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Introduction: Surgical stress is the systemic response to surgical injury. Analyzing these surgical stress responses and pharmacologically modulating them can be of immense use to an anesthetist for optimal patient care. Aim: The aim of the present study was to investigate the influence of dexmedetomidine and fentanyl premedication on the modulation of neuroendocrine stress response during laparoscopic cholecystectomy under general anesthesia. Methods: After obtaining approval from the institutional ethical committee [Date - 05/11/2020, Ethical Clearence Number - 133/2018], 60 patients undergoing laparoscopic cholecystectomy under general anesthesia were randomized into three study groups of 20 patients each. Group D patients were given intravenous (i.v.) dexmedetomidine 1 μg.kg−1, Group F patients fentanyl 2 μg.kg−1 and Group C patients 10 mL of normal saline. All patients received the same anesthetic drugs and surgical procedure. Patients were assessed for changes in hemodynamic parameters such as heart rate (H) and mean arterial pressure (MAP). Blood samples were analyzed for glucose, serum albumin, C-reactive protein (CRP), and serum cortisol levels at various time intervals. Results: H and MAP differed among the groups after intubation, 5 min after pneumoperitoneum (POT), and 10 min after POT. The increase in these parameters from their baseline values was less in the dexmedetomidine group when compared to other groups. Among the biological markers, the increase in serum cortisol levels and decrease in albumin levels could be detected 6 h after induction while blood glucose levels rose immediately after the incision. CRP levels started significantly rising only after 24 h of induction. All these changes were much less pronounced in patients receiving dexmedetomidine premedication as compared to other groups. Conclusion: i.v. dexmedetomidine 1 μg.kg−1 is better than injection fentanyl 2 μg.kg−1, in the modulation of neuroendocrine response in patients undergoing laparoscopic cholecystectomy under general anesthesia. [ABSTRACT FROM AUTHOR]

Background: Awake fibreoptic nasotracheal intubation is an effective technique for the management of patients with difficult airways. Adequate sedation with effective topicalization of the airway is important to overcome discomfort and achieve intubation successfully. Aim and Objectives: Our aim was to compare the effectiveness of dexmedetomidine-midazolam with fentanyl-midazolam infusion for providing conscious sedation during fibreoptic intubation in patients with anticipated difficult airway under topical anaesthesia. Materials and Methods: Thirty adult patients of ASA physical status classification I and II with anticipated difficult airway and planned for elective awake nasal fibreoptic intubation under conscious sedation were randomly allocated into two groups. Dexmedetomidine 1 μg.kg-1 diluted in 50 ml saline was infused in Group DM over 10 min and Fentanyl 2 μg.kg-1 diluted in 50 ml saline was infused in Group FM over 10 min. Topicalization of the airway was done in all patients. All patients were assessed for sedation score, ease of endotracheal tube placement, patient comfort and cooperation, tolerance to endotracheal tube, any adverse events and recall of procedure. Results: The score of the modified OAA/S was comparable between the groups (P > 0.05). Quality of AFOI was comparable in both groups (P > 0.05). The intubation time and first EtCO2 were significantly lower in dexmedetomidine group (P <0.05). Group DM also showed better hemodynamics and less episodes of desaturation than Group FM. Conclusion: Fentanyl-midazolam and dexmedetomidine-midazolam are both effective for awake fiberoptic intubation under topical anesthesia. Dexmedetomidine allows better endurance and more stable hemodynamics. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study is to evaluate the effectiveness of airway sonographic parameters as the predictors of difficult laryngoscopy and to evaluate the validity of combined sonographic and clinical tests. Materials and Methods: This prospective and observational study analyzed a sample of 200 patients who were categorized as having easy (Grades 1 and 2) or difficult (Grades 3 and 4) laryngoscopy based on the laryngoscopic criteria of Cormack-Lahane (CL). Sonographic parameters, including the anterior neck soft-tissue thickness at the level of vocal cord (ANS-VC), ANS tissue thickness at the level of hyoid, and ratio of depth of pre-epiglottic space to distance from epiglottis to midpoint of the distance between vocal cords and clinical parameters, including modified Mallampati class, thyromental distance, and hyomental distance ratio (HMDR), were analyzed. Univariate and multivariate regression analysis was used for the statistical analysis. Results: Twenty patients (10%) were categorized as having difficult laryngoscopy. Statistically significant differences between patients with difficult and easy laryngoscopy were noted for 5 of 6 parameters. The diagnostic validity profiles showed variable sensitivity (26.5%–87.5%) and good specificity (58.9%–94.2%) and negative predictive value (88.8%–97.03%). ANS-VC has the highest sensitivity (87.50%) and area under curve value (0.887), whereas HMDR showed highest specificity (94.2%) and highest accuracy (89.60%) which means it has low false-positive prediction rate. The combination of tests improved the diagnostic validity profile (highest area under the curve, 0.897). Conclusion: Sonographic predictors can help in identifying difficult laryngoscopy. Combined clinical and ultrasonographic parameters showed better validity profiles in comparison to the individual tests. [ABSTRACT FROM AUTHOR]

Background: Dexmedetomidine has been used as an effective adjuvant to local anesthetics in peripheral nerve blocks and at the incision site. Aims: We compared the postoperative analgesic effect of bupivacaine alone and in addition of dexmedetomidine to bupivacaine in wound instillation during lumbar laminectomy. Setting and Design: This was a prospective, double-blind, randomized control trial. Subjects and Methods: Sixty adults of the American Society of Anesthesiologists Grade I–II scheduled for elective lumbar laminectomy under general anesthesia were randomly allocated into two groups. Group B (control group) patients received wound instillation with 20 mL of 0.25% bupivacaine at the end of surgery and Group D patients received 2 μg.kg−1 dexmedetomidine diluted in 20 mL 0.25% bupivacaine as instillation over the incision site. If the NRS exceeded "4" at any point of time, rescue analgesia with injection diclofenac 75 mg deep intramuscular was administered. Postoperative pain score, duration of analgesia, total rescue analgesic required in the first 24 h, and side effects were compared between the groups. Results: Demographic data were comparable in both the groups. Duration of analgesia (19.93 ± 3.2 in Group D vs. 12.13 ± 1.8 in Group B) was significantly more in Group D, number of analgesic demands were less in group D as compared to Group B, and total rescue analgesic required (62.51 ± 39.13 vs. 95.68 ± 33.5) was significantly less in Group D as compared to Group B. Conclusions: We conclude that dexmedetomidine 2 μg.kg−1 is an effective adjuvant to bupivacaine for wound instillation in terms of quality and duration of postoperative analgesia following lumbar laminectomy. [ABSTRACT FROM AUTHOR]