This document describes a study aiming to compare the effects of intravenous and intratracheal lignocaine on airway and hemodynamic responses during emergence from general anesthesia and endotracheal extubation. The study will involve 80 patients randomized into two groups, with one group receiving intratracheal lignocaine and intravenous saline, and the other receiving intravenous lignocaine and intratracheal saline. Outcomes such as cough response, smoothness of extubation, and hemodynamic parameters will be observed and recorded before, during, and after extubation to compare the efficacy of the two lignocaine administration methods in attenuating the airway and circulatory responses to extubation.
Prospective Randomized Double-Blind Study of Effectiveness of Dexmedetomidine...asclepiuspdfs
Introduction: Laryngoscopy and endotracheal intubation is associated with transient increase in heart rate (HR) and arterial blood pressure due to the sympathoadrenal stimulation. It can produce deleterious effects in patients with cardiovascular and cerebrovascular disease, in the form of myocardial ischemia, pulmonary edema, and cerebral hemorrhage. Dexmedetomidine has been effective in blunting the hemodynamic response to laryngoscopy and tracheal intubation. In this study, we used dexmedetomidine in pre-operative intravenous infusion dose of 1 mcg/kg over 20 min before induction. Aims and Objectives: The aim of the study was to study the efficacy and safety of dexmedetomidine on attenuation of pressor response during laryngoscopy and tracheal intubation, w.r.t. (1) pressor response during laryngoscopy and tracheal intubation, (2) hemodynamic stability, and (3) any adverse effects.
Relative Efficacies of Nitroglycerine Infusion, Sublingual Nifedipine, and In...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.
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).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay
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.
Prospective Randomized Double-Blind Study of Effectiveness of Dexmedetomidine...asclepiuspdfs
Introduction: Laryngoscopy and endotracheal intubation is associated with transient increase in heart rate (HR) and arterial blood pressure due to the sympathoadrenal stimulation. It can produce deleterious effects in patients with cardiovascular and cerebrovascular disease, in the form of myocardial ischemia, pulmonary edema, and cerebral hemorrhage. Dexmedetomidine has been effective in blunting the hemodynamic response to laryngoscopy and tracheal intubation. In this study, we used dexmedetomidine in pre-operative intravenous infusion dose of 1 mcg/kg over 20 min before induction. Aims and Objectives: The aim of the study was to study the efficacy and safety of dexmedetomidine on attenuation of pressor response during laryngoscopy and tracheal intubation, w.r.t. (1) pressor response during laryngoscopy and tracheal intubation, (2) hemodynamic stability, and (3) any adverse effects.
Relative Efficacies of Nitroglycerine Infusion, Sublingual Nifedipine, and In...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.
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).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay
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.
Is Lignocaine Preconditioning Effective to Treat Severe Pulmonary Vasoconstri...semualkaira
Protamine is a low molecular weight protein fraction (5.5-13.0 kDa) that is rich in basic arginine (67%) and lysine amino acids. They are basic polypeptides that neutralize the strongly negatively charged heparin. This study was aimed to explore the effect of lignocaine preconditioning on protamine-induced pulmonary vasoconstriction, which is used to reverse the effect of heparin during cardiac surgery. This was a prospective, single-center, double- blind and randomized study performed among eighty pediatric patients of either sex in the age group between 1 to 12 years with a cyanotic congenital heart disease, scheduled for elective on-pump cardiac surgery under general Anaesthesia.
Presentation of Dr. Lluis Blanch at 10th Pulmonary Medicine Update Course, Cairo, Egypt. Pulmonary Medicine Update Course is organized by Scribe : www.scribeofegypt.com
journal club and critical appraisal checklist
intensive recruitment versus moderate recruitment strategy in postop cardiac surgery patients to avaoid postop pulmonary complications
“A Comparative Study of Bupivacaine with Dexamethasone and Bupivacaine with C...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.
Awake Fiberoptic Intubation with Sedation in Cardiac (High-Risk) Patients – O...info622939
Embark on a compelling exploration of anesthesia innovation with our presentation on 'Awake Fiberoptic Intubation with Sedation in Cardiac (High-Risk) Patients – Our Experience.' Delve into the intricacies of this specialized technique, tailored for high-risk cardiac patients, as we share our unique insights and experiences.
Comparative Evaluation of Recovery Characteristic and Consumption of Desflura...Apollo Hospitals
The rising cost of newer inhalational anaesthetic agent like desflurane has influenced increasing number of anaesthesiologist to use minimal flow anaesthesia. We did a randomised prospective study on total of sixty patient, who were divided into two groups of thirty patients each. Two volatile inhalational anaesthetic agents were compared: group I received desflurane (n=30) and group II isoflurane (n=30) in minimal flow anaesthesia. Recovery time was 5.70 ± 2.78 minutes in desflurane group and 8.06 ± 31 minutes in isoflurane group (P value 0.004). Desflurane was found costlier than isoflurane but it has many inherent quality which make it superior to other inhalational agent in use. A further saving by desflurane is due to more rapid recovery and patient remain alert and clear headed permitted more economical use of recovery facilities and discharge of patient.
Is Lignocaine Preconditioning Effective to Treat Severe Pulmonary Vasoconstri...semualkaira
Protamine is a low molecular weight protein fraction (5.5-13.0 kDa) that is rich in basic arginine (67%) and lysine amino acids. They are basic polypeptides that neutralize the strongly negatively charged heparin. This study was aimed to explore the effect of lignocaine preconditioning on protamine-induced pulmonary vasoconstriction, which is used to reverse the effect of heparin during cardiac surgery. This was a prospective, single-center, double- blind and randomized study performed among eighty pediatric patients of either sex in the age group between 1 to 12 years with a cyanotic congenital heart disease, scheduled for elective on-pump cardiac surgery under general Anaesthesia.
Presentation of Dr. Lluis Blanch at 10th Pulmonary Medicine Update Course, Cairo, Egypt. Pulmonary Medicine Update Course is organized by Scribe : www.scribeofegypt.com
journal club and critical appraisal checklist
intensive recruitment versus moderate recruitment strategy in postop cardiac surgery patients to avaoid postop pulmonary complications
“A Comparative Study of Bupivacaine with Dexamethasone and Bupivacaine with C...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.
Awake Fiberoptic Intubation with Sedation in Cardiac (High-Risk) Patients – O...info622939
Embark on a compelling exploration of anesthesia innovation with our presentation on 'Awake Fiberoptic Intubation with Sedation in Cardiac (High-Risk) Patients – Our Experience.' Delve into the intricacies of this specialized technique, tailored for high-risk cardiac patients, as we share our unique insights and experiences.
Comparative Evaluation of Recovery Characteristic and Consumption of Desflura...Apollo Hospitals
The rising cost of newer inhalational anaesthetic agent like desflurane has influenced increasing number of anaesthesiologist to use minimal flow anaesthesia. We did a randomised prospective study on total of sixty patient, who were divided into two groups of thirty patients each. Two volatile inhalational anaesthetic agents were compared: group I received desflurane (n=30) and group II isoflurane (n=30) in minimal flow anaesthesia. Recovery time was 5.70 ± 2.78 minutes in desflurane group and 8.06 ± 31 minutes in isoflurane group (P value 0.004). Desflurane was found costlier than isoflurane but it has many inherent quality which make it superior to other inhalational agent in use. A further saving by desflurane is due to more rapid recovery and patient remain alert and clear headed permitted more economical use of recovery facilities and discharge of patient.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Chapter 3 - Islamic Banking Products and Services.pptx
protocol laptop presentation copy.pptx
1. Principal investigator
DR. TUSHAR K MANKAR
GUIDE:
DR .M . SRINIVAS REDDY
PROFFESSOR
EFFECT OF INTRATRACHEAL AND INTRAVENOUS LIGNOCAINE ON
AIRWAY AND HEMODYNAMIC RESPONSE DURING EMERGENCE
AND EXTUBATION FOLLOWING GENERAL ANAESTHESIA : A
RANDOMIZED DOUBLE BLINDED COMPARATIVE STUDY
2. Tracheal extubation is the removal of endotracheal tube (ETT) from patient’s airway and is a
stressful situation, associated with 3 times more complication rates than intubation .
Complications of extubation include tube entrapment, hemodynamic changes such as
tachycardia, hypertension, increased intraocular and intracranial pressure, coughing,
breathholding, tracheal or laryngeal trauma, laryngeal spasm, and pulmonary aspiration [1,2,3].
Coughing and hemodynamic responses cause sympathoadrenergic responses due to
catecholamine release .
Lignocaine is a local anesthetic, causes blockade of the sodium channel , and suppresses cough
reflex to extubation by its effect on synaptic transmission and hemodynamic response by its
central stimulant effect, peripheral vasodilatory effect, and direct myocardial depressant effect [
4,5,6].
3. Lignocaine is administered intravenously , through laryngotracheal route or in the ETT cuff to blunt reflexes
during emergence from general anesthesia (GA) [7,8 ,9].
Emergence is defined as time period between the complete discontinuation of the maintenance anesthetic to 5
min post-extubation . The serum concentration of lignocaine required to suppress the cough reflex has been
recorded as >3 mcg/ml, while cough suppression has been achieved at recorded levels <1.63 mcg/ml when the
lignocaine is topically applied [10].
Lignocaine is a potent anti-inflammatory and antihyperalgesic agent [ 11,12, 13]. Even though cough reflex is
protective against aspiration, it can lead to hemodynamic fluctuations in post-operative period. George et al. [11]
found that the local mucosal anesthetizing effect of lignocaine is short lived and do not last for 20–30 min for
both intratracheal (IT) and intravenous (IV) lignocaine, thereby preventing aspiration risk.
Local anesthesia toxicity is a grave complication and requires high levels of alertness and anticipation [14, 15].
The main manifestations of its toxic accident are neurologic signs, with convulsions and no, or slight, cardiac
effects on the intact heart [18]. Cardiovascular effects come later, and they include myocardial depression,
prolonged conduction interval, bradycardia, hypotension, and heart failure [16, 17]. Administration of IV
lignocaine will rise plasma concentration rapidly as compared to IT lignocaine which contributes to such cardiac
complications.
Only a limited number of previous published studies compared the use of IT and IV lignocaine to reduce GA-
related complications during emergence and extubation . However, the results of these trials were conflicting.
Present study will be undertaken to compare efficacy of lignocaine administered through endotracheal tube to
lignocaine administered through intravenously
4. LIGNOCAINE
Lignocaine is a local anaesthetic with an amide linkage between the lipophilic benezene ring
and hydrophilic tertiary amine.
Lidocaine alters depolarization in neurons by blocking the fast voltage gated sodium channels
in the cell membrane. With sufficient blockade, the membrane of the presynaptic neuron will
not depolarize and so fails to transmit an action potential, leading to its anesthetic effects.
It gets metabolized by microsomal enzymes in the liver. The elimination half life of lidocaine
is approximately 1.5–2 hours in most patients. This may be prolonged in patients with hepatic
impairment and in congestive heart failure .
Lignocaine has long been used to modulate the unwanted airway and circulatory reflexes
seen in response to emergence and extubation. The administration of lignocaine has been
through several routes such as intravenous (IV) injection, endotracheal cuff, or intratracheal
instillation.
5. INTRAVENOUS LIGNOCAINE
I.V lignocaine effectively suppresses cough, I.V lignocaine (1.5 mg/kg) was used in several studies for
attenuation of stress response and produced significant decrease in cough responses.
INTRATRACHEAL LIGNOCAINE
Intratracheal lignocaine by instillation through endotracheal tube before extubation could significantly
reduce the incidence of coughing during extubation in patients undergoing surgery under general
anaesthesia . Local anaesthetics are rapidly absorbed into circulation following topical administration to
mucous membrane. Peak anaesthetic effect following topical application of lignocaine occur in 2 – 5 min and
anaesthesia last for 30-45 min.
6. Review of literature
1 .Divyagladston et al (2021) conductedintratracheallignocaine beforeextubation significantly
attenuatesthe post extubation coughreflex thanintravenouslignocaine (1)
2.Tabasum Shabnum et al (2017)conducted bothintratrachealandintravenous lignocaine effectivein
attenuating hemodynamicresponse before extubation (5)
3.George SEetal(2013) conducted study on comparison of effect oflignocaineinstilledthrough the
endotracheal tube and intravenouslignocaine on extubation responsein patients undergoing
craniotomywith skullpins(15)
Arun V Bidwaiet.al.(1979)conducted the study that intravenous administration of lignocaine depresses
cough reflexes during endotracheal extubation and to compare hemodynamic response to endotracheal
extubation (27)
7. AIM
The aim is to compare the effect of intravenous and intratracheal lignocaine on attenuation of airway
reflex to endotracheal extubation
OBJECTIVE
PRIMARY OBJECTIVE
To compare the effect of intratracheal lignocaine and intravenous lignocaine on airway reflexes using
smoothness of extubation
SECONDARY OBJECTIVE
1.To compare intratracheal and intravenous lignocaine on hemodynamic response (heart rate , systolic
blood pressure , diastolic blood pressure , mean arterial pressure) to extubation
2.To compare any side effects like bradycardia , and if any allergic reaction
8. MATERIAL AND METHODS
STUDY POPULATION
The study will be conducted upon in patients of MallaReddy Narayana MultispecialityHospital ,teritiary
care hospital , attached to MallaReddy Medical College For Women posted for surgical procedure
under general anaesthesia.
Inclusion Criteria
1. Patients undergoing surgical procedure under general anaesthesia.
2. Age 18 -65 years inclusive
3. ASA (American Society of Anaesthesiologist) class 1 & 2
9. Exclusion criteria :
Patients with
1. Sore throat or active URI
2.History of laryngeal or tracheal pathology/surgery.
3.History of asthma or COPD
4.Difficult intubation , obese patients
5.Patients with cardiovascular disease and respiratory disease and patients allergic to lignocaine
10. Study Design:Prospective Randomized Double Blinded Comparative
study.
Sample size : Study of 80 American society of anaesthesiology (ASA)
grade I and II patients
11. χ² tests - Goodness-of-fit tests: Contingency tables
Analysis: A priori: Compute required sample size
Input: Effect size w = 0.6155556
α err prob = 0.05
Power (1-β err prob) = 0.8
Df = 5
Output: Noncentrality parameter λ = 12.8828957
Critical χ² = 11.0704977
Total sample size = 34
Actual power = 0.8019718
By computing proportion of cough reflex of different grade
between group1 and group 2 effect size calculated was 0.610
with α err probability = 0.05 and power of the study 80%
sample size per group was 34
12. Randomization Procedure
The patients will be assigned to one of the following two groups using simple randomization ,
according to the computer generated table of random numbers
GROUP 1 – 2 % lignocaine 3 mg/kg intratracheal lignocaine and intravenous saline
GROUP II – 2% lignocaine 1.5 mg/kg intravenous lignocaine and intratracheal saline
Informed consent
After the approval of the study by the hospital ethics committee , the written informed consent will
be obtained from the patient and attenders explaining the procedure and risk factors involved in a
language understood by the patient . A copy of informed consent will be given to the patient and
attenders.
13. Ethics committee clearence :
The ethics committee approval will be sought
Information Collection
Patient demographic characteristics , including age , height , weight , BMI , ASA score and surgery duration will
be recorded . patient’s Heart rate , systolic blood pressure , diastolic blood pressure , mean arterial pressure
will be recorded and cough reflexes and smoothness of extubation will be recorded 1min , 2 min , 3min , 5min
, 10 min before and post extubation.
Observation will be made for any side effects such as sedation , bradycardia will be noted
Data collection procedure :
Institutional scientific committee and ethical committee approval will be obtained . Data will be collected by
taking the history, clinical examination ,and checking the investigation of patients , measurement will be made
during the study procedure and entered in data sheet and stored in excel sheet
14. Study Period : 12 Months ( May 2023 – April 2024)
Patient allocation :
The patients were randomly allocated into one of the 2 groups by randomization using computer
assignment. The study drug was allocated to patients by the another anaesthesiologist who is not involved in
study , data collection . participants were unaware of the group to which they were allocated .
Patients in group 1 received intratracheal lignocaine 3mg/kg and intravenous saline.
Patients in group 2 received intravenous lignocaine 1.5mg/kg and intratracheal saline.
15. Methodology
The patients will be visited on the evening before the surgery, the study will be explained
and written informed consent will be obtained. Patients were premedicated with diazepam
0.15 mg/kg per oral. On the day of surgery iv line , were started in the operating room and
monitoring established with ECG, NIBP , pulse oximetry, temperature monitor.
The patients will be induced using glycopyrolate 0.004 mg/kg ,Propofol 2mg/kg, Fentanyl 2
microgram/kg, along with oxygen/air/isoflurane, vecuronium 0.10mg/kg was administered to
facilitate intubation , maintained with air , oxygen , and isoflurane , allocated drugs were
given to patients in both groups 5 min before extubation . patients were reversed with
neostigmine 0.05 mg/kg and glycopyrrolate 0.001 mg/kg . After gentle aspiration of
oropharyngeal secretions ,extubation was performed when train of four count was more than
0.9. oxygen was supplemented through facemask and the airway response were noted in
terms of cough reflex to assess the smoothness of extubation and hemodynamic effect noted
in terms of heart rate , systolic blood pressure , diastolic blood pressure at extubation, 1 min ,
3 min , 5 min before and after extubation in group A and group B.
The tolerance to endotracheal tube at this time was noted and smoothness of
extubation graded as follows.
Grade 1: No cough or mild cough only during removal of endotracheal tube .
Grade 2: Coughing while breathing regularly.
Grade3: Bouts of coughing before regular breathing is established
The number of coughs were also noted
16.
17. IMPLICATION
To study the effect of intatracheal and intravenous lignocaine on airway and hemodynamic respone during
emergence and extubation following general anaesthesia
18. PATIENT PROFORMA
Random Number :
Name: Date of admission:
Age: Sex: Patient I.P. No:
weight: Date of surgery:
height:
Clinical examination –
Pulse: B.P.:
CVS: RS: CNS:
Airway assessment-
Oral cavity:
Tooth:
Mallampati grade:
ASA grade 1 / grade 2 –
19. Investigations –
Hb%: RBS: Serum Creatinine:
Virology: Blood group INR:
CUE:
H/O of medical illness:
H/O of surgical illness:
H/O allergy:
Provisional diagnosis:
Plan of surgery:
Name of the drug:
Volume of drug:
Time of injection of drug:
20. PARAMETER BEFORE EXTUBATION 1min 3 min 5 min 10 min
HR
SBP
DBP
MAP
SMOOTHNESS OF EXTUBATION : 1/2/3
Grade 1: no cough or coughing only during removal of endotracheal tube.
Grade 2: coughing while breathing regularly.
Grade3: coughing while not breathing regularly
21. REFERENCES
GLADSTON DV , Padmam S , Amma Rao , Koshy RC . A randomized controlled trial to study the effect of intratracheal
and intravenous lignocaine on airway and hemodynamic response during emergence and extubation following
general anaesthesia . North Clin Istanb 2022 ;9(4):323-330
Shabnum T, Ali Z, Naqash IA, Mir AH, Azhar K, Zahoor SA, et al. Effects of lignocaine administered intravenously or
intratracheally on airway and hemodynamic responses during emergence and extubation in patients undergoing
elective craniotomies in supine position. Anesth Essays Res 2017;11:216–22.
George SE, Singh G, Mathew BS, Fleming D, Korula G. Comparison of the effect of lignocaine instilled through the
endotracheal tube and intravenous lignocaine on the extubation response in patients undergoing craniotomy with
skull pins: A randomized double blind clinical trial. J Anaesthesiol Clin Pharmacol2013;29:168–72.
Bidwai AV, Stanley TH, Bidwai VA. Blood pressure and pulse rate responses to extubation with and without prior
topical tracheal anaesthesia. Can Anaesth Soc J 1978;25:416–8.