scholarly journals The median effective concentration of propofol with different doses of esketamine during gastrointestinal endoscopy in elderly patients：a randomized controlled trial

2021 ◽  
Author(s):  
Hua Yang ◽  
Qian Zhao ◽  
Hai-yan Chen ◽  
Wen Liu ◽  
Tong Ding ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Gastrointestinal Endoscopy ◽  
Controlled Trial ◽  
Effective Concentration ◽  
Saline Control ◽  
Control Group ◽  
Aspartate Receptor ◽  
Initial Plasma ◽  
Median Effective Concentration ◽  
Different Doses

Abstract Background: Propofol may result in hypotension, bradycardia, and loss of protective reflexes, especially in elderly patients, while esketamine, a N-methyl-D-aspartate receptor antagonists, has analgesic, anaesthetic and sympathomimetic properties and is known to cause less cardiorespiratory depression. We hypothesized that esketamine may reduce the median effective concentration (EC50) of propofol and cause more stable haemodynamic responses during gastrointestinal endoscopy in elderly patients. Methods: Ninety elderly patients, aged 65-89 years, undergoing gastrointestinal endoscopy were randomly assigned into three groups: SK0.25 group (0.25 mg/kg esketamine), SK0.5 group (0.5 mg/kg esketamine) and saline control group. Anaesthesia was achieved by target-controlled infusion of propofol with an initial plasma concentration of 2.5 μg/ml with different bolus doses of esketamine during gastrointestinal endoscopy. The EC50 of propofol for gastrointestinal endoscopy was determined by using an up-and-down method of Dixon with an adjacent concentration gradient at 0.5μg/mL to prohibit purposeful movements. Cardiovascular parameters were also measured and recorded. Results: Propofol EC50 and its 95% confidence interval for gastrointestinal endoscopy in elderly patients were 1.71 (1.15-2.27) μg/mL in SK0.5 group, 2.45 (1.85-3.05) μg/mL in SK0.25 group and 3.69 (2.59-4.78) μg/mL in control group respectively (P < 0.05). The average percent change to baseline mean arterial pressure (MBP) was -19.7 (7.55), -15.2 (7.14) and -10.1 (6.73) with P＜0.001, in the control group, the SK0.25 group and the SK0.5 group, respectively. Conclusions: Combination medication of propofol with esketamine reduced the propofol EC50 during gastrointestinal endoscopy in elderly patients and caused more stable haemodynamic responses compared with single administration of propofol.

scholarly journals Different doses of steroid injection in elderly patients with carpal tunnel syndrome: a triple-blind, randomized, controlled trial

2018 ◽  
Vol Volume 13 ◽  
pp. 117-124 ◽  
Author(s):  
Reza Salman Roghani ◽  
Mohammad Taghi Holisaz ◽  
Masoud Tarkashvand ◽  
Ahmad Delbari ◽  
Faeze Gohari ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Carpal Tunnel Syndrome ◽  
Elderly Patients ◽  
Carpal Tunnel ◽  
Steroid Injection ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Tunnel Syndrome ◽  
Different Doses

314 MELATONIN ON IN VIVO AND IN VITRO MATURATION OF MOUSE OOCYTES

2015 ◽  
Vol 27 (1) ◽  
pp. 246 ◽  
Author(s):  
H. Fernandes ◽  
L. Schefer ◽  
F. C. Castro ◽  
C. L. V. Leal
Keyword(s):  
Ovarian Stimulation ◽  
In Vitro Maturation ◽  
F1 Hybrids ◽  
Saline Control ◽  
Control Group ◽  
Mouse Oocytes ◽  
Maturation Rate ◽  
Different Doses

Melatonin is a pineal hormone related to the control of the circadian cycle, besides the reproductive seasonality of some animal species, and has shown positive effects on oocyte maturation and embryo development. The aim of this study was to assess the effects of melatonin on in vivo and in vitro maturation of mouse oocytes. Female F1 hybrids (C57BL/6 × CBA; n = 8 per group/treatment) were used in 3 different treatments (trt) groups: (I) in vivo trt: mice received 2 different doses of melatonin injections, 10 and 20 mg kg–1 per IP including a saline control dose (0 mg kg–1 per IP) for 4 days along with ovarian stimulation trt of 5 IU of eCG IP, followed by 5 IU of hCG IP 48 h later, and cumulus-oocyte complexes (COC) were collected 16 h after hCG; (II) mice received a similar in vivo melatonin trt, but ovarian stimulation trt was only 5 IU of eCG, no hCG, and COC were collected after 48 h and subsequently matured in vitro with 0.5 µg mL–1 of FSH for 16 h; (III) in vitro maturation of oocytes: COC were collected 48 h after 5 IU of eCG and maturated in the presence of 3 different doses of melatonin (10–9, 10–6, and 10–3 M) or 0.5 µg mL–1 of FSH (control) for 16 h. In vitro-maturing oocytes were in incubated at 37°C, 5% CO2, and 95% humidity. Maturation rates were evaluated according to the presence of the first polar body under an inverted microscope. Statistical analyses were performed by ANOVA followed by Tukey's test (4 replicates). In the first treatment, 20 mg kg–1 of melatonin showed the highest in vivo maturation rate, 80.3% (61/76), while 10 mg kg–1 of melatonin was 62.4% (53/85) and the saline control group was 69.4% (77/111), but differences were not significant (P > 0.05). For in vitro maturation of oocytes from animals previously treated with melatonin, the 10 mg kg–1 of melatonin group had the highest maturation rate, 53.2% (99/186), in comparison with the saline and 20 mg kg–1 of melatonin groups, which showed 46.6 (88/189) and 39.0% (85/218), respectively; again, no differences were detected (P > 0.05). In the last treatment, the maturation rates increased from 48.9 (43/88) to 53.7 (51/95) and 56.0% (56/100) as the melatonin concentrations decreased from 10–3, 10–6, and 10–9 M, respectively. The control group had the highest rate of 57.3% (55/96), but no statistical differences were observed (P = 0.706). In conclusion, under the conditions studied, melatonin was unable to improve the maturation rate neither after in vivo nor in vitro treatment. However, during in vitro maturation, melatonin alone was as efficient as FSH in promoting maturation in murine oocytes, indicating its potential effect on stimulating meiosis. Therefore, the role of melatonin in stimulating meiosis needs further investigation.Acknowledgments to FAPESP for fellowship (HF) and funding (CLVL).

Effects of transcutaneous electrical acupuncture point stimulation on peripheral capillary oxygen saturation in elderly patients undergoing colonoscopy with sedation: a prospective randomized controlled trial

2020 ◽  
pp. 096452842096047
Author(s):  
Yongming Chen ◽  
Yin Gong ◽  
Xiaorong Huai ◽  
Xiyao Gu ◽  
Diansan Su ◽  
...  
Keyword(s):  
Treatment Group ◽  
Elderly Patients ◽  
Oxygen Saturation ◽  
Controlled Trial ◽  
Acupuncture Point ◽  
Control Group ◽  
Prospective Randomized Controlled Trial ◽  
Electrical Acupuncture ◽  
Registration Number ◽  
Blood Pressures

Introduction: This study investigated whether transcutaneous electrical acupuncture point stimulation (TEAS) at PC6 can reduce the proportion of elderly patients experiencing a drop of ⩾4% in peripheral capillary oxygen saturation (SpO2) while undergoing colonoscopy under sedation. Methods: A total of 32 elderly patients (aged ⩾ 65 years) scheduled for colonoscopy were randomly assigned in a 1:1 ratio to receive either real or sham TEAS (treatment or control groups, respectively). Each patient received oxygen (2 L/min) delivered routinely via nasal cannula. The treatment group was given TEAS at PC6 for 20 min at 2 Hz frequency and 6 mA intensity; the control group underwent the same procedures but with zero frequency/intensity. SpO2 and other physiological parameters were measured prior to sedation and colonoscopy (baseline) and at seven other timepoints through departure from recovery. Depth of anesthesia was measured using a Narcotrend monitor. Results: Significantly fewer patients in the treatment group experienced a ⩾4% decrease from baseline SpO2 (2/16) than patients in the control group (10/16; p = 0.004). The two groups were comparable with regard to respiratory rate, systolic and diastolic blood pressures, mean arterial pressure, and heart rate. Conclusion: TEAS applied at PC6 with 2 Hz frequency was feasible and may be helpful in reducing the rate of hypoxia in elderly patients during colonoscopy. Trial registration number: NCT03775122 (ClinicalTrials.gov).

Does Epidural Anesthesia Have General Anesthetic Effects? 

1999 ◽  
Vol 91 (6) ◽  
pp. 1687-1687 ◽  
Author(s):  
Peter S. Hodgson ◽  
Spencer S. Liu ◽  
Troy W. Gras
Keyword(s):  
General Anesthesia ◽  
Epidural Anesthesia ◽  
Controlled Trial ◽  
Saline Control ◽  
Control Group ◽  
Double Blind ◽  
Lidocaine Group ◽  
Group I ◽  
End Tidal ◽  
Volatile Agents

Background Clinically, patients require surprisingly low end-tidal concentrations of volatile agents during combined epidural-general anesthesia. Neuraxial anesthesia exhibits sedative properties that may reduce requirements for general anesthesia. The authors tested whether epidural lidocaine reduces volatile anesthetic requirements as measured by the minimum alveolar concentration (MAC) of sevoflurane for noxious testing cephalad to the sensory block. Methods In a prospective, randomized, double-blind, placebo-controlled trial, 44 patients received 300 mg epidural lidocaine (group E), epidural saline control (group C), or epidural saline-intravenous lidocaine infusion (group I) after premedication with 0.02 mg/kg midazolam and 1 microg/kg fentanyl. Tracheal intubation followed standard induction with 4 mg/kg thiopental and succinylcholine 1 mg/kg. After 10 min or more of stable end-tidal sevoflurane, 10 s of 50 Hz, 60 mA tetanic electrical stimulation were applied to the fifth cervical dermatome. Predetermined end-tidal sevoflurane concentrations and the MAC for each group were determined by the up-and-down method and probit analysis based on patient movement. Results MAC of sevoflurane for group E, 0.52+/-0.18% (+/- 95% confidence interval [CI]), differed significantly from group C, 1.18+/-0.18% (P &lt; 0.0005), and from group I, 1.04+/-0.18% (P &lt; 0.001). The plasma lidocaine levels in groups E and I were comparable (2.3+/-1.0 vs. 3.0+/-1.2 microg/ml +/- SD). Conclusions Lidocaine epidural anesthesia reduced the MAC of sevoflurane by approximately 50%. This MAC sparing is most likely caused by indirect central effects of spinal deafferentation and not to systemic effects of lidocaine or direct neural blockade. Thus, lower concentrations of volatile agents than those based on standard MAC values may be adequate during combined epidural-general anesthesia.

scholarly journals The Efficacy of the Comprehensive Assessment and Multi-Disciplinary Management of Geriatric and Frail Patients: The Study Protocol of a Multi-Center, Randomized, Parallel Controlled Trial (MDT-F)

2020 ◽  
Author(s):  
Simin Yao ◽  
Peipei Zheng ◽  
Liwei Ji ◽  
Zhao Ma ◽  
Lijuan Wang ◽  
...  
Keyword(s):  
Patient Education ◽  
Elderly Patients ◽  
Drug Evaluation ◽  
Controlled Trial ◽  
Intervention Group ◽  
Nutritional Intervention ◽  
Control Group ◽  
Clinical Frailty Scale ◽  
Nutrition Risk ◽  
Frailty Status

Abstract Background: A comprehensive geriatric assessment (CGA) of elderly patients is useful for detecting the patients' vulnerabilities. Exercise and early rehabilitation, nutritional intervention, traditional Chinese medicine (TCM), standardized medication guidance and patient education can, separately, improve and even reverse the physical frailty status. However, the effect of combining a CGA and multi-disciplinary management on frailty in elderly patients remains unclear. The present study assessed the effects of a CGA and multi-disciplinary management on elderly patients with frailty in China.Methods: In this study, 320 inpatients with frailty ≥70 years old will be randomly divided into an intervention group and a control group. The intervention group will be given routine management, a CGA and multi-disciplinary management involving rehabilitation exercise, diet adjustment, multi-drug evaluation, acupoint massage in TCM and patient education for 12 months, and the control group will be followed up with routine management for basic diseases. The primary outcomes are the Fried phenotype and short physical performance battery (SPPB). The secondary outcomes are the clinical frailty scale (CFS), non-elective hospital readmission, basic activities of daily living (BADL), 5­level european quality of life 5 dimensions index (EQ-5D), nutrition risk screening-2002 (NRS-2002), medical insurance expenses, fall events and all-cause mortality. In addition, a cost-effectiveness study will be carried out. Discussion: This paper outlines the protocol for a randomized, single-blind, parallel multi-center clinical study. This protocol, if beneficial, will demonstrate the interaction of various intervention strategies, will help improve elderly frailty patients, and will be useful for clinicians, nurses, policymakers, public health authorities and the general population.Trial registration: Chinese Clinical Trials Register, ChiCTR1900022623. Registered on 19 April 2019, http://www.chictr.org.cn/showproj.aspx?proj=38141.

scholarly journals Intrauterine levobupivacaine for pain control during intrauterine device insertion

2017 ◽  
Vol 6 (3) ◽  
pp. 1117
Author(s):  
Nilufer Akgun ◽  
Esra Keskin ◽  
Muberra Namlı Kalem ◽  
Batuhan Bakirarar
Keyword(s):  
Pain Control ◽  
Controlled Trial ◽  
Intrauterine Device ◽  
Saline Control ◽  
Control Group ◽  
Double Blind ◽  
Pain Scores ◽  
Significant Difference ◽  
Vas Scores

Background: Safe, effective, long term and a reversible contraception method is offered by intrauterine devices (IUDs).  The objective was to determine the potency of intrauterine administration of 5 cc levobupivacain for pain relief with IUD insertion, when compared with saline placebo.Methods: This was a prospective randomized, double blind placebo-controlled trial undergoing İUD insertion. The trial medication was intrauterine anesthesia, either 5 mL 0.9% saline (control group), or 5 mL 0.5% levobupivacaine. Our primary outcome was self-reported pain scores on a 10 cm visual analogue scale (VAS) immediately following IUD insertion.Results: 95 women were enrolled, and data for 88 women were analyzed. In IUD insertion procedure, no difference was observed between groups during teneculum placement and solution administration, in the course of VAS scores (p=0.349, p=0.396). There was a significant difference in the VAS scores measuring pain suffering during and after IUD procedure (p=0.001).Conclusions: Intrauterine instillation of 5 cc of levobupivacaine along with saline solution reduces pain with IUD insertion when compared to intrauterine saline placebo. Broad deviation in pain scores and persistent pain after IUD insertion recommends that patient would benefit from more functioning method of pain control than before at IUD insertion and during the post interval.

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