scholarly journals A COMPARATIVE STUDY BETWEEN DEXMEDETOMIDINE AND MIDAZOLAM AS AN ADJUVANT TO INTRATHECAL BUPIVACAINE

2020 ◽  
pp. 1-4
Author(s):  
K.K. Arora ◽  
Neetu Gupta ◽  
Nidhi Sharma
Keyword(s):  
Side Effect ◽  
Motor Block ◽  
Local Anaesthetics ◽  
Efficacy And Safety ◽  
Significant Side Effect ◽  
Significant Difference ◽  
Haemodynamic Changes ◽  
The Common ◽  
Clinically Significant ◽  
Group D

Background: Subarachnoid block(SAB) is the common mode of anaesthesia. To prolong its action various adjuvants are being added to local anaesthetics(LA). In this study we compared the efficacy and safety of midazolam and dexmedetomidine as an adjuvant to intrathecal 0.5% hyperbaric (H) bupivacaine. Material & Methods: 80 ASA grade I or II patients of either sex scheduled for lower limb or lower abdominal surgeries were randomly allocated into two groups, Group D & Group M. In group D, patients received 3ml of 0.5% (H) bupivacaine + dexmedetomidine 5mcg in 0.5ml normal saline(NS). While group M received 3ml of 0.5% (H) bupivacaine + 2mg midazolam ( 0.4ml of 5mg/ml) + 0.1ml of NS. Onset of sensory & motor block and duration of sensory & motor block were recorded. Patients were monitored for any haemodynamic changes and side effect. Result: Duration of both sensory & motor blockade was significantly prolonged in group D as compared to group M. There was no clinically significant difference observed among both the groups in respect to hemodynamic parameters, sedation and side effect. Conclusion: Dexmedetomidine as an adjuvant to intrathecal bupivacaine (H) was better as compared to midazolam. It significantly prolongs the duration of analgesia postoperatively without any significant side effect.

scholarly journals The Efficacy and Safety of Nabufen and Sufentanil in the Prevention of Visceral Pain After Gynecological Laparoscopic Surgery: A Randomised Controlled Trial

2020 ◽  
Author(s):  
Xiaoxia Gu ◽  
Jingjing Wang ◽  
Huihua Liao ◽  
Jian Mo ◽  
Weiming Huang ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Adverse Reactions ◽  
Visceral Pain ◽  
Sedation Score ◽  
Efficacy And Safety ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Group D ◽  
Ramsay Sedation Score

Abstract Background: To compare the efficacy and safety of different compatibility schemes in the prevention of visceral pain after gynecological laparoscopic surgery. Methods: from April 2019 to April 2020, patients undergoing elective gynecological laparoscopic surgery in our hospital were randomly divided into four groups: group A: sufentanil 3 μ g / kg; group B: low-dose nalbuphine group: 0.1 mg / kg of nabufen + 3 μ g / kg of sufentanil; group C: medium dose of nabufen group: 1 mg / kg of nabufen + 2 μ g / kg of sufentanil; group D: high-dose nabufen 2 There were 30 cases in each group. The degree of pain and the number of adverse reactions at 2, 4, 8, 12, 24 and 48 hours after operation were observed and recorded. The number and dosage of morphine used as a remedial analgesic were recorded. The pain degree was assessed by visual analogue scale (VAS). The total amount of analgesic pump used, the total number of times of pressing and the effective times of pressing were recorded. The adverse reactions included respiratory depression, nausea and vomiting, drowsiness, restlessness and skin The skin itches. Results: the analgesic effect of group B was similar to that of group A, and there was no significant difference in the number of invalid pressing, total pressing times and rescue analgesia rate (P > 0.05), while the invalid pressing times, total pressing times and remedial analgesia rate of group C and group D were significantly lower than those of group A (P < 0.05). There was no significant difference between group C and group D in the number of invalid compressions, the total number of compressions and the rate of remedial analgesia (P > 0.05), suggesting that increasing the dose of nalbuphine could not significantly increase the analgesic effect. The incidence of postoperative nausea and vomiting, skin pruritus, lethargy and Ramsay Sedation score in group B and group C were significantly lower than those in group A (P < 0.05). Ramsay Sedation score and incidence of drowsiness were lower than those in group D, which indicated that the incidence of adverse reactions was higher in group D than group B and group C.Conclusion: the combination of 1 mg / kg nabufen and 2 μ g / kg sufentanil is a safe and effective combination scheme for the prevention of visceral pain after gynecological laparoscopic surgery with small adverse reactions.Trial registration: http://www.chictr.org.cn/showproj.aspx?proj=40635Registration number：ChiCTR1900025076 . Prospectively registered on 10 August 2019.

scholarly journals Comparative Study of Three Different BACTEC Culture Media for the Detection of Bacteremia in Ambulatory and Hospitalized Children

1998 ◽  
Vol 9 (2) ◽  
pp. 77-82 ◽  
Author(s):  
Deirdre L Church ◽  
H Dele Davies ◽  
G Cadrain ◽  
Cynthia L Trevenen
Keyword(s):  
Emergency Department ◽  
Blood Culture ◽  
Culture Media ◽  
Optimal Recovery ◽  
Pediatric Care ◽  
Hospitalized Children ◽  
Anaerobic Bottle ◽  
The Common ◽  
Clinically Significant ◽  
Group D

To compare the yield of two aerobic and an anaerobic BACTEC blood culture media in detecting bacteremia in ambulatory and hospitalized care settings at a children’s hospital, a prospective cohort study was completed. Over an 18-month period, equal blood volumes (minimum of 1 mL/bottle) were inoculated into a three-bottle culture set including aerobic BACTEC NR 6A, aerobic BACTEC PEDS Plus and anaerobic NR 7A broths. Chart reviews were completed on all children with bacteremia to determine whether the isolate was clinically significant based on predefined criteria. Among 5328 evaluable blood culture sets, 323 clinically significant organisms (110 from ambulatory and 213 from hospitalized children) were isolated. MostStreptococcus pneumoniae,Haemophilusspecies, andNeisseriaorMoraxellaspecies were recovered from children attending the emergency department or out-patient clinics. Important isolates in hospitalized children included most of the staphylococci andEnterobacteriaceae, and all group D enterococci, Gram-negative nonfermentative bacilli and allCandidaspecies. Overall, significantly more isolates were detected only in the anaerobic bottle from ambulatory children (P<0.0001), including 13 of 54 (24%) patients withS pneumoniaebacteremias presenting to the emergency department. This study indicated that different BACTEC blood culture media combinations are needed in ambulatory and hospitalized pediatric care settings to ensure the optimal recovery of all types of isolates. Whereas aerobic blood culture bottles are adequate for detection of bacteremia in hospitalized children, the common occurrence of fastidious organisms mandates the need for a combined aerobic/anaerobic culture set in ambulatory pediatric care settings.

A prospective study to evaluate the efficacy and safety of oral acetyl-L-carnitine (ALC) in treatment of chemotherapy-induced peripheral neuropathy (CPIN).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9017-9017 ◽  
Author(s):  
Yuanjue Sun ◽  
Baorui Liu ◽  
Ping Liu ◽  
Changping Wu ◽  
Rongsheng Zheng ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Oral Administration ◽  
Primary Endpoint ◽  
Side Effect ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Controlled Study ◽  
Efficacy And Safety ◽  
Cancer Related Fatigue ◽  
Significant Difference

9017 Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a major side effect of many commonly used chemotherapeutic. This side effect of chemotherapy can be debilitating and effective treatment for CIPN remains elusive. Previous studies demonstrated that Acetyl-L-Carnitine (ALC) is effective in attenuating CIPN, controlled study is needed to substantiate ALC’s effect in treatment of CIPN. Methods: This study was designed to evaluate the efficacy and safety of Acetyl-L-Carnitine (ALC) Hydrochloride Enteric-coated Tablet (oral administration) in the treatment of CIPN. It was a prospective, randomized, double-blinded, placebo-controlled and paralleled clinical study (registration No. 2007L03540). Of 239 subjects enrolled in the study (NCI grade 2 or above), 118 subjects received 3g/day ALC orally for 8 weeks and 121 received placebo. Primary endpoint was set as improvement of peripheral neuropathy at least 1 grade and assessment was made in week 4, 8 and 12 after enrollment. Results: In full analyses set (FAS) and per-proposal set (PPS), the peripheral sensory neuropathy was significantly ameliorated in ALC group with 50.5% and 51.6% patients meeting the primary endpoint at week 8 and 12 respectively while only 24.1% and 23.1% of patients in the placebo group at week 8 and 12 respectively (p<0.001 in both sets). Secondary endpoint such as nerve electrophysiological test and Physical Condition Score (Karnofsky performance status, KPS) were also significantly improved in patients with ALC treatment (in FAS, P=0.0463 and P=0.022; in PPS, P=0.0076and P=0.0064, respectively). Cancer-related fatigue was significantly alleviated after ALC treatment in PPS (P=0.0135). Safety: 236 subjects were included in safety assessment and 41 patients experienced 62 adverse events during the course of study. There was no significant difference in AE/SAE incidence between the two groups (P=0.3903). Conclusions: Oral administration of ALC is effective in attenuating CIPN as well as in reducing cancer-related fatigue and improving physical conditions in cancer patients. The treatment of oral ALC is safe and well tolerated.

scholarly journals A PROSPECTIVE STUDY OF COMPARISON OF EPIDURAL BUPIVACAINE, FENTANYLAND THEIR COMBINATION FOR POSTOPERATIVE ANALGESIA IN LOWER ABDOMINALAND LOWER EXTREMITY SURGERY

2021 ◽  
pp. 1-4
Author(s):  
Chandeshwar Choudhary ◽  
Praveen Kumar Singh ◽  
Debarshi Jana
Keyword(s):  
Adverse Effects ◽  
Lower Extremity ◽  
Postoperative Analgesia ◽  
Good Control ◽  
Local Anaesthetics ◽  
Analgesic Requirement ◽  
Vas Score ◽  
Epidural Bupivacaine ◽  
Significant Difference ◽  
Clinically Significant

BACKGROUND Epidural analgesia with local anaesthetics and opioids provide good control of postoperative pain in lower abdominal and lower extremity surgery. AIM To evaluate and compare the analgesic action and adverse effects of epidural bupivacaine, fentanyl and their combination in postoperative period. METHODS 75 patients undergoing elective infraumbilical surgery were allocated in three groups in a randomized double blinded fashion. Postoperative analgesia was maintained with continuous infusion of epidural drug in the following manner: Group B: Injection Bupivacaine 0.125% @ 0.1mL/kg/hr through epidural route; Group F: Injection Fentanyl 4µg/mL @ 0.1mL/kg/hr through epidural route; Group BF: Injection Bupivacaine 0.0625% and Fentanyl 2µ/mL @ 0.1mL/kg/hr through epidural route. RESULTS VAS score were almost similar in all three groups at 00, 04, 08hrs and not clinically significant at that point of time. VAS score showed significant difference at 12, 20 and 24 hrs, being persistently lower in Gr BF than Gr B and Gr F. According to VRS Scale Score at 04 hrs majority of patients of all three groups had mild-to-moderate pain (p=0.278). At 08 hrs, 24% (p=0.082), 12 hrs 60% (<0.001), 16 hrs 68% (<0.001), 20 hrs 88% (<0.001) and 24 hrs 84% (<0.001) of Gr BF patients were pain free which are clinically significant. At the end of 08, 12, 16, 20, 24 postoperative hours, no patients of any groups had residual motor paralysis. Rescue analgesic needed in Gr BF patients were significantly less than other two groups. CONCLUSION Combined bupivacaine and fentanyl infusion through an epidural route provides better analgesia in comparison to bupivacaine and fentanyl alone. Total drug, rescue analgesic requirement and adverse effects are much lower in combined group.

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.

scholarly journals Refractive Changes Induced by Strabismus Corrective Surgery in Adults

2017 ◽  
Vol 2017 ◽  
pp. 1-8
Author(s):  
Daphna Mezad-Koursh ◽  
Ari Leshno ◽  
Tomer Ziv-Baran ◽  
Chaim Stolovitch
Keyword(s):  
Postoperative Period ◽  
Side Effect ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Final Analysis ◽  
Spherical Equivalent ◽  
Corrective Surgery ◽  
Significant Side Effect ◽  
Refractive Change ◽  
Clinically Significant

Purpose. To investigate refractive changes after strabismus correction procedures among adults.Methods. Retrospective chart review of adult patients who had horizontal recti muscles surgery with preoperative and postoperative cycloplegic refraction measurements. The preoperative refraction was mathematically subtracted from the postoperative refraction, and the induced refractive changes were statistically analyzed. Vector analysis was used to examine the magnitude of the toric change. The proportion of clinically significant refractive change was evaluated as well.Results. Thirty-one eyes from 22 subjects met the criteria and were included in the final analysis. A significant postoperative refractive change of the spherical equivalent towards myopia and a change of the astigmatism in the with-the-rule direction were observed. In a subset of 9 cases a third cycloplegic refraction measurement demonstrated stable refraction compared to the 1-month postoperative measurement. In 10 cases of single eye surgery, significant refractive changes were observed only in the operated side when compared to the sound eye. The induced surgical refractive change was of clinical significance (≥0.5 D) in 11 eyes of 9 patients (40.9% of patients).Conclusions. Refractive changes are a significant side effect of horizontal strabismus corrective surgery among adults. Therefore, patients should be informed about it prior to surgery and should be rerefracted in the postoperative period.

scholarly journals Comparison of effect of intrathecal dexmedetomidine and clonidine as an adjuvant to hyperbaric bupivacaine in patients undergoing surgery for fracture femur and tibia

2017 ◽  
Vol 4 (12) ◽  
pp. 3833
Author(s):  
G. Praveen Chandra ◽  
Sampathi Shiva Krishna ◽  
Pooja Singh
Keyword(s):  
Motor Block ◽  
Elective Surgery ◽  
Onset Time ◽  
Hyperbaric Bupivacaine ◽  
Wound Infiltration ◽  
Nerve Blocks ◽  
Rescue Analgesia ◽  
Fracture Femur ◽  
Significant Difference ◽  
Group D

Background: Spinal anaesthesia with bupivacaine is administered routinely for lower abdominal and lower limb surgeries. The ensuing nerve block is sufficient to ensure patient’s wellbeing, while motor block facilitates the surgeon’s work. Post-operative pain relief can be achieved by various methods namely systemic opioid and non-opioid peripheral nerve blocks and local wound infiltration, each with their own merits and demerits. the present study was undertaken to compare the effect of intrathecal dexmedetomidine and clonidine as an adjuvant to hyperbaric bupivacaine in patients undergoing surgery for fracture femur and tibia.Methods: 80 patients between 20-60 years, undergoing elective surgery for closed fracture shaft of femur and tibia with ASA physical status of 1 and 2 were included in the study. All the subjects were randomly allocated to one of the two groups (Group C and Group D) by a computer-generated randomization chart. Group C received 2.5ml of 0.5% hyperbaric bupivacaine with 50mcg clonidine and group D received 2.5ml of 0.5% hyperbaric bupivacaine with 5mcg dexmedetomidine.Results: 30 of the 40 patients in group C were of ASA I and 10 were ASA II, while in group D, 25 were ASA I and 15 were ASA II. A significant difference was found in the onset time for sensory and motor block, receding time for sensory and motor block and the need of the first rescue analgesia between the two groups, showing that Dexmedetomidine was more potent than clonidine.Conclusions: Dexmedetomidine is a potent, highly selective and specific α2-adrenoreceptor agonist that has both sedative and analgesic effects and is also a valuable adjuvant when regional anaesthesia is incorporated.

Pseudohyperaldosteroism during itraconazole treatment: a hitherto neglected clinically significant side effect

2021 ◽  
Vol 14 (6) ◽  
pp. e243191
Author(s):  
Sandra L Brandi ◽  
Claus L Feltoft ◽  
Jørgen Serup ◽  
Ebbe Eldrup
Keyword(s):  
Blood Pressure ◽  
Adverse Effect ◽  
Side Effect ◽  
Married Couple ◽  
Daily Intake ◽  
Antifungal Treatment ◽  
Significant Side Effect ◽  
Clinically Significant ◽  
Itraconazole Treatment ◽  
Dose Dependent

We describe a married couple who both presented with hypertension and hypokalaemia. Both patients were diagnosed with pseudohyperaldosteronism triggered by the widely used antifungal drug itraconazole. This effect appears to be dose-dependent, where a daily intake of 100 mg itraconazole is enough to induce pseudohyperaldosteronism. Clinicians should be aware of pseudohyperaldosteronism as a possible adverse effect of itraconazole, and we recommend monitoring potassium levels and blood pressure in all patients receiving this drug over a longer period of time. Voriconazole is probably an alternative antifungal treatment to itraconazole but also with this drug potassium levels should be monitored.

scholarly journals Comparative Study of Effect of Etomidate Versus Propofol plus Ketamine on Haemodynamic Response to Laryngoscopy and Endotracheal Intubation

2021 ◽  
Vol 8 (15) ◽  
pp. 939-944
Author(s):  
Saraswathi Ramakrishna ◽  
Langpoklakpam Chaoba Singh ◽  
Bijaya Chingtham ◽  
Rahul Jain
Keyword(s):  
Endotracheal Intubation ◽  
Side Effect ◽  
Controlled Trial ◽  
Double Blind ◽  
Haemodynamic Stability ◽  
Significant Difference ◽  
Haemodynamic Changes ◽  
Drug Induction ◽  
Randomised Controlled ◽  
Post Operative Nausea

BACKGROUND Laryngoscopy and endotracheal intubation, a painful procedure, frequently used in airway management is commonly associated with undesired haemodynamic changes like hypertension, tachycardia and arrythmias. Thus, this study was designed to compare haemodynamic stability to laryngoscopy and intubation using single drug induction with etomidate and combined drug induction with propofol and ketamine. METHODS This was a double blind randomised controlled trial, a total of 90 patients of both sexes, aged between 18 - 60 years, who were scheduled for elective surgeries under general anaesthesia in regional institute of medical sciences (RIMS) operation theatre (OT) were divided into two groups. Group PK received propofol (1.5 mg / kg) + ketamine (0.5 mg / kg) and Group E received etomidate (0.3 mg / kg) as induction agents. The haemodynamic parameters (systolic blood pressureSBP, diastolic blood pressure-DBP, mean arterial pressure-MAP, heart rate-HR) were recorded before induction, immediately after induction, 1, 3 and 5 mins after intubation. Side effects like myoclonus and post-operative nausea and vomiting were also noted. RESULTS SBP, DBP, MAP which were recorded, before induction considered as the baseline, and after induction, were comparable between the two groups. SBP, DBP and MAP compared at 1, 3 and 5 mins after intubation showed statistically significant difference between the two groups with propofol-ketamine group showing better haemodynamic stability. The HR between both the groups at various time intervals were comparable and not considered statistically significant. The side effect associated after induction was myoclonus in 14 patients in Group E i.e. 31 % and post-operative nausea vomiting was observed in 8 patients in Group E i.e. 18 %. CONCLUSIONS Thus, in view of haemodynamic stability during laryngoscopy, intubation and side effect profile; propofol and ketamine combination proves to be a better alternative compared to etomidate according to our study. KEYWORDS Propofol, Ketamine, Etomidate, Haemodynamic Stability

A Comparative Study between Dexamethasone versus Paracetamol Added to Xylocaine in Local Intravenous Anesthesia in Upper Limb Minor Surgeries

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Reem Hamdy Elkabarity ◽  
Heba Abdel Azim Labib ◽  
Marwa Mamdouh Elfar ◽  
Mostafa Mohamed Mohamed Ibrahim Sharaf
Keyword(s):  
Regional Anesthesia ◽  
Motor Block ◽  
Intravenous Anesthesia ◽  
Full Stomach ◽  
Opioid Dose ◽  
Intravenous Regional Anesthesia ◽  
Significant Difference ◽  
Block Time ◽  
Recovery Times ◽  
Group D

Abstract Background Intravenous regional anesthesia (IVRA) is a technically simple, reliable and costeffective method of regional anesthesia for short operative procedures of the extremities. It is easy to be administered, of lower cost compared with general anesthesia, no need for deep sedation and can be used for emergency operations on extremities for patients with full stomach. Objective Comparison between the anesthetic and analgesic parameters in local intravenous anesthesia by adding Paracetamol and Dexamethasone to xylocaine. Patients and methods This study was carried out in Ain Shams University hospitals for six months (from August 2018 to February 2019) on 45 patients of both sexes aged 20-50 years belonging to ASA I & II undergoing forearm and hand surgeries using IVRA. Results There was no significant difference between group (P), Group (C) as regard sensory, motor recovery times, both had a shorter sensory and motor block time need to an opioid dose as an analgesic dose. Group (D) had the fastest sensory and motor block time and more prolonged recovery time than group (P) and group (C) need less opioid dose as analgesia for controlling pain. As regard postoperative analgesic requirements. Group (D) and group (P) needed less analgesic doses than group (C) but there was no significant difference between group (P) and group (C). Conclusion Addition of 8 mg Dexamethasone as adjuvant to xylocaine for intravenous regional anesthesia led to: Reduction the dose of xylocaine used for IVRA, Shortening the sensory and motor block onset times, Prolong the sensory and motor block recovery times, and Reduction the postoperative analgesic requirement with satisfaction for patient and surgeon.

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