scholarly journals High Dose Intrathecal Morphine for Major Abdominal Cancer Surgery: A Prospective Double-Blind, Dose-Finding Clinical Study

2014 ◽  
Vol 3;17 (3;5) ◽  
pp. 255-264
Author(s):  
Hala S. Abdel-Ghaffar
Keyword(s):  
Side Effects ◽  
Respiratory Rate ◽  
Sample Size ◽  
Intrathecal Morphine ◽  
Double Blind ◽  
Group Iii ◽  
Group I ◽  
The Mean ◽  
Group Ii ◽  
Peripheral Arterial

Background: Despite 30 years of clinical research, we still do not know the optimal dose of intrathecal morphine (ITM) when used alone. Objectives: A safety investigation and comparison of the analgesic efficacy of ITM 0.2 mg, 0.5 mg, and 1 mg in patients undergoing major abdominal cancer surgery. Study Design: A randomized, double-blind trial. Setting: Academic medical center. Methods: Ninety patients were randomly assigned to receive morphine intrathecally either 0.2 mg (Group I, ITM 0.2 mg, n = 30), 0.5 mg (Group II, ITM 0.5 mg, n = 30), or 1 mg (Group III, ITM 1 mg, n = 30) dissolved in 5 mL physiological saline before general anesthesia. Assessment parameters included hemodynamics, respiratory rate, peripheral arterial oxygenation, sedation score, pain severity, time of first analgesic request, total analgesic consumption, and side effects in the first 72 hours. Results: The mean time to first request for rescue analgesia was significantly prolonged in Group II (22.13 ± 5.21 hours, P < 0.001) and Group III (30.83 ± 4.89 h, P < 0.001), compared with Group I (0.50 ± 0.66 hours). The mean tramadol consumption dose was significantly reduced in Group II (383.33 ± 91.28 mg, P < 0.001) and Group III (300 ± 69.48 mg, P < 0.001) compared with Group I (770 ± 114.92 mg). Patients received 1 mg ITM showed lower VAS scores in the first 48 h postoperative (P < 0.04) compared with Group I and Group II. No significant differences were observed in the mean systolic and diastolic blood pressure values, respiratory rate, and peripheral arterial oxygen saturation between groups. Lower mean heart rate values were observed in Group III patients at 6 hours (P < 0.01) and 12 hours (P < 0.03) postoperative compared with Group I and Group II patients. Six patients (20%) in Group II and 8 (26.7%) in Group III exhibited pruritus compared with 2 patients (6.66%) in Group I (P < 0.01). No intergroup statistical differences were observed for other studied side effects. Limitations: This study is limited by its small sample size. Conclusion: One mg ITM provided superior analgesia for 48 hours postoperative compared with 0.2 mg and 0.5 mg ITM with a nonsignificant difference in the incidence of side effects. Further studies of larger sample size are recommended to confirm these findings. Key words: Anesthesia, analgesia, abdominal cancer, opioids, intrathecal, morphine

A comparative study on post-operative analgesic effect by intrathecal midazolam and neostigmine with control group

2017 ◽  
Vol 5 (3) ◽  
pp. 863
Author(s):  
Rashmi Dubey ◽  
Roseline Ali ◽  
Rashim Vachhani ◽  
Nishant Baghel
Keyword(s):  
Blood Pressure ◽  
Side Effects ◽  
Lower Limbs ◽  
Control Group ◽  
Group Iii ◽  
Group I ◽  
The Mean ◽  
Group Ii ◽  
Preservative Free ◽  
Effective Analgesia

Background: Pain happens to be the most common suffering during postoperative period, which is not generally effectively treated. There is good evidence in literature that addition of midazolam to spinal bupivacaine improved postoperative analgesia when compared to spinal bupivacaine alone. Neostigmine represents a novel approach to providing analgesia. Recent studies showed that intrathecal administration of various doses of neostigmine produces analgesia without neurotoxicity. The present study was undertaken to evaluate analgesic effects of intrathecal Midazolam and neostigmine.Methods: The present study was carried out in the department of anaesthesiology, CCM medical college, Durg Chhattisgarh, India during study period August 2015 to July 2016. The study comprised of 60 patients undergoing surgery of lower abdomen below umbilicus (T10) and lower limbs. Patients of age Group between 20-60 years of age of either sex of ASA group I and II were included in the study. Pre-anesthetic evaluation was done prior to surgery. The patients were randomly divided into 3 groups of 20 patients each. Data was compiled in MS excel and checked for its completeness and correctness, then it was analyzed.Results: Mean age in Group I was 39.3+1.5 years. in Group II was 37.8±11.7 years, in Group III was 42.2±13.7 years. In group I maximum 14 patients (70%) had analgesia of less than 4 hours. Mean duration of analgesia was 3.73±0.87 hours. In group II maximum 18 patients (90%) had analgesia 4-8 hours. The mean duration of analgesia was 6.34±1.28 hours. In group III 10 patients (50%) had analgesia of 4-8 hours and 10 patients (50%) had analgesia of 8-12 hours. The mean duration was 8.35±1.36. The difference in VAS score in group in group I and group III is significant. There was no statistically significant change in systolic blood pressure, diastolic blood pressure, Pulse rate & respiratory rate attributable to intrathecal Midazolam and neostigmine.Conclusions: Addition of preservative free midazolam to inteathecal bupivacaine prolongs duration of effective analgesia as compared to bupivacaine alone without any side effects. Addition of preservative free neostigmine to intrathecal bupivacaine prolongs duration of effective analgesia and sensory and motor block without any significant side effects.

STUDIES OF RESPIRATORY INSUFFICIENCY IN NEWBORN INFANTS

PEDIATRICS ◽  
1957 ◽  
Vol 19 (2) ◽  
pp. 224-232
Author(s):  
Herbert C. Miller ◽  
Ned W. Smull
Keyword(s):  
Tidal Volume ◽  
Respiratory Rate ◽  
Premature Infants ◽  
Respiratory Insufficiency ◽  
Newborn Infants ◽  
Group Iii ◽  
Group I ◽  
The Mean ◽  
Group Ii ◽  
Serial Measurements

Serial measurements have been made of the resting tidal and minute volumes and respiratory rates on 40 premature infants during the first 2 weeks after birth. The 40 infants were divided into three groups according to the trend of their respiratory rates. Infants whose respiratory rates were normal from birth (Group I) had the highest mean resting tidal volumes during the first 2 weeks. Mean resting tidal volumes were significantly lower throughout the first week among infants whose respiratory rates were initially high during the first hour and subsequently declined to normal (Group II) and among infants whose respiratory rates significantly increased after the first hour (Group III). Infants in Group III had the lowest tidal volumes and the most severe degrees of respiratory insufficiency. The mean resting tidal volume among infants in Group III was less at the end of the first week than that of infants in Group I at the end of the first day. Although tidal volumes in infants in Group II were in general much lower than normal the first few days after birth, exceptions to this rule may occasionally be encountered. Although all three groups showed an increase in mean tidal volumes of about 25% at the end of 24 hours over the volumes obtained during the first 3 hours after birth, the respiratory rates were different. In Group I the increase in tidal volume was accompanied by no significant change in respiratory rate; in Group II, by a significant decrease in respiratory rate; in Group III, by a significant increase in respiratory arte. During the second day Group III showed clinical improvement accompanied by a significant decrease in mean respiratory rate but not by any significant increase in mean tidal volume. Fluctuations in mean minute volumes in Groups II and III on the first 2 days were largely dependent on changes in respiratory rates.

Genoprotective role of vitamin E and selenium in rabbits anaesthetized with sevoflurane

2004 ◽  
Vol 23 (8) ◽  
pp. 413-419 ◽  
Author(s):  
Cetin Kaymak ◽  
Ela Kadioglu ◽  
Hulya Basar ◽  
Semra Sardas
Keyword(s):  
Dna Damage ◽  
Vitamin E ◽  
Comet Assay ◽  
Antioxidant Supplementation ◽  
Group Iii ◽  
Sevoflurane Anaesthesia ◽  
Group I ◽  
The Mean ◽  
Group Ii

In this study, genotoxic effects of repeated sevoflurane anaesthesia were investigated in rabbits with or without antioxidant supplementation. Twenty-one New Zealand male rabbits were included in the study and randomized into three groups as: placebo treated (Group I), vitamin E supplemented (Group II) and selenium supplemented (Group III). Vitamin E and selenium were given intraperitoneally for 15 days before anaesthesia treatment. Anaesthesia was administered using 3% sevoflurane in 4 L/min oxygen for a 3-hour period and continued for 3 days. Blood samples were collected before anaesthesia (Sample 1), after the first, second and third days of sevoflurane administration (Sample 2, Sample 3 and Sample 4 respectively) and the last samples were taken 5 days after the last sevoflurane administration (Sample 5). Genotoxic damage was examined using the comet assay. The degree of damage is assessed by grading the cells into three categories of no migration (NM), low migration (LM) and high migration (HM) depending on the fraction of DNA pulled out into the tail under the influence of the electric field. The number of comets in each sample was calculated (1 × number of comets in category NM + 2 × number of comets in category LM + 3 ×number of comets in category HM) and expressed as the total comet score (TCS), which summarizes the damage frequencies. In Group I, a significant increase in the mean TCSs was observed for Samples 3 and 4 as compared with Sample 1. However, there were no significant differences between Samples 1, 2 and 5. The mean TCS of Sample 4 was significantly higher than Sample 1, 2 and 3 in Group II. Group III demonstrated no significant mean TCSs for any experimental conditions. Statistical differences were also observed between the groups with significant P values. This experimental study points out the presence of DNA damage with repeated sevoflurane anaesthesia and the genoprotective role of antioxidant supplementation on DNA damage in mononuclear leukocytes of rabbits by highly sensitive comet assay.

Bone mineral density and spongiosa architecture in correlation to vertebral body insufficiency fractures

1998 ◽  
Vol 39 (5) ◽  
pp. 538-542 ◽  
Author(s):  
R. Andresen ◽  
S. Radmer ◽  
D. Banzer
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Vertebral Body ◽  
Unknown Etiology ◽  
Insufficiency Fractures ◽  
Mineral Density ◽  
Group Iii ◽  
Group I ◽  
The Mean ◽  
Group Ii

Objective: the clinical value of spinal quantitative CT (sQCT) and the structural patterns of the vertebral bone were studied Material and Methods: sQCT was performed on 246 patients with a mean age of 57 years for whom conventional lateral radiographies of the thoracic and lumbar spine were available. All patients were suffering from back pain of unknown etiology. the bone mineral density (BMD) of the midvertebral section of 3 lumbar vertebral bodies was determined by means of single-energy-(SE)-weighted QCT (85 kV). Spongiosa architecture and density profile analyses were made in the axial images. This was contrasted to BMD values ascertained in SE QCT. the mean BMD was compared to the number of fractures and the patients were divided into three groups: group I — no fracture; group II — one fracture; and group III 1 fracture Results: the mean BMD was: 134.3 (74.1–187.5) mg hydroxyapatite (HA)/ml in group I; 79.6 (58.6–114.3) mg HA/ml in group II; and 52.4 (13.1–79.1)mg HA/ml in group III. A significant deterioration in spongiosa structure was found with increasing demineralization: strongly rarefied patterns predominated in the fracture groups II and III Conclusion: sQCT provides a good risk assessment of the occurrence of vertebral body insufficiency fractures

Seasonal variations in wool growth and heat tolerance of sheep. I. Wool growth

1960 ◽  
Vol 11 (1) ◽  
pp. 75 ◽  
Author(s):  
M Wodzicka
Keyword(s):  
Body Weight ◽  
Day Treatment ◽  
The Other ◽  
Seasonal Rhythm ◽  
Group Iii ◽  
Wool Growth ◽  
Group I ◽  
The Mean ◽  
Group Ii ◽  
The Difference

The monthly wool growth of three groups of rams was studied at Beltsville, Maryland. Group I received natural daylight (at 38° 53' N.) and was shorn monthly. Group II had a 7:17 hours of daylight to hours of darkness rhythm and was shorn every 6 months, once in winter and once in summer. Group III received natural daylight and was likewise shorn every 6 months. The rams of all groups produced more wool in summer than in winter. This difference was significant (P<0.001). The mean body weight and food intake were both greater in the winter months, which indicated that the seasonal rhythm of wool growth was not a consequence of poorer feeding in winter. The rams which were shorn monthly (group I) grew considerably more wool than the other two groups, but the difference was not statistically significant. The short-day treatment of group II did not increase the annual wool production nor decrease the seasonal rhythm of wool growth. The balance of evidence from this and other experiments indicates that temperature rather than light controls the seasonal rhythm of wool growth.

A DOUBLE BLIND COMPARATIVE STUDY BETWEEN INTRATHECAL BUPIVACAINE AND INTRATHECAL FENTANYLAS THE INITIAL DOSE OF COMBINED SPINAL EPIDURAL TECHNIQUE FOR LABOUR ANALGESIA

2021 ◽  
pp. 48-50
Author(s):  
Niraj Kumar Mishra ◽  
Sushil Kumar
Keyword(s):  
Side Effects ◽  
Fetal Distress ◽  
Labour Pain ◽  
Sampling Procedure ◽  
Chi Square ◽  
Double Blind ◽  
Motor Weakness ◽  
Group I ◽  
Group Ii ◽  
Fetal Oxygenation

Introduction: Labour pain is among the most severe pain a woman can experience in her lifetime. Painful labour has decrimental effects on both mother and fetus leads to severe physical and psychological stress. Maternal hyperventilation in response to pain reduces fetal oxygenation and hypoventilation between contractions combined with decreased blood ow worsens fetal hypoxemia. It has been suggested that conning women to bed during labour may cause the labour to be longer and more painful with increase in abnormal presentation, instrumental deliveries and fetal distress. Aims And Objectives:The onset, quality and duration of their analgesic action. Incidence of unwanted effects like muscle weakness, hypotension, pruritus, nausea/vomiting, fetal bradycardia by the individual drugs. Materials And Methods: The study was conducted in the department of anesthesia, Darbhanga Medical College & Hospital, Laheriasarai, Bihar. Methods of collection of data (including sampling procedure if any) : After institutional committee approval and written informed consent from parturients and their relatives for the procedure the study was conducted and data were collected. Results: Duration of analgesia was found varying widely. It was 55±12.34 minutes in Group I whereas 75 ±14.36 minutes in Group II. The incidence of pruritus almost mild or negligible in both groups. The incidence of motor weakness in group II was 24 (80%) whereas in group I it was 10(33%). There was signicant statistics difference in motor weakness between two groups (p< 0.001) by Chi square test 9 with yate's correction. Other side effects differences between two groups were not statistically signicant. Summary And Conclusion:Both the drugs provided excellent quality of analgesia to the parturient in pain. The difference in duration of analgesia was signicant between the two groups statistically. Mean duration of analgesia lasted for 55 minutes in group I whereas in group II, it lasted for 75 minutes. Main side effects encountered in this study were motor weakness of longer duration in group II than in group I. Other side effects like nausea-vomiting were comparable to each other and were minimal in nature.

scholarly journals Effects of Ficus syncomorus and Datura metel stem-bark extracts on the sperm characteristics of Yankasa rams

2020 ◽  
Vol 47 (2) ◽  
pp. 37-45
Author(s):  
J. O. Okpara ◽  
M. B Abudul ◽  
S. I Garba ◽  
O. V Adelowo ◽  
A. C Mbgojikwe
Keyword(s):  
Sperm Morphology ◽  
Stem Bark ◽  
Haematological Parameters ◽  
Group Iii ◽  
Datura Metel ◽  
Sperm Characteristics ◽  
Group I ◽  
Semen Volume ◽  
The Mean ◽  
Group Ii

Interest in medicinal plants for the management of myriad of conditions including reproductive disorders refractory to orthodox medicinal care is on the increase. Ficus syncomorus and Datura metel are two of such plants with folkloric evidence of aiding fertility in human. This study investigated the effect of aqueous stem-bark extracts (200 mg/kg) of F. syncomorus and D. metel respectively on the sperm characteristics of Yankasa rams. Twelve (12) matured (15 – 16 months) old rams were used in this study and randomly assigned into three (I, II, III) groups of four (4) animals each. Group I served as the control while II and III served as the treatment groups and received daily oral doses (200 mg/kg) of F. syncomorus and D. metel extracts respectively for 7 consecutive days. Semen was collected from all the groups at the end of the treatments using Electro-ejaculation method and evaluated by light microscopy. The mean semen volume (68.70+4.2 to 65.62+2.00) and percentage progressive motile cells significantly (p<0.05) reduced 7 days post treatment in group III (84.05+1.3) compared to the control (85.20+1.32) and the group II (86.56+0.40) animals. The mean sperm count, the percentage liveability and the haematological parameters and erythrocytic indices (10.81±0.24 for group 111 to 12.54±0.30 for group1) significantly (p<0.05) decreased in group III compared to the values in the control and group II rams. Abnormal sperm morphology (bent mid-piece, curved tail, headless tail, tailless head) significantly (p<0.05) increased in D. metel group (7.26+0.12) compared to F. syncomorus (5.02+0.04) and control groups (5.62+0.01) respectively. D. metel aquesous extract adversely affected sperm characteristics with significant effect on semen volume, sperm morphology and counts as well as haematological parameters. Exposure of animals to D. metel at the dose used may impair sperm fertilizing ability, thus leading to reduced ram fertility. While F. syncomorus extract appears a potential drug candidate for improving fertility.

Association of Salivary Lipids and Early Childhood Caries in an Indian Subpopulation: A Preliminary Study

2019 ◽  
Vol 43 (6) ◽  
pp. 393-397
Author(s):  
Akhilesh Sharma ◽  
Mudunuri Sindhuja ◽  
Priya Subramaniam
Keyword(s):  
Flow Rate ◽  
Early Childhood Caries ◽  
Salivary Flow ◽  
Salivary Flow Rate ◽  
Total Lipids ◽  
Group Iii ◽  
Group I ◽  
The Mean ◽  
Preliminary Study ◽  
Group Ii

Aim: This preliminary study aimed to estimate and correlate the relationship between salivary flow rate and levels of salivary triglycerides, cholesterol and total lipids in children with and without early childhood caries. Study design: Ninety children aged 3 – 6 years were divided into three groups of 30 each based on their decayed missing filled tooth (dmft) score, group I (dmft score = 0), group II (dmft score ≥4 and ≤ 9) and group III (dmft scores ≥ 10). Whole unstimulated saliva was collected in a sterile graduated cup over a period of 5 minutes and was quantitatively analyzed for levels of salivary triglycerides, cholesterol and total lipids. Data obtained was subjected to statistical analysis by one way ANOVA, Post-Hoc tukey and Pearson’s correlation test. Results: Salivary flow rate was 1.20±0.36, 1.01±0.37 and 0.86±0.31 ml/min in group I, II and III respectively. The mean levels of salivary triglycerides in group I, II and III was 3.57±0.43mg/ml, 6.11±1.70mg/ml and 6.03±1.73 mg/ml, respectively. The mean levels of salivary total lipids were higher in group II and III, ie 22.51±2.87 mg/ml and 22.68±2.54 mg/ml respectively. The mean level of salivary cholesterol was highest in group III (8.03±2.91 mg/ml). Salivary triglycerides and total lipids showed a significant positive correlation with dmft scores of children (p≤ 0.001). Salivary cholesterol also had a positive association with dental caries experience of children but was not significant. There was a negative correlation between salivary flow rate and levels of salivary triglycerides, cholesterol and total lipids. Conclusion: Children with ECC (group II and III) had lower salivary flow rate and higher levels of salivary triglycerides and total lipids compared to caries free children (group I). Levels of salivary cholesterol did not differ between caries free and children with ECC.

The Role of sFas in the Immune Escape Mechanism and Progression of Cancer Larynx

2009 ◽  
Vol 2 ◽  
pp. CMENT.S2565
Author(s):  
Amr A El Badry ◽  
Ismail Elmofty ◽  
Amira Helmy
Keyword(s):  
Serum Level ◽  
Buffy Coat ◽  
Control Group ◽  
Group Iii ◽  
Soluble Fas ◽  
Group I ◽  
Significant Difference ◽  
Cancer Larynx ◽  
The Mean ◽  
Group Ii

This work assess serum levels of soluble Fas form (sFas) in patients with different stages of laryngeal squamous cell carcinoma(LSCC) to investigate its prognostic significance. We correlate its levels with the morphological changes of peripheral blood cells via buffy coat examinatin. The study population included 70 patients clinically diagnosed and pathohistologically confirmed LSCC in addition to 20 healthy controls. According to TNM classification 33(47.1%) patients were in stage I (group I) and 24(34.3%) in stage II (group II), 13(18.5%) in stage III (group III). The results revealed that the mean serum level of sFas (pg/ml) in the control group was 51.2, in group I was 66.33, in group II was 81.33 and in group III was 112.45. Statistical analysis of the mean of sFas by ELISA test in the patients' groups in comparison to the control revealed a significant increase of both group II and III in comparison to the control group (P < 0.01) but there was no significant difference (P > 0.05) between group I in comparison to either the control or group II. There was a significant difference (P < 0.05) between group I in comparison to group III. LM examination revealed massive extent of the apoptotic cells in group III when compared to both group I and group II. EM examination of the buffy coat revealed apoptotic changes, mainly in the peripheral blood mononuclear cells (PBMNCs), represented by surface membrane ruffles and blebs with clumped nuclear chromatin and vacuolated cytoplasm. In conclusion, this study may help us to better understand one of the escape mechanisms in cancer larynx. This mechanism is represented by the significant increase in both the serum level of sFas and the morphological apoptotic changes that detected in PBMNCs. Soluble Fas may contribute to the progression of laryngeal cancer. It can be used as an attractive target for anticancer therapy and may be considered as a marker of disease progression and poor prognosis in laryngeal cancer.

Platelet Function Studies in Normal Volunteers and Patients with Angina Pectoris

1979 ◽  
Author(s):  
J.J.C. Jonker ◽  
den G.J.H. Ottolander
Keyword(s):  
Platelet Aggregation ◽  
Angina Pectoris ◽  
Platelet Function ◽  
Normal Range ◽  
Double Blind ◽  
Group Iii ◽  
Platelet Survival ◽  
Group I ◽  
Group Ii

In 30 normal subjects (group I) and in 89 patients with angina pectoris we studied: the platelet survival time (PST), the platelet aggregation test I (PAT I) acc. to Breddin, the platelet aggregation ratio (PAR) acc. to Wu and Hoak and the Filtragometer log TA acc. to Hornstra. The patients were divided in two groups: 46 patients had already been treated for 6 months with Clofibrate (group II) and 43 patients with placebo (group III) in a double blind trial. The average PST (T½) was within the normal range (group I 99 hrs. group II 105,7 hrs.; group III 102,0 hrs.). About 20% of patients of group II and III had abnormally shortened T½. The PAT I was on average abnormal in group II and III (PAT I in group II 2,3; group III 2,7), but group II normalized after 12 months treatment (PAT I 1,85). The PAR was abnormal in group III, while group II was within the normal range (group I 0,87; group II 0,82; group III 0,69). The log TA results were abnormal in group II and III (group I 2, 45, group II 2,1; group III 2, 1), after 12 months treatment the patient group remained abnormal (group II 2,2; group III 2,1). We failed to find a correlation between the four platelet function tests, nor with these tests and basic laboratory values. The PAT I, the PAR and the Filtragometer seems to be valuable in the detection of abnormal platelet behavior in vitro, but it does not mean than an abnormal platelet survival in vivo occurs in the same individuals.

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