Anesthesia, essays and researches
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Surgery is a very stressful experience for patients. Children are the most susceptible to fear, anxiety, and stress due to their limited cognitive capabilities and dependency. In children, pharmacologic agents are frequently used as premedication to relieve the fear of surgery, to make child-parental separation easy, and to carry out a smooth induction of anesthesia. We conducted this study to compare the efficacy of intranasal fentanyl, midazolam, and dexmedetomidine as premedication in pediatric patients. ⋯ Onset of action of fentanyl and midazolam is early as compared to that of dexmedetomidine. However, fentanyl provided better conditions for induction and emergence than midazolam. With dexmedetomidine onset of action was delayed and duration of action was prolonged which helped child to remain calm and sedated even after the surgery.
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Stress-induced neuroendocrine and metabolic changes lead to intraoperative hyperglycemia which is related to surgery and the type of intravenous fluids used. ⋯ Nondiabetic patients undergoing major abdominal surgeries who received acetate-based fluids had relatively higher intraoperative blood sugar levels as compared to those receiving lactated solutions, but the incidence of hyperglycemia was comparable. When the duration of surgery exceeded 6 h, acetate-based solutions resulted in significantly higher lactate levels with progressive metabolic acidosis.
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In the past, many wash-in schemes have been used with initially high fresh gas flow (FGF) to achieve the necessary alveolar concentration of inhalational agent in 10-15 min. This study was designed to show whether 1-1-12 wash-in scheme proposes an earlier achievement of induction or is there any requirement of high FGF phase to know the time taken for induction with and without nitrous oxide (N2O). ⋯ Time taken to attain FAD from 1% to 6% was 4 min in both the groups. It is concluded that the recitation of 1-1-12 wash-in scheme is autonomous on the use of N2O and high FGF phase.
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Emergence delirium (ED) is a distressing side effect of sevoflurane anesthesia in children. Midazolam is a widely studied drug for the prevention of ED with conflicting results. ⋯ There is no difference in the reduction of incidence of ED following sevoflurane anesthesia when midazolam is administered at induction or the end of surgery. However, the time to recovery was longer when the drug was administered at the end of the surgery.
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In this prospective, randomized study, we evaluated the intranasal administration of Midazolam ketamine combination, midazolam, and ketamine in premedication for children. ⋯ We concluded that intranasal MK combination provides sufficient sedation, comfortable anesthesia induction with postoperative recovery for pediatric premedication.