Anesthesia, essays and researches
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Limited evidence supports the efficacy of peripheral route fentanyl and local anesthetic combination for postoperative analgesia. Our study was therefore designed to demonstrate the analgesic efficacy of two different doses of fentanyl in combination with bupivacaine for surgical site infiltration in patients undergoing modified radical mastoidectomy (MRM). ⋯ Fentanyl and bupivacaine combinations in doses of 50 and 100 μg along with 0.5% bupivacaine at a fixed dose of 2 mg/kg body weight are effective in the management of postoperative pain. Patients who received 100 μg fentanyl (Group II) had lower VAS scores as compared to the patients who received 50 μg fentanyl (Group I) with similar side effects.
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Preoperative anxiety is synonymous with pediatric surgery. Anxiolysis is of crucial importance and poses a significant challenge to the pediatric anesthesiologist. Orally administered midazolam and ketamine can be used as anxiolytic premedication in children. ⋯ The study documents the rapid achievement of preoperative sedation and anxiolysis in children with orally administered midazolam or ketamine, with the latter producing a superior quality of anxiolysis. An interval of 20 minutes is sufficient between premedication and parental separation.
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In spite of being the preferred induction agent for LMA insertion, propofol has many undesirable side effects including dose-related cardiorespiratory depression and local pain at injection site. Ketofol as a novel induction agent has been introduced recently with comparable efficacy and improved hemodynamic control. ⋯ ketofol is a safe and effective alternative induction agent for LMA insertion in children with rapid onset of action and lower incidence of injection pain. It provided better LMA insertion conditions, improved hemodynamic stability with less prolonged apnea when compared with propofol.
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It has been contended the general anesthetic agents also may affect the psycho-social behavior of the patients, especially during the emergence from GA. This assumes much significance in day cases where, patients have to be roadworthy and mentally stable before discharge. ⋯ Both the modalities of GA, viz; TIVA and VIMA, do produce significant psycho-behavioral changes in the patients after GA, though transiently. So it is imperative for the Clinicians to anticipate the entire aspect of Psycho-behavioral patterns before discharging the day cases from the Post anesthesia Care Unit (PACU).
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Supine emergence from anesthesia in patients undergoing lumbar surgery in prone position leads to tachycardia, hypertension, coughing, laryngospasm and loss of monitoring as the patients are rolled back to supine position at the end of surgery. The prone extubation might facilitate a smoother emergence because the patients are not disturbed during emergence and secretions are drained away from patient's airway. ⋯ In healthy normotensive patients, emergence from anesthesia in the prone position is associated with minimal hemodynamic change, and fewer incidences of coughing, laryngospasm, and monitor disconnections.