A COMPARATIVE EVALUATION OF PRE-OPERATIVE NEBULISATION WITH N-ACETYL CYSTINE AND LEVOSALBUTAMOL ON POST-OPERATIVE RESPIRATORY FUNCTION IN COPD PATIENT

Dr. Brajendra Verma; Dr. Roopesh Kumar; Dr. Mahesh Verma; Dr. Madhurmay; Dr. Amit Kumar Niranjan

Volume : X, Issue : VI, June - 2020

A COMPARATIVE EVALUATION OF PRE-OPERATIVE NEBULISATION WITH N-ACETYL CYSTINE AND LEVOSALBUTAMOL ON POST-OPERATIVE RESPIRATORY FUNCTION IN COPD PATIENT

Dr. Brajendra Verma, Dr. Roopesh Kumar, Dr. Mahesh Verma, Dr. Madhurmay, Dr. Amit Kumar Niranjan

Abstract :

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is an umella term used to describe progressive lung diseases including emphysema, chronic onchitis, refractory (non–reversible) asthma, and some forms of onchiectasis. This disease is characterized by increasing eathlessness. Chronic obstructive pulmonary disease (COPD) is characterized by poorly reversible airway obstruction and is strongly related to smoking. This preview summarizes the epidemiology, diagnosis and management of COPD, and highlights the mechanisms operating in the airways that cause this disease. Aim: To evaluate respiratory function before and after therapy with the study drugs. To assess any improvement in preoperative respiratory function following nebulization with N–acetyl cystine and levosalbutamol. To compare post operative respiratory function. Any per–operative systemic effects with either drug. Side effect and complication if any. Material and methods: The present study will be, a prospective randomized controlled double blind clinical study that will include 200 ASA Grade–I and II patients of both sexes with in age group 60–80 years diagnosed with COPD and posted for elective surgeries under spinal anesthesia at Maharani Laxmi Bai Medical College, Jhansi (U.P.). Result: In both group the patient divided into two age group of 60 to 70 years and 71 to 80 years. IN N–acetyl cystine between 60–70 years age group. Total 71 patient present and between 71 to 80 year age group 29 patient present in term of percentage 71.00% and 29.00% respectively. IN levosalbutamol 72 patient are between 60 to 70 year of age group (72.00%) and 28 patient between 71 to 80 years age group (28.00%). after comparison of both group in term of mean age distribution with standard deviation N–acetyl cystin group have 67.41±5.507 years and levosalbutamol group have 67.59±5.821 year with p value is 0.8225 and there is no significance mean age distribution. In group A the mean of MAP decreased from basal value 88.76±6.552 to 82.87±5.977 in 60 min duration (p<0.05). In group B the mean of MAP decreased from basal value 87.06±6.710 to 82.72±5.545 in 60 min duration (p<0.05). When both groups were compared for mean of MAP it was found that decrease in group A was much more than group B. In group A there was a decrease in mean heart rate from base value 81.02±10.615 to 72.18±7.244 (P<0.05). In group B the mean heart rate decreased from basal value 79.88±9.963 to 71.97±8.190 in 90 min duration (p<0.05).so group A patients in the study had a significant reduction in heart rate as compared with the group B.The mean of spo2 before block in group A and Group B were 96.54±1.314 and 96.24±1.120 respectively and there was no statistically significant difference in two group.The mean of spo2 in 15 min after study drugs in group A and group B were 98.3±0.845 and 98.08±0.631 respectively and there was no statistically significant in two group (p<0.05). There was no sign of respiratory depression in any patient after study drugs. The mean of pco2 and po2 before nebulization in group A and Group B were 43.62±3.396 & 44.43±3.207 and 71.88±12.303 &73.40±8.805 respectively and there was no statistically significant difference in two group. but after nebulization the mean of pco2 and po2 in group A and group B were 37.66±2.903 &38.33±2.089 and 84.13±7.290 & 83.22±6.004 respectively .the improvement of po2 level is more in group A as compare to group B. Conclusion: The nebulized with 50 mg N–acetylcysteine in 3 ml of 0.9% of saline solution is more effective than 0.63 mg levosalbutamol in 3ml of 0.9% saline solution in hemodynamic response on post operative COPD patients. No adverse effects like hypotension, adycardia, respiratory depression and vomiting occur in both study group during intraoperative and postoperative period. On the basis of improvement in clinical severity score and early discharge from the hospital N–acetylcysteine was found to be an effective therapy in COPD patient