IN DAY COMPARISON OF TWO ANESTHETIC TECHNIQUES WITH OUTCOME CARE SURGERY

Introduction: There are many anesthetic techniques such as general, regional, spinal, epidural, caudal, hypotensive, inhalation, nerve blocks, total intravenous and regional intravenous used for multiple surgical procedures. There is controversial in effect of anesthetic technique on perioperative outcomes. Central neuraxial blocks including epidural, spinal and caudal anesthesia are regional anesthesia techniques. Other use of regional anesthesia techniques including reduced side effects, pain control, improved cardiac and pulmonary function, decreased blood loss and shortened stay in the post anesthesia care unit. In this growing world, day care surgery in the patient being discharged from the hospital on the same day has become popular modality of treatment. In this fast speed of life, adoption of nuclear family need of early return to work, and resumption of daily routine chores to maintain social which have propelled this treatment modality to newer heights. Anesthesia for day-care surgeries may require administration of general, local and regional anesthesia or monitored anesthesia care supplemented with sedation. Availability of newer drugs has contributed in advancements in anesthesia techniques largely to the progress of day-care surgery. Aim: The aim is to compare two anaesthesia techniques for obese patients in day care surgery. Material and Method: This is prospective study which is carried out in Dept. of Anesthesiology at Rohilkhand Medical College and Hospital, Bareilly (UP), during the period of 1 year. All paediatric patients which undergoing circumcisions were included in this study. Patient’s queries regarding anesthesia and surgery were sought. Detail history of patients with lab routinely investigation like CBC, Creatine urine R/M etc. 60 Patients in each group with 30 patients not having any responsible adult at their homes were including in this study. Standard monitors SPO2, NIBP, ECG and Respiratory rate were attached. Every patient received 500 ml Ringer Lactate IV before surgery. inj. Ondansetron 4 mg, inj. Ranitidine 50 mg i.v. Fentanyl 2 mcg/kg i.v and inj Midazolam 1 mg i.v. 3 minutes prior to


Introduction
There are many anesthetic techniques such as general, regional, spinal, epidural, caudal, hypotensive, inhalation, nerve blocks, total intravenous and regional intravenous used for multiple surgical procedures.
There is controversial in effect of anesthetic technique on perioperative outcomes.Central neuraxial blocks including epidural, spinal and caudal anesthesia are regional anesthesia techniques.Other use of regional anesthesia techniques including reduced side effects, pain control, improved cardiac and pulmonary function, decreased blood loss and shortened stay in the post anesthesia care unit iiiiiiiv .
Throughout the world in anesthetic and surgical practices recent advances have facilitated the rapid rise in ambulatory surgery.Due to availability of rapid, short acting anesthetic, sympatholytic, analgesic and muscle relaxant drugs as well as improved monitoring device which become possible to minimize the adverse effects of anesthesia and recovery process.In the perioperative care allowed surgeons to perform an increasing array of more invasive surgical procedures on an ambulatory basis v .
In this growing world, day care surgery in the patient being discharged from the hospital on the same day has become popular modality of treatment.In this fast speed of life, adoption of nuclear family need of early return to work, and resumption of daily routine chores to maintain social which have propelled this treatment modality to newer heights vi , vii .Anesthesia for day-care surgeries may require administration of general, local and regional anesthesia or monitored anesthesia care supplemented with sedation.Availability of newer drugs has contributed in advancements in anesthesia techniques largely to the progress of day-care surgery viii .Nowadays Food habits and sedentary life styles have created a pandemic of obesity.World health statistics 2012 shows that one in six adults is obese.Every hospital is facing a major obese patient load ix .Patients' separation from their homes and family environment and loss of man hours is reduced ambulatory surgery does not depend upon the availability of a hospital bed x .The aim is to compare two anaesthesia techniques for obese patients in day care surgery.

Material and Methods:
This is prospective study which is carried out in Dept. of Anesthesiology at Rohilkhand Medical College and Hospital, Bareilly (UP), during the period of 1 year.All paediatric patients which undergoing circumcisions were included in this study.Patient's queries regarding anesthesia and surgery were sought.Detail history of patients with lab routinely investigation like CBC, Creatine urine R/M etc. patients with alcohol/drug abuse, H/O allergic reactions to any of the drug being used, motion sickness and last 24 hours of surgery use of antiemetic drugs were excluded in this study.60 Patients in each group with 30 patients not having any responsible adult at their homes were including in this study.

Standard monitors SPO2, NIBP, ECG and
Respiratory rate were attached.Every patient received 500 ml Ringer Lactate IV before surgery.inj.Ondansetron 4 mg, inj.Ranitidine 50 mg i.v.Fentanyl 2 mcg/kg i.v and inj Midazolam 1 mg i.v. 3 minutes prior to induction.After induction BIS was attached and Continuous capnography was used during the procedure.After the surgery, Propofol infusion was stopped and Sevoflurane was stopped.Total anaesthesia time was recorded from induction to discontinuation of anaesthetics as well as Total surgical time from incision to placement of dressing was also noted.

Observations and Results:
All the data were recorded and each of those variables was summarized by mean and standard deviation.Paired t test was applied for comparing the two main groups.p value less than 0.05(p < 0.05) have been considered as statistically significant.There was no statistically significant difference in oxygen saturation between these two subgroups at any stage during the study p> 0.05.Patients in Propofol infusion, group had apnea transiently, which was corrected by controlled although ventilation through LMA.

Conclusion:
Nowadays Ambulatory surgery for obese patients is an upcoming field.New technology and methods are developed to improve early recovery and complication free anaesthesia and it also help to developed decrease patient load in hospitals.In this study, Group A having more stable with haemodynamics.In both groups showed recovery profile are almost similar in this study.

Table 2 : Duration of Anaesthesia and Surgical Time
As p value is not significant in Mean surgical time and mean anaesthesia time were compared.Induction of anesthesia with Propofol produced a fall in B.P in this study.Mostly patients were of young age group of age 18 to 55yrs.Subsequently Ringer lactates 500ml were pre loading of every patient before induction.

Table 3 : Data Related To Recovery
Motsch et al studied in urological and ophthalmic day surgeries early recovery and the return of mental function and psychomotor in the first 60 min after anaesthesia is faster following Sevoflurane than after Propofo xvii .Other studied from Tramer et al showed Propofol is not the sole antiemetic and can be used as induction agent alone, because it has short duration of action xviii .