A Comparison of Ondansetron and Lidocaine in Reducing Injection Pain of Propofol: A Randomized Controlled Study

Background Propofol injection pain is common. Previous studies found that ondansetron can also block sodium channels. Objective The primary outcome was the efficacy of ondansetron compared to lidocaine and placebo for the reduction of propofol injection pain. Method This trial was conducted in 240 patients, American Society of Anesthesiologists classification I-III and aged between 18-65 years old, undergoing elective surgery, and having a 20-gauge intravenous catheter at the hand dorsum. Each group of 80 patients received 8 mg of ondansetron in the O Group, 40 mg of lidocaine in the L Group and normal saline in the C Group. The study medications were blindly given then 1 minute later, the propofol was administered via the syringe pump at the rate of 600 ml/hr. for 30 seconds. Thereafter, the syringe pump of propofol was temporarily paused, and the patients were asked to rate his/her pain. Result The incidence of pain was lowest in the L group (66.2%) compared with the O (82.5%) and the C groups (85.0%) (P<0.01). The median pain score in the L, O, and C groups were 2 (0-4), 4 (2-5), and 4.5 (2-6), respectively (P<0.01). The incidences of no pain, mild, moderate, and severe pain were also significantly different in the L group (33.8%, 37.5%, 21.2%, and 7.5%, respectively) compared with those in the O group (17.5%, 31.2%, 31.2%, and 20.0%, respectively) and the C groups (15.0%, 22.5%, 40.0%, and 22.5%, respectively) (P<0.01).. Conclusion Pretreatment with intravenous lidocaine, rather than ondansetron, can reduce the incidence and intensity of propofol-induced pain.

Subcutaneous Dihydrocodeine Tartrate: Compatibility in a Syringe Pump With Other Drugs Frequently Prescribed for the Management of Symptoms Associated With Brain Tumors

Background Dihydrocodeine can be more effective in the management of headache due to brain tumor than other opioids. It can be used as a subcutaneous infusion, but at present, there is little available data to support its use in combination with other medicines in a syringe pump. Aim This project aimed to establish physical stability data for the use of dihydrocodeine with other drugs when combined in a syringe pump. Design: Dihydrocodeine was combined in a syringe pump with either cyclizine, midazolam, or hyoscine butylbromide at different doses chosen to represent routine clinical practice. Each drug combination was repeated twice—with 0.9% sodium chloride and with water for injections. Setting: The project was conducted in an independent hospice after seeking appropriate approvals to use the drugs for this purpose. Results Dihydrocodeine and midazolam appear compatible at when 0.9% sodium chloride is used as the diluent. Dihydrocodeine and cyclizine appeared compatible when either 0.9% saline or water for injections was used as the diluent. Dihydrocodeine and hyoscine butylbromide appeared compatible with either diluent at 24 hours. Conclusions Physical stability data has been described that will support the use of dihydrocodeine and other drugs that are commonly used to manage symptoms due to brain tumors at the end of life. This information will benefit patients and ensure that one syringe pump can be used where possible. Future work could expand on this data and explore the physical stability of three drug combinations in each syringe.

TATALAKSANA GAGAL NAFAS AKUT AKIBAT EDEM PARU AKUT PADA PASIEN DENGAN HIPERTENSI

Gagal nafas merupakan kondisi kegagalan fungsi sistem respirasi dalam pertukaran gas di mana PaO2 < 60 mmHg dan/ PaCO2 > 50 mmHg. Telah dilakukan tindakan kepada seorang pasien laki-laki berusia tujuh puluh satu tahun dengan berat badan 70kg yang di bawa ke IGD RSUD Kota Dumai dengan keadaan penurunan kesadaran. Dari alloanamnesa terhadap keluarga pasien, diketahui sebelumnya pasien mengeluhkan sesak nafas yang muncul tiba-tiba. Pasien memiliki riwayat penyakit jantung yang diketahui sejak 6 bulan terakhir dan hipertensi tidak terkontrol. Pasien didiagnosis dengan respiratory failure type 1 et causa cardiogenic pulmonary oedem. Saat di ICU, saturasi O2 pasien turun menjadi 77% sehingga pasien diberikan bagging untuk bantuan nafas kemudian saturasi O2 naik menjadi 90%, kemudian pasien mengalami apneu, asistol dan arteri karotis tidak teraba sehingga dilakukan RJP kompresi: ventilasi 30:2 dengan total 15 siklus dan pasien mengalami ROSC. Pasien kemudian dipasang intubasi dan dibantu ventilator, saturasi O2 menjadi 99%. Sebelumnya pasien diberikan midazolam 15mg di dalam 50ml NaCl melalui syringe pump dan fentanyl 2 ampul dalam 50cc NaCl 50ml melalui syringe pump. Kemudian, pola nafas tidak efektif dan keadaan umum memburuk, ventilator diubah menjadi mode PCAC kemudian pernafasan kembali adekuat dan hemodinamik pasien stabil. Kemudian pada pasien dilakukan weaning ventilator.

A Universal Cassette-Based System for the Dissolution of Solid Targets

Cyclotron-based radionuclides production by using solid targets has become important in the last years due to the growing demand of radiometals, e.g., 68Ga, 89Zr, 43/47Sc, and 52/54Mn. This shifted the focus on solid target management, where the first fundamental step of the radiochemical processing is the target dissolution. Currently, this step is generally performed with commercial or home-made modules separated from the following purification/radiolabelling modules. The aim of this work is the realization of a flexible solid target dissolution system to be easily installed on commercial cassette-based synthesis modules. This would offer a complete target processing and radiopharmaceutical synthesis performable in a single module continuously. The presented solid target dissolution system concept relies on an open-bottomed vial positioned upon a target coin. In particular, the idea is to use the movement mechanism of a syringe pump to position the vial up and down on the target, and to exploit the heater/cooler reactor of the module as a target holder. All the steps can be remotely controlled and are incorporated in the cassette manifold together with the purification and radiolabelling steps. The performance of the device was tested by processing three different irradiated targets under different dissolution conditions.

Comparative Study between Nitroglycerine, Magnesium Sulfate and Dexmedetomidine to Induce Hypotension During Functional Endoscopic Sinus Surgery (FESS)

Background Functional Endoscopic Sinus Surgery (FESS) has been employed as a surgical intervention to treat chronic rhinosinusitis in patients with no response to drug therapy, during which the surgical vision may be greatly reduced by a small amount of bleeding. There by, the intraoperative controlled hypotension can improve the visibility. While excessive bleeding intraoperative cause serious complications in the postoperative period, including eye socket infections, visual acuity damage, meningeal infections, and other. Objective Induced hypotension limits intra operative (IO) blood loss provides better visibility of the surgical field and diminishes the incidence of major complications during Functional Endoscopic Sinus Surgery (FESS). We aimed at comparing Nitroglycerine; Magnesium Sulfate and Dexmedetomidine for inducing controlled hypotension and evaluate narcotic used, mac of inhalational anesthesia, and Ramsay Sedation Scale (RSS) in the recovery and pre-anesthetic time in patients undergoing Functional Endoscopic Sinus Surgery (FESS). Patients and Methods This study was conducted on 75 patients who underwent elective functional endoscopic sinus surgery (FESS) who matched the inclusion criteria and were randomly allocated into 3 groups each containing 25 patients. The first group received loading dose of dexmedetomidine 1μg/kg infused over 10 min before induction of anesthesia then 0.7 μg/kg/h via syringe pump, second group received nitroglycerine infusion at a dose of 2μg/kg/min according to the response started after induction, intubation, positioning and sterilization of the patient and third group received a loading dose of magnesium sulfate 40 mg/kg over 10 minutes followed by an infusion 15mg/kg/h via syringe pump. Results The result of our study showed that dexmedetomidine, magnesium sulfate, or nitroglycerine successfully induced deliberate hypotension and were effective in providing good surgical field during FESS, but dexmedetomidine showed superior hemodynamic profile. Compared with nitroglycerine, both dexmedetomidine and magnesium sulfate offered the advantage of inherent analgesic and sedative effect. Conclusion Dexmedetomidine, magnesium sulfate, or nitroglycerine successfully induced deliberate hypotension and were effective in providing good surgical field during FESS, but dexmedetomidine showed superior hemodynamic profile. Compared with nitroglycerine, both dexmedetomidine and magnesium sulfate offered the advantage of inherent analgesic and sedative effect. Dexmedetomidine also showed shorter duration of surgery with less blood loss and favorable frommer score with more surgeon satisfaction. Dexmedetomidine showed longest time to 1st analgesic rescue in PACU comparing with magnesium sulfate and nitroglycerine. So, it’s advised to use dexmedetomidine to induce hypotension than magnesium sulfate and nitroglycerine. However, dexmedetomidine should be used with caution as it caused hypotension and bradycardia, t had sedative effect with low aldert score comparing with nitroglycerine and magnesium sulfate.

Propofol-dexmedetomidine Versus Propofol-ketamine for Anesthesia of Endoscopic Retrograde Cholangiopancreatography (ERCP)

Background The ideal method for anesthetic management during ERCP varied between deep sedation and general anesthesia with preference for general anesthesia over sedation. Aim of the study Primary aim: The aim of this study will to compare the effects of propofoldexmedetomidine and propofol-ketamine combinations for anesthesia in patients undergoing ERCP regarding the following outcome measures: Hemodynamic changes. Respiratory parameters changes. Propofol requirements. The recovery criteria. Post-operative pain. Secondary aim: To assess the rate of other anesthetic and procedural complications regarding the following outcome measures: Anesthetic complications: Post-procedural nausea and vomiting. Post-procedural cognitive dysfunction or hallucinations. Procedural complications: Bleeding: may occur by sphincterotomy. Duodenal perforation; it is a serious condition but it has a rare incidence and usually requires surgical intervention. Material and methods Patients ERCP, aged 20-50ys old, ASA І-II-III, were randomly allocated in two groups each of which was 25 by a probability method in the form of sequentially numbered, opaque, sealed envelopes (SNOSE) that will be divided in 2 groups (25 envelopes for each group) with random selection for each patient for an envelope. Group-I received dexmedetomidine loading 1µg/kg slow IV over 15min then infused at a rate of 0.5µg/kg/h by syringe pump. Group II received Ketamine 1mg/kg slow IV over 15min then infused at a rate of 0.5mg/kg/h by syringe pump. Both groups received propofol; 1-2mg/kg induction – then 5mg/kg/h IV infusion, 0.5mg/kg boluses guided by hemodynamic parameters, atracurium 0.5mg/kg intubating dose followed by 0.1mg/kg every 20min. Cuffed ETT was inserted and CMV. By the end of the procedure, patients turned supine and reversed by administration of neostigmine (0.05mg/kg) + atropine (0.01mg/kg). Extubation was performed after fulfillment of the criteria of extubation. Conclusion Dexmedetomidine-propofol combination was better than ketamine-propofol combination as regard; hemodynamic parameters (intra- and post-procedural), PONV, cognitive functions and recovery time. Incidence of pain had no clinical significant value between both groups. Total propofol consumption had no clinical significant difference between both groups. Recommendation Dexmedetomidine - propofol combination as TIVA technique for ERCP requires further studies with recommendation to include; different types of patients; geriatric, critically ill and increasing the sample size of patients.

Fabrication of PVA/Carbon-Based Nanofibers Using Electrospinning

Nanofibers are widely used in various fields, including water filtration. In the development of nanofibers as water filtration, a mixture of carbon in a polymer solution is often used. Nanofibers can be made by several methods such as multicomponent fiber spinning techniques, melt blowing, electrospinning. Electrospinning is currently a simple development method but can produce nanofibers with a small fiber diameter, it is easy to develop and many parameters can be controlled. Parameters that affect the results of the nanofibers that are formed include flow rate or syringe pump flow rate and high voltage dc high voltage. Various types of nanofibers can be produced from various types of polymers, both natural polymers and synthetic polymers. Generally, because they have properties and characteristics such as high surface area, small pore size, and the possibility to be developed in various applications. Therefore, this chapter discusses the electrospinning of carbon nanofibers using PVA polymer.