Comparison of Dexmedetomidine Plus Ketamine Combination with Dexmedetomidine Plus Propofol for Awake Fiberoptic Nasotracheal Intubation: A Prospective Randomised and Controlled Clinical Trial

Background: Awake fibre optic intubation (AFOI) is a valuable technique in securing the airway in predicted difficult intubation scenario, compromised airway, airway pathology, when neck extension is to be avoided, vertebral artery insufficiency, Arnold Chiari malformation, limited mouth opening as in temporomandibular joint disease, mandibular-maxillary fixation and severe facial burns.[1] Fiberoptic intubation is the best, easiest and most successful method for awake intubation. Materials and Methods: A prospective, comparative and randomized study was conducted on 100 patients undergoing elective surgery under general anaesthesia. Patients were randomly divided into two groups of 50 each. Group-DK and group-DP patient received IV dexmedetomidine 1µg/kg over 10 mins. Upon completion of the dexmedetomidine bolus, preoxygenation was done with 100% oxygen via face mask with Bain’s circuit. Group-DK patients received ketamine 0.25 mg/kg IV and Group-DP patients received propofol 1mg/kg IV so as to achieve an adequate level of sedation i.e. Ramsay sedation scale=3. Haemodynamic parameters (heart rate, systolic and diastolic blood pressure, mean arterial pressure), SpO2, EtCO2, total comfort scale and patient’s tolerance were assessed during preoxygenation, fiberscope insertion and endotracheal intubation. Results: Statistically significant difference (p<0.05) between two groups in terms of HR, SBP, DBP, MAP, total comfort score and patient tolerance was seen during fiberscope insertion and endotracheal intubation. Conclusion: Dexmedetomidine (1µg/kg) plus ketamine (0.25mg/kg) and dexmedetomidine (1µg/kg) plus propofol (1mg/kg) are safe and effective in patients undergoing fibre optic nasotracheal intubation offering conscious sedation. There is better tolerance and comfort while maintaining oxygen saturation without any hemodynamic alteration in dexmedetomidine (1µg/kg) plus ketamine (0.25mg/kg) group while on the other side use of dexmedetomidine (1µg/kg) and propofol(1mg/kg) during fibre optic intubation causing statistically significant decrease in heart rate, blood pressure, SpO2 and provides less tolerance and comfort.

Characterization of the Cicatrization Process in Diabetic Foot Ulcers Based on the Production of Reactive Oxygen Species

The present study aims at evaluating the correlation between the free radical formation and the healing action of lower limbs’ ulcers in a randomized controlled trial with the use of an adhesive derived from natural latex associated with a light-emitting diode (LED) circuit. The sample consists of 15 participants with lower limb lesions divided into three groups: group 1 case (5 participants) received the proposed dressing system adhesive of the natural latex associated with the LED circuit; group 2 control (5 participants) received the dressings at home performed by nurses according to and established by the clinic of wounds (treated with calcium alginate or silver foam); and group 3 (5 participants) also received the dressing in their homes with the use of the dressing adhesive derived from the natural latex associated with the LED circuit. The collected data were analyzed qualitatively and quantitatively by electron paramagnetic resonance for determination of free radical formation. Kruskal-Wallis statistical test was used to evaluate the effect of treatment on the lower limb’s ulcer cicatrization process and its correlation with free radical. The results obtained corroborated the hypothesis about the reduction of the quantity of these molecules in the end of treatment related to the healing wound.

Impact of closed versus open venous reservoirs on patient outcomes in isolated coronary artery bypass graft surgery

Data were collected retrospectively on 1681 consecutive isolated coronary artery bypass graft patients at Millard Fillmore Hospital (Buffalo, New York, USA) undergoing coronary artery bypass. No patients were excluded. There were 616 patients in the open circuit group and 1065 in the closed circuit group. Patients in the closed circuit group exhibited a trend towards a higher incidence of most pre-existing comorbidities, with acute myocardial infarction, pre-existing cerebrovascular disease and the incidence of extensively calcified aortas all being significantly higher. Significantly different postbypass outcomes favored the closed circuit group, with levels of sepsis of 1% for open and 0% for closed and respiratory failure of 4% for open and 1% for closed. The length of stay approached significance with a p-value of 0.057 (open 9.85 days and closed 7.53). Use of an open circuit was a significant, independent predictor for increased use of units of packed red blood cells and total units of blood products. This study provides evidence that closed venous reservoirs can favorably impact surgical outcomes and reduce resulting healthcare costs.

Comparison of three oxygenator-coated and one total-circuit-coated extracorporeal devices

The present study was designed to compare the biocompatibility of three cardiopulmonary bypass setups with different surface coatings, and to determine if coating of the whole circuit with one of the coatings was more beneficial than coating of the oxygenator only. Extracorporeal devices entirely coated with synthetic polymers (Avecor, n = 6) were compared to oxygenators coated with synthetic polymers (Avecor, n = 6), end-point, covalently attached heparin (CBAS, n = 6) or absorbed heparin (Duraflo 2, n = 6) in an in vitro model of a heart-lung machine. The circuits were primed with fresh human whole blood and Ringer’s acetate and recirculated at 4 l/min at 30°C for 2 h. Test samples were obtained at regular intervals and analysed for myeloperoxidase (MPO), platelet counts, β-thromboglobulin, heparin, prothrombin fragment 1+2, plasmin-anti-plasmin complexes, and complement activation products. The mean MPO concentrations increased in the Avecor-coated oxygenator group (AV) from 247 at the start to 671 μg/l at the termination of the experiments, in the Avecor-coated total circuit group (AV-T) from 116 to 288 μg/l, in the Duraflo 2 coated oxygenator group (DU) from 160 to 332 μg/l, and in the CBAS-coated oxygenator (CA) group from 172 to 311 μg/l. The MPO concentrations increased significantly in all groups ( p < 0.03). The increase in group A was significantly higher than in the other three groups ( p = 0.007). The mean platelet counts decreased in the Avecor-coated total circuit group from 117 at start to 99 × 109/l at termination of the experiments, in the Avecor-coated oxygenator group from 119 to 103 × 109/l, in the Duraflo 2 group from 96 to 86 × 109/l, and in the CBAS group from 132 to 123 × 109/l. The platelet counts decreased significantly in all groups ( p < 0.01), but the intergroup differences were not significant ( p = 0.15). The mean β-thromboglobulin concentrations increased in the Avecor-coated total circuit group from 193 at the start to 754 ng/ml at the termination of the experiments, in the Avecor-coated oxygenator group from 474 to 1654 ng/l, in the Duraflo 2 group from 496 to 1280 ng/l, and in the CBAS group from 418 to 747 ng/l. The β-thromboglobulin increase was significant in each group ( p < 0.01), but not between the groups ( p = 0.49). The mean heparin concentrations in the Duraflo 2 group increased from 2460 at the start to 2897 IU/l at termination of the experiments, in the CBAS group from 2468 to 2518 IU/l. In the Avecor-coated oxygenator group heparin concentrations decreased from 2010 to 1968 IU/l, and in the Avecor-coated total circuit group from 2002 to 1927 IU/l. The differences in heparin concentrations were significant between the Duraflo 2 group and the other groups ( p < 0.05). The mean prothrombin fragment 1+2 concentrations increased in the CBAS group from 0.4 at the start to 2.1 nmol/l at the end of the experiments, in the Avecor-coated oxygenator group from 0.4 to 0.6 nmol/l, in the Avecor-coated total circuit group from 0.3 to 0.4 nmol/l, and in the Duraflo 2 group from 1.2 to 1.3 nmol/l. The prothrombin fragment 1+2 increase was significant in all groups ( p < 0.05), but there were no significant intergroup differences ( p = 0.54). There were no significant differences at the termination of the experiments among the four groups regarding complement activation as measured by C3 activation products and the terminal complement complex. In the present in vitro model of a heart-lung machine, none of the three specific setups with different coatings was superior with regard to all test parameters. The CBAS group generated the highest levels of prothrombin fragment 1+2 formation, but least complement activation. The increasing plasma heparin concentrations in the Duraflo 2 group indicated more unstable heparin bonding. The Avecor-coated total circuit group were superior to the Avecor-coated oxygenator group regarding plasma concentrations of MPO, but not compared to the CBAS and Duraflo 2-coated oxygenator groups.

Release Profile of Salofalk 750 mg Tablets

This study determined the release profile of Salofalk 750 mg tablets (Axcan Pharma), an enteric-coated 5-aminosalicylic acid (5-ASA) preparation. Twenty-one ileostomates were divided into two groups and studied. Group 1 consisted of 10 subjects (five males, five females, mean age 39 years) who had a mean length of 65 cm of small bowel resected or out of circuit. Group 2 consisted of 11 subjects (eight males, three females, mean age 59 years) whose small bowel was intact. Following an overnight fast and collection of baseline samples, one Salofalk tablet was ingested. Ileostomy effluent and urine were collected for 24 h. Plasma samples were collected hourly for 6 h, then at 8, 12 and 24 h. All subjects ate standardized meals. All samples were stored at --10 degrees C and 5-ASA and N-ac-5-ASA (a metabolite of 5-ASA) were measured by high performance liquid chromatography. The mean intestinal transit time was not statistically different between the groups but the mean ileostomy effluent output was higher in group 1 versus group 2 (10.9 versus 13.1 h, P=0.4; 918 versus 606 mL, P=0.05). The mean peak plasma concentrations of 5-ASA and N-ac-5-ASA were not significantly different (6.12 and 5.42 µ g/ mL, P=0.8, respectively, in group 1 versus 6.75 and 6.66 µ g/mL, P=0.8 in group 2). On average, 33.1% of the ingested dose was recovered in the ileostomy effluent in group 1 versus 21.2% in group 2 (P=0.06) whereas the mean recovery in urine was 40.9% in group 1 but 62.9% in group 2 (P=0.001). These results suggest that 5-ASA is released in the small bowel. There was decreased absorption of 5-ASA and increased recovery of 5-ASA in the ileostomy effluent of subjects who had a small bowel resection.