Anesthesia, essays and researches
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To date, racemic bupivacaine is the most popular local anesthetic for spinal anesthesia in parturients undergoing elective cesarean delivery. With the introduction of levobupivacaine as pure S (-) enantiomer of bupivacaine which offers advantages of lower cardiotoxicity and neurotoxicity and shorter motor block duration, its use has widely increased in India. However, very few studies have been conducted about its efficacy in obstetric anesthesia. Thus, this study was undertaken to compare the sensorial, motor block levels, and side-effects of equal doses of hyperbaric bupivacaine and levobupivacaine with intrathecal fentanyl addition in elective cesarean cases. ⋯ Intrathecal isobaric levobupivacaine-fentanyl combination is a good alternative to hyperbaric bupivacaine-fentanyl combination in cesarean surgery as it is less effective in motor block, it maintains hemodynamic stability at higher sensorial block levels.
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Postoperative pain is a common complaint and despite the availability of various drugs, is still not managed well. Analgesic effects of glucocorticoids are still to be substantially established. Hence, we designed randomized, double-blind, placebo-controlled trial to compare the effect of two different doses of dexamethasone on postoperative pain in patients undergoing infra-umbilical surgeries under spinal anesthesia. ⋯ Dexamethasone 16 mg reduces postoperative pain on motion at 24 and 36 h. It has no effect on postoperative pain at rest or on nausea and vomiting.
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Various sedative and analgesic techniques have been used during shock wave lithotripsy (SWL). ⋯ Ultrasound-guided unilateral TAP block is an effective alternative analgesic technique during ureteric SWL.
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Rocuronium (R) bromide and vecuronium (V) are monoquaternary aminosteroid compounds. The aim of this study was to evaluate the onset time, conditions of intubation and duration of action of equipotent doses (3ED95) of R and V. ⋯ At equipotent doses, R provides clinically acceptable intubation conditions much earlier than V without significant variation in clinical duration of action.
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Case Reports
Epidural catheter misplaced into the thoracic cavity: Utilized to provide interpleural analgesia.
Thoracic epidural analgesia is one of the most effective and time-tested modalities of providing postthoracotomy pain relief. It improves postoperative pulmonary outcome. Nevertheless, being a blind procedure several complications have been associated with the technique. ⋯ We have discussed a patient who underwent a right thoracotomy for excision of emphysematous bulla of lung under general anesthesia with thoracic epidural. The epidural catheter was misplaced in the pleural cavity and was detected intraoperatively after thoracotomy. The catheter was left in situ and was successfully utilized to provide postoperative analgesia via the interpleural route.