Randomised Study Comparing the use of Propofol Versus Dexmedetomidine as a Sedative Agent for Patients Presenting for Lower Gastrointestinal Endoscopy

2020 ◽  
Vol 15 (1) ◽  
pp. 61-66
Author(s):  
Sameh A. Ahmed ◽  
Nehad Hawash ◽  
Fatma H. Rizk ◽  
Mahmoud Elkadeem ◽  
Mohamed Elbahnasawy ◽  
...  
Keyword(s):  
Maintenance Dose ◽  
Demographic Data ◽  
Loading Dose ◽  
Hemodynamic Parameters ◽  
Traditional Use ◽  
Randomised Study ◽  
Sedative Agent ◽  
Significant Difference ◽  
Group D ◽  
Positive Effect

Objectives:: Dexmedetomidine, the alpha 2 agonist sedative and an analgesic agent may be beneficial in sedation for endoscopic intervention. Our aim was to compare the use of dexmedetomidine versus the traditional use of propofol as a sedative agent for colonoscopies. Methods:: This study included 100 patients presenting for elective colonoscopy under sedation with random and equal allocation of patients into two groups; group P, in which patients received propofol in a loading dose of 1.5 mg/kg and maintenance dose of 0.5 mg/kg/hr, and group D, in which patients received dexmedetomidine at a loading dose of 1ug/kg and maintenance dose of 0.5 ug/kg/hr. In addition to the demographic data, time to recovery, time of discharge, and endoscopist rating were measured. Also, the hemodynamic parameters were recorded, and also the incidence of postoperative complications. Results:: The basic patients' characteristics, time to recovery, and time of discharge were comparable between the two groups. Moreover, the endoscopist did not significantly report more convenient procedure with one group over the other. Also, there was no significant difference in hemodynamic parameters or in the incidence of complications between the two studied groups. However the use of dexmedetomidine decreased the incidence of hypoxemia. Conclusion:: The use of dexmedetomidine seems to have a similar effect to the use of propofol as a sedative agent for lower GIT endoscopy with the positive effect of dexmedetomidine in decreasing the incidence of perioperative hypoxemia.

scholarly journals Comparison of Dexmedetomidine, midazolam and propofol for sedation of post operative patients on mechanical ventilation- An open label randomised control trial

2021 ◽  
Vol 8 (3) ◽  
pp. 392-395
Author(s):  
Surajit Paul ◽  
Vaskar Majumdar
Keyword(s):  
Heart Rate ◽  
Mechanical Ventilation ◽  
Continuous Infusion ◽  
Maintenance Dose ◽  
Randomised Control Trial ◽  
Time Interval ◽  
Type I ◽  
Loading Dose ◽  
Open Label ◽  
Group D

Mechanical ventilation is a life-sustaining therapy for the treatment of patients with acute respiratory failure. One of the key factors for good clinical practice in the ICU is to provide adequate sedation. An ideal sedative should provide a rapid onset, a rapid recovery. On this background the present study is designed to evaluate the efficacy and safety of dexmedetomidine, propofol and midazolam for sedating property, hemodynamic effects and analgesic. It is an open label, single blinded randomized control trial. Census sampling is planned for recruitment which will have maximum power and type I error <0.05.This study is carried out in 39 adult patients with Glasgow coma scale score of 9-15, Patients were divided randomly into three groups of 13 each. Group M patients received IV inj. Midazolam loading dose 0.15mg/kg followed by maintenance dose of 0.02-0.1mg/kg/hour. Group P patients received intravenous inj. Propofol loading dose of 1.5mg/kg followed by continuous infusion of 1-6 mg/kg/hr. Group D patients received intravenous inj. Dexmedetomidine loading dose of 1μg/kg followed by maintenance dose of 0.2-0.5 μg/kg/hr of continuous infusion by infusion pump. Desired depth of sedation was assessed by Ramsay Sedation Score. The difference in mean age and ASA status among the three groups are not statistically significant. There is no statistical significance of sex & GCS status of the patients of these three groups. In our study, difference of mean HR at different time interval was not statistically significant. But the fall in Heart Rate is more in Group D and Group M than in Group P. The mean heart rate is less in Group D compared to Group M and Group P after 45 minutes of infusion. We found that difference of mean SBP & DBP at different time interval was not statistically significant. In overall Dexmedetomidine Group showed stable RSS score throughout the time interval (between RSS 2 to 3). One patient in Dexmedetomidine group developed bradycardia. Mean opioid at 24th hour was significantly higher in group M than other group and difference was statistically significant and post sedation delirium was not statistically significant. In this study we found that difference of mean hemodynamic parameters at different time interval in three drugs was not statistically significant. The Heart Rate remain lower in Dexmedetomidine Group compared to Midazolam and Propofol Group after 45 minutes of infusion.

scholarly journals Comparison of the Effects of Albumin 5% versus Ringer's Lactate on Blood Loss and Coagulation after Vascular Surgery Using Thromboelastography

2019 ◽  
Vol 7 (8) ◽  
pp. 1335-1341
Author(s):  
Ahmed Abdalla Mohamed ◽  
Nadia Gameel Elsharkawi ◽  
Osama Ismail Zaid ◽  
Ahmed Farag Mohamed ◽  
Nashwa Nabeel Mohamed ◽  
...  
Keyword(s):  
Blood Loss ◽  
Vascular Surgery ◽  
Trigger Point ◽  
Demographic Data ◽  
Human Albumin ◽  
Ringer Lactate ◽  
Randomised Study ◽  
Coagulation Profile ◽  
Significant Difference ◽  
Ringer’S Lactate

AIM: Comparing the effects of Albumin 5% versus Ringer's lactate on blood loss and coagulation after vascular surgery using METHODS: In this randomised study, 60 patients, aged (18-60 years) ASA physical status (I-III) undergoing vascular surgery were included in the study and randomly allocated into two groups using a random number generator, to receive either Human albumin or Ringer lactate after obtaining written informed consent. Group A received 1-2 ml per minute of human albumin 5% combined with normal saline (0.9%). Group B received Ringer's lactate only as of the main solution. Variables were measured after administration of fluids as postoperative measures. The amount of blood needed for testing was 4 ml drawn before the operation and at the end of surgery with a citrate tube (blue tube) from the venous line or using a regular needle. The standard time of 15 minutes was considered to begin processing. RESULTS: There was no statistically significant difference observed between both groups regarding demographic data, surgical wound drainage, haemoglobin level, hematocrit level and coagulation profile. Regarding ROTEM thermoelectrometry variables showed that there was no statistically significant difference was found between the two groups In-TEM variables (Ex-TEM Clotting time, TEM Clot Formation Time) but In-TEM Alpha Angel measured in degrees showed a Statistically significant difference between the two groups. P < 0.001 and Ex-TEM Maximum Clotting Firmness MCF values measured in mm, there was a statistically significant difference between the two groups P = 0.045. CONCLUSION: This study concluded that the use of human albumin (5%) in vascular surgeries before reaching the trigger point for blood transfusion didn’t improve blood loss or coagulation profile compared to the use of ringer lactate only. Therefore, ringer lactate can be used as a good replacement for human albumin. Ringer lactate is readily available and inexpensive while human albumin may be costly.

scholarly journals Comparison of the Effect of Lidocaine Adding Dexketoprofen and Paracetamol in Intravenous Regional Anesthesia

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Ali Akdogan ◽  
Ahmet Eroglu
Keyword(s):  
Motor Block ◽  
Risk Group ◽  
Demographic Data ◽  
Hemodynamic Effects ◽  
Intravenous Anesthesia ◽  
Intravenous Regional Anesthesia ◽  
Significant Difference ◽  
Dexketoprofen Trometamol ◽  
Analgesia Requirement ◽  
Group D

Objective.Comparison of dexketoprofen and paracetamol added to the lidocaine in Regional Intravenous Anesthesia in terms of hemodynamic effects, motor and sensorial block onset times, intraoperative VAS values, and analgesia requirements.Method.The files of 73 patients between 18 and 65 years old in the ASA I-II risk group who underwent hand and forearm surgery were analyzed and 60 patients were included in the study. Patients were divided into 3 groups: Group D (n=20), 3 mg/kg 2% lidocaine and 50 mg/2 mL dexketoprofen trometamol; Group P (n=20), 3 mg/kg 2% lidocaine and 3 mg/kg paracetamol; Group K (n=20), 3 mg/kg 2% lidocaine. Demographic data, motor and sensorial block times, heart rate, mean blood pressure, VAS values, and intraoperative and postoperative analgesia requirements were recorded.Results.Sensorial and motor block onset durations of Group K were significantly longer than other groups. Motor block termination duration was found to be significantly longer in Group D than in Group K. VAS values of Group K were found higher than other groups. There was no significant difference in VAS values between Group D and Group P. Analgesia requirement was found to be significantly more in Group K than in Group P. There was no significant difference between the groups in terms of heart rates and mean arterial pressures.Conclusion.We concluded that the addition of 3 mg/kg paracetamol and 50 mg dexketoprofen to lidocaine as adjuvant in Regional Intravenous Anesthesia applied for hand and/or forearm surgery created a significant difference clinically.

COMPARISION OF ORAL PREGABALIN VERSUS BOLUS DOSE OF INTRAVENOUS DEXMEDETOMIDINE IN ATTENUATING THE HEMODYNAMIC RESPONSES DURING LARYNGOSCOPY, INTUBATION AND PNEUMOPERITONIZATION IN LAPROSCOPIC CHOLECYSTECTOMY: A RANDOMIZED STUDY

2021 ◽  
pp. 74-77
Author(s):  
Jyoti Rani ◽  
Meenaxi Sharma ◽  
Deepak Kumar ◽  
Anumeha Jain
Keyword(s):  
Blood Pressure ◽  
Normal Saline ◽  
Bolus Dose ◽  
Pressor Response ◽  
Randomized Study ◽  
Intravenous Bolus ◽  
Hemodynamic Parameters ◽  
Randomised Study ◽  
Placebo Tablet ◽  
Group D

Background: Laryngoscopy, intubation and pneumoperitoneum during general anaesthesia are severe noxiousstimuli that can produce many adverse effects. Aim of the study was to compare the efcacy of oral pregabalin versus intravenous bolus dose of dexmedetomidine as premedication for attenuating the haemodynamic pressor response during intubation, pneumoperitonization and extubation as well as perioperative stability and requirement of postoperative analgesics. Methods: A Randomised study was conducted in 100 patients undergoing Laparoscopic Cholecystectomy. Participants were divided into two groups in which group P (n=50) received oral pregabalin 150mg with sips of water 1 hour prior to surgery and intravenous normal saline (0.9%) 10ml, 10 mins prior to induction over 10 minutes and those in group D (n=50) received oral placebo tablet with sips of water 1 hour prior to surgery and intravenous dexmedetomidine at 1mcg/kg diluted with normal saline (total volume 10ml), 10 minutes prior to induction over 10 minutes. Hemodynamic parameters like heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), oxygen saturation (SPO2) and ETCO2 were noted before premedication and induction (baseline), at the end of induction and at laryngoscopy and intubation (I0) and then at 1,3,5,10 minutes after intubation as well as atstart of pneumoperitoneum and then after every 10 minutesinterval till the deation of CO2 and also at the time of extubation and 10 minutes thereafte

Efficacy and Safety of High Loading Dose of Colistin in Multidrug-Resistant Acinetobacter baumannii: A Prospective Cohort Study

2017 ◽  
Vol 34 (11-12) ◽  
pp. 996-1002 ◽  
Author(s):  
Wasan Katip ◽  
Methisa Meechoui ◽  
Phatchawan Thawornwittayakom ◽  
Dujrudee Chinwong ◽  
Peninnah Oberdorfer
Keyword(s):  
Cohort Study ◽  
Clinical Response ◽  
Prospective Cohort ◽  
Maintenance Dose ◽  
Dose Group ◽  
Multidrug Resistant ◽  
High Loading ◽  
Loading Dose ◽  
Efficacy And Safety ◽  
Significant Difference

Objectives: We aimed to assess the efficacy and safety of a high loading dose of colistin and no loading dose of colistin to treat multidrug-resistant (MDR) Acinetobacter baumannii infections. Methods: We conducted a prospective cohort study of patients with MDR A baumannii infections at a university-affiliated hospital from December 2014 to January 2016. In the high loading dose group, the patients received a high loading dose of 300 mg colistin base activity (CBA) followed by a maintenance dose of 150 mg CBA twice daily, and patients in the no loading dose group received only the maintenance dose. The primary outcome was clinical response. The secondary outcomes were 28-day mortality and microbiological response. Results: A total of 255 cases were identified. The high loading dose of colistin strategy provided no significant difference in good clinical response when compared to the no loading dose group (65.5% vs 70.4%; P = .442), without a significant difference in the development of renal dysfunction (52.3% vs 49.4%; P = .664). However, microbiological eradication was significantly higher among patients who received the high loading dose of colistin when compared to those who received the no loading dose (87.9% vs 70.4%; P = .0006). Conclusions: The high loading dose of colistin strategy was effective and safe for treating patients with MDR A baumannii.

scholarly journals Effects of Dexmedetomidine on Perioperative Serum Potassium and Postoperative Rehabilitation of Patients Undergoing Radical Resection of Gastrointestinal Malignancy

2021 ◽  
Author(s):  
Shunping Tian ◽  
Dongsheng Zhang ◽  
Ying Wang ◽  
Leyang Yu ◽  
Yanlong Yu ◽  
...  
Keyword(s):  
Serum Potassium ◽  
Maintenance Dose ◽  
Potassium Concentration ◽  
Radical Resection ◽  
Loading Dose ◽  
Postoperative Rehabilitation ◽  
Gastrointestinal Malignancy ◽  
Serum Potassium Concentration ◽  
Registration Number ◽  
Group D

Abstract Background: To investigate the effects of dexmedetomidine on perioperative potassium and postoperative rehabilitation. Methods: Totally 124 patients scheduled for elective radical resection of gastrointestinal malignant tumor under general anesthesia were included. and randomly assigned to four groups (n=31): groups D1, D2 and D3 received dexmedetomidine loading dose 1, 1 and 0.5 μg/kg and maintenance dose 0.25, 0.5 and 0.5 μg/kg/h, respectively, group C received normal saline 50 ml/h for 10 min and maintenance dose 10 ml/h. Serum potassium and lactate changes were recorded at 5 min after arteriovenous puncture (T1), 1 h after surgery beginning (T6), surgery ending (T7) and 1 h into the post-anesthesia care unit (PACU) (T10). Serum potassium was examined at 48 h after surgery (T11). Perioperative rehabilitation indicators were recorded.Results: Compared with basal values, serum potassium concentration in groups C, D1 and D2 increased significantly at T11 (P=0.003, 0.002, and ˂0.001, respectively) and at T7 (P=0.008), T10 (P=0.015) and T11 (P˂0.001) in group D3. Serum potassium at T11 in group D2 was significantly lower than group C (P=0.032). Serum potassium at T7 in group D3 was significantly higher than group D2 (P=0.036). There were no significant differences in perioperative rehabilitation indicators in all groups. Conclusions: Dexmedetomidine did not decrease perioperative potassium significantly in patients undergoing radical resection of gastrointestinal malignancy, while its loading dose 0.5 μg/kg and maintenance dose 0.5 μg/kg/h can elevate potassium slightly with no adverse effect on perioperative rehabilitation.Trial registration: This study was retrospectively registered on the clinicaltrials.gov website (registration number: NCT04771637).

scholarly journals Effect of dexmedetomidine as adjuvant in supraclavicular block for upper limb orthopedic surgeries

2017 ◽  
Vol 4 (5) ◽  
pp. 1510 ◽  
Author(s):  
Dixitkumar B. Modh ◽  
Manthan Parmar ◽  
Shilpin Solanki
Keyword(s):  
Upper Limb ◽  
Motor Block ◽  
Demographic Data ◽  
Total Duration ◽  
Hemodynamic Parameters ◽  
Physical Status ◽  
Analgesic Requirement ◽  
Respiratory Parameters ◽  
Supraclavicular Block ◽  
Group D

Background: Dexmedetomidine has anxiolytic, sedative, hypnosis, analgesic, antisialogogue and sympatholytic properties which render it suitable as an adjuvant. Hence this study was aimed to prove its efficacy as an adjuvant to lignocaine and bupivacaine for supraclavicular block in patients undergoing orthopedic upper limb surgeries. Other objectives of the study were to evaluate and compare the onset and duration of sensory and motor block as well as total analgesia, to compare effect on hemodynamic and respiratory parameters and to study any adverse effect associated with dexmedetomidine as adjuvant.Methods: Sixty patients of ASA physical status class I & II of elective upper limb forearm orthopedic surgeries were selected in our study. Patients in group NS (n=30) received 10 ml lignocaine 2% + 20 ml bupivacaine 0.5% + 1 ml normal saline for supraclavicular block and group D (n=30) received 10 ml lignocaine 2% + 20 ml bupivacaine 0.5% + 1 µg/kg of Dexmedetomidine for the same block. The onset and duration of sensory and motor block, total duration of analgesia, need of rescue analgesic postoperatively, postoperative VAS score was assessed and compared between the two groups.Results: Demographic data and surgical characteristics are comparable in both the groups. The onset of sensory and motor block was significantly lower (p <0.05) in group D than in group NS. The duration of sensory and motor block was significantly higher (p <0.01) in group D when compared to group NS. The duration of analgesic requirement postoperatively was significantly higher (p <0.01) in group D than group NS. No significant change in observations was made for hemodynamic parameters in both the groups.Conclusions: Dexmedetomidine can be considered as an adjuvant to lignocaine and bupivacaine mixture for excellent quality supraclavicular block without any side effects and provide good sedation in patients undergoing orthopedic upper limb surgeries.

Predicting the Dose of Warfarin for Therapeutic Anticoagulation

1982 ◽  
Vol 47 (03) ◽  
pp. 230-231 ◽  
Author(s):  
N K Sharma ◽  
P A Routledge ◽  
M D Rawlins ◽  
D M Davies
Keyword(s):  
Therapeutic Range ◽  
Significant Relationship ◽  
Maintenance Dose ◽  
Warfarin Dose ◽  
Loading Dose ◽  
Intravenous Injections ◽  
Therapeutic Anticoagulation ◽  
Close Relationship ◽  
The Relationship ◽  
Anticoagulant Response

SummaryThe validity of a previously described technique for predicting warfarin requirements based on the anticoagulant response to a fixed loading dose was assessed prospectively in 57 patients. There was a close relationship between the predicted and initially observed daily warfarin dose required to maintain the patient within the therapeutic range for anticoagulation. The significant relationship between predicted and observed maintenance dose persisted at 4 and 12 weeks although it decreased with increasing time.The relationship between observed and predicted maintenance requirement of warfarin was not affected by the concomitant use of intermittent intravenous injections of heparin when 9 hr was allowed to elapse between the previous dose of heparin and the thrombotest estimation on which the prediction was based.It is concluded that the method is valuable in predicting an individual’s warfarin requirement, although it does not obviate the need for regular monitoring of anticoagulant control.

Parent’s Experiences from the Treatment of their Children at the Physic Children’s Surgery Clinic in Skopje.

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
M. Trajchevska ◽  
A. Lleshi ◽  
S. Gjoshev ◽  
A. Trajchevski
Keyword(s):  
Health Care ◽  
Health Status ◽  
Independent Predictor ◽  
Demographic Data ◽  
Parental Satisfaction ◽  
Pediatric Care ◽  
Simple Random Sample ◽  
Significant Independent Predictor ◽  
Cross Sectional ◽  
Significant Difference

Background: The respect of the needs and wishes of the patients is in the focus of the human health system. The experience of the parents in terms of child’s health care may be used as an indicator of quality of the health care. Material and methods: The research is a quantitative analytical cross-sectional study. In accordance with the inclusion and exclusion criteria, simple random sample of 207 parents / guardians is covered, whose children in the period of three months, had been hospitalized in the hospital department JZUU Pediatric Surgery Clinic in Skopje.It was used a two parted questionnaire. The first part is a standardized questionnaire (Parent Experience of Pediatric Care - PECP), and the second part concerns the general socio-demographic data of the parent/guardian. Statistical evaluation was performed using appropriate statistical programs (Statistics for Windows 7,0 and SPSS 17.0). Results: In accordance with the age of the parents, the survey respondents were divided into two groups: a) age ≤ 33 years - 107 (51.69%) and b) age> 33 years - 100 (48.31%).Significant independent predictor of parental satisfaction from the receipt of their child to the clinic research confirms the age of the parent under / over 33 years due to 4.1% of the change in satisfaction (R2 = 0,041). Parents generally believe that their children's room of the clinic is "good", without significant difference between parental satisfaction from both age groups (Mann-Whitney U Test Z = -0,9613 p = 0,3364). Significant independent predictor of parental satisfaction from the room of their child improves the health status after treatment due to 6% of the change in satisfaction (R2 = 0,060). Parents generally believe that testing and treatment of their children in the clinic was "very good" and an independent significant predictor is to improve the health status after the treatment - 7,8% (R2 = 0,078). Conclusions: Regardless of the generally good parental satisfaction about health care for their children, it is necessary to continuously monitor the status of the clinic in order to consider the possible deficiencies and needs of intervention.

Effect of Chewing Gum on Bowel Motility in Women Undergoing Post-Operative Cesarean Section

2018 ◽  
Vol 3 (06) ◽  
Author(s):  
Dr.Randa Mohammed AboBaker
Keyword(s):  
Cesarean Section ◽  
Hospital Stay ◽  
Demographic Data ◽  
Length Of Hospital Stay ◽  
Chewing Gum ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Bowel Motility ◽  
Gum Chewing ◽  
Significant Difference

Postoperative Ileus (POI) is one of the most common problems after obstetrics, gynecologic and abdominal surgeries. Sham feeding, such as gum chewing, accelerates the return of bowel function and the length of hospital stay. The present study aims to evaluate the effect of chewing gum on bowel motility in women undergoing post-operative cesarean section. Intervention study was used at the Postpartum Department of Maternity and Children Hospital, KSA. A randomized controlled clinical trial research design. Through a convenience technique, 80 post Caesarian Section (CS) women were included in the study. Data were collected through three tools: Tool (I): Socio-demographic data and reproductive history interview schedule. Tool (II): Postoperative Assessment Sheet. Tool (III): Outcomes of gum chewing and the length of hospital stay.  Method: subjects were assigned randomly into two groups of (40) the experimental and (40) the control. Subjects in the study group were asked to chew two pieces of sugarless gum for 30 min/three times daily in the morning, noon, and evening immediately after recovery from anesthesia and in Postpartum Department; while subjects in the control group followed the hospital routine care. Each woman in both groups was tested abdominally using a stethoscope to auscultate the bowel sounds and asked to report immediately the time of either passing flatus or stool. Results: illustrated that a highly statistically significant difference was observed between the two groups concerning their gum chewing outcomes. Where, P = 0.000. The study concluded that gum chewing is safe, well tolerated and appears to be effective in reducing the incidence and consequences of POI following CS.

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