scholarly journals A comparative evaluation of dexmedetomidine and fentanyl to attenuate hemodynamic response to laryngoscopy and intubation

2018 ◽  
Vol 9 (1) ◽  
pp. 65-72
Author(s):  
Erum Ozair ◽  
Qazi Ehsan Ali ◽  
Md Masood Husain Siddiqi ◽  
Syed Hussain Amir ◽  
Shagufta Naaz
Keyword(s):  
Elective Surgery ◽  
Pressor Response ◽  
Demographic Data ◽  
Hemodynamic Response ◽  
T Test ◽  
Chi Square ◽  
Demographic Profiles ◽  
Hemodynamic Variables ◽  
Group A ◽  
Group B

Background: Laryngoscopy and intubation are associated with a sympathetically mediated circulatory response due to irritation of respiratory tract which is associated with increase in pulse rate and blood pressure that may be dangerous.Aims and Objectives: The aim of the present study was to determine and compare the efficacy of dexmedetomidine and fentanyl in attenuating the hemodynamic response to laryngoscopy and intubation and to detect any complication or side effect as a result of these drugs.Materials and Methods: Following approval by ethical committee, 60 ASA grade I and II patients of either sex undergoing general anaesthesia for elective surgery were included in this study. Patients were randomly divided into two groups of 30 patients each. Dexmedetomidine in a dose of 1μg/kg was given to Group A patients and Fentanyl 2 μg/kg was given to Group B patients. Both the drugs were diluted with normal saline solution to make 10ml and were administered slow intravenous 10 min before induction.The hemodynamic parameters were recorded, demographic data was analyzed using unpaired t-test and hemodynamic variables were analyzed by using unpaired and paired t-test. Side effects were analyzed using chi square test.Result: The two groups were comparable in their demographic profiles. Dexmedetomidine proved itself to be an excellent drug when given intravenously as a premedicant in dose of 1μg/kg to attenuate hemodynamic response to laryngoscopy and intubation. It blunted the hemodynamic response to laryngoscopy and intubation to a greater magnitude than fentanylin a dose of 2μg/kg intravenously as a premedicant.Conclusion: We conclude that fentanyl 2μg/kg i.v. given ten minutes prior to airway instrumentation shows an inconsistent response to laryngoscopy and intubation. Between the two drugs under study, the use of dexmedetomidine 1μg/kg i.v. is satisfactory and produces a more favorable hemodynamic profile while fentanyl 2μg/kg is found to be non- dependable and less effective for the attenuation of the pressor response to laryngoscopy and endotracheal intubation. However, further larger studies are required to strengthen these conclusions.Asian Journal of Medical Sciences Vol.9(1) 2018 65-72

Combination Therapy Of Tadalafil And Pentoxifylline In Severe Erectile Dysfunction; A Prospective Randomized Trial

2015 ◽  
Vol 87 (8) ◽  
Author(s):  
Santosh Kumar ◽  
Rajesh Roat ◽  
Swati Agrawal ◽  
Kumar Jayant ◽  
Ravimohan S. Mavuduru ◽  
...  
Keyword(s):  
Erectile Dysfunction ◽  
Combination Therapy ◽  
Erectile Function ◽  
T Test ◽  
P Value ◽  
Chi Square ◽  
Significant Difference ◽  
Chi Square Test ◽  
Group A ◽  
Group B

Abstractwas to assess efficacy of Tadalafil alone versus Tadalafil plus Pentoxifylline in the treatment of erectile dysfunction by using self administered IIEF-5 questionnaire.Two hundred and thirty seven patients presenting with ED at andrology OPD were evaluated for ED by a self administered IIEF (International Index of Erectile Function) questionnaire. Patients were systematically randomized by computer generated random table into two groups groups namely, group A: Tadalafil only group, group B: combination of Tadalafil + Pentoxifyl-line. All the patients were re-assessed by IIEF-5 questionnaire after 8 weeks of medical therapy. Statistical analysis was performed using student’s unpaired t-test, paired t-test, chi square test. p-value < 0.05 was considered statistically significant.Two hundred and thirty seven patients were included in the present study, in group A: 92 patients (78.6%) showed improvement in their IIEF score after 8 weeks of tadalafil treatment. While in group B, overall 104 patients(86.6%) showed improvement after combination of Tadalafil and Pentoxifylline. There was a statistically significant difference of percentage change in IIEF score was seen in group B (group A 90.7±15.2%, group B 95.6±13.4%; p value – 0.014). We found this difference even more statistically significant in patients with severe ED (group A 72.7±47.2%, group B 132.3±54.3%; p value – 0.000). There was no significant difference in between the two groups with regards to occur-rence of side effects.Both tadalafil and combination of Tadalafil + Pentoxifylline improve erectile function in patients of ED. Patients with severe ED showed much significant improvement in erectile function with combination therapy.

scholarly journals A randomized controlled trial to compare effects of different volume and concentration of lidocaine for preventing propofol injection pain in adults

2019 ◽  
Vol 8 (3) ◽  
pp. 564
Author(s):  
Ashish Patyal ◽  
Anjana Verma ◽  
Madhavi Buddhi
Keyword(s):  
Rating Scale ◽  
Elective Surgery ◽  
Controlled Trial ◽  
Numeric Rating Scale ◽  
Injection Pain ◽  
Response Scale ◽  
Chi Square ◽  
Experienced Pain ◽  
Group A ◽  
Group B

Background: Pain on propofol injection is an unwanted effect which can lead to decreased patient satisfaction. Although many studies have shown that pre-treatment with lidocaine injection is effective in this pain, nevertheless, very few studies have been done  on different concentration and volume of lidocaine, effective of reducing pain significantly. Objective of the current study was to assess and compare the efficacy of intravenous lidocaine with  0.4% and 2% concentration in reducing the incidence and severity of propofol injection pain.Methods: A total of 126 American Society of Anesthesiologist grade I and II patients with age ≥18 years, scheduled for an elective surgery, were enrolled in the study. Patients were randomized into two equal groups of 63 each. Group A (n = 63) received pretreatment with 0.4% lidocaine and group B (n = 63) received 2% lidocaine. Propofol injection pain was measured by using Numeric Rating Scale (NRS) and Withdrawl Response Scale (WRS). Unpaired t test, ANOVA and Chi square test were used for statistical analysis.Results: A statistically significant decrease in the pain was recorded in group A (0.4% lidocaine) as compared to group B (2% lidocaine). Using NRS scale, 12% of patients in group A as compared to 33% patients of group B, experienced pain (p =0.02); while using WRS, 8% patients of group A as compared to 27% group B patients experienced pain (p= 0.04).Conclusions: The pain on injection of propofol is significantly decreased by the use of 0.4% lidocaine in comparison with 2% Lidocaine.

Image-guided versus palpation-guided injections for the treatment of chronic lateral epicondylopathy: a randomized controlled clinical trial

2018 ◽  
Vol 50 (05) ◽  
pp. 348-352 ◽  
Author(s):  
Michael-Alexander Malahias ◽  
Maria-Kyriaki Kaseta ◽  
Sotirios-Tsambikos Kazas ◽  
Panayiotis D Megaloikonomos ◽  
Andreas F Mavrogenis ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Statistical Difference ◽  
Lateral Epicondylitis ◽  
T Test ◽  
Controlled Clinical Trial ◽  
Ultrasound Guided ◽  
Chi Square ◽  
Before And After ◽  
Group A ◽  
Group B

Abstract Background There have been several studies published comparing the ultrasound-guided with the “blind” infiltrations in the shoulder’s area. On the contrary, there is only very limited data regarding the necessity of ultrasound guidance in lateral epicondylitis. Materials and Methods A prospective, randomized, blinded at initial and follow-up evaluation, comparative clinical trial was conducted, involving 44 patients with a history of chronic persistent epicondylopathy. The patients were randomly divided into 2 groups of 22 people each. Group A patients underwent three ultrasound-guided betamethazone injections, while group B included those who underwent three “blind” injections, centered at the palpable point of maximum pain. The evaluation was done before and after (4 and 12 weeks) the injections using the Visual Analogue Scale for pain (VAS, 0–10) and the Roles & Maudsley score. Results There was not any significant statistical difference between the two groups as for mean VAS at 4 weeks (p = 0.150, t-test) and mean VAS at 12 weeks (p = 0.286, t-test). Furthermore, the final success rate, as measured by the Roles & Maudsley score, was slightly superior in group B (67 % of the patients with excellent or good results) when compared with group A (46 % of the patients), but without any statistical difference (p = 0.161, chi-square). Conclusion Our trial proved that an ultrasound-guided injection is not superior than a palpation-guided injection of corticosteroids in the treatment of lateral epicondylopathy.

scholarly journals Perbandingan Insidensi Hipotensi Saat Induksi Intravena Propofol 2 Mg/Kg Bb Pada Posisi Supine dengan Perlakuan dan Tanpa Perlakuan Elevasi Tungkai

2016 ◽  
Vol 5 (1) ◽  
Author(s):  
Beni Indra ◽  
Untung Widodo ◽  
Yunita Widyastuti
Keyword(s):  
Randomized Control Trial ◽  
Elective Surgery ◽  
P Value ◽  
Chi Square ◽  
Parametric Data ◽  
Chi Square Test ◽  
Group A ◽  
Randomized Control ◽  
American Society ◽  
Group B

Abstrak          Penggunaan Propofol untuk induksi pada general anestesi dapat menyebabkan  hipotensi akibat vasodilatasi arteri dan vena terutama vena kapasitan ditungkai. Manuver elevasi tungkai dapat mempertahankan stabilitas hemodinamik dengan meningkatkan aliran balik vena ke jantung dan mengurangi penumpukan darah di vena kapasitan tungkai. Penelitian ini dirancang dengan menggunakan cara Open Randomized Control Trial. Subyek penelitian adalah 184 sampel pasien dewasa ASA I-II yang menjalani operasi elektif dengan menggunakan general anestesi dengan induksi propofol. Kelompok sampel penelitian dibagi dalam dua kelompok masing-masing berjumlah 92 orang. Setelah prabeban cairan RL 10 cc/kgbb dan pemberian fentanyl 2 mcg/kgbb dan midazolam 0,05 mg/kgbb maka kelompok A dilakukan elevasi tungkai 45º satu menit sebelum induksi propofol dan dipertahankan sampai penelitian selesai. Sedangkan kelompok B tidak dilakukan elevasi tungkai. Data yang dikumpulkan dianalisa dengan uji t tes. Untuk data proporsi dilakukan analisa dengan tes chi-square. Dari data demografi tidak didapatkan perbedaan yang bermakna secara statistik (p>0,05) antara kedua kelompok penelitian kecuali untuk BMI (p<0,05). Insidensi hipotensi  menit pertama pasca induksi propofol pada kelompok A (elevasi tungkai) secara signifikan lebih rendah (12%) dibanding kelompok kontrol B  (27,2%) (p=0,016; p < 0,05). Pada menit ketiga pasca induksi juga didapatkan insidensi hipotensi kelompok A  (15,2%) signifikan lebih rendah dibanding kelompok B (23,9%) (p= 0,014; p < 0,05). Elevasi tungkai 45 derajat efektif dalam menurunkan insidensi hipotensi pasca induksi propofol.  Kata kunci: propofol, hipotensi, elevasi tungkai AbstractThe induction of general anaesthesia with propofol may induce of considerable degree of hypotension that has been atributed to decrease in systemic vascular resistance  caused by combination of venous and arterial vasodilatation. It will produce a shifting  of blood to venous reservoir, especially capacitance venule of legs. Leg elevation can provide hemodynamic stability by increases cardiac preload and recruits blood contained in the venous reservoir. This is Open Randomized Control Trial include 184 elective surgery patients with American Society of Anaesthesiologist (ASA) physical status I and II. Anesthesia  was induced with propofol. Patients were randomly allocated into two groups with 92 patients in each. All the patients received Ringer’s Lactate (10 ml/kg) and premedicated with fentanyl (2 mcg/kg) and midazolam (0,05 mg/kg) before induction of anesthesia. Group A was performed passive leg raising 45 degree 1 minute before injection of propofol until  the end of study and group B (control) did not receive any maneuver. Parametric data were analyzed with t-test and categorical data was done by using Chi-square test. A p value of less than 0,05 was consider significant. Demografic characteristics (age, sex, body weight and height) and  baseline haemodynamic parameters of the patients were similar in two groups (p > 0.05) except for BMI (p < 0.05) . The incidence of hypotension was significantly lower in group A (12 %, ) than group  B (27,2%) at the first minute after propofol  injection, p value = 0.016 (p < 0,05). In the third minute, incidence of hypotension was also significantly lower in group A (15,2%) than group B (23,9%), p value = 0,014 (p < 0,05). Leg elevation maneuver 45º significantly decrease incidence of hypotension after propofol induction. Keywords: Propofol, hypotension, leg elevation

scholarly journals Study of Dexmedetomidine in Caudal Block for Children Undergoing Inguino-scrotal Surgery

2020 ◽  
Vol 18 (1) ◽  
pp. 68-73
Author(s):  
B. Gautam ◽  
B. Piya ◽  
D. Karki
Keyword(s):  
Adverse Events ◽  
Local Anaesthetics ◽  
P Value ◽  
Healthy Children ◽  
Caudal Block ◽  
Chi Square ◽  
Hemodynamic Variables ◽  
Caudal Analgesia ◽  
Group A ◽  
Group B

Background Caudal block is the most common anaesthetic technique employed in children for managing perioperative pain of inguino-scrotal surgery. However, despite using long-acting local anaesthetics, caudal analgesia lasts relatively shorter. Dexmedetomidine, an alpha-2 agonist, augments local anaesthetic action. Objective To assess the analgesic effect of caudal Dexmedetomidine. Method This is a randomized, double-blinded study conducted on otherwise healthy children (one to five years) undergoing elective inguino-scrotal surgery. General anaesthesia was administered and a laryngeal mask airway was inserted for assisting ventilation. The caudal block was applied using 0.8 milliliters/kilogram drug volume comprising either two milligrams/kilogram Bupivacaine in group A (n=42) or two milligrams/ kilogram Bupivacaine mixed with 0.75 micrograms/kilogram Dexmedetomidine in group B (n=42). Intraoperatively, inhaled Halothane, intravenous Fentanyl, fluids, and ventilation were titrated to maintain monitored hemodynamic variables within 15% from baseline values. The primary endpoint comprised the duration of analgesia, defined by a time when postoperative pain score (face, legs, activity, cry, consolability; FLACC scale) reached four out of ten. Perioperative events were studied for 24 hours. Student’s t-test and Chi-square test were used for analysis, with p-value less than 0.05 considered as significant. Result Demographic, surgical, and anaesthetic characteristics were similar between the groups. Duration of analgesia was significantly prolonged in group B (group B, 413±101 minutes; group A, 204±40 minutes). The intraoperative requirement for supplement Fentanyl was significantly reduced in group B. Adverse events were comparable between the groups. Conclusion Dexmedetomidine prolongs the duration of analgesia when mixed with caudal Bupivacaine, without increasing adverse events.

scholarly journals Comparative Study of Safety and Efficacy of Three Different Doses of Fentanyl on Hemodynamic Response to Laryngoscopy and Tracheal Intubation in Patients under General Anaesthesia

2021 ◽  
pp. 541-551
Author(s):  
Bhavini Shah ◽  
Dipanjali Mahanta ◽  
Ruchir Sakhrani ◽  
Samsuddin Afreen Boat
Keyword(s):  
General Anaesthesia ◽  
Endotracheal Intubation ◽  
Elective Surgery ◽  
Hemodynamic Response ◽  
Safety And Efficacy ◽  
Intravenous Fentanyl ◽  
Hemodynamic Variables ◽  
Group B ◽  
Fentanyl Administration ◽  
Different Doses

Aim of Study: Laryngoscopy and endotracheal intubation are the commonest method for securing a definitive airway for general anaesthesia. It is one of the most invasive and painful stimuli in anaesthesia producing clinically relevant changes in the hemodynamic variables. This study has been designed to compare the safety and efficacy of three different doses of fentanyl (2µg/kg, 3µg/kg and 4µg/kg) in attenuating hemodynamic response, following laryngoscopy and endotracheal intubation. Materials and Methods: In this observational study, three groups of 90 patients belonging to ASA grade I and II, aged between 18 to 65 years, including either gender, posted for elective surgery under GA with informed consent. Baseline vital hemodynamic parameters and the serial heart rate, arterial pressures, SpO2 and respiratory rate were noted at five minutes after intravenous fentanyl administration, during laryngoscopy & intubation and at 1-, 3-, 5-, 10- and 20-minutes after laryngoscopy. Ramsay sedation scores were also noted at five minutes after intravenous fentanyl administration, during extubation and at 10-, 20- and 30-minutes after extubation. Results: There was substantial difference in mean HR, SBP, DBP & MAP values post 5 minutes after intravenous fentanyl administration, during laryngoscopy, at 1, 3-, 5-, 10- and 20-minutes following laryngoscopy and intubation between the three groups. Patients’ behaviour belonging to group C (IV fentanyl 4µg/kg), followed by the patients of group B (IV fentanyl 3µg/kg) presented considerable amount of attenuation of all the hemodynamic stress parameters effectively, with statistically significant results when compared to group A (IV fentanyl 2µg/kg). Conclusion: Intravenous fentanyl 4µg/kg and 3µg/kg are better at attenuating the laryngo-tracheal stress response, in comparison to intravenous fentanyl 2µg/kg.

scholarly journals Role of Dermaroller and Prp In Post-Traumatic Facial Scar Treatments

2020 ◽  
Vol 11 (3) ◽  
pp. 4061-4067
Author(s):  
Alpesh ◽  
Jumale V P
Keyword(s):  
Statistical Significance ◽  
T Test ◽  
P Value ◽  
Chi Square ◽  
Chi Square Test ◽  
Group A ◽  
Post Traumatic ◽  
Group B

In the present study follow up kept on immediate post-operative day and at one week to evaluate pain, bleeding and inflammation. Final follow up at two months for assessment of aesthetic score by three independent personnel. Pain and inflammation were more associated with Group B compared to Group A, but there are no statistical significance differences among this groups (P value- 0.074 and 0.136 for pain and inflammation respectively on immediate post-operative day. Chi-square test). Final follow up assessment of aesthetic scores at two months calculated by Chi- square test and comparisons of two groups for aesthetic scores done by Independent t-Test. All three personnel gave higher aesthetic score to Group B but statistically this was not significant (P-value 0.287, 0.129 and 0.400 by Observer 1, 2 and patients respectively. Chi-square test). The mean aesthetic score given by Observer 1, 2 and patient was higher associated to Group B but statistically this was not significant (P=0.526, 0.055 and 0.232 independent t-Test).

scholarly journals A COMPARATIVE STUDY OF ORAL CLONIDINE VERSUS ORAL PREGABALIN ON HEMODYNAMIC RESPONSES TO LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION UNDER GENERAL ANAESTESIA

2019 ◽  
Vol 3 (4) ◽  
Author(s):  
Pratibha Rathore ◽  
Varsha Saini ◽  
Fareed Ahmed ◽  
Rama Chatterjee ◽  
Monika Rathore
Keyword(s):  
Blood Pressure ◽  
Endotracheal Intubation ◽  
Sympathetic Activity ◽  
Elective Surgery ◽  
Pressor Response ◽  
Hemodynamic Changes ◽  
Oral Clonidine ◽  
Group A ◽  
Group B ◽  
Better Than

Background: Laryngoscopy and endotracheal intubation are potent stimuli that can induce increased sympathetic activity leading to tachycardia, hypertension and dysrrhythmias. Various drugs and methods have been tried to obtund this response. To obtain ideal drugs, studies still continue. We compared the efficacy of clonidine and pregabalin to attenuate the pressor response during laryngoscopy and intubation. Method: Total 80 patients of ASA grade I scheduled for elective surgery under general anaesthesia, were randomized into two groups. Group A received oral clonidine 300 mcg 2 hrs prior to surgery, group B received oral pregabalin 75mg 2 hrs prior to surgery. Heart rate and blood pressure (SBP, DBP &MAP) were recorded at baseline, before induction, before intubation, during laryngoscopy, 0, 1, 3, 5, and 10 minutes after intubation. Results: When compared to clonidine and pregabalin, there was a significant increase in HR and MAP in pregabalin after laryngoscopy and tracheal intubation. Clonidine was better than pregabalin in suppressing the pressor response. Conclusion: Clonidine appears to be better than Pregabalin for control of haemodynamic response to laryngoscopy and intubation besides providing sedation. Keywords: Clonidine, Pregabalin, hemodynamic changes and endotracheal intubation.

Pregabalin As A Premedicant To Attenuate Pressor Response In Patients Undergoing Laparoscopic Cholecystectomy: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study

2020 ◽  
Vol 11 (3) ◽  
pp. 3418-3423
Author(s):  
Sweety Agrawal ◽  
Shubdha Bhagat ◽  
Pratibha Deshmukh ◽  
Amol Singham
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Pressor Response ◽  
Controlled Study ◽  
Double Blind ◽  
Co2 Insufflation ◽  
Ramsay Sedation Scale ◽  
Minute Interval ◽  
Group A ◽  
Group B ◽  
Induction Of Anaesthesia

The present study was done to evaluate the ability of oral pregabalin to attenuate the pressor response to airway instrumentation in patients undergoing laparoscopic cholecystectomy under general anesthesia. Sixty-four adult patients aged between 25-55 year of either gender belonging to ASA-1 or ASA2 physical status weighing 50-70 kg were enrolled in this study. Thirty-two patients each were randomized to group A, or group B. Patients in group A received tablet Pregabalin (150mg) and those in group B received placebo orally one hour before induction of anaesthesia. Heart rate, blood pressure, and sedation were assessed preoperatively before giving the tablets and after 30 minutes, and just before induction of anaesthesia. Intraoperative, pulse rate, mean arterial pressure, ECG in the lead II, SPO2 and ETCO2 were monitored. All the above parameters were noted during laryngoscopy and intubation, 3 minutes after CO2 insufflation, and then at every 10-minute interval till the end of surgery. These parameters were also recorded after extubating the patient. The Ramsay sedation scale was used to assess the sedation at the baseline, one hour after drug intake , one hour after extubation and 4 hour after surgery. Any adverse effects in the postoperative period were recorded. The result of our study shows that pre-emptive administration of oral pregabalin 150 mg significantly reduced the pressor response at the time of laryngoscopy and intubation, after CO2 insufflation and just after extubation. We conclude that oral pregabalin premedication is effective in successful attenuation of hemodynamic pressor response to laryngoscopy, intubation and pneumoperitoneum in patients undergoing laparoscopic cholecystectomy

COMPARISON OF EFFECTIVENESS OF MOBILIZATION AND SELF-EXERCISES IN ADHESIVE CAPSULITIS OF SHOULDER

2018 ◽  
Vol 7 (1) ◽  
pp. 35-41
Author(s):  
Muhammad Usman Khan ◽  
Ghazala Noor Nizami ◽  
Ali Farhad
Keyword(s):  
Pain Intensity ◽  
Adhesive Capsulitis ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Sampling Technique ◽  
Simple Random Sampling ◽  
T Test ◽  
P Value ◽  
Group A ◽  
Group B

OBJECTIVE To compare the effectiveness of mobilization and self-exercises in the management of adhesive capsulitis of shoulder STUDY DESIGN Randomized Control Trial SAMPLE SELECTION 30 patients of adhesive capsulitis of shoulder from physiotherapy department of tertiary care hospitals of Karachi were selected through simple random sampling technique. PROCEDURE Treatment was continued for 5 days per week for the period of 3 weeks followed by assessment. Patients were randomly divided into two equal groups. Group A was treated with midrange mobilization while group B performed self-exercises. Both groups received TENS and hot pack prior to the exercises. Mean ± SD, frequencies and percentages were used for descriptive analysis. ROM via goniometry and pain intensity through VAS was analyzed by paired t-test within the groups and by independent t-test between the groups, using SPSS. P-value of less than 0.05 was considered significant. RESULTS 60% were females (n=18) and 40% were males (n=12) with mean age of 50.17±6.37 years. Significant improvement (p-value <0.05) in pain and shoulder ROM was observed among patients of Group A as compared to Group B. Pain intensity was decreased to 1.67 ± 0.62 in group A, whereas ROMs in these patients were also better than other group.

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