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: AÂ• Both, Propofol and etomidate are safe induction agents AÂ• Etomidate maintains better haemodynamic stability than propofol as induction agent AÂ• Pain on injection was more with propofol. However, myoclonus was more with etomidate AÂ• Both drugs were associated with no significant side effects/complication.

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A COMPARATIVE STUDY BETWEEN ETOMIDATE AND PROPOFOL AS AN INDUCTION AGENT DURING INDUCTION, LARYNGOSCOPY AND INTUBATION

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i12.1601 ◽

2020 ◽

Vol 4 (12) ◽

Author(s):

Supriya Agarwal ◽

Vidushi Sharma

Keyword(s):

P Value ◽

Induction Agent ◽

Loss Of Consciousness ◽

Double Blind Study ◽

Double Blind ◽

College Hospital ◽

Medical College ◽

Pain On Injection ◽

Elective Surgical Procedures ◽

Induction Agents

Background: The objective of study was to compare Etomidate and Propofol as induction agents and their effect on Pain on injection, time to loss of consciousness and myoclonic movements. Methods: The study was carried out on 100 patients of ASA grade I and II between 18-58yrs of age of either sex enrolled for this prospective randomized double blind study, admitted in K D Medical College, Hospital & Research Center, Mathura (U.P) and scheduled for elective surgical procedures under general anaesthesia and endotracheal intubation. Results: The incidence of pain on injection in propofol group was more as compared to etomidate group (p value <0.05). In propofol group 25(50%) patients while in etomidate group only 2(4%) patients had pain on injection. Etomidate group had significantly more myoclonic movements than propofol group (p value <0.05). In etomidate group 18(36%) patients had myoclonic movements of various severity, while in propofol group no patient had myoclonic movements. Conclusion: Incidence of apnoea on induction was more in propofol group than etomidate group but comparison was not statistically significant. Keywords: Apnea, Propofol, Etomidate.

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Topical Diltiazem Versus Topical Glyceryl Trinitrate In The Management Of Chronic Anal Fissure

JMS SKIMS ◽

10.33883/jms.v17i2.241 ◽

2014 ◽

Vol 17 (2) ◽

pp. 55-58

Author(s):

Shams Ul Bari ◽

Ajaz Ahmad Malik ◽

Khurshid Alam Wani ◽

Ajaz A Rather

Keyword(s):

Side Effects ◽

Anal Fissure ◽

Chronic Anal Fissure ◽

P Value ◽

Double Blind ◽

Surgical Methods ◽

Significant Difference ◽

Topical Glyceryl Trinitrate ◽

One Year

Background: Chemical sphincterotomy is a novel way for treating patients of chronic anal fissure which avoids the risk of fecal incontinence associated with traditional surgical methods. Aims and objectives: The aim of this study was to compare the results of topical Diltiazem with topical Glyceril trinitrate in the management of chronic anal fissure. Methods: 71 patients in the age group of 15 - 61 years with chronic anal fissure were included in this prospective, randomized, double-blind trial over a period of two years with further follow up for one year. The patients were randomly allocated to either Diltiazem gel 2% (37 patients) or Glyceril trinitrate ointment 0.2% (34 patients) and were asked to use the treatment twice daily for 8 weeks. Each patient was reviewed every two weeks. Symptoms, healing, side effects and recurrence were compared using SPSS version 10 employing X2 test. A p-value below 0.05 was considered statistically significant. Results: Patients who received topical diltiazem (DTZ) showed statistically significant difference than those who were prescribed topical glyceril trinitrate in terms of symptoms, wound healing, side effects ( headaches) and recurrence (p=0.03 and 0.003 respectively). Healing occurred in 34 of 37 (92%) patients treated with Diltiazem after 6 weeks and 27 of 34 (80%) patients treated with Glyceril trinitrate after 8 weeks, which shows a significant difference in favour of Diltiazem (P < 0.001). The rest of the patients did not heal and underwent sphincterotomy (SILS). Headache occurred in all of the patients treated with Glyceril trinitrate but none of the patients treated with Diltiazem. Conclusion: Diltiazem gel was found to be better than Glyceril trinitrate ointment due to significantly higher healing rate and fewer side-effects. JMS 2014;17(2):55-58

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Effect of Dexamethasone as an Adjuncton Efficacy of Ropivacaine in Caudal Block forPostoperative Analgesia in Paediatric Infra-Umbilical Surgeries: A Randomised Double-blind Controlled Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/47738.14918 ◽

2021 ◽

Author(s):

Veena Patodi ◽

Kavita Jain ◽

Mukesh Choudhary ◽

Surendra Kumar Sethi ◽

Neena Jain ◽

...

Keyword(s):

Side Effects ◽

Postoperative Analgesia ◽

Controlled Study ◽

P Value ◽

Single Shot ◽

Caudal Block ◽

Analgesic Consumption ◽

Pain Scores ◽

Paediatric Patients ◽

Haemodynamic Changes

Introduction: Caudal block is a routinely performed analgesic and anaesthetic technique in paediatric population undergoing various infra-umbilical surgeries. Various adjuvants have been used along with local anaesthetics like ropivacaine in single-shot caudal block for enhancing postoperative analgesia in paediatric infra-umbilical surgeries. Aim: To evaluate the efficacy of dexamethasone used as an adjuvant to 0.2% ropivacaine in caudal block for postoperative analgesia in paediatric patients. Materials and Methods: This was a randomised doubleblinded controlled study conducted on 80 paediatric patients (8 months-8 years), with American Society of Anesthesiologists (ASA) physical status I or II undergoing various infra-umbilical surgeries,at a tertiary care teaching institute from April 2019 to September 2019. These total subjects were randomly allocated into two groups. GroupR (n=40) administered 0.2% ropivacaine (1 mL/kg) while GroupRD (n=40) administered 0.2% ropivacaine (1 mL/kg) with dexamethasone (0.1 mg/kg) in caudal block. The duration of analgesia, postoperative pain scores (Face Legs Activity Cry Consolability (FLACC) score), rescue analgesic consumption in 24 hours, haemodynamic changes and side-effects were noted. The rescue analgesic (paracetamol 15 mg/kg oral) was given whenever FLACC ≥4. Standard qualitative and quantitative tests (unpaired student t-test, Chi-square test) were used to analyse and compare the results obtained. Results: The mean duration of analgesia was significantly longer in Group RD (745.21±146.91 min) as compared to GroupR (440.38±76.44 min); (p-value <0.001). The significantly lower FLACC pain scores were noted in patients in Group RD compared to Group R; (p-value <0.05). The rescue analgesic consumption was significantly lesser in Group RD in terms of requirement of number of doses of rescue analgesic than in Group R; (p-value <0.05). No significant haemodynamic changes or side-effects were observed in both groups; (p-value >0.05). Amongst postoperative complications noted, fever was observed in 1 patient (3.33%) and PONV in 2 patients (6.66%) in Group R. None complications were observed in the patients of RD group. Conclusion: Dexamethasone (0.1 mg/kg) was found to be safe and effective adjuvant to 0.2% ropivacaine for caudal block in children undergoing various infra-umbilical surgeries.

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Analgesic Effect of Intraarticular Tramadol with Morphine after Arthroscopic Knee Surgery

Nepal Orthopaedic Association Journal ◽

10.3126/noaj.v3i1.9320 ◽

2013 ◽

Vol 3 (1) ◽

pp. 14-18

Author(s):

Hussain Faisal ◽

Arjun Lamichhane ◽

Deepak Mahara

Keyword(s):

Side Effects ◽

Arthroscopic Surgery ◽

Visual Analogue Score ◽

Work Load ◽

P Value ◽

Double Blind Study ◽

Morphine Group ◽

Double Blind ◽

Duration Of Symptoms ◽

Significant Difference

Introduction: Post-operative improved pain control of patients has made arthroscopy as a day care procedure, reducing patient’s expenses and hospital staffs work load. Various analgesic drugs have been administered into the joint following Arthroscopy. Intra-articular injection of morphine has been practiced in many centres all over the world. We aimed to compare the efficacy of intra-articular tramadol and morphine. Tramadol is an opioid drug with similar analgesic properties like morphine. Tramadol unlike morphine is readily available over the counter not being abused and has more favourable side effects. Methods: It was a prospectively randomized double-blind study in which sixty patients having elective arthroscopic surgery of the knee were randomized into two groups. Group A (Tramadol Group) received intra-articular tramadol 50mg and Group B (Morphine Group) received morphine 5mg in equivalent volumes. Post-operative pain using Visual Analogue Score (VAS) between 0 and 10, (0 no pain to 10 worst pain) requirement of first analgesic, and incidence of side effects were recorded postoperatively at intervals of 3,4,5,6 and 24 hours. Results: The assessment of VAS score among the two groups in 3,4,5,6 and 24 hours of IA injection showed a p value of 0.349, 0.807, 0.676, 0.271 and 0.163 respectively, suggesting non significant difference in two groups. There was statistically significant result (p=0.005) for request of first analgesia (Ibuprofen 400mg+ Paracetalmol 500mg) at 6 hours of IA injection with tramadol group, requiring less analgesics. There are no other clinically important differences between the groups, including preoperative duration of symptoms, postoperative pain scores and side effects irrespective of the diagnosis and the procedure performed. Conclusion: 50 mg IA tramadol provides analgesia equivalent to 5 mg IA morphine. DOI: http://dx.doi.org/10.3126/noaj.v3i1.9320 Nepal Orthopedic Association Journal 2013 Vol.3(1): 14-18

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Intravenous Propofol and Inhalational Sevoflurane for Ease of Classic Laryngeal Mask Airway Insertion in Patients Undergoing Elective Surgery: A Randomised Clinical Trial

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/49212.15277 ◽

2021 ◽

Author(s):

Nilanjan Chakraborty ◽

Prosenjit Mukherjee ◽

Rita Pal

Keyword(s):

Clinical Trial ◽

Laryngeal Mask Airway ◽

Induction Time ◽

Elective Surgery ◽

Randomised Clinical Trial ◽

Laryngeal Mask ◽

Insertion Time ◽

P Value ◽

Induction Agent ◽

Haemodynamic Changes

Introduction: The Laryngeal Mask Airway (LMA) has gained extensive popularity for airway management during surgery. Propofol, the most commonly used induction agent for LMA insertion, causes significant haemodynamic changes. Sevoflurane has the potential to be as good an induction agent as propofol. Aim: To compare ease of insertion of classic LMA in patients undergoing elective surgery using intravenous propofol and inhalational sevoflurane. Materials and Methods: The study was a randomised clinical trial conducted in the Operation Theatres of Midnapur Medical College and Hospital, Medinipur, West Bengal, India, from August 2019 to July 2020. Eighty patients of American Society of Anaesthesiologists (ASA) physical status grade I and II, of both sexes, and aged between 18 years to 65 years were equally divided into two groups: group P (Propofol group) and group S (Sevoflurane group). Group P was given injection Propofol 2.5 mg/kg body weight and group S was given vital capacity breath induction with 8% sevoflurane and oxygen at 8 litres/min. Loss of Consciousness (LOC) was confirmed and induction time was noted for each group. After confirmation of ease of mouth opening, by an independent observer, LMA insertion was attempted. Ease of LMA insertion was assessed by a predefined 18 points table along with time to LMA insertion and number of attempts. Haemodynamic changes and adverse effects were also recorded. Chi-square test or Student’s t-test were used and a p-value ≤0.05 was considered as statistically significant. Results: With respect to age, sex and weight there were no significant differences between the two groups. Induction time was significantly less in group P (51.85±6.66 seconds) compared to group S (68.38±13.93 seconds) (p-value=0.0001), but LMA insertion time, number of attempts and overall ease of LMA insertion conditions according to the 18 points score were comparable between the two groups. Mean arterial pressure at certain points after induction was significantly less in group P (at 3 minute p-value=0.009 and at 5 minute p-value=0.007). Apnea was significantly more in group P (p-value=0.023). Conclusion: Sevoflurane was comparable to propofol for LMA insertion in respect of ease of insertion and insertion time. Although induction time was significantly less for propofol, sevoflurane offered better haemodynamic stability and lesser incidence of apnea.

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Intermittent clobazam prophylaxis in simple febrile convulsions: a randomised controlled trial

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20190720 ◽

2019 ◽

Vol 6 (2) ◽

pp. 732

Author(s):

Vinod Kumar ◽

Ashish Gupta

Keyword(s):

Side Effects ◽

Febrile Seizure ◽

Controlled Trial ◽

Central Nervous System Infection ◽

Febrile Seizures ◽

P Value ◽

Seizure Recurrence ◽

Normal Children ◽

Double Blind ◽

Effective Measure

Background: Febrile seizure (FS) is the most common type of childhood seizure disorder with a prevalence of 2-5% in children less than 5 years. Although the prognosis of febrile seizure is usually good, however, the possibility of recurrence keeps many parents and families in a state of anxiety and concerned, for years after the first seizure. Thus, intermittent prophylactic treatment might be advised in children with high risk of recurrence.Methods: The study was a prospective randomized, double blind, placebo-controlled trial conducted at Department of Pediatrics, Umaid Hospital, Dr S N Medical College, Jodhpur on neurologically normal children aged from 6 months to 5 years with a history of simple febrile seizures and normal electroencephalogram without any evidence of acute central nervous system infection. Subjects were randomly prescribed oral clobazam according to weight of child and placebo when they developed a febrile disease during the first 48 h of the onset of fever. Temperature reduction measures with paracetamol and tepid sponging were also advised. Patients were followed up for the frequency and time of febrile seizure recurrence, febrile episodes and side effects of drugs for 12 months.Results: Ten (3.8%) of 257 episodes in clobazam group and 38 (14.07%) episodes in placebo group had seizure recurrence (p value <0.001). The two groups were not significantly different in terms of side effects. (p >0.05).Conclusions: Intermittent oral clobazam therapy is a very effective measure in preventing recurrence of febrile seizures.

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Tracheal Intubation without Muscle Relaxant Comparison Between Three Techniques

Journal of the Bangladesh Society of Anaesthesiologists ◽

10.3329/jbsa.v17i1.4049 ◽

2009 ◽

pp. 32-35

Author(s):

M Ali ◽

KM Iqbal ◽

AYF Elahi Chowdhury

Keyword(s):

Side Effects ◽

Tracheal Intubation ◽

Muscle Relaxation ◽

Randomized Study ◽

Alternative Methods ◽

Double Blind ◽

Group A ◽

Thiopental Sodium ◽

Group B ◽

Induction Of Anaesthesia

The standard techniques of tracheal intubation are usually done after induction of anaesthesia followed by skeletal muscle relaxation. The muscle relaxants are associated with many side effects. These side effects have spurred research into development of alternative methods for providing good intubation condition. Forty-five patients with ASA grade I or II, having Mallampati class-I or II airways were divided in three groups depending on administration of drugs in a double blind randomized study. Group-A, thiopental sodium (5mg/kg) + fentanyl (10mcg/ kg) + lignocaine(1mg/kg), Group-B, thiopental sodium (5mg/kg) + fentanyl (10mcg/kg ) and Group-C, thiopental sodium (5mg/kg) + suxamethonium(1mg/kg) Group-C acted as control. The blood pressure and heart rate were measured before induction,after induction and after intubation. Ease of intubation was judged by Scheller intubation criteria. The intubation was possible in all patients of the three groups and there were no significant differences between them in respect to total score.DOI: http://dx.doi.org/10.3329/jbsa.v17i1.4049 Journal of BSA, Vol. 17, No. 1 & 2, 2004 p.32-35

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Effect of Oral Clonidine on Hemodynamic Response During Surgery

Nepalese Heart Journal ◽

10.3126/njh.v7i1.8495 ◽

2013 ◽

Vol 7 (1) ◽

pp. 8-14

Author(s):

Bharati Sharma Regmi ◽

SR Regmi ◽

B Pradhan ◽

MN Marahatta ◽

L Dubey

Keyword(s):

Analgesic Effect ◽

Randomized Study ◽

Hemodynamic Response ◽

P Value ◽

Institute Of Medicine ◽

Special Issue ◽

Double Blind ◽

Oral Clonidine ◽

Adrenoceptor Agonist ◽

Haemodynamic Changes

Clonidine is an alpha 2-adrenoceptor agonist. It has recently, however, found a new and possibly significant role in anaesthesia and the treatment of pain. Diazepam has been used as a drug for premedication for years but oral clonidine has not been used as premedication even though it is cheaper and has longer postoperative analgesic effect. This prospective, double blind randomized study was conducted in department of anaesthesiology, institute of medicine, TUTH. A total 60 consecutive patients scheduled for abdominal gynaecological surgeries were randomized to clonidine or diazepam premedication group and received these drug one hour before surgery planned under spinal anaesthesia. Intraoperative haemodynamic changes in terms of blood pressure, heart rate, oxygen saturation, were recorded. Hypotension was occurred in 9(15%) in clonidine group and 10(16.7%) in diazepam group, (p value> 0.05). During surgery, bradycardia was noted in 6(10%) vs. 3(5%) patient in diazepam and clonidine group respectively (p value >0.05). Nausea, shivering, restlessness were other side effects seen during surgery in both clonidine and diazepam group (33.33% vs. 36.66%). Although few more cases of nausea (1 vs. 5) with clonidine and few more cases of restless (3 vs. 7) were noted with diazepam , the overall difference was not statistically significant between two groups (p value >0.05). Oral clonidine premedication had similar hemodynamic response to diazepam. It is cheaper and has longer postoperative analgesic effect as well as similar sedative effect. Nepalese Heart Journal | Volume 7 | No.1 | November 2010 (special issue) | Page 8-14 DOI: http://dx.doi.org/10.3126/njh.v7i1.8495

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

Indian Journal of Clinical Anaesthesia ◽

10.18231/j.ijca.2021.113 ◽

2021 ◽

Vol 8 (4) ◽

pp. 521-526

Author(s):

Neha Amey Panse ◽

Jyoti Kale ◽

Priyanka Praphulchandra Khondalay

Keyword(s):

Side Effects ◽

Pressor Response ◽

Early Discharge ◽

Airway Device ◽

Supraglottic Airway ◽

P Value ◽

Induction Agent ◽

The Awakening ◽

Supraglottic Airway Devices ◽

Airway Devices

: 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.

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