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Introduction: Premedication is used to provide sedation and anxiolysis and to enhance the quality of induction; maintenance and recovery from anesthesia. The ideal premedicant should be orally effective, possess sedative; analgesic antianxiety, antisialogogue and antiemetic properties. It should maintain cardiovascular stability and normal respirations. No single drug has all the forementioned features. Hence search continues for an ideal premedicant. Recently emphasis has shifted to a2- adrenoceptor agonists, because of their properties, which are of potential benefit in anesthesia. Objectives: To evaluate the effectiveness of oral clonidine as a preanesthetic medicant and as a drug to attenuate the hemodynamic responses associated with laryngoscopy and endotracheal intubation. Material and methods: Study was performed on 100 patients of the age group 18-65 years in whom 4 μg/kg body weight of oral clonidine (max 0.2 mg) was administered 90 minutes prior to induction of anesthesia. Degree of sedation, anxiolysis, antisialagogue effect and changes in heart rate, systolic blood pressure (BP), diastolic BP, mean arterial pressure and ECG changes before and after premedication with oral clonidine were evaluated. Statistical methods: Descriptive statistical analysis has been carried out in the present study. Results on continuous measurements are presented on mean ± SD (Min-Max) and results on categorical measurements are presented in number (%). Statistical software: The statistical software namely SPSS 15.0, Stata 8.0, MedCalc 9.0.1 and Systat 11.0 were used for the analysis of the data and Microsoft word and Excel have been used to generate graphs, tables, etc. Results: Clonidine produced significant sedation with a p value of <0.05, before premedication 61% of patients had anxiety score of 1 and 27% had a score of 2 and after premedication 77% had a score of zero and 19% had score 1, which is significant anxiolysis. The association that is observed between clonidine as antisialogogue is mildly significant statistically. Premedication with clonidine produced decrease in pulse rate, decrease in systolic, diastolic and mean arterial pressure was highly significant statistically (p < 0.001). These values remained lower than the basal value after 1 minute up to 5 minutes after intubation. Conclusion: The premedication with oral clonidine produces significant sedation, anxiolysis, mild antisialagogue effect and hemodynamic stability during laryngoscopy and endotracheal intubation with no adverse effects. Thus oral clonidine may be used as an ideal preanesthetic medication.
RESUMO
Introduction: Phyllodes tumors (PT) of the breast seem to get pre-operatively misdiagnosed as fibroadenomas resulting in inadequate resections and high local recurrence rates. Materials and Methods: Data of 150 patients with PT of the breast managed from January, 2003 to February, 2013 were retrospectively analyzed. Statistical analysis performed using SPSS version 17 (Pearson Chi-square test and analysis of variance test for analysis). Aim: The aim of this study is to compare clinico-pathological profile and recurrence rates in patients with benign (B), borderline malignant (BL) and malignant (M) PT. Results: In a total of 150 patients with PT (n = 77 B, n = 24 BL, n = 49 M), mean age was 36.92, 44.04 and 40.46 years respectively (P 0.015) and mean tumor size being 8.15 cm, 14.7 cm and 12.9 cm respectively (P 0.000). Pre-operatively cytology suggestive of PT in 24% patients with B PT and 63% in M PT; core tissue biopsy suggestive of PT in 85.4% patients with B PT and 100% in M PT. Recurrence seen in 34.7% out of which 32.7% were post-lumpectomy performed elsewhere. Majority of B PT had lumpectomy (49.3%)/wide local excision (WLE, 31.2%) compared with M PT where 55.1% had simple mastectomy (SM) due to large tumor size. Local recurrence was more in M PT (53%) compared with B PT (20%). We found recurrence rates in L (39.3%) compared with WLE (27.3%) and SM (33.9%) (P 0.049). Conclusions: Larger tumor size, incomplete resection and M/BL histology predicted higher recurrence in PT. Core biopsy is much more accurate than fine needle cytology in the diagnosis.