Perioperative effect of dexmedetomidine on quality of analgesia and hemodynamic parameters in vaginal hysterectomy: A tertiary centre experience

Vaginal hysterectomy Surgery with long acting local anaesthetic like bupivacaine still requires higher doses of analgesics in the post-operative period. Dexmedetomidine is highly selective αadrenoreceptor agonist and sympatholytic drug is a useful adjunct drug in patients undergoing vaginal hysterectomy under continuous spinal epidural block (CSE). We sought to study duration of perioperative analgesia, observe the intra-operative and post-operative hemodynamic changes and post-operative sedation effect of dexmedetomidine.: The study groups were divided as Group D (study group) administered 1 µg/kg Dexmedetomidine and Group C (control group) administered 0.9% saline drip at the rate of 1ml/kg. Dexmedetomidine group had prolonged duration of sensory blockade, duration for 2 dermatomal regression of sensory blockade and the duration for motor block regression to Modified Bromage scale 0. This group had prolonged duration of Time to first request for rescue analgesic.14% patients required mephentermine for management of hypotension.Intraoperative diastolic blood pressure (DBP) was lower in study group while Intraoperative Systolic blood pressure (SBP) was comparable in both the groups. Intravenous dexmedetomidine significantly decreases the heart rate and is associated with higher incidence of bradycardia. It is effective in providing postoperative analgesia and in preventing postoperative shivering with reduced incidence of postoperative nausea and vomiting.

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Application of the Measurement of Carotid Intima-Media Thickness for Prediction of the Essential Hypertension in Children

Revista de Chimie ◽

10.37358/rc.18.6.6366 ◽

2018 ◽

Vol 69 (6) ◽

pp. 1550-1553

Author(s):

Rosana Manea ◽

Bianca Elena Popovici ◽

Carmen Daniela Neculoiu ◽

Dan Minea ◽

Alina Calin

Keyword(s):

Blood Pressure ◽

Essential Hypertension ◽

Carotid Artery ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Diagnostic Methods ◽

Control Group ◽

Study Group ◽

Media Thickness ◽

Hypertension In Children

Hypertension is a major risk factor for progression of the atherosclerotic process and for developing of degenerative cardiovascular diseases in adulthood. The aim of this study is to evaluate how the measurement of carotid intima - media thickness for prediction of essential hypertension in children can be used.The study group included 81 children and the control group 61 children, all aged between 5 - 17 years and 11 months old, and admitted in Children Hospital Brasov in the period of 2009 � 2014. The study protocol included: BMI, blood pressure and Doppler echography of the common carotid artery for each group. Mean age of the patients from the study group was 13.67 years, 43.20 % girls and 56.80 % boys, while in the control group, the mean age was 14.07 years, 54.10% girls and 45.90 % boys. 70.37% of the children from the study group presented obesity, while in the control group 40.98% were obese. The IMTC study group ranged from 0.52 - 0.69 mm and the limits of the normotensive subjects were 0.32 -0.54 mm. In both groups the obese patients were found to have increased carotid artery intima-media, which means that IMTC was positively correlated with BMI (p=0.000001).It is necessary to identify diagnostic methods easily applicable for children, allowing involvement of the characteristics of the arterial wall in the degenerative pathological processes. Increased intima-media ratio is positively correlated with high values of blood pressure.

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Effect of intravenous oxycodone on the physiologic responses to extubation following general anesthesia

BMC Anesthesiology ◽

10.1186/s12871-021-01350-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Menglu Jiang ◽

Jiawei Ji ◽

Xin Li ◽

Zhenqing Liu

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

General Anesthesia ◽

Control Group ◽

Study Group ◽

Clinical Trial Registry ◽

Blood Oxygen Saturation ◽

Blood Concentrations ◽

Number Of Patients ◽

Blood Hormones

Abstract Background Endotracheal intubation and extubation may cause undesirable hemodynamic changes. Intravenous oxycodone has recently been introduced and used for relieving hemodynamic alterations in response to intubation, but there is insufficient information regarding its application in stabilizing hemodynamics during extubation in the patients emerging from general anesthesia. Methods One hundred patients, who had undergone assorted laparoscopic surgeries under general anesthesia, were randomly assigned to Control group (saline injection, 50 cases) and Study group (intravenous injection of 0.08 mg/kg oxycodone immediately after completion of the surgical procedure, 50 cases). Blood pressure, heart rate, blood oxygen saturation (SpO2) as well as blood concentrations of epinephrine, norepinephrine, and cortisol were recorded or measured immediately before extubation (T0), during extubation (T1), as well as one minute (T2), 5 min (T3), and 10 min after extubation (T4). In addition, coughing and restlessness, time of eye-opening, and duration from completing surgery to extubation as well as Ramsay Sedation Scale were analyzed. Results Blood pressure and heart rate as well as blood concentrations of epinephrine, norepinephrine, and cortisol were significantly higher in the Control group compared with the Study group at the time of extubation as well as 1, 5, and 10 min after extubation (P < 0.05). When the patients emerged from general anesthesia, 70 % of the Control group had cough, which was significantly higher than that of Study group (40 %, P < 0.05). Significantly higher number of patients manifested restlessness in the Control group before (40 %) and after extubation (20 %) compared with that in the Study group (20 and 2 %, respectively, P < 0.05). In addition, patients of Control group had lower Ramsay score at extubation (1.7 ± 0.7) as well as 30 min after extubation (2.4 ± 0.9) compared to that of the patients of Study group (2.2 ± 0.9, and 3.0 ± 0.8, respectively, P = 0.003 and 0.001). Conclusions Intravenous oxycodone attenuated alterations of hemodynamics and blood hormones associated with extubation during emergence from general anesthesia. Trial registration Chinese Clinical Trial Registry: ChiCTR2000040370 (registration date: 11-28-2020) “‘retrospectively registered”.

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A randomised, open label comparative study of hydroxychloroquine with betamethasone oral mini pulse in the management of patients with alopecia areata

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20210189 ◽

2021 ◽

Vol 10 (2) ◽

pp. 187

Author(s):

Jeyasudha Jambusayee ◽

Kulur Mukhyaprana Sudha

Keyword(s):

Alopecia Areata ◽

Life Quality ◽

Autoimmune Disorder ◽

Study Groups ◽

Pulse Therapy ◽

The Body ◽

Control Group ◽

Study Group ◽

Open Label ◽

Significant Difference

Background: Alopecia areata is an autoimmune disorder causing patchy hair loss on scalp and other parts of the body and leading to poor self-esteem and anxiety in patients. Treatment with topical or systemic drugs like steroids or other immunosuppressants is associated with adverse effects. Hydroxychloroquine is an antimalarial drug, with T cell modulating function. This study was undertaken to assess the safety, efficacy and tolerability of Hydroxychloroquine in Alopecia areata compared to betamethasone oral mini pulse (OMP) therapy. Methods: 60 patients with alopecia areata were randomized into two groups of 30 each. Control group received tab. betamethasone 5 mg/day on two consecutive days of week for 12 weeks and Study group received tab. hydroxychloroquine 200 mg/day for 12 weeks. They were followed-up for further 12 weeks. Scale of alopecia tool, dermatology life quality index and global assessment at baseline, 12 weeks and 24 weeks were used to assess the outcome.Results: 94 patients were screened and 60 patients were included. All patients completed the study. At the end of 12 weeks, there was a statistically significant reduction in SALT and DLQI scores in both control and study groups. But at the end of 24 weeks, the study group showed an increase in the scores. Relapses were more in the study group. No significant difference in the incidence of adverse events was noted between the two groups.Conclusions: Hydroxychloroquine 200 mg/day is less efficacious in the management of alopecia areata in comparison to betamethasone oral mini pulse therapy.

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A Comparative Study of Addition of Midazolam to Lignocaine—Bupivacaine vs only Lignocaine— Bupivacaine in Brachial Plexus Block

Research & Innovation in Anesthesia ◽

10.5005/jp-journals-10049-0002 ◽

2016 ◽

Vol 1 (1) ◽

pp. 5-9

Author(s):

Naina P Dalvi ◽

Harshali Salunkhay ◽

Shubha N Mohite

Keyword(s):

Comparative Study ◽

Brachial Plexus ◽

Brachial Plexus Block ◽

Control Group ◽

Study Group ◽

Motor Blockade ◽

Peripheral Nerve Stimulator ◽

Sensory Blockade ◽

Supraclavicular Brachial Plexus Block ◽

Plexus Block

ABSTRACT Introduction This prospective, randomized, double-blind study compared the onset and duration of sensory blockade, motor blockade, and analgesia with lignocaine, bupivacaine, and midazolam combination vs only lignocaine, bupivacaine in brachial plexus block. Materials and methods Patients of either sex, aged 18–60 years, American Society of Anesthesiologists grade I/II, posted for upper limb surgeries to be performed under supraclavicular brachial plexus block with the help of peripheral nerve stimulator were administered either 10 ml 0.5% bupivacaine with 50 μg/kg midazolam (preservative free) + 20 ml 2% lignocaine with adrenaline (1:200,000) in Group lignocaine– bupivacaine–midazolam (LBM) or 10 ml 0.5% bupivacaine + 20 ml 2% lignocaine with adrenaline (1:200,000) in Group lignocaine–bupivacaine (LB). Onset and duration of sensory and motor blockade were monitored. Postoperative analgesia was graded with visual analog scale. Sedation was monitored with Ramsey sedation score. Results A total of 60 patients were randomized to the group LBM (n = 30) and group LB (n = 30). The analgesia was significantly prolonged in the study group, with a mean of 11.72 ± 1.924 hours as compared with a mean of 6.383 ± 1.031 hours in the control group. Sedation scores were higher in the study group, that is, group LBM compared to group LB postoperatively. Conclusion In conclusion, midazolam when added to bupivacaine and adrenalized lignocaine for supraclavicular brachial plexus block hastens the onset of sensory and motor blockade. This combination improves analgesia, as manifested by lower pain scores and prolonged duration of analgesia. How to cite this article Dalvi NP, Salunkhay H, Mohite SN. A Comparative Study of Addition of Midazolam to Lignocaine–Bupivacaine vs only Lignocaine–Bupivacaine in Brachial Plexus Block. Res Inno in Anaesth 2016;1(1):5-9.

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Comparison of Effect of Intrathecal Fentanyl-bupivacaine and Tramadol-bupivacaine Combination on Postoperative Analgesia in Lower Abdominal Surgeries

Research & Innovation in Anesthesia ◽

10.5005/jp-journals-10049-0010 ◽

2016 ◽

Vol 1 (2) ◽

pp. 35-40 ◽

Cited By ~ 2

Author(s):

Naina P Dalvi ◽

Narendra Patil

Keyword(s):

Blood Pressure ◽

Postoperative Analgesia ◽

Total Duration ◽

Double Blind Study ◽

Motor Blockade ◽

Hyperbaric Bupivacaine ◽

Double Blind ◽

Sensory Blockade ◽

Prolonged Duration ◽

American Society

ABSTRACT Introduction This single-center, prospective, randomized, double-blind study compares the effect of intrathecal fentanylbupivacaine and tramadol-bupivacaine on the onset and duration of sensory and motor blockade, as well as postoperative analgesia in lower abdominal surgeries. Materials and methods Patients of either sex, aged 18 to 60 years, American Society of Anesthesiologists (ASA) grade I/II undergoing lower abdominal surgeries like appendicectomy, inguinal hernia repair surgery, and hydrocele surgery were administered either 2.5 mL of 0.5% bupivacaine + 0.5 mL (25 μg) of fentanyl citrate (group F) or 2.5 mL of 0.5% bupivacaine + 0.5 mL (25 mg) of tramadol (group T) intrathecally. Monitoring of the vital parameters, onset and duration of sensory and motor block, duration of postoperative analgesia, visual analog scale (VAS) score, sedation score, and any adverse drug reactions was done at predetermined intervals. Results Sixty patients were randomized to the group F (n = 30) and group T (n = 30). The duration of sensory blockade was significantly prolonged in group F (314.66 ± 49.25 minutes) as compared to group T (261.66 ± 27.92 minutes). Similarly, duration of motor blockade was longer in group F (263.66 ± 40.97 minutes) compared to group T (214.66 ± 26.61 minutes). The total duration of analgesia was significantly prolonged (p < 0.001) in group F (412 ± 97.888 minutes) compared to group T (301 ± 38.75 minutes). Hemodynamic parameters, such as pulse, systolic blood pressure, diastolic blood pressure and oxygen saturation were comparable in both the groups. Visual analog scores were significantly lower in the group F patients as compared to the group T patients. The group F patients had got significantly higher sedation scores as compared to Group T patients. Discussion Fentanyl 25 μg, when added to 2.5 mL of 0.5% hyperbaric bupivacaine, confers prolonged duration of sensory and motor blockade than 25 mg tramadol added to 2.5 mL of 0.5% hyperbaric bupivacaine. The bupivacaine-fentanyl combination prolonged duration of sensory and motor blockade, improved analgesia, as manifested by lower pain scores, and prolonged duration of postoperative analgesia. How to cite this article Dalvi NP, Patil N. Comparison of Effect of Intrathecal Fentanyl-bupivacaine and Tramadol-bupivacaine Combination on Postoperative Analgesia in Lower Abdominal Surgeries. Res Inno in Anesth 2016;1(2):35-40.

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Anesthetic Effect of Compound Artevacaine Hydrochloride in Patients Undergoing Oral Implantation

Journal of Clinical and Nursing Research ◽

10.26689/jcnr.v5i4.2373 ◽

2021 ◽

Vol 5 (4) ◽

pp. 220-224

Author(s):

Chengxi Chi ◽

Mengmeng Zhao ◽

Jiajing He ◽

Yanli Wang

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Operation Time ◽

Control Group ◽

Study Group ◽

Research Subjects ◽

Implant Surgery ◽

Anesthetic Effect ◽

Significant Difference ◽

Oral Implant

Objective: To investigate and analyze the anesthetic effect of compound artevacaine hydrochloride in patients undergoing oral implantation. Methods: In this study, 60 patients receiving oral implant surgery in our hospital were selected as the research subjects, and the operation time was from July 2019 to March 2021. Patients were randomly selected and divided into groups for the study. 30 patients receiving lidocaine hydrochloride anesthesia were used as the control group, and 30 patients receiving compound artevacaine hydrochloride anesthesia were used as the research group. The anesthetic effect and safety of the two groups were compared and analyzed. Results: The anesthetic effect of the study group was significantly better than that of the control group (P < 0.05). The blood pressure and heart rate in the study group were significantly lower than those in the control group (P < 0.05). There was no significant difference in blood pressure and heart rate between the two groups before anesthesia (P > 0.05). There was no significant difference in the incidence of ADR between the two groups (P > 0.05). Conclusions: For patients undergoing oral implant surgery, choosing compound artevacaine hydrochloride as anesthetic drug has obvious anesthetic effect and can stabilize patients' life indexes. The anesthetic effect is obvious, and there is no obvious adverse reaction, and the clinical value is obvious.

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Effects of occupational stress on working ability of patients suffering from arterial hypertension

Medicinski pregled ◽

10.2298/mpns1312497m ◽

2013 ◽

Vol 66 (11-12) ◽

pp. 497-501 ◽

Cited By ~ 4

Author(s):

Marijana Matic ◽

Jovana Jovanovic ◽

Jovica Jovanovic ◽

Nada Macvanin

Keyword(s):

Blood Pressure ◽

Arterial Hypertension ◽

Diastolic Blood Pressure ◽

Occupational Stress ◽

Stress Index ◽

Work Place ◽

Control Group ◽

Study Group ◽

Working Ability ◽

Disability Retirement

Introduction. The aim of this research was to quantify the presence of occupational stressors and to analyze their effects on temporary and permanent working ability of workers with arterial hypertension. Material and Methods. The research included 817 workers. The study group consisted of 504 workers with arterial hypertension without other diseases or disorders, whereas the control group was composed of 313 healthy workers. Results. The study group showed a significantly higher level of total occupational stress index as well as of the stress index related to high job demands, conflicts at work place, underload and time limit (p<0.001) compared to the control group. A positive and statistically significant correlation between total occupational stress index and systolic and diastolic blood pressure was found in the study group. The total level of occupational stress over 40 led to a significant increase of systolic and diastolic blood pressure in persons with arterial hypertension. The analysis of temporary working inability determined a statistically significantly higher level of lost workdays per a worker in the study group compared to the controls (p<0.001). The average number of lost workdays per a worker in a year in the study group increased statistically significantly along with the occupational stress index values at their work place (p<0.001). In the study group the number of workers eligible for disability retirement over a period of one year was significantly higher compared to the controls. The number of workers eligible for disability retirement in the exposed group increased statistically significantly along with occupational stress index values at their work place. Conclusion. The results show that occupational stress is a significant factor in the development of arterial hypertension and reduction of work ability of exposed workers.

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The effect of requesting a reason for non-adherence to a guideline in a long running automated reminder system for PONV prophylaxis

Applied Clinical Informatics ◽

10.4338/aci-2016-08-ra-0138 ◽

2017 ◽

Vol 26 (01) ◽

pp. 313-321 ◽

Cited By ~ 2

Author(s):

Fabian O. Kooij ◽

Toni Klok ◽

Benedikt Preckel ◽

Markus W. Hollmann ◽

Jasper E. Kal

Keyword(s):

Decision Support ◽

Support System ◽

Guideline Adherence ◽

Postoperative Nausea And Vomiting ◽

Study Groups ◽

Historical Control Group ◽

Historical Control ◽

Control Group ◽

Reminder System ◽

Screening Clinic

SummaryBackground: Automated reminders are employed frequently to improve guideline adherence, but limitations of automated reminders are becoming more apparent. We studied the reasons for non-adherence in the setting of automated reminders to test the hypothesis that a separate request for a reason in itself may further improve guideline adherence.Methods: In a previously implemented automated reminder system on prophylaxis for postoperative nausea and vomiting (PONV), we included additional automated reminders requesting a reason for non-adherence. We recorded these reasons in the pre-operative screening clinic, the OR and the PACU. We compared adherence to our PONV guideline in two study groups with a historical control group.Results: Guideline adherence on prescribing and administering PONV prophylaxis (dexamethasone and granisetron) all improved compared to the historical control group (89 vs. 82% (p< 0.0001), 96 vs 95% (not significant) and 90 vs 82% (p<0.0001)) while decreasing unwarranted prescription for PONV prophylaxis (10 vs. 13 %). In the pre-operative screening clinic, the main reason for not prescribing PONV prophylaxis was disagreement with the risk estimate by the decision support system. In the OR/PACU, the main reasons for not administering PONV prophylaxis were: ‘unintended non-adherence’ and ‘failure to document’.Conclusions: In this study requesting a reason for non-adherence is associated with improved guideline adherence. The effect seems to depend on the underlying reason for non-adherence. It also illustrates the importance of human factors principles in the design of decision support. Some reasons for non-adherence may not be influenced by automated reminders.

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Effects of Confounding Factors on Blood Pressure in Hypertensive Patients: A Cross Sectional Study

10.21203/rs.3.rs-283642/v1 ◽

2021 ◽

Author(s):

Emrah Ersoy ◽

Cuneyt Ardic

Keyword(s):

Blood Pressure ◽

Blood Pressure Control ◽

Pressure Control ◽

Control Group ◽

Poor Sleep ◽

Study Group ◽

Confounding Factors ◽

Cross Sectional ◽

Hypertensive Patients ◽

Significant Difference

Abstract Background Blood pressure is influenced by biopsychosocial factors such as physical, environmental, emotional, cognitive and behavioral in hypertensive patients. ObjectiveThe aim of this study is to investigate confounding factors in hypertensive patients who have poor blood pressure control.DesignThis study was designed as a cross-sectional study.ParticipantsOur sample was 407 patients with hypertension in Rize, a Northern city in the Black Sea Region of Turkey. In study group, there were 207 hypertensive patients who had admission to emergency department due to high blood pressure. In control group, there were 200 hypertensive patients visiting family physician,who defined themselves as having regulated blood pressure over the past six months.Main MeasuresPatients completed the questionnaire including sociodemographic data, lifestyle behaviors, health risks and confounding factors via the face-to-face interview method. Key ResultsOf the hypertensive patients, 81.2% (n=168) of the study group and 34.0% (n=68) of the control group had confounding factors. There was a significant difference between the hypertensive patients of study and control group in terms of their confounding factors (p<0.001). When we asked the patients of study group questions to reveal their confounding factors, 21.3% (n=44) stated ‘anger’, 12.6% (n=26) ‘sadness’, 11.1% (n=23) ‘anxiety’, 10.6% (n=22) ‘depressed’, 9.2% (n=19) ‘unhealthy diet’, 7.2% (n=15) ‘fatigue and poor sleep quality’, and 3.9% (n=8) ‘irregular medication’. Mean systolic and diastolic blood pressure were significantly higher in hypertensive patients having confounding factors than those without confounding factors (p=0.001, p=0.001, respectively). Mean systolic blood pressure of hypertensives who stated their confounding factor as ‘anger’ was significantly higher than those the remaining groups (p<0.001).ConclusionsThis study has shown that confounding factors impair blood pressure control in patients with hypertension. Confounding factors should be kept in mind and revealed in case of poor blood pressure control in hypertensive patients.

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VEGFR2 expressions in Th1 and CD8+ cytotoxic T lymphocytes (CTL) in colon cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e15535 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e15535-e15535

Author(s):

Mehmet Artac ◽

Ayca Ceylan ◽

Melek Karakurt Eryılmaz ◽

Murat Araz ◽

Mustafa Karaagac ◽

...

Keyword(s):

Colon Cancer ◽

T Cell ◽

Cancer Patients ◽

Study Groups ◽

T Cell Subsets ◽

Control Group ◽

Study Group ◽

Metastatic Colon Cancer ◽

Vegf Receptors ◽

Cancer History

e15535 Background: VEGF receptors have an important role for inhibiting adaptive immun response in colon cancer. Therefore, we analyzed VEGF receptors in circulating T cell subsets according to stage in colon cancer patients. Methods: The prospective study group consisted of 50 patients with histologically confirmed colon cancer and 30 person without any cancer history as a control group. Peripheral blood specimens were collected from the patients after the diagnosis before inducing chemotherapy and radiotherapy. Patients with active infections or autoimmune disorders, who were treated with steroids and antibiotics in the last four weeks before the study enrollment were excluded from the study group. VEGFR2 expressions in circulating T cell subsets (Th1, Th2, Th17, CTL) were analyzed by flow cyctometry. Results: Age and gender were not different between the all study groups. Mean circulating CD4+ folicullar cells were less in colon cancer patients (9.54%±3.99) than the control group (12.03%±4.34), (p < 0.01). Mean circulating CD8+ follicular cells were higher in metastatic colon cancer (n = 26) 2.48% ± 1.68, than the non-metastatic colon cancer patients (n = 24) 1.63% ± 1.37, (p = 0.02). Mean VEGFR2 expressions in Th1 cells were higher in colon cancer patients 248.8 (Mean Flourescein intensity-MFI) than the control group 224.6, (P = 0.006). Mean VEGFR2 expressions in CTL were higher in colon cancer patients (381.8) than the control group (284.7), (p < 0.001). PD-1 expressions were not different between the colon cancer patients and the control group in all circulating T cell subsets. Mean VEGFR2 expressions in Th17 cells were higher non-metastatic colon cancer patients than the metastatic colon cancer patients (326.5 and 268.4 MFI, respectively, p = 0.02). Conclusions: VEGFR2 expressions are increased in circulating Th1 and CTL subsets in colon cancer patients. Whereas PD-1 expressions were not different in circulating T cell subsets than the control. VEGFRs may play an important role for the inhibition of circulating T cell subsets in colon cancer.

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