Oral Clonidine: A Simple, Effective and Safe Sedative Agent for Hemodynamic Stability during Laparoscopic Surgery and a Calm Post-surgical Phase | Chapter 7 | Achievements and Challenges of Medicine and Medical Science Vol. 6

 Background: Laparoscopic surgery is the quintessence of modern surgical practice due to its cosmetic scar, early ambulation, less mortality (less than 0.1%), and less compromised postoperative respiratory and gastro-intestinal functions. Carbon dioxide pneumoperitoneum (PNP), the hallmark of laparoscopic surgery and patient positioning leads to significant hemodynamic changes in laparoscopic surgeries. Laparoscopy is the essence of modern surgery but the carbon dioxide pneumoperitoneum used therein significantly impairs patient’s cardiopulmonary function. Clonidine, by its central sympatholysis, reduces perioperative hemodynamic instability and also has multiple added advantages in the post-operative period.

Methods: In this prospective, randomized, double-blind, placebo-controlled study on 60 ASA I/II patients, clonidine 150 µg for weight <55 kg and 200 µg for weight >55 kg was administered per oral to 30 patients (clonidine group) 90 minutes before induction of general anaesthesia and intra-operative haemodynamics were monitored at specific time periods and compared with the placebo group patients (n=30) who received oral vitamin C. The tablet Arkamin (100 µg/ tablet), manufactured by Unichem laboratories, India for pre-medicating all the patients in the clonidine group, was used. A pre-operative anxiety score, post-operative sedation and pain scores and the presence of nausea-vomiting, shivering and dry mouth at the end of the first and sixth postoperative hours, were noted. An α error of 0.05 and power of study 80% after permitting β error of 0.2 was assumed.

Results: Clonidine group patients remained haemodynamically stable throughout the intra-operative period. In the clonidine group, less number of patients required fentanyl for tachycardia (1 vs 11) and NTG for hypertension (none vs 7). Similarly, the pain and anxiety scores were significantly less in clonidine group patients. At the end of the first postoperative hour incidence of pain, shivering and vomiting in the placebo group was 33%, 36% and 20% respectively whereas in the clonidine group incidence was 6%, 0 and 0. At the end of 6 post-operative hours, the incidence of pain and vomiting was 73% and 36% in the placebo group whereas it was 10% and 0 in the clonidine group.

Conclusions: Oral clonidine in the present dose is able to maintain stable intra-operative haemodynamics and achieve a calm post-operative period during laparoscopic surgeries in ASA I/II patients. Further studies are needed to confirm its safety in elderly patients and patients with compromised cardiovascular function.

 

Author (s) Details

 

Ketaki Marodkar
Department of Anaesthesiology, NKPSIMS & RC and LMH, Nagpur, Maharashtra, India.

 

Please see the book here:- https://doi.org/10.9734/bpi/acmms/v6/3163

Intranasal Midazolam Premedication for Anxiolysis in Children Prior to Nitrous Oxide Sedation | Chapter 1 | Achievements and Challenges of Medicine and Medical Science Vol. 12

Background: Children and adolescents show diverse maturity, personality, temperament, and emotions, which lead to a variety in their vulnerability and coping ability in dental situations. Therefore, dentists need a plethora of techniques to manage children. Midazolam, a benzodiazepine has enjoyed a lot of attention in recent years as a good pediatric sedative agent.

Aim: The aim of the study was to compare the administration of 0.1 mg/kg intranasal midazolam as premedication against a normal saline control in alleviating anxiety relating to and increasing acceptance of nasal hood by child patients receiving nitrous oxide sedation for dental treatment.

Materials and Methods: After ethical clearance and informed consent, on the basis of odd and even numbers patients were allocated to group midazolam or group normal saline, respectively. Thirty children between the ages of 4–8 years requiring bilateral endodontic treatment with Frankl’s negative or definitely negative behavior were selected. The physical parameters were recorded at the beginning and after the dental procedure; the time required for the procedure was also recorded. The level of cooperation during acceptance of the nasal mask by the patient was evaluated using the four-point scale. The sensory perception levels (alertness) and overall behavior of the child were evaluated using the first and fourth categories of the Houpt Behavior Rating scale.

Results: Participants in group N consumed more time than group M. A Higher percentage of children were seen in the time frame of 31 minutes and more in group N and group M timings were largely concentrated around the 30 minutes or less mark. Midazolam premedication was more effective in improving the acceptance of the nasal hood in children than without premedication (p=.002308).

Conclusion: In the present study, the combination of midazolam and nitrous oxide proved to be an effective combination, resulting in good to excellent behavior in children who were Frankl’s behavior rating definitely negative and negative. The operator could carry out the procedure at all stipulated 60 appointments, the combination of the two agents proved to be 100% safe there were no adverse reactions reported in both the groups and the physiologic markers were within limits.

Clinical Significance: For successful sedation premedication with nitrous oxide, midazolam is an excellent premedication drug.

 

Author (s) Details

 

Shikha Choubey
Department Pediatric and Preventive Dentistry, I.T.S. Dental College, Ghaziabad, India.

 

Please see the book here:- https://doi.org/10.9734/bpi/acmms/v12/3306