Ravi Kumar, M (2006) A Comparitive study of Intrathecal Fentanyl with Hyperbaric Bupivacaine Versus Hyperbaric Bupivacaine with Normal Saline for Elective Caesarean Delivery and in early Post-operative period. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: Neuromuscular blocking agents are commonly used to facilitate tracheal intubation. An ideal muscle relaxant should have rapid onset, profound relaxation of all muscles and short duration of action so that the patient’s own respiratory function can be restored, should intubation proved to be impossible. These requirements are best met with Succinylcholine, an ultra short acting depolarizing muscle relaxant. Unfortunately, succinylcholine has many undesirable side effects, some of which may be life threatening. Rocuronium bromide is a newer steroidal non-depolarizing neuromuscular blocker with a rapid onset and may be a suitable alternative to succinylcholine for rapid control of airway. There is dose dependent decrease in onset time with Rocuronium and dose of Rocuronium used may influence the rate of onset of satisfactory intubating conditions. Large doses of Rocuronium (more than 1mg/kg) produces ideal intubating conditions in 30-60 seconds but the duration of action is very much prolonged. AIM OF THE STUDY: The aim of my study is to evaluate the intubating conditions in 60 seconds using two different doses of Rocuronium with suxamethonium for intubation in children. It is a study comparing two doses of Rocuronium (0.6mg/kg (2xED95) and 0.9mg/kg (3xED95) with suxamethonium 1.5mg/kg for intubation in children in 60 seconds and observed: 1. Intubating conditions, 2. Hemodynamic changes, 3. Adverse effects. MATERIALS AND METHODS: This study was conducted at Government Stanley Medical College And Hospital, Chennai. After institutional approval and informed consent, 60 patients were enrolled in the study. Inclusion Criteria: 1. Children between 2 – 10 years, 2. ASA Physical status I & II, 3. For Elective surgeries posted under G.A. Exclusion Criteria: 1. Infants, 2. Known / suspected difficult Intubation, 3. H/o any neuromuscular disorder, 4. Renal / Hepatic disorder, 5. Known allergy to drugs, 6. Surgical procedures of very short duration, 7. Patients receiving any medication known to interact with Neuromuscular blocking agent. RESULTS: 1. Statistical Analysis showed that there was no significant difference between distribution of age, sex, and weight among study groups. 2. All children were successfully intubated in 60 seconds without need for second attempt after administration of neuromuscular relaxant. 3. (a) Statistical analysis showed that mean score for Jaw Relaxation was significantly higher in Group II (R9) and Group III (2.65+0.49 in Group II, 2.89+ 0.3 in Group III , and 2.16+0.4 in Group I). (b) Mean score for vocal cord position was significantly higher in Group II & Group III when compared to Group I (2.35+ 0.49, 2.85+ 0.37 2.95+ 0.22 in group I, II & III respectively. (c) Mean score for response to intubation was significantly higher in Group II and Group III when compared to Group I. (2.1+ 0.44, 2.7+ 0.47, 2.8+0.41 in Group I, II & III respectively). (d) Mean total intubating score in Group II (R9) and Group III (S) were identical which is significantly higher than Group I. (6.7+ 0.86, 8.2+ 0.61, 8.7+ 0.57 in Group I, II & III respectively). 4. Acceptable Intubating Conditions (Excellent and Good Scores) are observed in almost all the patients except in one patient in Group I (100% in Group II & Group III and 95% in Group I). But, Excellent Intubating Conditions were produced in most of the patients in Group II and Group III which was significantly higher than in Group I. 5. Statistical anaylsis showed that Mean heart rate, Systolic Blood Pressure, Diastolic Blood Pressure, Mean Arterial Pressure during Intubation in Group I (R6) was higher than in Group II and Group III. (123.6+9.88, 121.2+7.93, 83+5.3, 93.5+5.94 in Group I and in Group II 120.9 +11.114, 120.1+9.7, 79+7.85, 92.4+7.65) and in Group III 106.8+15, 112+8.56, 75.6+6.28, 88.95+6.4 respectively) 6. Mean heart rate at the end of 5 minutes was higher in Group II (R9) compared to Group I (R6) and Group III (S). (112.7+11.5, 116.64+11.5, 99.75+7.38) in Group I, II and III respectively). 7. Clinical duration of the intubating dose was significantly lower in Group III and among Group I & II, the duration was significantly longer in Group II. (20.35+2.08 minutes in Group I 29.35 +2.64 minutes in Group II and in Group III 4.6+0.7 minutes). SUMMARY: 1. Both doses of Rocuronium 0.6mg/kg and 0.9mg/kg produced acceptable intubating conditions (good or excellent) in one minute. 2. But, Excellent intubating conditions identical to suxamethonium was provided with rocuronium 0.9mg/kg group. 3. Duration of action was significantly more in Rocuronium 0.9mg/kg group when compared to suxamethonium. 4. No signs of Histamine release was observed in any of the patients. 5. Increase in Heart rate and Blood pressure at intubation was more in Rocuronium 0.6mg/kg group compared to other groups. CONCLUSION: Rocuronium 0.9mg/kg (3xED95) can be used as an alternative ideal agent to suxamethonium for intubation in children. But while choosing Rocuronium as an alternative to suxamethonium factors such as intubation difficulty and surgical duration should be considered against the potential side effects of suxamethonium.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Intrathecal Fentanyl ; Hyperbaric Bupivacaine ; Hyperbaric Bupivacaine ; Normal Saline ; Elective Caesarean Delivery ; early Post-operative period ; Comparitive study. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Subramani R |
| Date Deposited: | 22 Apr 2018 15:29 |
| Last Modified: | 28 Apr 2018 04:19 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7228 |
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