Preoperative Dexmedetomidine Prevents Tourniquet Induced Hypertension In Upper Limb Orthopaedic Surgeries During General Anaesthesia

Introduction: During limb operations tourniquets are widely used to minimize surgical bleeding and to maintain a relatively bloodless field. Tourniquet induced hypertension occurs more frequently under general anaesthesia than spinal anaesthesia and more with lower limb tourniquet than with upper limb tourniquet and can be serious in patients with cardiopulmonary diseases, neurological disease and glaucoma. This study was designed to investigate the hemodynamic effects of dexmedetomidine on prolonged tourniquet inflation. Material and Methods: Sixty patients scheduled for elective orthopaedic surgery of the upper limb under general anaesthesia were recruited. They were randomly assigned to receive intravenous dexmedetomidine (0.5 mcg/kg; n=30) or normal saline (NS group; n = 30) before tourniquet inflation. Arterial blood pressure and heart rate were recorded every 10 minutes until 90 minutes after the start of tourniquet inflation and again immediately after deflation. Result: In the dexmedetomidine group, arterial pressure was not significantly changed, but in the Control group arterial pressure was significantly increased at 90 minutes after the start of tourniquet inflation. Development of more than 30% increase in arterial pressure during tourniquet inflation was more frequent in the Control group than in the dexmedetomidine group. Conclusion: Preoperative intravenous dexmedetomidine could therefore prevent tourniquet-induced hypertension in patients undergoing general anaesthesia.

The opinion of undergraduate medical students on current curriculum and teaching methodology of pharmacology in four medical colleges of India: a questionnaire based study.

Background: The objective of current study was to obtain an opinion from 2nd professional year passed medical students on current curriculum, teaching methodology and importance of pharmacology subject and to identify the area of improvement. Methods: A set questionnaire was distributed among randomly distributed to 2nd year passed 100 undergraduate (UG) students to each of four medical colleges. They were instructed to tick out the best possible option of each question on the basis of their own perceptions. They are also asked to give suggestion to improve teaching and learning of pharmacology subject. Results: Out of the 400 students, only 387 responses of students were suitable for data analysis. The majority of students 99.22% (384) were unsatisfied with the practical teaching. Teachings of preparing and dispensing types of exercises were irrelevant in today’s clinical practice according to 87.78% of the students and were in favor of the deletion of such exercises from the curriculum. The analysis showed that 62.27% of the students were the opinion that animals should not be used in experimental pharmacology. More than half of the UGs (63%) supported the use of computer assisted learning. All of the students were interested in the inclusion of case, problem and multiple choice based question discussions in the regular teaching classes followed by quizzes (31.78%) and group discussions (14.47) while small number of students (1.03%) were interested in the conduction of seminars. Conclusion: There is an urgent need to reform the curriculum and practical teaching methods for fulfilling the objective of reading pharmacology.

Adverse drug reaction monitoring on antiretroviral therapy in human immunodeficiency virus patients in a tertiary care hospital.

Background: The aim of current study was to assess the pattern of adverse drug reactions (ADRs) in patients receiving antiretroviral (ARV) therapy. Methods: A prospective, observational study was carried out for duration of 15 months. Clinical and treatment data were collected from patients, who underwent ARV therapy during the study period. CDSCO forms were used to record the ADRs. Causality, severity and preventability were assessed by suitable scales. Result: Out of 216 patients 165 (76%) patients develop ADRs. Total of 274 ADRs were noted among 165 patients (1.66 ADR/patient). Out of them 100 (60.60%) were males and 65 (39.39%) were females. The most common ADR was gastrointestinal disorders (83, 30.29%). The most numbers of ADRs were observed in ZLN (Zidovudine + Lamivudine + Nevirapine) regimen (54%) followed by SLN (Stavudine + Lamivudine + Nevirapine) regimen (26%). According to WHO causality assessment scale most ADRs were possible (236, 86.13%). Hartwig and Siegel severity scale show 243 (88.69%) ADRs were moderate. Schumock and Thornton scale show all, ADRs were “not preventable.” Conclusion: Early detection of drug toxicity helps to treat the patient and modify the drug regimen to minimize toxic effects.

Anesthetic management of peripartum cardiomyopathy using "epidural volume extension" technique: A case series.

Peripartum cardiomyopathy is a rare cause of dilated cardiomyopathy in parturients, occurring in approximately one in 1000 deliveries, manifesting during the last few months or the first 5 months of the postpartum period. It can result in severe ventricular dysfunction during late puerperium. The major concern while managing these patients is to optimize fluid administration and avoid myocardial depression, while maintaining stable intraoperative hemodynamics. We present a case series of five parturients that were posted for elective cesarean section and managed successfully by the epidural volume extension technique.