A STUDY ON COMPARISON OF INTRAVENOUS BUTORPHANOL WITH INTRAVENOUS FENTANYL FOR PREMEDICATION IN GENERAL ANESTHESIA

Background: An ideal premedicant drug is anxiolytic, sedative, amnesic, reduces salivary and respiratory tract secretions, analgesic as well as residual post-operative analgesia. The present study was undertaken to compare the effects of intravenous butorphanol and intravenous fentanyl as a premedicant drug in general anesthesia. Methodology: A comparative study between butorphanol and fentanyl was conducted in 100 patients of either sex at Government Medical College, Surat who belong to ASA physical status I or II, in the age group of 18-65 years. Post-operatively respiratory rate, tidal volume, sedation score, oxygen saturation and assessment of pain score was done in the recovery room. Results: When comparing both the groups the patients in the butorphanol group were found to be more sedated upto 60 minutes postoperatively. The difference between the two was statistically significant (p<0.001). In group F, 82% patients had analgesia for 60-120 minutes while remaining 18% of patients had analgesia for 121-180 minutes. In group F, 44% patients had analgesia for 121-180 minutes while 56% of patients had analgesia for 181-240 minutes. In group F, 82% patients had pain (VAS ≥5) by 30 minutes in the postoperative period whereas none of the patients in Group B had significant pain (VAS ≥5) by 30 minutes. Conclusion: We conclude that Butorphanol 20 µg/kg gives better attenuation of the hemodynamic response, longer duration of postoperative pain relief, without producing excessive sedation and with negligible side effects in comparison with fentanyl 1 µg/kg when given intravenously as premedicant for general anesthesia

Effect of pre-treatment on induction of anaesthesia with etomidate: A comparison between dexmedetomidine and midazolam–fentanyl combination

Background: Because of its prompt onset of action and clearance, the use of etomidate as an anaesthetic induction agent is increasing in clinical practice. However, etomidate-induced myoclonus (EIM) remains a prevalent issue. Such myoclonic activity can be prevented by the administration of drugs that inhibit subcortical neuronal activity. Aims: This study was designed to compare the effects of pre-treatment with dexmedetomidine and fentanyl–midazolam combination on EIM as well as on attenuation of pharyngolaryngeal reflex. Materials and Methods: One hundred adult patients with the American Society of Anesthesiologists Grades 1 or 2 posted for elective surgery were enrolled and were randomly divided into two groups of 50 patients each. Group D received dexmedetomidine (1 μg/kg) in over 10 min and Group F received midazolam (0.02 mg/kg) + fentanyl (2 μg/kg) intravenously. Haemodynamic variables, incidence and severity of myoclonus were recorded. Results: The incidence of EIM was lower in Group F (26%) when compared to Group D (40%), but the difference was not statistically significant (P = 0.28). Eighteen per cent of the subjects in Group F had Grade 1 myoclonus as compared to 32% of Group D, whereas 8% of the subjects in Group F had Grade 2 myoclonus as compared to 6% of Group D. None of the patients in Group F experienced myoclonus of Grade 3, whereas 2% of the subjects had Grade 3 myoclonus. Conclusion: Administration of a combination of fentanyl and midazolam, along with dexmedetomidine as a pre-treatment, has been found to be an effective strategy for mitigating the incidence of myoclonus