scholarly journals Comparative Study of Effect of Etomidate Versus Propofol plus Ketamine on Haemodynamic Response to Laryngoscopy and Endotracheal Intubation

2021 ◽  
Vol 8 (15) ◽  
pp. 939-944
Author(s):  
Saraswathi Ramakrishna ◽  
Langpoklakpam Chaoba Singh ◽  
Bijaya Chingtham ◽  
Rahul Jain
Keyword(s):  
Endotracheal Intubation ◽  
Side Effect ◽  
Controlled Trial ◽  
Double Blind ◽  
Haemodynamic Stability ◽  
Significant Difference ◽  
Haemodynamic Changes ◽  
Drug Induction ◽  
Randomised Controlled ◽  
Post Operative Nausea

BACKGROUND Laryngoscopy and endotracheal intubation, a painful procedure, frequently used in airway management is commonly associated with undesired haemodynamic changes like hypertension, tachycardia and arrythmias. Thus, this study was designed to compare haemodynamic stability to laryngoscopy and intubation using single drug induction with etomidate and combined drug induction with propofol and ketamine. METHODS This was a double blind randomised controlled trial, a total of 90 patients of both sexes, aged between 18 - 60 years, who were scheduled for elective surgeries under general anaesthesia in regional institute of medical sciences (RIMS) operation theatre (OT) were divided into two groups. Group PK received propofol (1.5 mg / kg) + ketamine (0.5 mg / kg) and Group E received etomidate (0.3 mg / kg) as induction agents. The haemodynamic parameters (systolic blood pressureSBP, diastolic blood pressure-DBP, mean arterial pressure-MAP, heart rate-HR) were recorded before induction, immediately after induction, 1, 3 and 5 mins after intubation. Side effects like myoclonus and post-operative nausea and vomiting were also noted. RESULTS SBP, DBP, MAP which were recorded, before induction considered as the baseline, and after induction, were comparable between the two groups. SBP, DBP and MAP compared at 1, 3 and 5 mins after intubation showed statistically significant difference between the two groups with propofol-ketamine group showing better haemodynamic stability. The HR between both the groups at various time intervals were comparable and not considered statistically significant. The side effect associated after induction was myoclonus in 14 patients in Group E i.e. 31 % and post-operative nausea vomiting was observed in 8 patients in Group E i.e. 18 %. CONCLUSIONS Thus, in view of haemodynamic stability during laryngoscopy, intubation and side effect profile; propofol and ketamine combination proves to be a better alternative compared to etomidate according to our study. KEYWORDS Propofol, Ketamine, Etomidate, Haemodynamic Stability

scholarly journals A double-blind, randomised, controlled trial of protein supplementation to enhance exercise capacity in COPD during pulmonary rehabilitation: a pilot study

2021 ◽  
pp. 00077-2021
Author(s):  
Abdulelah M. Aldhahir ◽  
Yousef S. Aldabayan ◽  
Jaber S. Alqahtani ◽  
Heidi A. Ridsdale ◽  
Colette Smith ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Exercise Capacity ◽  
Pulmonary Rehabilitation ◽  
Controlled Trial ◽  
Protein Supplementation ◽  
High Protein ◽  
Double Blind ◽  
Meaningful Improvement ◽  
Significant Difference ◽  
Randomised Controlled

BackgroundPulmonary rehabilitation (PR) is a cost-effective management strategy in chronic obstructive pulmonary disease (COPD) which improves exercise performance and health-related quality of life. Nutritional supplementation may counter malnutrition and enhance PR outcomes but rigorous evidence is absent. We aimed to investigate the effect of high protein-supplementation (Fortisip Compact Protein, FCP) during PR on exercise capacity.MethodsA double-blind randomised controlled trial comparing FCP with preOp (a carbohydrate control supplement) in COPD patients participating in a PR programme. Participants consumed the supplement twice a day during PR and attended twice-weekly PR sessions, with pre- and post-PR measurements including the incremental shuttle walk test (ISWT) at 6-weeks as the primary outcome. Participants’ experience using supplements was assessed.ResultsSixty-eight patients were recruited; (FCP: 36 and control: 32). The trial was stopped early due to COVID-19. Although statistical significance was not reached, there was the suggestion of a clinically meaningful difference in ISWT at 6 weeks favouring the intervention group (intervention: 342 m±149; n=22 versus control: 305 m±148; n=22, p=0.1). Individuals who achieved an improvement in ISWT had larger mid-thigh circumference at baseline (responder: 62 cm±4 versus non-responder: 55 cm±6; p=0.006). 79% were satisfied with the taste and 43% would continue taking the FCP.ConclusionAlthough the data did not demonstrate a statistically significant difference in ISWT, high protein supplementation in COPD during PR may result in a clinically meaningful improvement in exercise capacity and was acceptable to patients. Large, adequately powered studies are justified.

12-month randomised controlled trial of ginseng extract for moderate COPD

Thorax ◽  
2019 ◽  
Vol 74 (6) ◽  
pp. 539-545 ◽  
Author(s):  
Johannah Linda Shergis ◽  
Francis Thien ◽  
Christopher John Worsnop ◽  
Lin Lin ◽  
Anthony L Zhang ◽  
...  
Keyword(s):  
Short Form ◽  
Controlled Trial ◽  
Chronic Obstructive Lung Disease ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Double Blind ◽  
Ginseng Extract ◽  
Exacerbation Rate ◽  
Significant Difference ◽  
Randomised Controlled

BackgroundPanax ginseng (ginseng) is a therapeutic herb which might be beneficial in COPD. The study investigated if ginseng, compared with placebo, is effective and safe for people with moderate COPD.MethodsThis multicentre, randomised, double-blind, placebo-controlled trial compared 24 weeks of ginseng capsules (100 mg twice daily) with placebo. Participants were followed up for a further 24 weeks. Participants were aged 40 years and over and had airflow limitation in the moderate (Global Initiative for Chronic Obstructive Lung Disease 2) COPD range. The coprimary endpoints were the St George’s Respiratory Questionnaire, the COPD Assessment Test and the Short Form Health Survey. Secondary outcomes included lung function, exacerbation rate and use of relief medication.Findings168 participants were randomised 1:1 from five centres in Australia and China. Baseline characteristics were balanced between groups. There were no significant differences between ginseng and placebo, with overall results improving in both groups. Ginseng seemed safe for, and well tolerated by, people with COPD.InterpretationThere was no significant difference in improvement in health-related quality of life (primary outcome) between the ginseng and placebo groups.Trial registration numberACTRN12610000768099.

scholarly journals Antibiotic prophylaxis in acute cholecystectomy revisited: results of a double-blind randomised controlled trial

2020 ◽  
Vol 405 (8) ◽  
pp. 1201-1207
Author(s):  
Gona Jaafar ◽  
Gabriel Sandblom ◽  
Lars Lundell ◽  
Folke Hammarqvist
Keyword(s):  
Antibiotic Prophylaxis ◽  
Acute Cholecystitis ◽  
Controlled Trial ◽  
Study Groups ◽  
Double Blind ◽  
Randomised Study ◽  
Significant Difference ◽  
Preoperative Antibiotic Prophylaxis ◽  
Randomised Controlled ◽  
The Impact

Abstract Purpose Evidence supporting the value of preoperative antibiotic prophylaxis (PAP) in surgery for acute cholecystitis is lacking. This study aimed to shed light on whether PAP in acute cholecystectomy for cholecystitis reduces the postoperative infectious complication (PIC) rate. Secondary outcomes were the prevalence of bacteriobilia, CRP values and leucocyte counts. Methods The study was performed as a single-centre, double-blinded, placebo-controlled, randomised study. Patients with acute cholecystitis amenable for acute laparoscopic cholecystectomy were randomly assigned to either PAP (piperacillin/ tazobactam) or placebo, and the subsequent clinical course was followed. Results A total of 106 patients were enrolled, 16 of whom were excluded due to protocol violation. PIC developed in 22 of the 90 patients included with no significant difference between the PAP and placebo groups (8 patients in the PAP group and 14 in the placebo arm, p = 0.193). The PIC rate was significantly higher in patients with a raised CRP at randomisation and on the day of surgery and in cases of conversion to an open procedure (p = 0.008, 0.004 and 0.017, respectively) but with no differences between the study groups. Conclusion PAP does not affect the risk for PIC in patients with acute cholecystitis. The major risk factors determining PIC in these patients need defining, in particular, the impact of bacteriobilia. Trial registration The study was registered at clinicaltrials.gov (NCT02619149) December 2, 2015.

scholarly journals OC 8568 A RANDOMISED CONTROLLED TRIAL OF ORAL IRON FOR TREATMENT OF POST-MALARIA ANAEMIA IN MALAWIAN CHILDREN COMPARING IMMEDIATE VERSUS DELAYED ADMINISTRATION

2019 ◽  
Vol 4 (Suppl 3) ◽  
pp. A14.2-A14
Author(s):  
Kamija Phiri ◽  
Herbert Longwe ◽  
Sarah White ◽  
Michael Esan ◽  
Feiko Ter Kuile ◽  
...  
Keyword(s):  
Placebo Group ◽  
Iron Supplementation ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Group Versus ◽  
Double Blind ◽  
Iron Administration ◽  
Double Blind Clinical Trial ◽  
Significant Difference ◽  
Randomised Controlled

BackgroundAlthough universal provision of iron supplements to children is recommended by the WHO, it is not yet clear whether the administration of the supplements poses a risk in children in malaria-endemic areas. We investigate the effects of iron supplementation in children with post-malaria anaemia and haematological response with immediate and delayed (2’weeks) iron administration.MethodsA randomised double-blind clinical trial was conducted in Zomba and Blantyre between 2009 and 2013. All children aged 4 to 36 months with uncomplicated malaria and with iron deficiency were enrolled into the study. Malaria treatment was administered to all the children and they were randomly assigned to 3 groups as follows: immediate iron administration, delayed iron administration, or placebo. The children were followed up for 10 weeks, with their haematological recovery indices and adverse effects being monitored at 2, 4, 8 and 10 weeks. The primary outcome of the study was the proportion of children without anaemia (defined as Hb >10.9 g/dl) at the end of the iron supplementation period.ResultsA total of 538 participants were randomised to immediate iron administration (n=183), delayed iron administration (n=183), or placebo (n=172). The incidence rate ratio (IRR) of being non-anaemic at the end of the follow-up period (10 weeks post-malaria infection) was 1.51 (95% CI 1.17–1.94, p<0.001) among immediate group versus the placebo group. There was no significant difference between delayed and placebo group (IRR 1.18, 95% CI 0.91–1.55). Secondary analysis of risk of malaria and bacterial infection and iron markers at the end of the intervention period is underway and shall be presented at the conference.ConclusionThe results so far support the administration of iron immediately after completing antimalarial treatment in anaemic children, however safety results will be needed to be reviewed before conclusive recommendations.

scholarly journals 388Investigating the utility of the customised fetal growth chart: a pragmatic randomised controlled trial

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Kristen Gibbons ◽  
Michael Beckmann ◽  
Vicki Flenady ◽  
Glenn Gardenre ◽  
Peter Gray
Keyword(s):  
Randomised Controlled Trial ◽  
Fetal Growth ◽  
Primary Outcome ◽  
Adverse Pregnancy Outcome ◽  
Controlled Trial ◽  
Growth Chart ◽  
Singleton Pregnancy ◽  
Double Blind ◽  
Significant Difference ◽  
Randomised Controlled

Abstract Background To determine if the routine use of a customised fetal growth chart, when compared to a standard growth chart, reduces the risk of adverse pregnancy outcome through increased detection of adverse growth. Methods A double-blind, single centre, randomised controlled trial was conducted. All women with a singleton pregnancy receiving routine antenatal care through hospital clinics were included and randomised to either a standard growth chart (SC) or a customised growth chart (CC). Serial measurements of symphyseal fundal height (SFH) were plotted onto the chart in the electronic clinical record; pre-programmed alerts notified the clinician when growth or size required review. The primary outcome measure was a composite perinatal morbidity/mortality outcome. Results 3993 women were recruited; 45.4% nulliparous; 50.0% Caucasian, 17.8% Asian; 34.9% were overweight/obese prior to pregnancy; average 30 (SD 5.5) years old. The median (IQR) number of growth alerts was 2 (0-3) for both groups (p = 0.378); there was no difference in the total number of ultrasounds per pregnancy (median [IQR] 3 [2-4] for both groups, p = 0.266). There was no significant difference in primary composite outcome (CC 6.4%, SC 7.5%, p = 0.171) or individual components, apart from stillbirth (CC n = 1 0.05%, SC n = 8 0.4%, p = 0.039). Conclusions Use of a CC resulted in no difference in primary outcome, number of growth alerts or number of ultrasounds. Key messages In a large, pragmatic RCT use of a CC in conjunction with serial SFH measurements may infer some benefit over a SC, particularly in relation to stillbirth.

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