scholarly journals Effective dose of propofol for smooth induction in midazolam premedicated and in unpremedicated children

Author(s):  
Veena Shukla ◽  
Harpreet Kaur

Background: Propofol, an intravenous (IV) anaesthetic agent, is widely used in paediatric day care surgeries. Present study was conducted to determine clinically effective dose of Propofol for smooth induction in children.Methods: This randomized controlled study was conducted in 100 children of American Society of Anaesthesia (ASA) grade I and II, posted for short genitourinary surgeries. Group P patients received premedication with injection glycopyrrolate and midazolam IV. Group U patients were unpremedicated. Both groups were split in five subgroups with ten patients in each as per propofol dose of 2.0, 2.5, 3.0, 3.5, and 4.0mgkg-1 respectively. Following observations were made-pain on injection site, facemask tolerance, repeat dose and total dose of Propofol required for smooth induction, time of recovery and complications like post-operative nausea and vomiting (PONV). All data was analyzed by using chi square test and student t test.Results: Demographic profile showed no significant difference. Mean dose of Propofol in group P was 3.29±0.51 mg kg-1 while for group U was 3.70±0.57mg kg-1. Facemask tolerance was maximum in group P5 (100%) followed by (80%) in U5. Mean dose of Propofol required for younger children 1-3 years (group P 3.46±0.43 mgkg-1 v/s group U 3.94±0.48 mgkg-1) was much higher than dose required for 7-10 years (group P 3.13±0.52 mgkg-1 and group U 3.18±0.59 mgkg-1) for both groups. Recovery time after anaesthesia was delayed in group P and complications were more in group U.Conclusions: Propofol is the drug of choice for paeditric ambulatory surgery. Midazolam premedication enhances the benefits.

Author(s):  
Mallikarjuna Rao I. ◽  
Usha Kiran Prayaga ◽  
Dharma Rao Uppada ◽  
Ramachandra Rao E. ◽  
B. L. Kudagi

Background: The SSRIs being used as 1st line therapy in treatment of depression have delayed therapeutic effect which makes the patient vulnerable to an increased risk of suicide and decreased adherence to the treatment and will prematurely discontinue the therapy. The present study was conducted to evaluate if low dose mirtazapine-escitalopram combination therapy has any add on benefit over monotherapy with escitalopram.Methods: In a single-centered, comparative study involving patients with depression attending the out-patient after screening and exclusion, 60 eligible patients were randomly assigned to receive tablet mirtazapine 7.5 mg plus tablet escitalopram 10 mg intervention or tablet escitalopram 10 mg plus placebo intervention in a double-blind 6-week treatment phase. The primary outcome measure was the change in the 17-item Hamilton Depression Rating Scale (HDRS) and Montgomery-Asberg Depression Rating Scale (MADRS) score from baseline. Participants were evaluated at baseline, 1st, 2nd,4th and 6th week. Results were analyzed using Chi-Square test for adverse effects and independent t-test analysis for efficacy parameter.Results: In the analysis of results at 6th week the numbers of patients achieved remission in mirtazapine group are more with a p-value of 0.018 which is significant and the numbers of responders in mirtazapine group are also more which is statistically significant on chi-square test. There is no significant difference was observed between the two groups with reference to occurrence of adverse effect.Conclusions: Adding low dose mirtazapine has an added benefit in terms of efficacy and getting remission early with more number of responders in the treatment of major depression.


1970 ◽  
Vol 43 (156) ◽  
Author(s):  
Babu Raja Shrestha

This is a comparative study of ondansetron versus metoclopramide in the prevention of post-operativevomiting in routine major gynecological surgery under general anesthesia. The purpose of this study was toperform a comparative study of injection ondansetron 8 mg I.V. with injection metoclopramide 10 mg I.V.in preventing post-operative vomiting.This was a randomized, double blinded study conducted in sixtypatients of American Society of Anaesthesiologist (ASA) I and ASA II undergoing routine major gynecologicalsurgery (Transabdominal Hysterectomy, laprotomy and cystectomy, tubal surgery) under general anesthesia.Either of the drug was diluted to 5 ml of normal saline and given intravenously prior to induction ofanesthesia. The post-operative period of first 24 hours was divided into two phases, the early (0-6 hrs.) andlate (6-24 hrs.). The frequencies of vomiting and requirement of rescue antiemetics in both groups werestudied. The general characteristics of the patients in the two groups were similar. In both groups, induction,maintenance, duration of anesthesia as well as the type of surgery and opioids requirement were similar.The data recorded were statistically analyzed using Chi -square test and t - test. The frequency of vomitingwas less in ondansetron group compared to metoclopramide group. Rescue antiemetics was given only oncein ondansetron group patients, whereas the need of rescue antiemetics was eight times in the metoclopramidegroup. The difference was statistically significant (p=0.03). No unwanted effects were noticed in both groups.Ondansetron seems more effective in preventing Post-Operative Nausea & Vomiting (PONV) thanmetoclopramide but it has to be evaluated further by more clinical trials and tests in larger series.Key Words: Antiemetics, vomiting, general anesthesia, gynaecological surgery.


Author(s):  
Vigil Peter ◽  
Sumesh Mathew ◽  
Tom Thomas

Background: The use of electroconvulsive therapy (ECT) as a treatment modality has increased over the recent years. This is largely due to the use of general anaesthetics, which reduces the physical and psychological trauma associated with the procedure. We attempted to compare the hemodynamic variations and recovery characteristics, along with their effect on seizure quality in patients induced with Thiopentone /Propofol, for Modified ECT.Methods: This was a prospective, randomised controlled study, involving 80 patients. Patients in group 1 received Thiopentone 5 mg/kg, while patients in group 2 received Propofol 1 mg/kg. The hemodynamic status and recovery status were monitored in both the groups for the first thirty minutes. Seizural duration were also recorded. Data was analysed using Students t-test and Pearson Chi-square test.Results: The induction time as well as recovery time was found to be significantly lesser (p <0.05) in the propofol group. The hemodynamic response to was blunted and returned to baseline levels within 10-15 minutes after ECT in the propofol group, whereas it persisted even after 30 minutes in the thiopentone group. There was however, no significant difference in the duration of the seizural activity(p> 0.05).Conclusions: The quick and smooth induction, transient changes in hemodynamics, rapid recovery profile and minimal effects on the seizure quality altogether makes Propofol the preferred anaesthetic agent in Modified ECT.


Author(s):  
Karan Morje ◽  
Manna Debnath ◽  
Akhlaque Ahmad ◽  
Santosh Ojha

Aim: The main purpose of this present study is to determine the effects of sitting (S) and lateral (L) position during spinal anaesthesia on patient satisfaction, Post dural puncture headache (PDPH), Post-Operative Nausea and Vomiting (PONV). Study Design: Prospective comparative study Place and Duration of Study: Charusat Healthcare and Research foundation (CHRF), Changa, Gujarat, between September 2021 to November 2021. Methodology: A total of 50 female volunteers who were above the age of 18 years, had an American Society of Anaesthesiologist (ASA) status of I & II and those who have undergone hysterectomy surgery are included in this study. The patients were categorized into two groups, group S (n=25) and group L (n=25). Patients were asked about PONV 4 hours after surgery and the possibility of PDPH on post-operative days 1 and 2. The study was analysed by using descriptive statistics, chi-square and Kruskal-Wallis test. Results: When comparing the incidence of PDPH on post-operative day 1 and day 2, there is a statistically significant difference between the Sitting (group S) and Lateral decubitus (group L) groups (P-value= 0.14 and.001). On the other hand, there is no statistical significant difference found for PONV when compared between both the groups (P- value= .776). Conclusion: Spinal anaesthesia with lateral decubitus position has better outcomes than sitting position for the incidence of Post dural puncture headache. However, there is no difference in both groups for PONV.


2019 ◽  
Vol 3 (2) ◽  

Radiographic Mandibular Indices serve as easy and relatively cheap tools for evaluating bone mineralization. Objectives: To examine the effect of age and gender on three mandibular indices: the panoramic mandibular index (PMI), the mandibular ratio (MR) and the mandibular cortical index (MCI), among Libyan population. Methods: The three indices were measured on 317 digital (OPGs) of adult humans (155 males, 162 females). The sample was divided into six age groups (from 18-25 years through 56-65 years). The measurements were analyzed for interactions with age and sex, using SPSS (Statistical Package for Social Studies) software version no. 22. The tests employed were two way ANOVA, the unpaired T-test and chi-square test. Results: The mean PMI fluctuated between 0.37 s.d. 0.012 and 0.38 s.d. 0.012. among the sixth age groups. One-way ANOVA statistical test revealed no significant of age on PMI. On the other hand gender variation has effect on PMI, since independent sample t-test disclosed that the difference between the male and female PMI means statistically significant. ANOVA test showed that the means of MR among age groups showed a negative correlation i.e. MR mean declined from 3.01 in 18-25 age groups to 2.7 in 55-65 age groups. In contrary, the gender showed no effect on MR according two sample t-test at p> 0.05. In regards with MCI, statistical analysis showed that it affected by age that is C1 was decreasing by age while C2 and C3 were increased by age. Using chi square test the result indicated that there is a significant difference among the different age group and the two genders in MCI readings. Conclusion: PMI was influenced significantly by age but minimally by the gender. MR is not affected by gender but has a negative correlation with age. MCI is affected by both age and gender


Author(s):  
Satoe Fujiwara ◽  
Ruri Nishie ◽  
Shoko Ueda ◽  
Syunsuke Miyamoto ◽  
Shinichi Terada ◽  
...  

Abstract Background There is uncertainty surrounding the prognostic value of peritoneal cytology in low-risk endometrial cancer, especially in laparoscopic surgery. The objective of this retrospective study is to determine the prognostic significance of positive peritoneal cytology among patients with low-risk endometrial cancer and to compare it between laparoscopic surgery and conventional laparotomy. Methods From August 2008 to December 2019, all cases of pathologically confirmed stage IA grade 1 or 2 endometrial cancer were reviewed at Osaka Medical College. Statistical analyses used the Chi-square test and the Kaplan–Meier log rank. Results A total of 478 patients were identified: 438 with negative peritoneal cytology (232 who underwent laparotomy and 206 who undertook laparoscopic surgery) and 40 with positive peritoneal cytology (20 who underwent laparotomy and 20 who received laparoscopic surgery). Survival was significantly worse among patients with positive peritoneal cytology compared to patients with negative peritoneal cytology. However, there was no significant difference among patients with negative or positive peritoneal cytology between laparoscopic surgery and laparotomy. Conclusion This retrospective study suggests that, while peritoneal cytology is an independent risk factor in patients with low-risk endometrial cancer, laparoscopic surgery does not influence the survival outcome when compared to laparotomy.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ye Wu ◽  
Zhen Zhang ◽  
Meng Liao ◽  
Qi Li ◽  
Xue Lin Tang ◽  
...  

Abstract Background To analyze whether corneal refractive surgery (CRS) is associated with the distribution of different accommodative dysfunctions (ADs) and binocular dysfunctions (BDs) in civilian pilots. A further aim was to analyze the percentages and visual symptoms associated with ADs and/or BDs in this population. Methods One hundred and eight civilian pilots who underwent CRS from January 2001 to July 2012 (age: 30.33 ± 4.60 years) were enrolled, the mean preoperative SE was − 1.51 ± 1.15 D (range: − 1.00- − 5.00 D). Ninety-nine emmetropic civilian pilots (age: 29.64 ± 3.77 years) who were age- and sex-matched to the CRS group were also enrolled. Refractive status, accommodative and binocular tests of each subject were performed. Visually related symptoms were quantified using the 19-item College of Optometrists in Vision Development Quality of Life (COVD-QOL) questionnaire. The 19 items were summed to obtain visual symptom scores that might indicate visual dysfunctions. The chi-square test was used to analyze differences in percentages of ADs and/or BDs between the CRS and emmetropic groups. The Mann-Whitney U test was used to compare visual symptom scores between pilots with ADs and/or BDs and pilots with normal binocular vision. Results No significant difference was observed between the CRS and emmetropic groups in the overall prevalence of ADs and BDs (15.7% and 15.2% in the CRS and emmetropic groups, respectively; P = 0.185). ADs were present in 4.63% and 3.03% of the CRS and emmetropic group, respectively. BDs were observed in 11.1% and 12.1% of the CRS and emmetropic group, respectively, yielding no significant differences between the groups in the prevalence of ADs or BDs (AD: P = 0.094; BD: P = 0.105). Pilots with ADs and/or BDs had significantly more visual symptoms than pilots with normal binocular vision (p < 0.001). Conclusions CRS for civilian pilots with low-moderate myopia might not impact binocular functions. ADs and/or BDs commonly occur in both emmetropia pilots and pilots who undergo CRS, and pilots with ADs and/or BDs are associated with increased symptoms. This study confirms the importance of a full assessment of binocular visual functions in detecting and remedying these dysfunctions in this specific population.


2021 ◽  
Vol 11 (8) ◽  
pp. 3469
Author(s):  
Khalid H. Almadi ◽  
Muhammad Adeel Ahmed ◽  
Tuba Ghazal ◽  
Rizwan Jouhar ◽  
Mazen F. Alkahtany ◽  
...  

Propolis is proposed to possess antibacterial and anti-inflammatory properties, which can be used in endodontic applications. However, evidence on its efficacy in comparison to chlorhexidine against Enterococcus faecalis (E. faecalis) is controversial. The aim of the current study was to compare the antibacterial efficacy of Propolis and chlorhexidine as an intracanal medicament against E. faecalis in extracted human permanent teeth. The focused question was, “Does Propolis show better antibacterial efficacy than Chlorhexidine (CHX) as an intracanal medicament against E. faecalis in extracted human permanent teeth?”. Databases including PubMed/Medline, Scopus, EMBASE, ISI-Web of Science were searched from 1990 to August 2020 using different combinations of the following keywords: “Propolis”, “Intracanal medicament”, “E. faecalis”, “Antibacterial activity” and “Chlorhexidine”. Ten studies fulfilling inclusion criteria were considered for qualitative analysis, followed by quantitative analysis of eight studies. Heterogeneity was calculated for colony forming units (CFU) of E. Faecalis using the Chi-square test and I2 statistics. Forest plots were computed reporting standard mean difference (SMD) of outcomes and 95% confidence intervals. The overall mean difference for CFU of E. faecalis showed a statistically significant difference between the antibacterial efficacy of Propolis and CHX (SMD = 3.20 [1.70, 4.69] Z = 4.20; p < 0.001). CHX showed superior antibacterial efficacy against E. faecalis compared to Propolis.


2021 ◽  
Vol 61 (1) ◽  
Author(s):  
Isadora Carvalho Medeiros Francescantonio ◽  
Leandro Augusto Rodrigues dos Santos ◽  
Paulo Luiz Carvalho Francescantonio ◽  
Luiz Eduardo Coelho Andrade ◽  
Wilson de Melo Cruvinel

Abstract Objective To evaluate the perception of rheumatologists regarding the recommendations of the Brazilian Consensus for detection of Autoantibodies (BCA) on HEp-2 Cells by Indirect Immunofluorescence assay (IFA) and how BCA recommendations help in clinical practice. Methodology A structured questionnaire regarding the BCA recommendations for detection and interpretations of autoantibodies in HEp-2 cells was applied to randomly selected rheumatologists. The results were tabulated using the Microsoft® Excel program, expressed as a simple percentage and the dichotomous data were analyzed using the Chi-square test and the Epi Info® program. Results Four hundred fuorteen rheumatologists participated in the study: 70% of them considered their knowledge of the HEp-2 IFA test satisfactory or excellent, and 43% said they knew the BCA recommendations in general, without distinguishing the edition of the BCA to which they refer. The Revista Brasileira de Rheumatologia/Advances in Rheumatology was the means of dissemination most consulted by specialists (50%). According to the rheumatologists’ opinion, the most relevant pattern was the homogeneous nuclear (78%) and 65% stated they were satisfied with the BCA recommendations at a level of satisfaction greater than or equal to 80%. There was no significant difference in the perception of rheumatologists from the several Brazilian geographic regions. Conclusion Brazilian rheumatologists are aware of the BCA guidelines and most are satisfied with the content published, considering that the BCA recommendations assist positively in the clinical practice. Most rheumatologists recognize the patterns associated with rheumatic autoimmune diseases and have used BCA recommendations to interpret the results of the HEp-2 IFA test.


Electronics ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 1114
Author(s):  
Tatsunori Sawada ◽  
Hiroki Uda ◽  
Akira Suzuki ◽  
Kounosuke Tomori ◽  
Kanta Ohno ◽  
...  

Background: Although various technologies are used to evaluate driving skill, there are some limitations such as the limited range of the monitor and the possible risk of causing cybersickness. The purpose of this study is to investigate differences in the hazard perception and cybersickness experienced between novice and experienced drivers measured in a VR hazard perception test with a head-mounted display (HMD). Methods: The novice (n = 32) and the experienced drivers (n = 36) participated in the hazard perception test through the VR of an HMD. Results: The total number of identified hazards was 1071 in the novice drivers and 1376 in the experienced drivers. Two of the hazards appeared to be only identifiable through the HMD. A chi-square test revealed that experienced drivers were more likely to identify the hazards than the novice drivers (p < 0.05). The novice drivers appeared to identify “hazard prediction of the current behavior of other road users” more than other hazard types, unlike the experienced group. The Simulator Sickness Questionnaire scores indicated no significant difference in the different age or gender groups (p > 0.05). Conclusion: Our results suggest that the VR hazard perception test may be useful for evaluating patients’ driving skills.


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