomidine vs Fentanyl
as sedative & analgesic in short general
anaesthesia in day care obstetric &
gynaecological surgeries
42. AIMS AND OBJECTIVES
• To compare the time required for onset and offset
of sedation, quality of intra-operative & post-
operative analgesia and the time required for post-
operative recovery using Inj. Dexmedetomidine
and Inj. Fentanyl
• To evaluate cardio-respiratory and any other
systemic side effects at equal doses
43. METHODOLOGY
• Age group 18 - 65 years of ASA-I & II
•Randomized into two equal groups of 20 each by computer
generated model
•Pre-medicated with Inj. Glycopyrrolate 0.2mg i.v.
• Group A: patients received Inj. Dexmedetomidine
1μg/kg i.v. 10 min. prior to induction by infusion
• Group B: patients received Inj. Fentanyl 1μg/kg i.v.
10 min. prior to induction by infusion
44. • Induction done with Inj. Propofol i.v in titrated doses
• Maintained with 66% N2O, 33% Oxygen & Isoflurane ( titrated
concentration) with the patient breathing spontaneously on
Magill circuit
• Time to eye opening at the conclusion of surgery was recorded
• In post anaesthesia care unit patients were evaluated
periodically for
- vitals
- sedation using Ramsay sedation scale
- visual analog scale
- time of rescue analgesia (when VAS >5)
- Standard Aldrete score for post anaesthesia recovery
METHODOLOGY
45. RESULTS
• Demographic profile for Age, Sex and ASA grade had no
statistical significance & hence were comparable
• The requirement of Propofol was significantly reduced in Dex
Group
• Comparison of pulse rate in Dexmedetomidine Group
showed significant fall immediately after pre medication ,
without any intervention it returned to baseline, & remained
equivalent to that in Fentanyl Group throughout surgery
•
Line diagram showing comparision of pulse rate in study groups
0
10
20
30
40
50
60
70
80
90
On table AFT PMD AFT IND At 5 min At 10 min At 15 min At end Post - op
PR
Average
Group A
Group B
P < 0.05 after premedication.
46. RESULTS
• No significant change in blood pressure
seen in Dex. group whereas continuous
fluctuation of systolic BP seen in
fent.group
• No significant change in diastolic BP &
Respiratory rate seen in any of the groups
• significant fall in saturation was observed
with Fentanyl group
• The time of eye opening is highly
significantly early in Dex. group (p<0.001)
and delayed eye opening seen with
fentanyl group
Line diagram showing comparision of systolic blood pressure in study
groups
90
95
100
105
110
115
120
125
On table AFT PMD AFT IND At 5 min At 10 min At 15 min At end Post - op
SBP (mm Hg)
Average
Group A
Group B
Line diagram showing comparision of SPO2 in study groups
0
10
20
30
40
50
60
70
80
90
100
110
On table AFT PMD AFT IND At 5 min At 10 min At 15 min At end Post - op
SPO2
Average
Group A
Group B
0
1
2
3
4
5
6
7
Average
Eye opening after surgery (min)
Bar chart showing comparison of eye opening after surgery in study
group
Group A
Group B
47. RESULTS
• The post operative analgesia duration was
more in Dex. group (approx. 4-6 hrs.),
whereas in Fentanyl group patients required
rescue analgesia within 1 – 1.5 hrs of surgery
• The sedation was highly significantly
profound in fentanyl group according to
Ramsay sedation score (p < 0.001) after 15
min of surgery
• The quality of recovery was highly
significantly better (Aldrete score = 9+)was
observed in most of the patients after 30 min
in Dex.group & Similar results were seen
only after 1.5 – 2 hrs. in Fentanyl Group
Line diagram showing comparision of VAS score in study groups
0
2
4
6
8
At End of surgery At 30 min At 1 hr At 1.5 hr At 2 hr
VAS Score
Average
Group A
Group B
Line diagram showing comparision of Ramsay sedation in post operative in study
groups
0
1
2
3
4
End of surgery At 15 min At 30 min At 1 hr At 2 hr
Ramsay sedation
Average
Group A
Group B
P < 0.001 at 1.5 hrs.
P < 0.001 at 15 min.
Line diagram showing comparision of standard aldrete score in post operative in study
groups
0
2
4
6
8
10
12
End of surgery At 15 min At 30 min At 1 hr At 1.5 hr At 2 hr
Standard aldrete score
Average
Group A
Group B
P < 0.001 at 15,30, 60 min.
48. TO EVALUATE THE EFFECT
OF ADDITION OF
DEXMEDETOMIDINE TO 0.5%
HYPERBARIC BUPIVACAINE
INTRATHECALLY
49. AIMS & OBJECTIVES
• To study the onset and duration of analgesia with the
addition of 10 µg Dexmedetomidine to 0.5% heavy
Bupivacaine in sub-arachnoid block
• To evaluate the quality of block and post operative
analgesia as compared to control i.e. 0.5% heavy
Bupivacaine
• To observe any side effects of intrathecal administration
of Dexmedetomidine with 0.5% Bupivacaine intra
operatively and post operatively
50. METHODOLOGY
• Patients of ASA I,II and age group 18-65 years were
randomized into two equal groups of 20 each by a
computer generated model
• Group A (Dexmedetomidine Group) were given 3ml of
0.5% heavy Bupivacaine + 0.5ml (10 µg) of
Dexmedetomidine
• Group B (Control Group) were given 3ml of 0.5% heavy
Bupivacaine + 0.5ml of Water for injection
• Patients will be preloaded with Ringer Lactate solution
10 ml/kg body
• Spinal anaesthesia was given using a 26G Quincke’s
needle in sitting position through a midline approach
51. METHODOLOGY
• Sensory block was tested by pinprick method till T6
sensory level
• Degree of motor blockade was assessed by modified
Bromage scale
• Intraoperative vitals were monitored
• Hypotension: SBP < 90 mm Hg or a decrease of >20%
from baseline. Hypotension was treated with a bolus
administration of 250 ml Ringer lactate and 6 mg of i.v.
Mephentermine if required
• Bradycardia was defined as HR < 50 bpm and was
treated with 0.6 mg of i.v. Atropine
• Postoperatively, 2 segment sensory regression, motor
regression and time to rescue analgesia were monitored
52. • No statistically
significant difference
for age, height ,
weight, Sex wise and
ASA distribution in
both groups
RESULTS
53. • Difference in sensory onset
not statistically significant
• Motor onset significantly
shorter in Dexmedetomidine
Group (t value-2.54,
p value < 0.05)
• Difference in peak sensory
insignificant
• Peak motor significantly
longer in Dex Group(t value-
4.59, p value<0.0001)
RESULTS
0
1
2
3
4
5
6
7
8
Average
Time of Peak sensory (T3) Time of Peak motor(T4)
After spinal anesthesia
Multiple bar diagram showing comparison of time of sensory and motor
Peak after spinal anesthesia in study groups
Group A
Group B
54. • 2 segment sensory
regression
• motor regression
and
• time of rescue
analgesia
significantly longer
in Dex. Group
RESULTS
Parameters Group A Group B t
Value
P Value
Mean SD
(n=20)
Mean SD
(n=20)
2 segment sensory
regression (T5)
190.3 34.80 98.65 14.95 10.81 <0.000
1
Motor regression
(T6)
265.05 57.50 138.7 14.76 9.51 <0.000
1
Time of rescue
analgesia (T7)
342.75 76.94 189 20.71 8.62 <0.000
1
0
50
100
150
200
250
300
350
Average
2 segment sensory
regression (T5)
Motor regression
(T6)
Time of rescue
analgesia (vas > 7)
(T7)
Level of sensory blockade
Multiple bar diagram showing comparison of level of sensory blockade
in study groups
Group A
Group B
55. • Both groups with
manageable
Bradycardia &
Hypotension0
1
2
3
4
No.ofcases
Bradycardia Hypotension
Side effect
Multiple bar diagram showing side effect wise distribution of cases in
study groups
Group A
Group B
Line diagram showing comparision of heart rate in study groups
0
10
20
30
40
50
60
70
80
90
100
P
re
–
op
A
t3
m
in
A
t10
m
in
A
t15
m
in
A
t30
m
in
A
t45
m
in
A
t60
m
inE
nd
ofS
urgery
P
ost-op
HR (min)
Average
Group A
Group B
Line diagram showing comparision of systolic blood pressure in study
groups
0
20
40
60
80
100
120
140
P
re
–
op
A
t3
m
in
A
t10
m
in
A
t15
m
in
A
t30
m
in
A
t45
m
in
A
t60
m
inE
nd
ofS
urgery
P
ost-op
SBP (mm Hg)
Average
Group A
Group B
Line diagram showing comparision of diastolic blood pressure in study
groups
0
10
20
30
40
50
60
70
80
90
Pre – op At 3 min At 10
min
At 15
min
At 30
min
At 45
min
At 60
min
End of
Surgery
Post -
op
DBP (mm Hg)
Average
Group A
Group B
56. Indications: Future plans
• Use of dexmedetomidine as an
adjuvant to Local Anaesthetic Mixture,
in peri- bulbar block
57. Summarizing
• Quest for an ‘Ideal’ peri-operative sedative-
analgesic goes on… &… on…&….on!!
• α2 agonists are unique class of drugs, with
many desirable properties!!
• Clonidine and now dexmedetomidine, are
versatile, multi-faceted and potent drugs!!!
• It has been successfully employed in Cardiac,
Neuro-surgical, abdominal, Head & Neck
Surgeries and Procedural sedation !!!!
58. Conclusion!
• Dexmedetomidine can be considered a suitable
agent for providing pre-operative sedation &
pre-anaesthetic anxiolysis
• Useful in the day care procedures like
conscious sedation and procedural sedation
• changing our viewpoint of providing intra &
post operative analgesia, without any potential
and significant side-effects of existing agents
employed for this purpose.