A Comparative Study of Different Doses of Lignocaine on Prevention of Etomidate Induced Myoclonus during Induction of Anesthesia

Background and Aims Etomidate, an intravenous (IV) induction agent known for its stable myocardial action, can produce myoclonus which can be detrimental for the cardiac patients. Though lignocaine has proven its efficacy in attenuating the etomidate-induced myoclonus, the ideal dose of lignocaine is not known. The aim of our trial was to analyze two different doses of lignocaine on the occurrence and intensity of etomidate induced myoclonus. Materials and Methods A total of 120 patients were randomly assigned into three groups of 40 each. Patients in group A were injected lignocaine 0.5 mg/kg intravenously, group-B patients were injected lignocaine 1 mg/kg intravenously, and group-C patients were injected saline placebo. After 2 minutes, anesthesia was induced with 0.3 mg/kg of etomidate over 30 seconds. The patients were assessed for myoclonus using clinical severity scoring system during first 2 minutes of induction. Our primary outcome was the incidence of myoclonus. The severity of myoclonus and adverse effects were the secondary outcomes. Results No remarkable variation was found regarding demographic profile among three groups. Incidence of myoclonus in groups A and B was 35% and in group C was 98%, the difference being statistically significant. Both doses of lignocaine reduced the severity of myoclonus up to same extent. Conclusion Pretreatment with IV lignocaine 0.5mg/kg and 1 mg/kg IV remarkably decreased the occurrence and severity of myoclonus induced by etomidate up to same extent.

Microencapsulation of a Pseudomonas Strain (VUPF506) in Alginate–Whey Protein–Carbon Nanotubes and Next-Generation Sequencing Identification of This Strain

Alginate is a common agent used for microencapsulation; however, the formed capsule is easily damaged. Therefore, alginate requires blending with other biopolymers to reduce capsule vulnerability. Whey protein is one polymer that can be incorporated with alginate to improve microcapsule structure. In this study, three different encapsulation methods (extrusion, emulsification, and spray drying) were tested for their ability to stabilize microencapsulated Pseudomonas strain VUPF506. Extrusion and emulsification methods enhanced encapsulation efficiency by up to 80% and gave the best release patterns over two months. A greenhouse experiment using potato plants treated with alginate–whey protein microcapsules showed a decrease in Rhizoctonia disease intensity of up to 70%. This is because whey protein is rich in amino acids and can serve as a resistance induction agent for the plant. In this study, the use of CNT in the ALG–WP system increased the rooting and proliferation and reduced physiological complication. The results of this study showed that the technique used in encapsulation could have a significant effect on the efficiency and persistence of probiotic bacteria. Whole genome sequence analysis of strain VUPF506 identified it as Pseudomonas chlororaphis and revealed some genes that control pathogens.

Remimazolam for induction of anesthesia in elderly patients with severe aortic stenosis: a prospective, observational pilot study

Background Remimazolam, a novel benzodiazepine, has been reported to cause less hypotension than propofol during induction of anesthesia. Therefore, remimazolam might be a valuable option in elderly patients with severe aortic stenosis who are considered to be the most vulnerable to hemodynamic instability. We aimed to evaluate the feasibility and hemodynamic effects of remimazolam as an induction agent in elderly patients with severe aortic stenosis. Methods This prospective, open-label, single-arm, observational pilot study was conducted in a university hospital between November 2020 and April 2021. We included 20 patients aged 65 years or older scheduled for transcatheter or surgical aortic valve replacement for severe aortic stenosis under general anesthesia. Patients were administered intravenous remimazolam infusion at 6 mg/kg/h combined with 0.25 μg/kg/min of remifentanil infusion. The primary outcome was the vasopressor dosage between the induction of anesthesia and the completion of tracheal intubation. The secondary outcomes included hemodynamic changes, bispectral index changes, and the time from the start of remimazolam infusion to loss of consciousness. We also recorded awareness during anesthesia induction and serious adverse events related to death, life-threatening events, prolonged hospitalizations, and disability due to permanent damage. Results Twenty patients aged 84 [79–86] (median [interquartile range]) with American Society of Anesthesiologists physical status 4 were analyzed. Ephedrine 0 [0–4] mg and phenylephrine 0.1 [0–0.1] mg were administered to 14/20 patients (3 doses in 1 patient, 2 doses in 4 patients, and one dose in 9 patients). Loss of consciousness was achieved at 80 [69–86] s after the remimazolam infusion was started. The mean arterial pressure decreased gradually after loss of consciousness but recovered immediately after tracheal intubation. The bispectral index values gradually decreased and reached < 60 at 120 s after loss of consciousness. Neither awareness during induction of anesthesia nor serious adverse events, such as severe bradycardia (< 40 bpm), life-threatening arrhythmia, myocardial ischemia, or anaphylactic reactions were observed. Conclusions Remimazolam could be used as an induction agent with timely bolus vasopressors in elderly patients with severe aortic stenosis. Trial registration UMIN Clinical Trials Registry, identifier UMIN000042318.

STUDY OF THE EFFECT OF PROPOFOL & ETOMIDATE AS AN INDUCTION AGENT ON HAEMODYNAMIC CHANGES DURING INDUCTION & ENDOTRACHEAL INTUBATION

Introduction: Laryngoscopy and subsequent tracheal intubation cause a fugitive tachycardia and hypertension as a result of sympathoadrenal stimulation. Careful selection of anestheshetic is thus required, as cardiovascular reserve is decreased in certain patients, so as to avoid undue depressions of cardiac and circulatory function Aims And Objectives: This randomized double blind prospective study had been designed for comparative evaluation of inj propofol 2.5 mg/kg, inj Etomidate 0.3 mg/kg an induction agent on haemodynamic changes such as HR, SBP, DBP, MAP and oxygen saturation during induction and tracheal intubation and also to study the adverse effects the two drugs under study Material And Methods: After approval from medical ethics committee, Dr D Y Patil Medical College and Hospital, Pune, the study was carried out on sixty (60) patients undergoing elective surgeries under standard general anesthesia. ? All patients were premedicated with Ondansetron 0.1mg/kg i.v., inj midazolam 0.02mg/kg and inj fentanyl 2 mcg/kg i.v. ? All patients pre-oxygenated with 100% oxygen for 3 min, all vital parameters recorded (T1) ? Group P received inj. propofol 2.5 mg/kg i.v. and group E received Etomidate 0.3mg/kg i.v. over 30 sec and vital parameters recorded as (T2) ? Inj succinylcholine as muscle relaxant given after administering induction agent, laryngoscopy and tracheal intubation attempted with appropriate sized endotracheal tube. All vital parameters recorded during laryngoscopy(T3), periodic monitoring of vital parameters carried out at 1,2,3,5 and 10 minutes intervals post intubation ? Further the patient was maintained on O2 /N2O / Isoflurane and Vecuronium i.v. top-ups as and when required ? At the end of surgery, patient reversed with inj. Glycopyrrolate 0.008mg/kg i.v. along with inj. Neostigmine 0.05mg/kg intravenously and extubated after gaining consciousness and adequate power ? Patient shifted to recovery room observed for any side effects such as nausea, vomiting, Result: The demographic profile was comparable. There was no statistically considerable difference between the two study groups with respect to baseline parameters of HR, SBP, DBP, MAP and SpO2. There was decrease in mean heart rate seen in group P compared to group E at post induction (T2), after intubation 1 min, 2min, the values were statistically significant with P value <0.05,.and decrease in mean SBP, mean DBP AND MAP in group P compared to group E at post induction (T2), after intubation 1,2 3, 5 min values were statistically significant with p value <0.05 Pain on injection was more in group P 26 out of 30(86.7%) than group E, which was statistically significant with p value <0.05 Incidence of myoclonus was more in group E 23 patients out of 30(76.7%) compared to group P which was statistically significant with p value <0.05. In group P 2 out of 30 patients (6.7%) had vomiting and in group E 3 out of 30 patients (10%) had vomiting, difference was statistically insignificant with p value >0.05 Conclusion: A• Both, Propofol and etomidate are safe induction agents A• Etomidate maintains better haemodynamic stability than propofol as induction agent A• Pain on injection was more with propofol. However, myoclonus was more with etomidate A• Both drugs were associated with no significant side effects/complication.

Anesthesia-Induced Oxidative Stress: Are There Differences between Intravenous and Inhaled Anesthetics?

Agents used for the induction of anesthesia have been shown to either promote or mitigate oxidative stress. A fine balance between the presence of reactive oxygen species (ROS) and antioxidants is crucial for the proper normal functioning of the cell. A basal concentration of ROS is essential for the manifestation of cellular functions, whereas disproportionate levels of ROS cause damage to cellular macromolecules such as DNA, lipids, and proteins, eventually leading to necrosis and apoptosis. Increased ROS has been linked with numerous illnesses, such as cardiovascular, immune system, liver, and kidney, and has been shown to promote cancer and accelerate aging. Knowledge of the various pharmacologic agents that increase or reduce oxidative stress may promote a safer way of inducing anesthesia. Furthermore, surgery itself leads to increased ROS production and ischemia/reperfusion injury. Indeed, increased perioperative oxidative stress has been correlated with increased postoperative complications and prolonged recovery. Anesthesiologists care for patients during the whole spectrum of perioperative care and thus are in a unique position to deliver countermeasures to oxidative stress. Using preferentially an induction agent which reduces oxidative stress might lead to better clinical outcomes and fewer postoperative complications. Propofol has been shown in several studies to reduce oxidative stress, which reduces postoperative complications and leads to a faster recovery, and thus might represent the preferred induction agent in the right clinical setting.

Comparative evaluation of sevoflurane and propofol to facilitate insertion of supra glottic airway device

: Propofol has been used since ages as induction agent to aid in insertion of Supraglottic airway devices however its side effects like hypotension, apnea and pain on injection do coexist. To avoid these side effects sevoflurane has been studied and well recognized because of its sweet smelling property. We conducted this study with primary aim to compare the insertion conditions such as no. of attempts for insertion, hemodynamic variations and awakening after surgery. The secondary aim was to note the adverse effects associated with Sevoflurane and propofol. We included sixty female patients of age 18-65 years graded as ASA I and II undergoing short gynecological procedures. Patients were induced with Sevoflurane 8% or IV Propofol 2mg/kg. Attempts for I-gel insertion, jaw relaxation, biting, coughing, gagging, laryngospasm and hemodynamic pressor response and awakening after surgery were noted.Induction time with Propofol is less compared to Sevoflurane. I-Gel insertion time with Sevoflurane and Propofol is insignificant (p value= 0.93). 25 patients in Group S and 27 patients in group P had very easy insertion of I-gel. 23 patients in Group S and 27 patients in Group P had relaxed jaw. None of the patients in both groups experienced laryngospasm. Propofol provided better conditions for I-gel insertion with manageable hypotension while the patients induced with Sevoflurane were hemodynamically more stable but the jaw relaxation was less as compared to that provided by propofol. Induction with 8% Sevoflurane by Vital Capacity Breath (VCB) technique can be an alternative for induction in high risk patients. Also the awakening from anaesthesia is faster with sevoflurane and is more suitable for patients demanding early discharge after day care surgeries.

BIO-INDUKSI RANTING CABANG GAHARU (GYRINOPS VERSTEEGII) DI PERKEBUNAN GAHARU DESA PEJARING LOMBOK TIMUR

Bio-induction on the branch of agarwood tree (Gyrinops versteegii) is a good alternative method to increase resin productivity. The aim of this research is to applied bio-induction on the branch of G. versteegii with different diameters. Different branch diameter was the treatment on this research including branch 1 (diameter 70 mm ± 5 mm), branch 2 (85 mm ± mm), branch 3 (100 mm ± mm). Fusarium solani isolate of Institute for Technology Research and Development of Non-Timber Forest Product was used as a bio-induction agent. This isolate was cultured on bean sprout broth media for 28 days. Bio-induction was carried using standard procedure developed by Forest Research and Development Agency. Observation of the result conducted 3 months after bio-induction. There were 3 parameters of bio-induction result including resin area production, discoloration in form of browning on branch, and fragrance level of resin. Branch 2 has the largest resin area production. However, branch 3 has the highest score of browning and fragrance level. This result indicated a correlation between browning on branch and fragrance level quality. It could be concluded that bio-induction on larger branch diameter could produce higher productivity of resin, especially on browning and fragrance level parameter

Cardiovascular complications of prehospital emergency anaesthesia in patients with return of spontaneous circulation following medical cardiac arrest: a retrospective comparison of ketamine-based and midazolam-based induction protocols

BackgroundHypotension following intubation and return of spontaneous circulation (ROSC) after cardiac arrest is associated with poorer patient outcomes. In patients with a sustained ROSC requiring emergency anaesthesia, there is limited evidence to guide anaesthetic practice. At the Essex & Herts Air Ambulance Trust, a UK-based helicopter emergency medical service, we assessed the relative haemodynamic stability of two different induction agents for post-cardiac arrest medical patients requiring prehospital emergency anaesthesia (PHEA).MethodsWe performed a retrospective database review over a 5-year period between December 2014 and December 2019 comparing ketamine-based and midazolam-based anaesthesia in this patient cohort. Our primary outcome was clinically significant hypotension within 30 min of PHEA, defined as a new systolic BP less than 90 mm Hg, or a 10% drop if less than 90 mm Hg before induction.ResultsOne hundred ninety-eight patients met inclusion criteria. Forty-eight patients received a ketamine-based induction, median dose (IQR) 1.00 (1.00–1.55) mg/kg, and a 150 midazolam-based regime, median dose 0.03 (0.02–0.04) mg/kg. Hypotension occurred in 54.2% of the ketamine group and 50.7% of the midazolam group (p=0.673). Mean maximal HRs within 30 min of PHEA were 119 beats/min and 122 beats/min, respectively (p=0.523). A shock index greater than 1.0 beats/min/mm Hg and age greater than 70 years were both associated with post-PHEA hypotension with ORs 1.96 (CI 1.02 to 3.71) and 1.99 (CI 1.01 to 3.90), respectively. Adverse event rates did not significantly differ between groups.ConclusionPHEA following a medical cardiac arrest is associated with potentially significant cardiovascular derangements when measured up to 30 min after induction of anaesthesia. There was no demonstrable difference in post-induction hypotension between ketamine-based and midazolam-based PHEA. Choice of induction agent alone is insufficient to mitigate haemodynamic disturbance, and alternative strategies should be used to address this.

To compare the hemodynamic effects of the infusion of both intravenous induction anaesthetic agents Etomidate and Propofol under bispectral index guidance

Intravenous anaesthetic agents are preferred to induce anaesthesia in day to day practice because of rapid and smoother action with fewer risks. An ideal induction agent for general anaesthesia should have hemodynamic stability, minimal respiratory side effects and rapid clearance. This is a prospective, randomised, single blind, control study of total 60 patients.This study was carried out in Department of Anaesthesiology, at a Tertiary Care Teaching Hospital over a period of 1 year. In this study, a total of 60 patients undergoing elective surgery under general anaesthesia were randomized into two groups comprising of 30 patients in each group using envelop method. Group A- Patients received Inj. Etomidate infusion at the rate of 0.05 mg/kg/min through syringe infusion pump, and Group B – Patients received Inj. Propofol infusion at the rate of 0.5 mg/kg/min through syringe infusion pump.The hemodynamic response during induction of general Anaesthesia using Inj. Etomidate and Inj. Propofol under BIS guidance. There was no statistically significant difference observed in mean time taken for induction in both the groups. Mean consumed dose for Etomidate was 0.18+0.05 mg/kg and for Propofol group was 1.82+0.34 mg/kg. There was statistically significant fall in mean arterial blood pressure observed in Group B compared to Group A during and after induction up to 7 minutes. After that there was no significant difference observed in both the groups.: Propofol resulted in hypotension and bradycardia even with the reduced doses given with BIS- guided protocol. However, Etomidate provides more hemodynamic stability during induction and in post induction period also. So, Etomidate can be a better choice of agent for induction of General Anaesthesia as compared to Propofol.