ABSTRACT
Background: A prospective, randomized controlled study with parallel treatment groups carried out to assess efficacy and tolerability of atorvastatin in escalating doses (10 mg, 20 mg, 40 mg and 80 mg) in modulating the lipid profile in patients of coronary artery disease in eastern Indian population and whether “Rule of six” commonly referred to in context of low-density lipoprotein (LDL) reduction by statins stands true in our population. Methods: Patients randomly allocated into four groups (n=632) as per selection criteria. Groups A, B, C, D received atorvastatin 10 mg, 20 mg, 40 mg and 80 mg, respectively once daily at bedtime, for 24 weeks after which evaluation of efficacy and tolerability was done. Comparison between groups performed with one-way ANOVA; p<0.05 considered to be statistically significant. Results: There was a significant reduction in cholesterol, LDL and triglycerides in all the groups, but between group comparisons did not reveal any significant reduction in lipid parameters between Groups C and D. “Rule of six” was not observed at higher doses of atorvastatin (40, 80 mg). Further, there was significant reduction of high-density lipoprotein (HDL) in Groups C and D, which is not accepted especially in Indian context where it is already low at baseline. Conclusion: In Indian perspective, where HDL is low, and the LDL values are not very high, escalating dose of atorvastatin does not give additional clinical benefit. On the contrary, reduction of HDL itself predicts an adverse cardiovascular outcome. Increased adverse events and burden of cost must be taken into account, while prescribing atorvastatin.
ABSTRACT
Background: Laryngoscopy and tracheal intubation after the induction of anesthesia are nearly always associated with a sympathetic hyperactivity. To attenuate the pressor response, various drugs have been tried, but studies to compare the effects of dexmedetomidine or clonidine on the hemodynamic response during laryngoscopy and tracheal intubation are anecdotal and sparse. This study aims to find the drug, which was best suited for this purpose and to compare their effects on sedation and anesthetic requirements. Methods: This was a prospective study, which involved three groups of patients. Each group had 20 patients who presented for elective, non-cardiovascular surgeries. The patients in group I (control) were given normal saline and the groups II and III were given dexmedetomidine and clonidine, respectively. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and Ramsay sedation score were recorded at 1 and 2 min after completion of administration of study drug. Induction was done with propofol and required dose is noted. HR, SBP, and DBP were again assessed during intubation and at 1, 3, 5, and 10 min after intubation. The obtained clinical data were analyzed statistically with analysis of variance. Results: In our study, HR, SBP, and DBP all increased during intubation and thereafter in all three groups. Pretreatment with dexmedetomidine 1 μg/kg and clonidine 2 μg/kg significantly attenuated the cardiovascular and catecholamine responses to tracheal intubation. However, attenuation was significantly more with the dexmedetomidine group with a quicker return to baseline. Dexmedetomidine also fared in terms of anesthetic requirement (propofol) and sedative action. Conclusion: Preoperative administration of a single dose of dexmedetomidine blunted the hemodynamic responses more than clonidine or placebo during laryngoscopy, and reduced anesthetic requirements.