Journal articles: 'Modified Aldrete score'

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Aggarwal, Shagun, Julie C. R. Misquith, Sumesh T. Rao, and Priyanka Mahanta. "Comparison of Three Scoring Criteria to Assess Recovery from General Anesthesia in the Postanesthesia Care Unit in the Indian Population." Annals of African Medicine 23, no. 1 (2024): 82–86. http://dx.doi.org/10.4103/aam.aam_165_23.

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Background: Different discharge criteria are available for shifting patients out from postanesthesia care room following surgery. This study was done to compare the three-scoring system namely traditional time-based criteria, Fast track criteria and modified Aldrete score, in Indian population patients who recover after general anesthesia in postanesthesia care unit (PACU). Materials and Methods: Three hundred and seventy-five patients scheduled for general anesthesia were included in this study. Induction of anesthesia was done with intravenous (IV) propofol and maintained with sevoflurane inhalation with oxygen and nitrous oxide. Reversal of residual neuromuscular blockade was done with IV neostigmine and glycopyrrolate. Patients were shifted to PACU following tracheal extubation and recovery was assessed using the traditional time-based criteria, fast track criteria, and modified Aldrete score. Results: As per modified Aldrete score, mean time of shift out is 19 min with median of 15 min and standard deviation of 21.7 min. As per fast-track score, mean time of shift out is 187 min with median of 30 min and standard deviation of 243.7 min. As per the time-based criteria, mean time of shift out is 222 min with median of 240 min and standard deviation of 136.8 min. While using modified Aldrete score, majority of patients had a shorter stay in PACU and faster time to shift out as compared to fast-track criteria and traditional time-based criteria. Conclusion: Modified Aldrete score when compared to fast-track scoring and time-based criteria shows early recovery and reduces the length of stay in PACU.

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Santushti, Vijay, Yadav Deepa, Jaiswal Aakriti, and Shrivastava Sonal. "Comparison of Airway Response and Early Versus Late Recovery Profile During Sevoflurane and Desflurane Administration Via Laryngeal Mask Airway for Maintenance of Anaesthesia." International Journal of Pharmaceutical and Clinical Research 15, no. 8 (2023): 773–78. https://doi.org/10.5281/zenodo.11493947.

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Objective: The aim of our study was comparison of airway response and early versus late recovery profile during Sevoflurane and Desflurane administration via laryngeal mask airway for maintenance of anaesthesia. Methods: Prospective randomized controlled study, 56 ASA grade I or II patient, aged 19 – 60 years who were posted for minor surgical procedures were enrolled in the study from June 2015 to May 2016. Patients were divided in two groups– Desflurane – group D and – Sevoflurane – group S. Heart rate, Systolic blood pressure, Diastolic blood pressure, Oxygen Saturation, Respiratory rate were measured intraoperatively till the end of surgery (max 120 minutes). Incidence of respiratory events –coughing, breath holding and laryngospasm were recorded intraoperatively as well as in post operative period till the patient has achieved modified Aldrete score of 10. Results: All the demographic characteristics, ASA grading, baseline vital parameters were comparable in both the groups. There was no statistical difference in the mean arterial systolic blood pressure between the two groups. No significant difference is observed in respiratory rate at induction, intraoperatively and postoperatively among both the groups. There was no statistical difference after induction up to the end of the procedure in SpO2 between the groups. 1 patient had single emergent cough episode whereas 3 patients had multiple coughing episode at the time of emergence in Desflurane group. The time taken to open the eyes, to obey the verbal commands, the time taken for orientation and to achieve Modified Aldrete score 10 was shorter in the group which received Desflurane. The time taken to sit, to first oral intake, the time taken for standing and ambulate unassisted was again shorter in the group which received Desflurane than the group which received Sevoflurane which is statistically significant ( P value < 0.001). Conclusion: The emergence (eye opening, obey the verbal commands, orientation and Modified Aldrete score 10) from anaesthesia was faster following the administration of Desflurane compared to Sevoflurane. In the group which received Desflurane, the Aldrete score was higher on arrival at the time of emergence, and at 10 minutes of arrival in the ICU. The time taken to reach an Aldrete score of 9 was lower in the group which received Desflurane. Recovery in PACU (post anaesthesia care unit) – (sit, first oral intake, standing and ambulate unassisted) was faster following the administration of Desflurane compared to Sevoflurane.

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M, Kavya. "Comparative study of Intraoperative Haemodynamics and recovery characteristics of desflurane and sevoflurane in patients receiving General Anaesthesia." MedPulse International Journal of Anesthesiology 19, no. 3 (2021): 54–59. http://dx.doi.org/10.26611/10151932.

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Background: Inhaled anesthetics used for general anaesthesia have a rapid onset and offset of action. The Induction and recovery depends on anaesthetic drug solubility, cardiac output and minute ventilation. Sevoflurane and desflurane have low blood gas partition coefficients, and therefore share the advantage of faster onset and recovery from anaesthesia when compared to other inhaled anesthetics. Hence, we designed this prospective randomized study to compare the intraoperative haemodynamic parameters and recovery characteristics of desflurane and sevoflurane. Methods: Sixty patients aged between 18-50 years belonging to ASA I and II scheduled for elective general anaesthesia were enrolled in the study and randomly divided into two groups to receive desflurane(group D) and sevoflurane(group S) for the maintenance of anaesthesia. Both groups were premedicated, pre oxygenated and induced with propofol. Muscle relaxation maintained with vecuronium. Desflurane and sevoflurane concentrations were adjusted according to entropy parameters and clinical variables like HR, NIBP, MAP and SPO2. Neuromuscular blockade reversed with neostigmine and glycopyrrolate. Recovery characteristics assessed using modified Aldrete scoring. Results: The intraoperative haemodynamics was similar with both desflurane and sevoflurane, and was maintained within 20% of baseline values. However, early recovery characteristics were significantly better in group D. Time to eye opening was 6.63 + 2.17 min in group S versus 4.77 + 1.41 min in group D (P< 0.001). Time to Extubation was 8.03 + 2.54 min in group S and 5.93 + 1.44 min in group D (P < 0.001). Response to verbal commands was 8.77 + 3.01 min in group S and 6.97 + 1.67 min in group D (P < 0.001). Modified Aldrete score were significantly better in group D than group S at 1st min, 2nd min and 3rd min. Thereafter, modified Aldrete score assessed at 5, 10, 15, 30 and 60 min were similar in both groups. Conclusion: Both desflurane and sevoflurane produce similar stable haemodynamic profile. Despite the faster early recovery with desflurane, no significant differences were found between the two volatile anaesthetics after 5 minutes during intermediate recovery period.

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Nida, Fatima, Ozair Ahmad, and Haleem Shahla. "The effect of clonidine on peri-operative neuromuscular blockade and functional recovery: a randomized placebo-controlled trial." Central Journal of Indian Society of Anesthesiologists (ISA) 2 (December 29, 2018): 44–51. https://doi.org/10.5281/zenodo.3899725.

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Background: Alpha-2-agonists are as used adjunct for anaesthesia. We conducted this study with the aim to determine whether the addition of clonidine, an α-2-agonist, decreases the time to recovery from neuromuscular blockade caused by non-depolarising muscle relaxant. Secondary objectives were to know whether clonidine as an adjuvant improves hemodynamic stability, decreases stress hyperglycaemia, pain and time to discharge from Post-Anaesthesia Care Unit (PACU). Methods: This placebo-controlled clinical trial, enrolled 64 patients into clonidine (n = 32) or placebo (saline) group (n = 32). Study drug was given 1.5 mcg/kg IV bolus at the time of induction followed by infusion (1.5 mcg/kg/hour) intra-operatively. Extubation was started when train-of-four (TOF) count was ≥ 2. Primary outcome measure was time to achieve TOF ratio of ≥ 70% and ≥ 90%, assessed at 5, 15, 30- and 60-min intervals following extubation. Results: 2 patients in each group were excluded due to intra-operative requirement of additional supportive medications, hence in each group 30 were analysed. Significant difference was observed between clonidine and placebo groups in terms of time to achieve TOF ratio ≥ 70% and ≥ 90%, stress hyperglycemia, hemodynamic and pain profile, no statistical difference in the Ramsey sedation score and modified Aldrete score between groups. Patients given clonidine required repeat doses of non-depolarising muscle relaxant at longer intervals, with decrease in total amount administered. Clonidine group had a median time to achieve TOF ratio ≥ 70% at 15 min compared to 60 min in placebo group. Conclusion: Clonidine hastens the recovery from neuromuscular block with reduced stress hyperglycaemia and post-operative pain, along with unaffected Ramsey sedation score and modified Aldrete score.

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Elhoshy, Hassan S., and Ayman F. Khalifa. "Modified thoracoabdominal nerves block through perichondrial approach: a new strategy with a wide range of utilization in laparoscopic gynecological surgeries." Research and Opinion in Anesthesia & Intensive Care 11, no. 4 (2024): 278–86. https://doi.org/10.4103/roaic.roaic_39_24.

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Background Modified thoracoabdominal nerve block via the perichondrial approach (M-TAPA) was expressed lately as an effective regional anesthetic technique involving the anterolateral aspects of the thoracoabdominal wall via deposition of local anesthetics to the perichondrium’s underneath side. Even though the efficacy of M-TAPA has been registered, additional research is advocated. The rationale of the current study was to evaluate the analgesic effectiveness of M-TAPA blockade accomplished before surgery in subjects undergoing laparoscopic gynecological surgeries. Patients and methods 60 female patients (20–65 years) were categorized randomly into two groups. Group (M): received bilateral M-TAPA using bupivacaine (0.25%), whereas group (C): (control group) received conventional general anesthesia with multimodal analgesia. Postoperative pain assessment, time to first rescue analgesic requirement, total opioid consumption during the first 24 h postoperatively, and patients’ satisfaction were recorded. Also, the time to modify the Aldrete score greater than or equal to 9 was estimated. Results Pain scores were significantly lower in the M-TAPA group versus the control group at all times of measurement (P<0.05 at each time point). Also, the total amount of opioid consumption was significantly less in the M-TAPA group versus the control group. Patients in the M-TAPA group were statistically more satisfied with their analgesia (P<0.001) and attained a modified Aldrete score greater than or equal to 9 earlier than those in the control group. Conclusions Ultrasound-guided M-TAPA block achieved efficient analgesia to the anterolateral aspects of the anterior abdominal wall and reduced opioid consumption in patients who underwent laparoscopic gynecological surgeries.

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Kaasat, Ankita, Sakshi Thakore, Nirdesh Thakore, Mohan K. Nalliboyina, and Suman Kaushik. "Comparative Evaluation of Dexmedetomidine-Ketamine versus Ketamine-Propofol for Procedural Sedation during Dilatation and Curettage: A Prospective Randomized Double-Blind Study." Medical Journal of Dr. D.Y. Patil Vidyapeeth 18, no. 2 (2025): 257–63. https://doi.org/10.4103/mjdrdypu.mjdrdypu_264_24.

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ABSTRACT Background and Aims: Dilatation and curettage (D and C) is commonly performed as a daycare procedure under procedural sedation. We are comparing Dexmedetomidine-Ketamine (Dexket) versus Ketamine-Propofol (Ketofol) for sedation and analgesia in patients with abnormal uterine bleeding undergoing dilatation and curettage. Primary objective of the study was to compare time to onset of sedation and recovery. Secondary objectives included hemodynamics, time to achieve modified Aldrete score 9, number and time of additional doses of ketamine, and postoperative analgesia. Methods: In this randomized trial, 80 female patients, ASAI and II, 20 and 60 years, scheduled for elective D and C were analyzed. Group DK (n = 40) received inj dexmedetomidine (0.5 μg/kg) and ketamine (1 mg/kg) and group PK (n = 40) received inj ketamine (1mg/kg) and propofol (1 mg/kg). Statistical significance for continuous variables was assessed by unpaired t-test, whereas for categorical variables, Chi-square test was used. P value < 0.05 was considered as statistically significant. Results: Time to onset and recovery from sedation, time to achieve modified Aldrete score >9, and additional doses of ketamine were comparable in both the groups. Time to first additional ketamine dose was significantly longer in group DK. Patients in group PK had more pain postoperatively. There were no major adverse effects. Conclusion: Ketamine-dexmedetomidine is safe and effective alternative to ketamine-propofol for procedural sedation and analgesia in patients undergoing D and C with comparable onset and recovery times without any hemodynamic or respiratory adverse effects.

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Babali, P., I. Plaitakis, A. Katsioulas, E. Hrona, and N. Palgimesi. "Evaluation of two widely used anesthetic techniques in laparoscopic cholecystectomy with modified Aldrete post anesthetic recovery score." European Journal of Anaesthesiology 21, Supplement 32 (2004): 7. http://dx.doi.org/10.1097/00003643-200406002-00024.

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Bharadwaj, Devika, Charu Mahajan, Richa Aggarwal, Hemanshu Prabhakar, and Arvind Chaturvedi. "Comparison of Bispectral Index-Guided Administration of Desflurane and Propofol for Endoscopic Transnasal Transsphenoidal Resection of Pituitary Tumors." Journal of Neuroanaesthesiology and Critical Care 7, no. 01 (2020): 19–26. http://dx.doi.org/10.1055/s-0039-3400663.

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Abstract Background Use of short-acting anesthetic agents such as propofol and desflurane allows rapid awakening and prompt neurological assessment of patients undergoing endoscopic transnasal transsphenoidal resection of pituitary tumors. However, there are no studies comparing the effect of these two agents in these patients. We performed this study to compare the intraoperative hemodynamics and postoperative recovery characteristics of patients undergoing endoscopic transnasal transsphenoidal (TNTS) pituitary tumor surgery using bispectral index (BIS)-guided administration of desflurane and propofol. Materials and Methods In this prospective, randomized trial, 60 patients undergoing endoscopic TNTS pituitary surgery were randomized to receive BIS-guided administration of either propofol (Group P) or desflurane (Group D) for the maintenance of anesthesia. Heart rate (HR), mean arterial pressure (MAP), intraoperative complications, time to emergence, extubation, cognition, and modified Aldrete score were evaluated. Statistical analysis was performed using STATA 12.0. Categorical and continuous variables were compared between the groups using Fisher’s exact test and t-test, respectively. Emergence from anesthesia and hemodynamics at various stages of surgery was compared between the groups using Wilcoxon rank sum test. The p-value < 0.05 was considered statistically significant. Results The HR was significantly higher at all stages of surgery in group P (p = 0.01). MAP was comparable between the groups at various time points (p > 0.05). Both emergence time (8.5 vs. 15 minutes; p < 0.00) and extubation time (10 vs. 17.5 minutes; p < 0.00) were significantly shorter in Group D compared with Group P. Modified Aldrete score at 5 and 10 minutes after extubation was higher with desflurane than propofol, but early cognition was comparable between the two groups. Conclusion The hemodynamics and early cognition score were comparable in patients receiving propofol or desflurane. Desflurane provides rapid emergence and recovery when compared with propofol.

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Eskander, Jonathan P., Yury Rapoport, Elyse Cornett, et al. "Does promethazine shorten the length of stay in the post anesthesia care unit?" Journal of Perioperative Practice 28, no. 7-8 (2018): 194–98. http://dx.doi.org/10.1177/1750458918776548.

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The combination of promethazine and opioids is known to have an opioid-sparing effect, thereby facilitating a reduction in total patient opioid consumption. In recent years, this practice has fallen out of favor in many healthcare facilities, except primarily in the post anesthesia care unit (PACU). The goal of this study was to highlight the potential of promethazine as a direct or indirect adjuvant medication in acute pain management. The present investigation was undertaken with a case series of adult female patients who underwent open total abdominal hysterectomies. Data from the PACU was reviewed with patients being separated into two groups. Group 1 received only intravenous opioids for acute pain management. Group 2 received a combination of intravenous opioids for acute pain management and intravenous promethazine for nausea and/or vomiting. Patients were discharged from the PACU with a modified Aldrete score of 9 or 10. The study showed that patients who received promethazine in addition to opioids were discharged from the PACU an average of 19.2 minutes earlier than those patients who received only opioids (p=0.003). The time to achieve modified Aldrete score of 9 or higher was more quickly achieved when open abdominal hysterectomy patients received promethazine in addition to opioids in the PACU. The study concluded that promethazine, in combination with opioids, could potentially decrease PACU stay postoperatively. Based on the present investigation, the prospect of using promethazine in other facets of pain management are intriguing and warrant future studies. Specifically, it may be worth investigating whether promethazine is truly an adjunct in combination with opioids and to determine if there are any other antihistamines or neuroleptics which may have similar clinical effects to promethazine.

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Banik, Sujoy, Girija Prasad Rath, Ritesh Lamsal, and Parmod K. Bithal. "Effect of dexmedetomidine on dynamic cerebral autoregulation and carbon dioxide reactivity during sevoflurane anesthesia in healthy patients." Korean Journal of Anesthesiology 73, no. 4 (2020): 311–18. http://dx.doi.org/10.4097/kja.19246.

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Background: There are conflicting opinions on the effect of dexmedetomidine on cerebral autoregulation. This study assessed its effect on dynamic cerebral autoregulation (dCA) using a transcranial Doppler (TCD).Methods: Thirty American Society of Anesthesiologists physical status I and II patients between 18 and 60 years, who underwent lumbar spine surgery, received infusions of dexmedetomidine (Group D) or normal saline (Group C), followed by anesthesia with propofol and fentanyl, and maintenance with oxygen, nitrous oxide and sevoflurane. After five minutes of normocapnic ventilation and stable bispectral index value (BIS) of 40-50, the right middle cerebral artery flow velocity (MCAFV) was recorded with TCD. The transient hyperemic response (THR) test was performed by compressing the right common carotid artery for 5-7 seconds. The lungs were hyperventilated to test carbon dioxide (CO2) reactivity. Hemodynamic parameters, arterial CO2 tension, pulse oximetry (SpO2), MCAFV and BIS were measured before and after hyperventilation. Dexmedetomidine infusion was discontinued ten minutes before skin-closure. Time to recovery and extubation, modified Aldrete score, and emergence agitation were recorded. Results: Demographic parameters, durations of surgery and anesthesia, THR ratio (Group D: 1.26 ± 0.11 vs. Group C: 1.23 ± 0.04; P = 0.357), relative CO2 reactivity (Group D: 1.19 ± 0.34 %/mmHg vs. Group C: 1.23 ± 0.25 %/mmHg; P = 0.547), blood pressure, SpO2, BIS, MCAFV, time to recovery, time to extubation and modified Aldrete scores were comparable. Conclusions: Dexmedetomidine administration does not impair dCA and CO2 reactivity in patients undergoing spine surgery under sevoflurane anesthesia.

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Jigna, R. Shah, R. Moghe Apoorva, P. Gosai Samarth, and D. Humbal Maulik. "Randomized Clinical Trial of Desflurane Vs Sevoflurane for Hemodynamic Stability and Recovery Profile in Laparoscopic Surgeries." International Journal of Toxicological and Pharmacological Research 12, no. 9 (2022): 38–45. https://doi.org/10.5281/zenodo.11465438.

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Background and Aim: Inhalational anaesthetic agents are used for maintenance of general anaesthesia. Sevoflurane and Desflurane have been in use for ambulatory anaesthesia as both have properties of an ideal agent. This study was carried out to compare the effect of sevoflurane and desflurane anaesthesia on emergence and extubation in laparoscopic surgeries. Material and Methods: Present Randomized Control Trial was done at the Department of Anaesthesia, GMERS Medical college and hospital, Sola, Ahmedabad, Gujarat from July 2019 to June 2021. Simple randomization technique was employed using a computer-generated random number table and final sample size calculated was 68. Two groups were created by Randomized Computer Sampling method. GROUP D: Maintenance anaesthesia with desflurane. GROUP S: Maintenance anaesthesia with sevoflurane. Perioperative hemodynamic parameters were recorded. Postoperative recovery was assessed by the time from discontinuation of inhalational agent to response to painful stimuli, to spontaneous eye opening, to verbal commands, stating name, able to lift limb. Modified ALDRETE Score was recorded at the time of arrival to PACU. Results: Intra-operative systolic and diastolic blood pressure and SpO2 did not differ in both the groups during course of anesthesia. Patients in group D were responding to verbal command at an average 4.9 min as compared to 7.46 min in sevoflurane group. Time to achieve MODIFIED ALDRETE SCORE of 9 was faster in desflurane (9.14) group then sevoflurane (10.17) group. p<0.05, the difference is statistically significant. (p<0.05). Conclusion: Both Desflurane and Sevoflurane provide stable intraoperative hemodynamic, but the main difference lies in their recovery profile. Desflurane is associated with faster and better recovery as compared to sevoflurane.

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Thakur, Jaya Prakash, Resham Bahadur Rana, and Abhay Pokharel. "Ketamine with Midazolam and Ketamine alone as oral premedication in children: a randomized trial." Journal of Society of Anesthesiologists of Nepal 4, no. 2 (2018): 66–73. http://dx.doi.org/10.3126/jsan.v4i2.21206.

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Background: Fear of operation, injections, physicians and peculiar operation theatre environment where children are separated from their parents prior to anesthesia invariably produce traumatic experiences in tender mind of young children. Midazolam and Ketamine are useful for oral premedication in children to allay anxiety, allow separation from parents and to ensure smooth induction.Methodology: It was a prospective, randomized, double-blinded and comparative study conducted in 80 children of ASA I and II aged 1-6years undergoing elective ophthalmological procedures under general anesthesia. Children were randomized and divided into two groups, K received 4mg/kg of Ketamine and MK received 0.2mg/kg of Midazolam+2mg/kg of Ketamine peroral. Sedation level, ease of parental separation and ease of mask acceptance were evaluated within 20-30 minutes on a 4-point scale. The time to achieve modified Aldrete score of ≥9 was also noted.Results: Two groups were identical regarding age, sex, weight and ASA status. In sedation score, 31(77.5%) children in group K and 35(87.5%) children in group MK were awake, calm and quite (score3)(p=0.50). In parental separation score, 34(85%) children in group MK and 25(62.5%) children in group K have good separation, awake and calm (score2) (p=0.04). In mask acceptance score, 34(85%) children in group MK and 17(42.5%) children in group K were calm, awake, cooperative, accepting Mask (score1)(p=0.001). Time of recovery in group K was 17.92}6.50min whereas in group MK was 17.80}4.059min(p=0.91).Conclusion: Ketamine 4mg/kg and combination of Midazolam 0.2mg/kg with Ketamine 2mg/kg are equally effective but low dose combination is safe and superior. Journal of Society of Anesthesiologists of NepalVol. 4, No. 2, 2017, Page: 66-73

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Mohammed, Abdul Samad, Fathima Yaseen, Krishna B. Vamshi, and Bharat Kumar S. "Effect of BIS (Bispectral Index) Monitoring on Recovery Profile of Patients using Sevoflurane as a Maintenance Inhalational Anaesthetic Agent." International Journal of Toxicological and Pharmacological Research 12, no. 12 (2022): 149–57. https://doi.org/10.5281/zenodo.7538123.

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Background: One of the objectives of modern anaesthesia is to ensure adequate depth of anaesthesia to prevent awareness without inadvertently overloading the patient with potent drugs. An important achievement of modern anaesthesia is the ability to monitor depth of anesthesia. Bispectral index uses a combination of EEG sub parameter that were selected after analysis of large database of EEG. This parameter were combined to form optimum configuration to monitor the hypnotic state. This is then described as a dimensionless number ranging from o to 100 with lower number corresponding to deeper level of hypnosis. Aim of the Study: To evaluate efficacy of Bispectral index monitoring on recovery profile of patients maintained with sevoflurane under general Anaesthesia.  Methods: This clinical study was conducted in the Department of Anaesthesiology & Critical care of Osmania General Hospital, Hyderabad, from June 2020 to November 2021. Results: The recovery profile is better in patient who were administered BIS guided anaesthesia. Conclusion: BIS monitoring results in higher modified aldrete score on arrival to PACU, there by leading to early discharge from PACU.

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Tutika, Spandana, Dhawale Yashwant, Ahirwal Rajkumar, Sandhya Rani Y, and P. Kaushal R. "Study between Fentanyl - Propofol versus Ketamine - Propofol Combination for Sedation and Recovery in ERCP Procedure." International Journal of Pharmaceutical and Clinical Research 16, no. 1 (2024): 1495–98. https://doi.org/10.5281/zenodo.11122660.

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Background: The gold standard diagnostic and therapeutic approach for pancreaticobiliary diseases is the ERCP, which is frequently carried out in daycare. It is necessary to have a sufficient depth of anaesthesia under sedation or Total Intravenous Anaesthesia (TIVA) for immobility, analgesia, and patient comfort. The ideal sedative–analgesic mixture ought to preserve a patient’s hemodynamic status and ought to cause no breathing depression, a quick onset and reversal to initial values, and a small occurrence of postoperative nausea and vomiting. Several pharmacological agents including dexmedetomidine, fentanyl, ketamine, and propofol, are now widely accessible, taking into consideration short induction, rapid recovery, and lessening complications associated with using a single drug. Aims and Objectives: To investigate the groups receiving Fentanyl-Propofol (FentP) versus Ketamine-Propofol (KetP) in ERCP in terms of sedation, rescue sedation requirement, and recovery scores during ERCP. To observe the procedure’s hemodynamic changes, postoperative pain score and complications of ERCP. To observe the occurrence of any side effects and complications related to Fentanyl-Propofol (FentP) versus Ketamine-Propofol (KetP). Materials and Methods: A study was carried out at Gandhi Medical College, Bhopal which included 30 adult patients between the age of 18-65 years of ASA Grade I, II and III who underwent ERCP after informed consent. Both groups received 1mg Midazolam and Inj Glycopyrrolate 0.2mg in the pre-anaesthesia area. Group A received Ketamine-Propofol (KetP) and Group B received Fentanyl-Propofol (FentP), each contain 15 patients. All patients are given a loading dose of Propofol 0.75 mg/kg and 75𝜇g/kg/minute infusion was started. The group FentP received Fentanyl 2𝜇g/kg and the group KetP received Ketamine 0.5mg/kg. Ramsay sedation scores, the necessity for rescue sedation, hemodynamics changes, complications during surgery and Modified Aldrete score are noted. Results: Ramsay sedation scores at 0, 2, and 4 minute in group B (FentP) are significantly lower, suggesting patients in group A (KetP) experience early sedation (P value 0.00). However, the FentP group has significantly greater sedation scores at 8, 10, and 15 minutes (P value 0.05).There was no statistical difference between the two groups in terms of recovery time (P value > 0.05). There was a significantly reduced requirement of rescue sedation in group KetP (P value < 0.01). FentP caused slightly delayed recovery time and respiratory depression compared to KetP. MAP in group FentP was lower than baseline, this suggests KetP provides better hemodynamic stability than FentP. Conclusion: KetP (Ketamine – Propofol) group offers greater sedation, need lesser rescue sedation dose of Propofol, faster recovery with better hemodynamics and fewer complications when compared to FentP (Fentanyl – Propofol) group. Ketamine and Propofol are advised in patients having higher risk of respiratory depression. Pain after ERCP is less in FentP group compared to KetP group.

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Phalgune, Deepak, Ganesh Ghongate, Naveen Gavel, and Rajendra Gosavi. "The efficacy of propofol and etomidate for sedation in endoscopic bronchial ultrasound- A randomized controlled study." Indian Journal of Clinical Anaesthesia 9, no. 2 (2022): 263–68. http://dx.doi.org/10.18231/j.ijca.2022.050.

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There is paucity of Indian data regarding the use of sedation for endobronchial ultrasound. We compared the efficacy of etomidate and propofol in patients undergoing endoscopic bronchial ultrasound for the achievement of satisfactory sedation. Seventy patients aged more than 18 years posted for endoscopic bronchial ultrasound under sedation for diagnostic and therapeutic purpose were included in this randomised double- blind controlled study. Patients were randomly allocated to propofol and etomidate group. Comparison of cardiovascular adverse events and haemodynamic parameters were the primary objectives. Comparison of gag reflex, visual analogue scale score and recovery from sedation using Modified Aldrete Score were the secondary objectives. Patient satisfaction in terms of visual analogue scale score was the same in both propofol and etomidate groups. Endoscopist’s satisfaction was significantly higher in etomidate group as compared to propofol group. The post-operative hypotension was significantly lower in etomidate group as compared to propofol group. The post-operative bradycardia was significantly lower in etomidate group as compared to propofol group.Endoscopist’s satisfaction and the haemodynamic control was better in etomidate group as compared to propofol group during endobronchial ultrasound.

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Kyvelou, E., G. Tziatzios, N. Mathou, et al. "Application of modified ALDRETE score after sedation and analgesia for gastrointestinal endoscopy results in shorter recovery time: a randomized trial." Endoscopy 57, S 02 (2025): S92. https://doi.org/10.1055/s-0045-1805276.

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Swarup Dutta, Tirtha Ratan Ghosh, Debarati Goswami, Subrata Mondal, Somnath Dey, and Debasish Saha. "Comparison of hemodynamic alterations and post-operative profile of sevoflurane and propofol during laparoscopic cholecystectomies." Asian Journal of Medical Sciences 14, no. 6 (2023): 82–87. http://dx.doi.org/10.3126/ajms.v14i6.51567.

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Background: Modern laparoscopic surgeries with insufflation of gas into peritoneal cavity are gold standard treatment for cholelithiasis. Propofol, a GABA receptor positive allosteric modulator and Sevoflurane, an inhalational anesthetic are used for maintenance of general anesthesia. In laparoscopy, significant hemodynamic changes occur. Searching in field of anesthesia is going on for anesthetic agent for better recovery. Aims and Objectives: Objective of the study is to compare sevoflurane with propofol for intraoperative hemodynamic changes and post-operative recovery profile of patient’s undergone laparoscopic cholecystectomies under general anesthesia. Secondary objective is to compare post-operative complications. Materials and Methods: A prospective, randomized, single-blinded, and comparative study done after permission from the institutional ethical committee and informed consent from patients. Total 84 patients of 20–50 years age of either sex were scheduled for laparoscopic cholecystectomy, divided in two equal groups – Group P, induced with propofol and anesthesia was maintained with propofol (100–120 μg/kg/min), nitrous oxide and oxygen and Group S induced with propofol and anesthesia was maintained using sevoflurane (1–2%), nitrous oxide, and oxygen. Results: We found that time for eye opening was 9±1.21 min in Group P and 8±1.34 min in Group S. Time for following verbal command was 10±1.20 min in Group P and 9±1.32 min in Group S. Time for speaking name by patient was 11±1.20 min in Group P and 10±1.34 min in Group S. Difference between two groups regarding eye opening, following verbal command, and time to speak own name are highly significant with P<0.001 which proves that eye opening, following verbal command and time for speaking name by patient were significantly shorter in sevoflurane group. Time to achieve modified aldrete score >8 was 14±1.30 min in Group P and 13±1.37 min in Group S. Difference between two groups is also highly significant with P<0.001 which proves that time to achieve modified aldrete score>8 were significantly shorter in sevoflurane group. Conclusion: From our study, maintenance of general anesthesia with sevoflurane is associated with faster recovery from anesthesia.

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Banerjee, Shraya, Pramod Kohli, and Maitree Pandey. "A study of modified Aldrete score and fast-track criteria for assessing recovery from general anaesthesia after laparoscopic surgery in Indian adults." Perioperative Care and Operating Room Management 12 (September 2018): 39–44. http://dx.doi.org/10.1016/j.pcorm.2018.10.001.

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Han, Jiwon, Ah-Young Oh, Yong-Tae Jeon, et al. "Quality of Recovery after Laparoscopic Cholecystectomy Following Neuromuscular Blockade Reversal with Neostigmine or Sugammadex: A Prospective, Randomized, Controlled Trial." Journal of Clinical Medicine 10, no. 5 (2021): 938. http://dx.doi.org/10.3390/jcm10050938.

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The risk of neuromuscular blockade is certainly minimized by sugammadex in combination with monitoring. However, the effect of sugammadex-aided recovery on patients’ satisfaction is unclear. This study compared the Quality of Recovery (QoR)-15 score, which is a patient-reported outcome, in patients undergoing laparoscopic cholecystectomy. Eighty patients were randomly assigned to the neostigmine or sugammadex groups. At the end of surgery, neostigmine or sugammadex was administered, and tracheal extubation was performed after confirmation of a train of four ratio ≥ 0.9. The QoR-15 questionnaire was administered at 1 day before surgery and on post-operative days (POD) 1 and 2. The primary outcome was the QoR-15 score on POD 1. The secondary outcomes were the QoR-15 score on POD 2, modified Aldrete score, length of post-anesthetic care unit stay, post-operative pain, administration of anti-emetics, urinary retention, and length of hospital stay. No significant differences were found in QoR-15 scores on POD 1 (94.4 vs. 95.5, p = 0.87) or 2 (116.3 vs. 122, p = 0.33). Secondary outcomes were also comparable, with the exception of urinary retention (15.8% neostigmine vs. 2.6% sugammadex, p = 0.04). This study demonstrated that the quality of recovery was comparable between the neostigmine and sugammadex groups when reversal and tracheal extubation were performed in accordance with the current guidelines.

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Bhalabhai Rupakar, Vinay, Rashmi D Souza, and Shah Parth Shrenikbhai. "A Comparison of Effects of Dexmedetomidine-Ketamine versus Dexmedetomidine-Midazolam Combination in Ambulatory Transurethral Procedures." Indian Journal of Anesthesia and Analgesia 8, no. 3 (2021): 375–83. http://dx.doi.org/10.21088/ijaa.2349.8471.8321.53.

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Introduction: Minimally invasive transurethral procedures can be successfully performed on outpatient basis. The anaesthetic technique of choice for suchprocedures is Monitored Anaesthesia Care with a combination of local anaesthesia and sedation-analgesia. It ensures a rapid onset and early recovery with minimal cardiorespiratory adverse effects, facilitating same day discharge. Various drugs are being used in combination to achieve this goal. In this study, we have compared the effects of a combination of dexmedetomidine-ketamine and dexmedetomidinemidazolam in ambulatory transurethral procedures. Materials and Methods: This prospective, randomised, comparative study was carried out on sixty patients aged 20-60 years, of either sex, ASA I/II physical status, scheduled for elective, outpatient transurethral procedures. These patients were randomly allocated into two groups - Group DK received a bolus of IV ketamine 1mg/kg and IV dexmedetomidine 1µg/kg and Group DM received a bolus of IV midazolam 0.05mg/kg and IV dexmedetomidine 1µg/kg, bothwere followed by amaintenance infusion of dexmedetomidine 0.2µg/kg/hr IV throughout the procedure. The heart rate, mean arterial blood pressure, analgesia using Numerical Rating Scale and sedation using the Ramsay Sedation Scale were measured intraoperatively. The recovery characteristics were assessed using the Modified Aldrete Score, time to spontaneous eye opening and length of stay in the recovery room. Statistical analysis: The data was compared and analysed using the Unpaired t test and Fisher’s exact test. Results: Group DMshowed statistically significant lower mean arterial pressure (MAP) up to 35 mins duringthe procedure when compared with group DK (P <0.05). Although the sedation scores were similar, Numerical Rating Scale scores were significantly higher in group DM than in group DK till 10 minutes of the procedure (P <0.001). The Modified Aldrete score was higher and time to spontaneous eye opening, length of recovery room stay was shorter (P <0.001 andP <0.001, respectively) in group DK compared to group DM. The incidence of hypotension, bradycardia and postoperative nausea/vomiting was lower in group DK. Conclusion: Although, good sedation was seen with both the combinations, the dexmedetomidine-ketamine group provided better intra operative analgesia and cardiorespiratory stability with a shorter recovery time and lower incidence of post-operative nausea/vomiting. Thus, dexmedetomidine-ketamine combination is a better, safer alternative for monitored anaesthesia care in ambulatory transurethral procedures. Keywords: Dexmedetomidine; Ketamine; Midazolam; Ambulatory; Transurethral; Recovery.

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Fattahi-Saravi, Zeinabsadat, Reza Jouybar, Rezvan Haghighat, and Naeimehossadat Asmarian. "Comparison of the Effect of Ketamine, Ketamine-Midazolam and Ketamine-Propofol on Post-Tonsillectomy Agitation in Children." Malaysian Journal of Medical Sciences 28, no. 5 (2021): 72–81. http://dx.doi.org/10.21315/mjms2021.28.5.7.

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Background: Emergence agitation (EA) in children is one of the most common complications following anaesthesia. We aimed to compare the effect of ketamine, ketaminemidazolam and ketamine-propofol on EA after tonsillectomy. Methods: This study was a randomised, double-blind clinical trial conducted on 162 children undergoing adenotonsillectomy surgery. The participants were randomly divided into three groups of receiving ketamine (0.5 mg/kg) (N = 54), ketamine (0.5 mg/kg) + propofol (1 mg/kg) (N = 54) and ketamine (0.5 mg/kg) + midazolam (0.01 mg/kg) (N = 54) 10 min before the end of the operation. At the time of the patients’ entry into the post-anaesthesia care unit (PACU) and at intervals of 5 min, 10 min and 20 min after that, consciousness, mobility, breathing, circulation and SpO2 were recorded. Modified Aldrete recovery score (MARS), the objective pain score (OPS) and Richmond agitation-sedation scale (RASS) were also evaluated. Results: At the time of entrance to the PACU and 5 min later, the ketamine-midazolam and ketamine-propofol groups had lower RASS scores than the ketamine group (P < 0.001); after 10 min and 20 min, the ketamine-propofol group showed the lowest RASS score (P < 0.001). Ketamine-propofol group had a significantly lower MARS score at all-time points (P < 0.001). Recovery time was the longest for the ketamine-propofol group (P = 0.008). Conclusion: The ketamine-midazolam group had lower RASS, greater haemodynamic stability and MARS values without delayed awakening.

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El Aoufy, Khadija, Carolina Forciniti, Yari Longobucco, et al. "A Comparison among Score Systems for Discharging Patients from Recovery Rooms: A Narrative Review." Nursing Reports 14, no. 4 (2024): 2777–94. http://dx.doi.org/10.3390/nursrep14040205.

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Introduction: The recovery room (RR) is a hospital area where patients are monitored in the early postoperative period before being transferred to the surgical ward or other specialized units. The utilization of scores in the RR context facilitates the assignment of patients to the appropriate ward and directs necessary monitoring. Some scoring systems allow nurses to select patients who can be discharged directly to their homes. Aim and methods: The aim of this narrative review was to describe and compare the scoring systems employed to discharge postoperative patients from RR, with a focus on item characteristics. Results: Nine scoring systems were identified and discussed: the “Aldrete Score System” and its modified version, the “Respiration, Energy, Alertness, Circulation, Temperature Score”, the “Post Anesthetic Discharge Scoring System”, the “White and Song Score”, the “Readiness for Discharge Assessment Tool”, the “Anesthesia and Perioperative Medicine Service Checklist”, the “Post-Anesthetic Care Tool”, the “Post-operative Quality Recovery Scale”, and the “Discerning Post Anesthesia Readiness for Transition” instrument. Discussion and conclusions: To obtain a comprehensive overview, the items included in the scoring systems were compared. Despite the availability of guidelines for patients’ discharge readiness from the RR, there is no universally recommended scoring system. Next-generation scores must be improved to ease their use, minimize errors, and increase safety. The main goals of the scores included in this narrative review were to be simple to use, feasible, intuitive, comprehensive, and flexible. However, these goals frequently conflict because patient assessment takes time, and a smart and comprehensive score may not consider some clinical parameters that may be crucial for the discharge decision. Therefore, further research should be conducted on this topic.

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Babu, T. Raghavendra, M. R. Anil Kumar, N. R. Anup, and Sarika M. Shetty. "Dexmedetomidine as an Adjunct to Propofol in Patients Undergoing Elective Endoscopic Retrograde Cholangio-Pancreaticography – A Double-blind Randomized Controlled Study." Journal of Pharmacy and Bioallied Sciences 16, Suppl 1 (2024): S399—S402. http://dx.doi.org/10.4103/jpbs.jpbs_617_23.

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ABSTRACT Background: Propofol is the drug of choice for procedural sedation. The addition of α2 agonist dexmedetomidine may improve the safety profile of the procedure by providing stable hemodynamics, better sedation quality, and decreasing the side effects of each drug during elective endoscopic retrograde cholangio-pancreaticography (ERCP). Materials and Methods: Eighty patients aged between 18 and 60 years were distributed randomly into two groups. The dexmedetomidine + propofol group (group DP) received an injection of dexmedetomidine at the dose of 1 mcg/kg in 100 mLsaline, and the propofol group (group P) received plain 100 mL normal saline over 10 min. Subsequently, both groups received a bolus dose of injection propofol 1 mg/kg as sedation, and a modified observer’s assessment of alertness/sedation score (MOASS) score was assessed, followed by infusion at the rate of 50 mcg/kg/min during the procedure. A rescue bolus dose (20 mg) of propofol was administered when the patient showed signs of inadequate sedation or analgesia in both groups. Cardiovascular and respiratory parameters were recorded every 10 min throughout the procedure. Post-procedure modified Aldrete score was evaluated for 30 min, and the endoscopist’s score was noted at the end of the procedure. Results: There was a significant difference (P = 0.001) in the additional number of rescue doses of propofol administered in group DP (3.47 ± 0.77) as compared to group P (8.78 ± 1.11). The total dose of propofol was lower in group DP (316.59 ± 43.29 mg) than in group P (443 ± 41.1 mg) with P value = 0.001. Statistically significant differences in the hemodynamic values were observed in group DP during infusion (P value < 0.05) of dexmedetomidine and throughout the procedure (P < 0.05) when compared with group P. Endoscopists graded the satisfaction score as very high (3.477 ± 0.77) in group DP. Conclusion: The addition of dexmedetomidine to propofol during ERCP provided better and safer sedation.

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M.K, Mamatha. "Comparative Study between Dexmedetomidine and Midazolam in Inducing Conscious Sedation in Patients Undergoing Cataract Surgery." Indian Journal of Anesthesia and Analgesia 8, no. 2 (2021): 169–75. http://dx.doi.org/10.21088/ijaa.2349.8471.8221.24.

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Background: Cataract surgery are usually done in elderly patients. Dexmedetomidine is a potent non-opiod sedative and analgesic devoid of respiratory depression. Midazolam is the most commonly used sedative which is commonly associated with respiratory depression specially in elderly patients. Objectives: To compare the effects of intravenous dexmedetomidine and midazolam on the haemodynamic stability, sedation and intraocular pressure and to study the safety profile of the drug Methodology: After obtaining permission from institutional ethical committee and patient informed consent, study was conducted at BMCRI from November 2016 to May 2018 in ASA Grade 1 and 2 patients of 40 to 70 year age undergoing cataract surgery. Patients were randomly allocated to two Group D and M of 32 each. Group D received inj. dexmedetomidine 0.25mcg/kg, Group M received inj. midazolam 0.02mg/kg diluted to 10ml over 10 minutes as intravenous injection. Peribulbar block was given with 8-10ml of injection 2% lignocaine with adrenaline with hyaluronidase. Haemodynamic parameters like Heart Rate, Mean Arterial Pressure and SpO2, Intra Ocular Pressure in non-operating eye, Ramsay Sedation Score, Visual Analogue Score and Modified Aldrete Score were recorded. Results: We concluded that in our study demographic data were comparable. Patients of Dexmedetomidine group had reduction of IOP after drug injection (p=0.001) and at post bulbar block (p=0.002) which is statistically significant compared to Group M patients and also there was statistically significant difference in RSS Score between two groups. Conclusions: Dexmedetomidine provides same conscious sedation as Midazolam. Dexmedetomidine reduces intraocular pressure and maintains SpO2 when compared to Midazolam in cataract surgery.

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Farrukh, Raza, Waseem Sadiq Awan, Ahmed Hassan Khan, Asaad Rizwan Rana, Ahmed Aziz Jilani, and Khalid Mahmood. "Comparison of dexmeditomidine and propofol for hemodynamic and recovery characteristics in dilatation and curettage." Professional Medical Journal 27, no. 06 (2020): 1244–48. http://dx.doi.org/10.29309/tpmj/2020.27.06.4216.

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Objectives: To evaluate the hemodynamic and recovery characteristics of dexmeditomidine and propofol in dilatation and curettage. Study Design: Randomized control trial. Setting: Department of Anaesthesia, DHQ Teaching Hospital Sargodha. Period: March 2016 to December 2017. Material & Methods: Patients undergoing dilatation & curettage were randomly divided into two groups, group P received IV propofol 1.5mg/kg slowly over 5 min and group D received dexmeditomidine at a loading dose of 1µg/kg followed by 0.5 µg/kg/h. During the procedure blood pressure and heart rate were compared in both groups. In the recovery room, recovery time was compared in both groups by using modified aldrete score. Results: In Group D, the decrease in heart rate was statistically significant when compared with group P. Both groups showed a decrease in MAP but results were not statistically significant when compared in both groups. Patients in group D were discharged earlier from recovery room than group P and results were statistically significant. Conclusion: Dexmeditomodine provides better recovery than propofol so it is a suitable drug for day care minor surgical procedures. Similarly dexmeditomidine is superior to propofol by providing less respiratory depression intraopertaively.

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Maffucci, Rosalba, Uberto Maccari, Luca Guidelli, et al. "Pulmonologist-Administered Balanced Propofol Analgosedation during Interventional Procedures: An Italian Real-Life Study on Comfort and Safety." International Journal of Clinical Practice 2022 (June 13, 2022): 1–8. http://dx.doi.org/10.1155/2022/3368077.

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Propofol-based sedation provides faster recovery than midazolam-based regimens with similar safety and comfort during video flexible bronchoscope (VFB) procedures. Pulmonologist-administered propofol “balanced” analgosedation (PAP-BAS) is still debated in Italy. In this real-life study, PAP-BAS safety and comfort during VFB procedures were investigated. We analysed prospectively the subjects undergoing elective VFB procedures in the Pulmonology and RICU of Arezzo Hospital between February and July 2019. PAP-BAS combined low propofol and meperidine doses titrated to achieve an RASS score between 0 and −3. The primary end-point was the complications’ rate. Secondary end-points were as follows: the relation between propofol’s dose and a subject’s comfort assessed with a VAS, recovery time according to a modified Aldrete score ≥9, RASS, and subjects’ will of undergoing the procedure again. We collected postprocedure symptoms’ intensity too. Our 158 study patients (67 years; SD ± 14; 64% males) incurred in 25% of complication, fully resolved with medical therapy. Neither recourse to ventilator support nor death was reported. Intraprocedural comfort was good (94% of VAS score ≤2). Among postprocedural symptoms, cough was the most frequently reported, in 36% of the cases. Although half of subjects remembered the procedure, 90% of them would have repeated it, if necessary. 85% of them recovered from procedures within 10 minutes. Complications, VAS, and recovery time were not correlated with propofol dose. To our knowledge, this is the first Italian study showing that PAP-BAS to perform a VFB procedure is safe, well tolerated with a quick recovery. Randomised controlled trials are warranted to confirm these preliminary results.

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Manek, Jinal. "Evaluation of efficacy and hemodynamic stability of propofol- ketamine and propofolfentanyl in patients undergoing dilatation and curettage." MedPulse International Journal of Anesthesiology 19, no. 2 (2021): 44–48. http://dx.doi.org/10.26611/10151925.

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Background: To evaluate and compare the efficacy and hemodynamic stability of ketamine / fentanyl along with propofol and also assess recovery profile, post-operative analgesia and complications in patients undergoing Dilatation and Curettage (DandC). Method: Total 100 patients of ASA grade I and II, age between 18-55 years were enrolled and divided into two equal groups with adjuvant drugs in group PK- ketamine (0.75mg/kg IV) and in group PF-fentanyl (2ug/kg IV). Both groups received induction dose of Propofol- 2-2.5 mg/kg. Depth of sedation maintained with 0.5 mg/kg boluses of Inj.Propofol and assessed with Ramsay Sedation Score (RSS). The total dose of propofol was noted in both the groups. Intraoperative and postop vital parameters and complications were compared. Visual Analog Scale(VAS) was recorded and if VAS Score >6, then patients received Inj.Paracetamol 15mg/kg IV as rescue analgesia. The recovery was assessed by Modified Aldrete Score (MAS). The time from completion of procedure to reach MAS of 9-10 was noted. Results: The hemodynamics was better with ketamine than fentanyl group. The total dose of propofol requirement, intraoperative and postop complications, and VAS scores were higher in group PF than in group PK, thus more patients required rescue analgesia in fentanyl group as compared to ketamine group. The recovery was delayed in ketamine group as compared to fentanyl (higher MAS and prolonged time to reach MAS>9). Conclusion: Ketamine (0.75 mg/kg) provides better perioperative hemodynamic stability with good analgesia and fewer complications as compared to Fentanyl (2ug/kg) in patients undergoing DandC.

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Hariprasad. "1: Comparison of the effect of caffeine and aminophylline on recovery from total intravenous anaesthesia with propofol and fentanyl in laparoscopic hysterectomy: A randomised controlled trial." Indian Journal of Anaesthesia 66, Suppl 1 (2022): S68. http://dx.doi.org/10.4103/0019-5049.340653.

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Background and Aims: During extubation, the loss of consciousness (LOC) after general anaesthesia (GA) is reversed by stopping the administration of anaesthetic agents. It is a passive process and it is affected by many factors like age, sex, weight, temperature, duration of surgery, and type of anaesthetic agent used. This study is conducted to find whether caffeine and aminophylline hasten the emergence and reversal of LOC caused by propofol.To evaluate recovery time [time to Bispectral(BIS) index 90] from total intravenous anaesthesia (TIVA) in patients receiving caffeine and aminophylline in comparison to saline/placebo. Methods: This study was conducted on 75 American Society of Anesthesiologists (ASA) I and II female patients undergoing laparoscopic hysterectomy, aged between 18 to 60 years. The patients were divided into three equal groups (Group C: Caffeine citrate, Group A: aminophylline, and Group S: saline) of 25 each by random number computer table. The allocation was concealed by the sealed envelope method which was opened after giving GA. GA was induced with propofol, fentanyl, and rocuronium followed by endotracheal intubation and was maintained with propofol infusion. On completion of surgery, infusion of propofol was stopped. The study drug was administered intravenously when a BIS of 60 was achieved. Time to achieve BIS 90, time to the return of regular breathing with adequate tidal volume, to the return of first gag reflex, time to eye-opening on verbal command, handgrip on verbal command, and time to extubation after study drug administration were noted. Haemodynamic and respiratory parameters were also monitored. The Modified Aldrete score was recorded in all patients. Results: The time for BIS 60 to 90 was 10.6±3.9 min in the caffeine group, 12.6± 2.9 min in the aminophylline group, and 24.8 ± 4.8 min in the saline group. Thus, time to recovery was decreased by 57% and 49% in caffeine and aminophylline groups respectively and is statistically significant. The time to return of adequate tidal volume was least in the aminophylline group while it was highest in the control group. The difference was statistically significant when the aminophylline group was compared to the control group while it was insignificant for others. Time to return of gag reflex and time to extubation were statistically significant between aminophylline and saline group, and between caffeine and saline group. Haemodynamic parameters after infusion of the study drug were comparable in all three groups. Modified Aldrete score was higher in both caffeine and aminophylline group than in the control group and the difference was statistically significant Conclusion: Caffeine hastens the recovery from TIVA with propofol and fentanyl in laparoscopic hysterectomy as effectively as aminophylline. The recovery is significantly earlier with either of the drugs compared to when none of the drugs is given JOURNAL/ijana/04.03/01762628-202203001-00105/inline-graphic1/v/2022-09-30T091728Z/r/image-tiff

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Sultana, Nasima, Mohammad Mominul Haque, Shamim Ara Sultana, et al. "Comparative Analysis of Early Recovery Profiles Following General Anesthesia with and without Pectoral Nerve Block2 in Modified Radical Mastectomy." SAS Journal of Surgery 11, no. 05 (2025): 488–93. https://doi.org/10.36347/sasjs.2025.v11i05.007.

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Background: Modified radical mastectomy (MRM) is often associated with significant postoperative pain, which can delay recovery and increase opioid requirements. The use of regional blocks like Pectoral Nerve Block II (PECS II) as an adjunct to general anesthesia may enhance postoperative better outcome. Methods: This randomized controlled study was conducted to compare early recovery profiles, hemodynamic parameters, and postoperative analgesia in patients undergoing MRM under general anesthesia (GA) alone and GA combined with PECS II block at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from September 2021 to October 2022. A total of 60 female patients aged 30–60 years (ASA grade I–II) were randomly assigned into two groups: Group A received GA alone, while Group B received GA with PECS II block. Results: The demographic characteristics were comparable between the two groups. Pain scores during recovery and 6 hours postoperatively were significantly lower in Group B (p<0.001). Group B had a delayed time to first rescue analgesia (144.0 ± 68.9 min vs. 38.0 ± 13.5 min; p=0.001) and significantly reduced total pethidine consumption (72.5 ± 7.9 mg vs. 120.0 ± 10.0 mg; p<0.001). A higher proportion of patients in Group B achieved a modified Aldrete score >9 (76.7% vs. 20.0%; p<0.001) and reported very high satisfaction (73.4% vs. 6.6%; p<0.001). Heart rate was consistently higher in Group A during and after surgery (p<0.05), while mean arterial pressure showed no significant difference. Conclusion: The addition of Pectoral Nerve Block II to general anesthesia in modified radical mastectomy significantly improves postoperative pain control, reduces opioid requirement, enhances recovery, and increases patient satisfaction without compromising hemodynamic stability.

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Sadeq, Mohammad Da’meh MD*; Mohammad Abdellatif Adaileh; MD Ali Dakhilallah Almajali MD; Khaled Suleiman El-Share; MD Khaled Mohammed Shhadat MD. "USAGE OF VARIOUS CONCENTRATIONS OF KETAFOL FOR DILATATION AND CURETTAGE." Indian Journal of Medical Research and Pharmaceutical Sciences 3, no. 10 (2016): 33–38. https://doi.org/10.5281/zenodo.163586.

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Background:Ketafol is a combination of Ketamine and Propofol in different proportions. Various gynecological techniques are short periods and need only pain relief with moderate sedation. Aim:To compare the benefit of Ketafol with different concentration in dilatation and curettage regarding onset of sedation, level of sedation, recovery time, post operative pain and surgeon satisfaction score. Methods:Our respective investigation includes 104 adult female patients, aged 20-38 years, classed I by the American Society Of Anesthesiologists and planned for elective Dilatation and Curettage procedure with a period of surgical intervention not more than 15 min, during the period Jan 2015 - Mar 2016, at Prince Hashim hospital, Zarqa, Jordan, after obtaining approval from our Ethics and research board review Committee of the Royal Medical Services and written informed consent from all participants. Patients were divided into two groups: group (I, n=51) given Ketafol containing Ketamine: Propofol (1:1) while group (II, n=53) given Ketafol containing Ketamine: Propofol (1:2) .Then we compare two groups regarding onset of sedation, level of sedation using Ramsey sedation scale, recovery time using modified Aldrete score, post operative pain using verbal rating scale and surgeon satisfaction score. Results: Ketofol in groups I and II was similar in onset of sedation (GI: 1.46 ± 0.45 min, GII: 1.47 ± 0.59 min), intraoperative Ramsey sedation scores at 10 min (GI: 5.47 ± 0.37, GII: 5.72 ± 0.24) and recovery times (GI: 3.87 ± 0.88 min, GII: 3.42 ± 0.54 min). Regarding the onset of sedation, intraoperative sedation score and recovery time, there were no remarkable differences between the groups. Conclusion:Ketofol in a proportion of 1:2 induces better sedation level in comparison to the other group, both ketofol concentrations (1:1 and 1:2) are comparable regarding sedation profile in dilatation and curettage procedures.

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Atiqur Rahman, Md Kutub Uddin Khan, Md Abbas Uddin, Md Mizanur Rahman, and Ayesha Hasina. "Sedation for Endoscopic Retrograde Cholangiopancreatography (ERCP) – A comparative study between propofol-fentanyl with Propofol-fentanyl-ketamine Combination." Central Medical College Journal 7, no. 2 (2024): 70–81. http://dx.doi.org/10.3329/cemecj.v7i2.74415.

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Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a painful and long procedure requiring transient deep sedation and analgesia. The purpose of our study was conducted to evaluate and compare the sedation efficacy and propofol-fentanyl-ketamine could be a better regime than propofol-fentanyl for sedation in ERCP. Material and Method 100 ASA II-III patients, 18-60 yrs old schedule for planned ERCP procedure in the Dept. of Hepatobiliary Surgery & Gastroenterology of BSMMU. They were selected by inclusion and exclusion criteria and allocated to one of the two groups: group PF (n=50) and group PFK (n=50) by randomization. Group PF received propofol 1mg/kg + fentanyl 1µg/kg and group PFK received propofol 1mg/kg + fentanyl 1µg/kg + ketamine 0.25mg/kg and subsequent doses of propofol were given as a dose 0.5mg/kg accordingly. Recovery time was assessed from the discontinuation of procedure to modified aldrete recovery score ≥ 9. All result was expressed as number or mean ± SD or in frequencies (percentage) as applicable. The result were compiled and analyzed using SPSS-16, Student unpaired t test, Chi-square test. Result The average age of group PF and group PFK study population was 40.16(±9.34) and 44.56(±3.75) respectively whereas there average weight in initial group was 60.83(±5.54) and in the second group 58.39(±7.37). Male patients were more in both the groups. Group PF belongs to ASA II 35(70%) patients and ASA III 15(30%) patients whereas group PFK belongs to 30 (60%) and 20(40%) patients respectively. In the peroperative vital parameters, sedation related side effect as hypotension 10(20%) patients was observed in group PF and 3(6%) patients was observed in group PFK which was found statistically significant (p value 0.032) and apnea has been found 7(14%) patients in group PF and 2(4%) patients in PFK group. Which was found statistically significant (p value 0.018). No post-operative vital parameters were found statistically significant (p value >0.05). Total doses of propofol consumed was significantly higher in group PF (p<.05) than group PFK (190.45±12.8 mg and 140.67 ± 10.23mg). Time needed to achieve Aldrete recovery scale score of 9 in between PF group and PFK group were 18.25±6.76 min and 12.24 ±5.45 min respectively and the result found statistically significant (p value <0.001). Conclusion: Propofol-fentanyl-ketamine provided better sedation quality over propofol-fentanyl combination in term of less side effects, early recovery, cost effectiveness in patients undergoing ERCP procedure. Central Medical College Journal Vol 7 No 2 July 2023 Page: 70-81

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Mistry, Tuhin, Shobha Purohit, Gunjan Arora, Nitesh Gill, and Jaya Sharma. "Attenuation of extubation responses: Comparison of prior treatment with verapamil and dexmedetomidine." Journal of Neuroanaesthesiology and Critical Care 03, no. 01 (2016): 033–39. http://dx.doi.org/10.4103/2348-0548.173234.

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Abstract Background: Tracheal extubation is almost always associated with stress response, airway response, and arrhythmias. There are many ways to attenuate this stress response. We have compared verapamil and dexmedetomidine on attenuation of these responses. Materials and Methods: Thirty patients (American Society of Anaesthesiologists Grade I, II) scheduled for spinal surgeries under general anaesthesia were randomly divided into two groups. At the end of surgery, after return of spontaneous efforts (bispectral index >80), in “Group V” verapamil 0.1 mg/kg and in “Group D” dexmedetomidine 0.3 mcg/kg were administered as bolus intravenously over one minute. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded just before (T0) and 2 min after intravenous administration of study medications (TM), just after oral suction (TS), immediately after extubation (TE) and 1, 3, 5 and 10 min postextubation (E1, E3, E5, E10). Duration of emergence and extubation, quality of extubation, Richmond Agitation Sedation Scale (RASS) score and time to reach modified Aldrete score ≥9 were compared. Results: HR, SBP, DBP, MAP were higher in Group V than Group D, but statistically insignificant (P > 0.05). Extubation quality scores was 1 for 20%, 2 for 60% and 3 for 20% patients in Group V, whereas 1 in 80%, 2 in 20% in Group D. There was occurrence of bradycardia within 2 min of administration of drug in one patient in Group D. RASS score was in the range of -1 to +1 in >90% patient in Group V, whereas -3 to -1 in 80% cases in Group D. Conclusion: Single dose of dexmedetomidine (0.3 mcg/kg) given before extubation produced significant attenuation of circulatory and airway responses during extubation as compared to verapamil (0.1 mg/kg).

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Liu, Yang, Jinye Gu, Jianbo Liu, et al. "Determination of the effective dose of remimazolam combined with sufentanil for inhibiting body movement during surgical abortion: An up-and-down sequential allocation trial." Medicine 103, no. 30 (2024): e39063. http://dx.doi.org/10.1097/md.0000000000039063.

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Background: Remimazolam, a recently developed anesthetic characterized by its rapid and ultra-short-acting properties, exhibits pharmacological attributes that make it potentially suitable for painless surgical abortion procedures. The objective of this study was to determine the effective dose of remimazolam when administered in combination with sufentanil, with the intention of inhibiting body movement during surgical abortion. Additionally, a secondary objective was to assess the recovery profile from general anesthesia. Methods: The study enrolled a total of 25 healthy women aged 20 to 40, with a body mass index between 18 and 28 kg/m2, in their first trimester of pregnancy (up to 12 weeks), and American Society of Anesthesiologists status I and II. Anesthesia induction was initiated by administering sufentanil at a dose of 0.1 μg/kg. The modified Dixon up-and-down method was employed to determine the induction dose of remimazolam for each patient. Results: The 50% and 95% effective dose of remimazolam for inhibitory effects of body movement was estimated using centered isotonic regression to be 0.145 mg/kg (95% CI: 0.115, 0.207), and 0.242 mg/kg (95% CI: 0.232, 0.620), respectively. Five out of 25 (20%) experienced hiccups, with 1 patient having persistent hiccups until the end of the surgery. The mean time to first eye-opening was 51.4 ± 20.5 seconds, and the time to obey verbal command was 54.5 ± 20.6 seconds. Upon arrival at the postanesthesia care unit, 95.7% of the patients achieved a Modified Aldrete score ≥ 9. Conclusions: The 50% and 95% effective dose of remimazolam for inhibiting body movement during surgical abortion when used in combination with 0.1 μg/kg of sufentanil were 0.145 mg/kg and 0.242 mg/kg, respectively.

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Eesha, Banerjee, Sahu Alisha, Pattnaik Shaswat, Sriramka Bhavna, and Mallik Diptimayee. "A Comparative Study of the Effect of Oral Pregabalin Versus Oral Clonidine as Premedication on Early Postoperative Pain, Sedation in Laparoscopic Hysterectomy Under General Anesthesia." International Journal of Pharmaceutical and Clinical Research 15, no. 6 (2023): 1956–66. https://doi.org/10.5281/zenodo.12529557.

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Background: Premedication is the cornerstone of good anesthesia practice. Pregabalin a lipophilic (GABA) analog, a novel anti-convulsant drug and has analgesic effect. Premedication with Clonidine alpha-2 agonist abolishes the stress response to the painful surgical stimulus by inhibiting pre- and possibly the post-synaptic α-2 adrenergic receptors in the spinal cord and medulla. Thus, we aim to compare the duration of postoperative analgesia, sedation, and recovery scores with premedication with oral Pregabalin versus Clonidine during the 1st 24 hours post-surgery among the patients posted for laparoscopic hysterectomy. Materials and Methods: This study was performed on 90 patients of ASA 1, of age 35 to 65 years female posted for laparoscopic hysterectomy, assigned to either of 3 groups of 30 participants randomly. All patients have taken oral Alprazolam (0.5 mg) at night before the operation. Preoperatively, patients had taken oral Pregabalin 75 mg tablet (group A, n=30), Clonidine 150 mg tablet (group B, n=30), and oral placebo tablets in group C(n=30) 60 minutes before surgery. Patients were induced with the injection of Fentanyl, Propofol, and Vecuronium Bromide, and anesthesia was maintained with N2O and O2 gas mixture with Isoflurane. Result: It was observed that all most all patients in group A experienced mild pain up to 4 hours postoperatively with VAS score not going more than 3 on average, while 5 patients in Group B experienced moderate pain after 2 hours of surgery, and the 4-hour VAS score was 4 or more on an average. There was not much difference in modified RSS score in group A and group B just after surgery, but 1hr post-operative score was higher among group A in comparison to group B (1.83 in group A vs 2.30 in group B). Modified Aldrete score was also observed to be less in the premedicated group compared to the control (9.73 in group A vs 9.70 in group B vs 10.00 in group C). Conclusion: It was concluded that clonidine and pregabalin both provide similar pain relief and sedation in the immediate postoperative period in our study. Pregabalin 75 mg pre-emptively provides better analgesia than clonidine 150 mcg. These two drugs are good pre-emptive analgesics for surgeries under general anesthesia and can be used alternatively.

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ÇAM, Ender, Sibel BARİS, and Deniz KARAKAYA. "A comparison of propofol with ketofol for sedation quality and side effects in patients undergoing colonoscopy." Journal of Experimental and Clinical Medicine 38, SI-1 (2021): 65–70. http://dx.doi.org/10.52142/omujecm.38.si.gastro.10.

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Colonoscopy is an endoscopic method and ıt is better to perform this procedure under sedoanalgesia in order to eliminate patients’ anxiety, the colic-like pain and discomfort that occur during the procedure [1]. The aim of this study was to compare the effects of propofol and propofol+ketamine (ketofol) on sedation and side effects in patients undergoing colonoscopy. Material-Method: 50 patients with ASA I-II that are between the ages of 18-65. The patients in the propofol group and Ketofol group were given 0.1mL/kg of drug and/or combination of drugs. The vital parameters, injection pain, spontaneous time of opening eyes, the time of Modified Aldrete Score (MAS) ≥ 9 and the amount of medication used during the procedure and in the recovery room were recorded. Results: There was no significant difference between the two groups during the procedure and in the recovery room (p<0.05). It was shown that the ketamine reduces the amount of propofol by 50% and propofol induced injection pain. Ketofol had no positive effects on hemodynamic and respiratory parameters. Conclusion: We assert that the ratio of combinations will vary depending on the necessary sedation level and analgesic need of the procedure to be performed and depending on the frequency of the administration of additional doses. Although ketofol is being used in different procedures and different age groups in the recent years, there is still need for studies conducted with different drug dosages of this combination.

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Sanfilippo, Maria, Ahmed Abdelgawwad Wefki Abdelgawwad Shousha, and Antonella Paparazzo. "Emergence in Elderly Patient Undergoing General Anesthesia with Xenon." Case Reports in Anesthesiology 2013 (2013): 1–3. http://dx.doi.org/10.1155/2013/736790.

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Introduction. It is a consensus that the postoperative cognitive function is impaired in elderly patients after general anaesthesia, and such category patient takes more time to recover. Xenon is a noble gas with anesthetic properties mediated by antagonism of N-methyl-D-aspartate receptors. With a minimum alveolar concentration of 0.63, xenon is intended for maintaining hypnosis with 30% oxygen. The fast recovery after xenon anaesthesia was hypothesized to be advantageous in this scenario.Case Presentation. We report the case of 99-year-old woman who underwent sigmoid colon carcinoma resection with colorectal anastomosis. We carried out the induction phase by propofol, oxygen, fentanil, and rocuronium bromide, and then we proceeded to a rapid sequence endotracheal intubation consequently. The patient was monitored by IBP, NIBP, ECG, cardiac frequency, respiratory rate, capnometry, TOF Guard, blood gas analysis, and BIS. For maintenance we administrated oxygen, remifentanil, rocuronium bromide, and xenon gas 60–65%. Shortly after the end of surgery the patients started an autonomous respiratory activity, and a high BIS level was also recorded. Decision was made by our team to proceed into the emergence phase. The residual neuromuscular block was antagonized by sugammadex, modified Aldrete score was implicated, and we got our patient fully awake without any cognitive dysfunction or delirium.Conclusion. The rapid emergence to full orientation in very elderly patient who had been anesthetized by xenon shows concordance to the high BIS values and the clinical signs of the depth of anesthesia.

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Geleta Eshete, Zemed, Yidersal Demsie Denberu, Semira Endris, and Faiza Hulala. "Assessment of Incidence and Associated Risk Factors of Awareness with Recall Under General Anesthesia in Non-Cardiac and Non-Obstetric Patients in Tikur Anbessa Specialized Hospital, Addis Ababa From May 2021 to October 2021, Addis Ababa, Ethiopia." Journal of Surgery Care 3, no. 3 (2024): 01–10. https://doi.org/10.33140/jsc.03.03.07.

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Introduction General anesthesia involves administering drugs to induce hypnosis, amnesia, and stress suppression during surgery. Anesthesia awareness, an unintended event where patients recall experiences during anesthesia, can lead to long-term psychological effects. Objective This study evaluated the incidence and risk factors associated with awareness under general anesthesia among non-cardiac and non-obstetric patients at Tikur Anbesa Specialized Hospital (TASH), Addis Ababa, Ethiopia, from May to October 2021. Methodology A prospective cross-sectional study was conducted at TASH using the modified Brice questionnaire and Aldrete score to assess intra-operative awareness and wakefulness. Systematic random sampling was used to select patients assessed in the PostAnesthesia Care Unit (PACU) and ward. Data were analyzed using SPSS version 25, and logistic regression was used to determine variable associations (p < 0.05). Results The study included 354 patients (response rate: 96.4%); 58.7% were male, and 41.5% were female, with a mean age of 39.3 years. The incidence of awareness with recall was 11.7%, while dreaming occurred in 9.1% of patients. Awareness was significantly associated with muscle relaxants (OR 2.793, 95% CI 1.872-1.948, p = 0.003). Dreaming was more common in females. Conclusions The incidence of awareness was higher than in many global studies, with consistent risk factors, particularly the use of muscle relaxants. Dreaming was more common among females. Recommendations Anesthesia providers should monitor intra-operative awareness, manage muscle relaxant dosages, and maintain anesthesia equipment, including gas and depth monitors

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Naveen, Kumar, Naithani Udita, K. Ahamed Riyaz, Kumar Sethi Surendra, Garg Isha, and Yadav Pratibha. "A Randomized Placebo-Controlled Study to Evaluate the Efficacy of Nebulized Dexmedetomidine Premedication for Attenuation of Hemodynamic Stress Response during Laparoscopic Cholecystectomy under General Anesthesia." International Journal of Pharmaceutical and Clinical Research 15, no. 9 (2023): 01–08. https://doi.org/10.5281/zenodo.11314772.

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Background: Intravenous dexmedetomidine is frequently used as an adjuvant in anaesthesia to provide hemodynamic stability during laparoscopic cholecystectomy; however, the role of nebulized dexmedetomidine for the same is not yet investigated. We aimed this study to determine the effect of nebulized dexmedetomidine administered as a premedication in attenuating the hemodynamic response during laparoscopic cholecystectomy as the primary objective while its effect on sevoflurane requirement, recovery profile and side effects as secondary objectives. Materials and Methods: This prospective, randomized, placebo-controlled study included 60 patients of American Society of Anaesthesiologists (ASA) I and II aged 18-60 years of both gender undergoing laparoscopic cholecystectomy. They were randomized into two groups of 30 each to receive either nebulization with dexmedetomidine (1 mcg/kg in 5ml normal saline) in Group D and 5ml normal saline in Group C, administered 15 min before induction of general anaesthesia. Hemodynamic variables, sevoflurane requirement, Ramsay sedation score (RSS) and Modified Aldrete score were recorded preoperatively, and compared with t-test or chi-square test with P<0.05 as statistically significant. Results: Mean arterial pressure and heart rate were significantly less in Group D as compared to Group C following intubation, pneumoperitoneum, surgery and extubation, P<0.05. Mean sevoflurane requirement (volume %) was significantly less in Group D (1.24±0.29%) as compared to Group C (2.69±0.28%), P=0.001, showing 53% reduction in Group D. Both groups were comparable regarding RSS scores, extubation time and recovery time, (P>0.05). Conclusion: Administration of nebulized dexmedetomidine (1µg/kg) before induction provides hemodynamic stability and reduces sevoflurane requirement during laparoscopic cholecystectomy without any delay in recovery or side effects.

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Ahmad, Shireen, Meltem Yilmaz, R.-Jay Marcus, Silas Glisson, and Annette Kinsella. "Impact of Bispectral Index Monitoring on Fast Tracking of Gynecologic Patients Undergoing Laparoscopic Surgery." Anesthesiology 98, no. 4 (2003): 849–52. http://dx.doi.org/10.1097/00000542-200304000-00010.

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Background The need for increasing operating room efficiency has led to various initiatives, one of which is the elimination of mandatory admission to the phase I recovery area postoperatively, also referred to as fast tracking of ambulatory surgery patients. This Institutional Review Board-approved study was conducted to evaluate the effect of Bispectral Index (BIS) monitoring on the ability of patients to successfully bypass the phase I recovery area following gynecologic laparoscopy during general anesthesia. Methods Ninety-nine consenting patients were randomly assigned to one of two groups: group one, in which the BIS monitor (Aspect Medical Systems, Natick, MA) was used, and group two, in which no BIS monitor was used. All patients received a standardized anesthetic that included 1 microg/kg sufentanil and sevoflurane in oxygen, titrated in group one to a BIS value of 50-60 and in group two to maintain vital signs within 20% of preoperative values. All patients received prophylactic nonsteroidal antiinflammatory drugs and antiemetics. Postoperatively, patients were evaluated using the modified Aldrete scoring system, and those who achieved a score of 9 or higher within 10 min were permitted to bypass the phase I recovery area. Results There was no statistically significant difference between the two groups with respect to the number of patients who successfully bypassed the phase I recovery area, postoperative length of hospital stay, or cost of hospitalization. Conclusion With a standardized anesthetic regimen and a strict discharge scoring system, BIS monitoring does not have a significant effect on the ability to fast track outpatients.

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ŞAHİN, Tuna, and Zehra HATİPOĞLU. "Insomnia and wake up and recovery from anesthesia: a prospective observational study." Cukurova Medical Journal 48, no. 1 (2023): 283–88. http://dx.doi.org/10.17826/cumj.1226061.

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Purpose: The aim of this study was to investigate whether wake up and recovery from anesthesia is earlier or later in patients with insomnia. Material and Methods: This study included adult patients who were scheduled for elective ureteroscopy under general anesthesia. Using the Jenkins-Sleep Questionnaire (JSQ), the patients were separated into two groups: Insomnia Group and Control Group. Anaesthesia was standardized. After anesthesia induction, 4-6 % desflurane in nitrous oxide/oxygen (60-40%) concentration at flow of 3 L min¯¹ was administered. The parameters recorded were noninvasive arterial blood pressure, heart rate, peripheral oxygen saturation, end-tidal carbon dioxide values, inspiratory and expiratory concentrations of desflurane, anesthesia time, surgery time, time of eye opening, time of transfer to the recovery room. Pain was assessed with a Visual Analogue Scale (VAS) and recovery with the Modified Aldrete Recovery Score (MARS).  Results: Evaluation was made of 80 patients, comprising 25 females and, 55 males, grouped as 42 patients in the insomnia group and 38 in the control group. The demographic and hemodynamic data were not significantly different between the groups. The time of eye opening, transfer to the recovery room, VAS and MARS values were similar in both groups. When operation times were classified as ˂ 30 min. and ≥ 30 min, no significant differences were determined between the groups in respect of wake up, recovery and pain parameters. Conclusion: Compared with normal sleepers, patients with insomnia showed no differences in respect of wake up and recovery from anesthesia.

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Srinivasa, Navyashree Krishnashastry, Rajeeb Kumar Mishra, Varadarajan Bhadrinarayan, and Karthik Kulanthaivelu. "Hippocampal volume and recovery profile following propofol sedation in children undergoing magnetic resonance imaging: An exploratory study." Saudi Journal of Anaesthesia 18, no. 1 (2024): 12–16. http://dx.doi.org/10.4103/sja.sja_108_23.

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Background: Reduction in the hippocampal volume may contribute to agitated and delayed emergence after anesthesia in epilepsy surgery. We hypothesized that hippocampal volume and the duration of various recovery parameters after a short duration of sedation may be correlated. The primary objective was to evaluate the correlation between hippocampal volumes with time to recovery after the stoppage of propofol infusion. Methods: After obtaining Institute Ethical Clearance, we included all children of the age group 5–17 years, who needed sedation for brain magnetic resonance imaging (MRI) for at least 20–60 minutes for the evaluation of epilepsy. The hippocampal volume was estimated bilaterally in the pre-contrast volumetric magnetization-prepared rapid gradient-echo (MPRAGE) brain imaging by the radiologist using statistical parametric mapping. The correlation of hippocampal volume with recovery and time to discharge (assessed by the modified Aldrete score (MAS)) was obtained using Spearman's correlation coefficient (rho). A rho > ± 0.5 was considered a good correlation between the variables. Results: Data on a total of 18 children (10 males and 8 females) who required sedation for an MRI were studied over a period of six months. The correlation coefficients of right and left corrected hippocampal volumes with time to spontaneous eye opening were -0.052 and -0.195, respectively. The correlation coefficients of right and left corrected hippocampal volumes with time to respond to oral commands were -0.017 and -0.219, respectively. Conclusion: There was a weak negative correlation between hippocampal volumes and recovery parameters after a short duration of sedation with propofol in children.

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Sowbhagyalaxshmi, B., P. Krishna Prasad, and M. Santhi Sree. "A Comparitive Evaluation of Propofol, Sevoflurane and Desflurane for Neuroanaesthesia in Patients Undergoing Elective Supratentorial Craniotomies." Indian Journal of Anesthesia and Analgesia 7, no. 6 (2020): 1365–72. http://dx.doi.org/10.21088/ijaa.2349.8471.7620.71.

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Aim: To compare the effects of propofol, sevoflurane and desflurane in patients undergoing supratentorial craniotomies under general anaesthesia with regard to, perioperative haemodynamic stability, emergence and recovery characteristics. Materials and Methods: A prospective randomized study of 150 adult patients belonging to both sexes undergoing elective supratentorial craniotomies under general anaesthesia were takenup for study and divided into three groups of 50 each. Group P : Anaesthesia was induced with Inj. Thiopentone sodium and maintained with 66% nitrous oxide (N20), in 33% oxygen (02) and Propofol (3-6mg/kg/hr) Group S: Anaesthesia was induced with Inj.Thiopentone sodium and maintained with 66% nitrous oxide (N2O) in 33% oxygen (O2) and Sevoflurane. (1-2%) Group D: Anaesthesia was induced with Inj. Thiopentone sodium and maintained with 66% N 2O and 33% O2 and Desflurane. (4-6%). The effects of Propofol, Desflurane and Sevoflurane on haemodynamics and recovery characteristics were observed. Results: In Desflurane Group the mean time taken for response to verbal commands was 4.61±0.47 min, spontaneous eye opening was 5.3±0.49 min,to squeezing fingers and lift limb was 6.17 ± 0.31 min. While the mean time taken for extubation was 7.72±0.53 min and time taken to orientation to place, name was 9.38±0.52min. These desflurane values are very much lower than the other two groups. Conclusion: We conclude that Desflurane as the inhalational agent ensures faster recovery in the early postoperative period as evident from significant decrease in the time required for extubation and the time required to achieve a modified aldrete score of when compared to patients receiving sevoflurance and propofol.

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Ali, Liyakhat, and Shrinivas TR. "The Sedation Score (Ramsay Sedation Score) and Recovery Profile (Modified Aldrete’s Score) in Fentanyl, Dexmedetomidineand Placebo Groups." Academia Anesthesiologica International 4, no. 2 (2019): 357–61. http://dx.doi.org/10.21276/aan.2019.4.2.81.

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Muralidhara KS, Shivakumar G, Santhosh MCB, and Shashwatha N Gowda. "A clinical, comparative, prospective, and observational study of two different ratios of ketamine and propofol in short surgical procedures at a tertiary care hospital." Asian Journal of Medical Sciences 14, no. 12 (2023): 27–31. https://doi.org/10.71152/ajms.v14i12.3390.

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Background: Ketamine and propofol are two medications commonly used for procedural sedation because they possess many of the desired characteristics including rapid induction and recovery. The opposing physiologic effects of ketamine and propofol suggest the potential for synergy, and this has led to an interest in their combined use, commonly termed “Ketofol.” The purpose of this study is to compare two different proportions of ketamine and propofol, 1:2 and 1:3 in short surgical procedures. Aims and Objectives: The aim of the study was to compare the quality of analgesia, level of sedation, and respiratory and hemodynamic parameters of two different proportions of ketamine and propofol in the ratio of 1:2 and 1:3 in short surgical procedures. Materials and Methods: After obtaining approval from the institutional ethics and scientific committee, with IEC no.MIMS/IEC/2021/474 dated February 23, 2021, 86 consenting patients of 18–60 years categorized under American Society of Anesthesiologists Category I and II undergoing elective short surgical procedures lasting for about 20 min were selected. The study patients were divided into two groups of 43 each by convenient sampling method. In Group A, 43 patients received 1 mL of ketamine (50 mg/mL) mixed with 10 mL of 100 mg propofol (10 mg/mL). In Group B, 43 patients received 30 mg of ketamine mixed with 9 mL of 90 mg propofol (10 mg/mL). Non-invasive blood pressure, heart rate, oxygen saturation, Ramsay Sedation Score, Modified Aldrete Score, and any incidence of side effects were recorded. Results: The quality of analgesia and level of sedation was achieved better in Group A compared to Group B. No significant difference was observed between the two groups with respect to hemodynamic and respiratory parameters. Conclusion: The combination of propofol and ketamine has several benefits such as hemodynamic stability, lack of respiratory depression, good recovery, and potent procedural analgesia. Ketofol 1:2 proportion is comparatively better and can be used safely in short surgical procedures.

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Muralidhara KS, Shivakumar G, Santhosh MCB, and Shashwatha N Gowda. "A clinical, comparative, prospective, and observational study of two different ratios of ketamine and propofol in short surgical procedures at a tertiary care hospital." Asian Journal of Medical Sciences 14, no. 12 (2023): 27–31. http://dx.doi.org/10.3126/ajms.v14i12.57710.

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Background: Ketamine and propofol are two medications commonly used for procedural sedation because they possess many of the desired characteristics including rapid induction and recovery. The opposing physiologic effects of ketamine and propofol suggest the potential for synergy, and this has led to an interest in their combined use, commonly termed “Ketofol.” The purpose of this study is to compare two different proportions of ketamine and propofol, 1:2 and 1:3 in short surgical procedures. Aims and Objectives: The aim of the study was to compare the quality of analgesia, level of sedation, and respiratory and hemodynamic parameters of two different proportions of ketamine and propofol in the ratio of 1:2 and 1:3 in short surgical procedures. Materials and Methods: After obtaining approval from the institutional ethics and scientific committee, with IEC no.MIMS/IEC/2021/474 dated February 23, 2021, 86 consenting patients of 18–60 years categorized under American Society of Anesthesiologists Category I and II undergoing elective short surgical procedures lasting for about 20 min were selected. The study patients were divided into two groups of 43 each by convenient sampling method. In Group A, 43 patients received 1 mL of ketamine (50 mg/mL) mixed with 10 mL of 100 mg propofol (10 mg/mL). In Group B, 43 patients received 30 mg of ketamine mixed with 9 mL of 90 mg propofol (10 mg/mL). Non-invasive blood pressure, heart rate, oxygen saturation, Ramsay Sedation Score, Modified Aldrete Score, and any incidence of side effects were recorded. Results: The quality of analgesia and level of sedation was achieved better in Group A compared to Group B. No significant difference was observed between the two groups with respect to hemodynamic and respiratory parameters. Conclusion: The combination of propofol and ketamine has several benefits such as hemodynamic stability, lack of respiratory depression, good recovery, and potent procedural analgesia. Ketofol 1:2 proportion is comparatively better and can be used safely in short surgical procedures.

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Samson, Sumanth, Sagiev Koshy George, B. Vinoth, Mohd Saif Khan, and Bridgitte Akila. "Comparison of dexmedetomidine, midazolam, and propofol as an optimal sedative for upper gastrointestinal endoscopy: A randomized controlled trial." Journal of Digestive Endoscopy 05, no. 02 (2014): 051–57. http://dx.doi.org/10.4103/0976-5042.144826.

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Abstract Context: Midazolam and propofol are effective sedatives for use in upper gastrointestinal endoscopy (UGIE); however, their utility is limited when used alone. In this regard, dexmedetomidine seems to be a promising sedative. Aims: The aim was to compare the hemodynamic effects and sedation efficacy of these drugs in patients undergoing elective diagnostic UGIE. Settings and Design: Randomized control double-blind study was conducted at a teaching hospital. Subjects and Methods: Patients belonging to ASA Grade I or II, undergoing diagnostic elective UGIE were enrolled in the study and randomized into three groups; Group I received midazolam infusion, Group II received propofol infusion and Group III received dexmedetomidine infusion. Hemodynamic parameters and adverse events were recorded during the procedure (intra-operative period [IOP]). Both patient and endoscopist satisfaction were rated on visual analog scale (0 = no pain/least difficulty to 10 = worst pain/maximum difficulty). Recovery was recorded as time to achieve modified Aldrete score of 10/10. Statistical Analysis: Parametric test analysis of variance was applied to compare the means of three groups of continuous data. Results: Ninety patients were analyzed. Mean arterial pressure was significantly lower in the propofol group at IOP2, IOP4, IOP8, and IOP10 compared with dexmedetomidine and midazolam group. The endoscopist satisfaction level was significantly higher in dexmedetomidine group as compared to propofol and midazolam (60%, 56.7%, 13.3%; P < 0.001). Significantly faster recovery was observed in dexmedetomidine group compared to midazolam and propofol group (7.7 ± 3.9, 18.3 ± 3.8, 12.7 ± 2.9 min; P = 0.001). Conclusions: Use of dexmedetomidine was associated with greater hemodynamic stability and faster recovery when compared to propofol and midazolam.

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Özdemir, Rüştü, and Ferda Yaman. "An Investigation into the Effects of Frailty and Sarcopenia on Postoperative Anesthesia Recovery and Complications Among Geriatric Patients Undergoing Colorectal Malignancy Surgery." Medicina 61, no. 6 (2025): 969. https://doi.org/10.3390/medicina61060969.

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Backgrounds and Objectives: In this study, we aimed to assess preoperative frailty among hospitalized patients over 60 undergoing colorectal cancer surgery. We investigated the impacts of frailty and sarcopenia on postoperative recovery, complications, and discharge time, while also identifying a cost-effective, bedside-accessible USG parameter for diagnosing sarcopenia among patients assessed using the “Sonographic Thigh Adjustment Ratio” method. Materials and Methods: In this prospective study, we investigated the impacts of frailty and sarcopenia on the postoperative outcomes of 42 geriatric patients (with American Society of Anesthesiologists (ASA) scores of I–III) undergoing colorectal cancer surgery under general anesthesia. Frailty was assessed using the FRAIL scale, and sarcopenia was evaluated using the STAR (sonographic thigh adjustment ratio). Ultrasonographic measurements of rectus femoris and vastus intermedius muscle thicknesses were taken, and thigh lengths (TLs) were recorded. Ratios, including rectus femoris thickness/TL (RFT/TL), vastus intermedius thickness/TL (VIT/TL), and total muscle thickness/TL (TMT/TL), were calculated. Postoperative anesthesia recovery was monitored using the Modified Aldrete Score, indicating the time until discharge from the recovery unit. Complications were classified using the Clavien–Dindo system, and hospital discharge times were noted. Results: We observed significant differences between frailty status and ASA scores, as well as between age and frailty status. Muscle thickness significantly differed between the frail and pre-frail patients. Among the sarcopenic patients, age differences were significant. In men, VIT/TL was significantly correlated with sarcopenia diagnosis, whereas, in women, RFT/TL, VIT/TL, and TMT/TL were all correlated with sarcopenia. Conclusions: Based on our results, we conclude that VIT/TL measurement can serve as a predictive marker for preoperative sarcopenia, optimizing patient health before surgery.

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Luthra, Ankur, Hemanshu Prabhakar, and Girija Prasad Rath. "Alleviating Stress Response to Tracheal Extubation in Neurosurgical Patients: A Comparative Study of Two Infusion Doses of Dexmedetomidine." Journal of Neurosciences in Rural Practice 08, S 01 (2017): S049—S056. http://dx.doi.org/10.4103/jnrp.jnrp_91_17.

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ABSTRACT Background: Tracheal extubation is almost always associated with increase in sympathoadrenal activity may result in hypertension, tachycardia, and arrhythmias. Attempts have been made to oppose the pressor response by the use of various drugs. Dexmedetomidine decreases norepinephrine which reduces the blood pressure and the heart rate (HR). We hypothesize that the infusion of dexmedetomidine may produce more stable hemodynamics during extubation as compared to boluses. Materials and Methods: Ninety adult patients aged 18–65 years, the American Society of Anesthesiologists Grade I–II undergoing intracranial surgeries for various neurologic problem at All India Institute of Medical Sciences were enrolled in this randomized controlled trial. Primary Objectives: (1) To observe the hemodynamic changes (HR and mean arterial pressure [MAP]) and airway responses during tracheal extubation following two infusion doses of dexmedetomidine. Secondary Objectives: (1) Time to emergence and time to tracheal extubation, (2) Early postoperative complications such as laryngospasm and bronchospasm, and (3) adverse effects of the study drug. Patients were assigned into three groups – (1) Group D0.2 – 0.2 μg/kg/h diluted to 50 ml, (2) Group D0.4 – 0.4 μg/kg/h diluted to 50 ml and Group P (Placebo) – 0.9% NS 50 ml. The hemodynamics including the HR and MAP were recorded just before the loading dose of the study drug and then were recorded every 5 min till the infusion was stopped at tracheal extubation and every 1 min till 10 min postextubation. In addition, the airway, respiratory and cardiovascular complications along with postoperative nausea and vomiting, shivering, cough grading, Aldrete score, Ramsay sedation scale, and intraoperative awareness were recorded. Statistical Analysis: Continuous variables such as HR and MAP were analyzed using analysis of variance and categorical variables were analyzed using the Chi-square test. Results: Patient demographics were comparable between the three groups. There was a significant reduction in HR and MAP just before extubation and up to 10 min post extubation in the D0.2 and D0.4 groups as compared to placebo (P < 0.001) but the difference among the dexmedetomidine groups were not significant. Patients belonging to D0.2 group emerged faster than D0.4 group, however, the results were comparable with placebo group. 73.3% patients of the placebo group had tachycardia and hypertension at emergence as compared to only 3.3% patients in the D0.4 group (P < 0.001). Eighty percentage patients of D0.2 and 100% patients of D0.4 group had a significant reduction in cough as compared to placebo (P < 0.001). No patient in either groups had intraoperative awareness, any respiratory complications, or allergic reactions to the study drug. Modified Aldrete scoring and Ramsay sedation scale were comparable in all the three groups. Conclusion: Dexmedetomidine suppresses cough and hemodynamic responses (HR and MAP) to tracheal extubation significantly without delaying emergence.

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Akcaalan, Yasemin, Mehmet Sahap, Handan Gulec, Eyup Horasanli, Mahmut Ugurlu, and Serhat Akcaalan. "Comparison of propofol and ketofol for sedation in patients undergoing shoulder surgery with interscalene and suprascapular nerve blocks." Anaesthesia, Pain & Intensive Care 26, no. 1 (2022): 102–9. http://dx.doi.org/10.35975/apic.v26i1.1775.

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Introduction and Purpose: We compared propofol and ketofol for sedation in patients who underwent shoulder arthroscopy under anesthesia with interscalene and suprascapular blocks. We evaluated both of agents the intraoperative hemodynamic effects, sedation efficiency, postoperative recovery times and the time to discharge to the service. We aimed to achieve an effective sedation with stable hemodynamics, resulting in rapid recovery with early onset. Methodology: The study was carried out prospectively in a double-blind randomized study on ASA I and II patients aged 18-65, total of 42 shoulder surgeries planned. Anesthesia was provided to the patients by performing interscalene and suprascapular nerve block with USG. Group 1 (Propofol group), 1 mg/kg propofol iv, in Group 2 (Ketofol group), a mixture of ketamine-propofol was prepared in a 1:1 ratio, 1 mg / kg ketofol iv was administered. Processing was started in both groups when Ramsey Sedation Scale (RSS) was 3. SBP, DBP, MBP, heart rate, O2 saturation, RSS, Faces scale were recorded throughout the case. The patients with an Aldrete score of 9 were discharged and sent to the service. Results: A total of 42 patients undergoing planned shoulder surgeries were enrolled. No statistically significant was determined between the groups in respect of demographic data (age, gender, height, weight, ASA), operating time and postoperative length of stay in hospital. More patients required esmolol in the ketofol group compared to propofol group; 15 (71.4%) vs. 7 (33%) patients (p < 0.05). Significant higher mean values of hemodynamic findings in the ketofol group were noted; SBP at 55 min, DBP at 60 min, MBP at 60 min and MBP on discharge (p < 0.05). In the absence of esmolol, the pulse measurements at 0, 1, 3, 25, and 30 min were determined to be statistically significantly higher in the ketofol group than the propofol group (p < 0.05). The mean values of the SpO2 measurements were significantly lower in the ketofol group (p < 0.05). No statistically significant difference was determined in respect of the postoperative modified Aldrete Scores (MAS) at any of the time points (p > 0.05). Conclusion: While a deeper and higher quality sedation was provided with ketofol, we achieved rapid onset and short-acting sedation with propofol. Both agents have different superior properties and can be used safely for sedation. Key words: Brachial plexus block, ketofol, shoulder arthroscopy, propofol, sedation Citation: Akcaalan Y, Sahap M, Gulec H, Horasanli E, Ugurlu M, Akcaalan S. Comparison of propofol and ketofol for sedation in patients undergoing shoulder surgery with interscalene and suprascapular nerve blocks. Anaesth. pain intensive care 2022;26(1):102-109. DOI: 10.35975/apic.v26i1.1775 Received: September 24, 2021, Reviewed: October 18, 2021, Accepted: Nov 09, 2021

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Palai, Pramod Kumar, Sheela Ekka, Mahendra Ekka, Saurabh Agrawal, and Sapan Kumar Jena. "A Comparative Study of Dexmedetomidine and Propofol for Sedation in Middle Ear Surgery under Monitored Anaesthesia Care at VIMSAR, Burla, Odisha." Journal of Evidence Based Medicine and Healthcare 8, no. 17 (2021): 1105–10. http://dx.doi.org/10.18410/jebmh/2021/214.

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BACKGROUND Middle ear surgeries done under local anaesthesia require adequate patient sedation and analgesia to prevent patient anxiety and movement during surgical procedures. This study was undertaken to compare dexmedetomidine and propofol for their sedative and analgesic properties, safety profile, adverse events and recovery profile in patients undergoing middle ear surgery under monitored anaesthesia care. METHODS This is a prospective observational study. 96 patients of both sexes, of American society of anaesthesiologist (ASA) grade I or II, between 18 - 60 years of age were randomly divided into two groups; group D and group P consisting of 48 patients each. Patients in group D received a loading dose of injection dexmedetomidine 1 µg / kg I.V. over 10 minutes followed by an infusion at a rate of 0.5 µg / kg / hr. Patients in group P received a loading dose of injection propofol 75 µg / kg / min. I.V. over 10 min followed by an infusion at a rate of 50 µg / kg / min. Time taken to achieve the modified Aldrete score of 10 was compared between both the groups. Before discharge from post anaesthesia care unit (PACU), patient’s satisfaction with sedation & surgeon satisfaction was recorded on Likert scale. Time to rescue analgesia was compared. RESULTS The Bi-Spectral Index values in intra-operative period were on the lower side in the group D as compared to the corresponding values in the group P, but P values were statistically insignificant suggesting that both dexmedetomidine and propofol produced similar sedation. Time to rescue analgesia was greater for group D. CONCLUSIONS Having similar sedation effect, dexmedetomidine was better than propofol for sedation in patients undergoing middle ear surgery under monitored anaesthesia care. KEYWORDS Dexmedetomidine, Propofol, Monitored Anaesthesia Care, Bi-spectral Index

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Journal articles on the topic 'Modified Aldrete score'

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