Comparison of Ketamine and Pentazocine with Fentanyl and Propofol combination for anaesthesia during laparoscopic tubal ligation

Background: Laparoscopic tubal ligation have advantages of minimally invasive surgical technique, without risk of major haemorrhage, early postoperative ambulation and alimentation, making it suitable for ambulatory surgery. The choice of aneasthesia for laparoscopic ligation hence should consider the anaesthetic agents with a rapid onset of action and fast recovery time, with minimal problems for intraoperative control of haemodynamic, airway and pain relief as well as take consideration of the safety, quality, efficacy, and utilization of resources available to the given situation.Methods: A total of 100 patients aged from 18 to 45 years who were scheduled to undergo laparoscopic tubal ligation  were divided into Group I-  Ketamine plus pentazocine group (n=50), Group II- Propofol plus fentanyl group (n=50) and studied  for the intraoperative parameters (hemodynamic and respiratory profile), recovery time, postoperative side effects and discharge time.Results: Intraoperatively MAP and HR were consistently higher in group I as compared to group II. Incidence of apnea and need for bag and mask ventilation was significantly more in Group II than in Group I as was the incidence of Bradycardia. Postoperative nausea and vomiting, psychomimetic effects were significantly more in Group I than in Group II. The time to reach modified PADSS ≥9 (discharge time) was significantly longer in group I (140.3±12.82 min than in group II 102.2±9.2 min), P<0.01.Conclusions: Combination of ketamine and pentazocine gives good anaesthetic conditions during procedure with less incidence of airway and haemodynamic complications intraoperatively but more incidence of postoperative side effects like nausea, vomiting, psycomimetic effects, and time to meet discharge criteria, compared to propofol plus fentanyl.

A Comparative Study of Autonomic Cardiovascular Parameters in Obese and Non-Obese Adults

Globally, the epidemic of obesity in children and young adults is on a constant rise over the past decade. Obesity makes individual highly susceptible to a variety of chronic diseases and their complications. An altered autonomic response in the form of enhanced baseline sympathetic activity, feeble response to sympathetic stimuli and compromised parasympathetic activity is observed in obesity. We have assessed potentially perturbed autonomic responses in young overweight/obese first year medical students. Methods: This cross sectional analytical study was undertaken in the research lab of the Department of Physiology, M.K.C.G. Medical College over a period of 12 months on 300 students (both males and females) to determine sympathetic and parasympathetic responses to stress using hand-grip dynamometer and sinus arrhythmia test respectively. Independent ‘t’ test, Pearson’s correlation coefficient and multiple linear regression analysis in SPSS 20.0 was used to statistically ascertain the differences for the aforementioned parameters between obese and non-obese adults. Results: Weight, Body mass index (BMI), waist hip ratio (WHR), Pulse rate (PR), baseline systolic blood pressure (BSBP) & baseline diastolic blood pressure (BDBP) is significantly greater in obese than in non-obese. BMI shows positive correlation with BSBP & BDBP (r=0.660**; p<0.001 & 640**; p<0.001) and negative correlation with ΔDBP, and E/I Ratio. A negative correlation is appreciated amongst ΔDBP and BMI (R2 = 39.6). A similar negative correlation is again seen between E/I ratio and BMI (R2 = 37.2). Conclusion: Obesity potentially alters autonomic balance with increased sympathetic and reduced parasympathetic tone posing elevated risk of cardiovascular and cerebrovascular accidents.

Effect of Moderate Aerobic Exercise Training on Autonomic Functions and its Correlation with the Antioxidant Status.

Aerobic exercise is a proven measure to enhance the cardio-respiratory efficiency. This improvement is primarily due to improvement in autonomic function where in there is increase in the parasympathetic function and decrease in sympathetic function. Exercise also affects many metabolic activities in our body and may be one of the factors which reduce the oxidative stress. The aim of the present study was to see the effect of moderate aerobic exercise training on autonomic function and its correlation with antioxidant status. 30 healthy volunteers in the age group of 18-22 years were screened. Autonomic function tests included activity (tone) and reactivity parameters. Antioxidant status was assessed by the level of malondialdehyde in plasma. We observed a significant change in SBP, DBP, LF nu, HF nu, delta value of DBP in CPT and MDA. Our findings are consistent with earlier findings that short duration physical training is known to reduce blood pressure and that there is a relationship between HF (in HRV) and training response Physical exercise also provides a favorable change in the biochemical parameters such as MDA.

Assessment of Tear Secretions in Healthy Indian Volunteers.

Dry eye syndrome is currently seen with increasing frequency throughout the world including India. An evaluation of tear physiology in the form of tear secretion and tear film stability is the most important aspect of dry eye diagnosis. The aim of this study is to investigate the age and gender related changes in the result of these tear function tests (Schirmers Test and Tear Break up time) in normal Indian population. This crosssectional observational study included 120 normal subjects (60 Male and 60 females) with no ocular symptoms or ocular surface disorders. Schirmer and tear film break-up time tests were assessed in both eyes of each subject. The study subjects were divided into 4 groups according to their ages (< 20y, 20-40y, 41-60y and > 60y) each group was composed of 60 eyes of 30 subjects (15 male and 15 female subjects). The One way ANOVA test and the Statagraphic software was used for statistical analysis. We detected a statistically significant decline in both the tear function tests with increasing age. Tear function tests did not show statistically significant difference according to sex. This study suggests that the age of subjects should be taken into consideration in the evaluation of tear function test results. It is also revealed that Indian population values are different from Caucasian and Chinese values. We propose age specific cut off values of tear function tests in Indian population to aid in the diagnosis of dry eye in Indian conditions.

Effect of stress on academic performance in medical students – a cross sectional study.

Introduction- Stress, a universal phenomenon, affects an individual’s productivity either by increasing it (‘eustress’) or decreasing it (‘distress’). It is widely acknowledged that the medical fraternity is predisposed to enormous stress. The same may be true for the budding medicos- the undergraduate medical students. In our study we attempted to identify situations that predisposed the medical students to stress and their effects on academic performance and to suggest certain coping mechanisms. Objectives- firstly to explore common sources of stress in medical students, secondly to establish correlation of stress, gender, attendance, and academic performance if any. Method- 114 medical undergraduates were assessed for the common sources of stress and the level of stress using semi structured Performa and stress scale. The results were compared and correlated with various variables like attendance, demographic factors, average marks etc. Pearson correlation coefficient was used for statistical correlation amongst different variables. Results & Conclusions- Stress shows beneficial effects in females when compared to males. High attendance and better day to day performance in female medical students was associated with more amount of stress when compared to male students. Thus, stress among medical students should be acknowledged and attempts should be made to alleviate it.

Comparative study of effect of anuloma-viloma (pranayam) and yogic asanas in premenstrual syndrome.

The present study was planned to investigate the effects of Anuloma-viloma and specific yogic asanas in Premenstrual syndrome (PMS). The study group comprised of 60 females suffering from PMS between the age group of 18- 40 years, having 28-34 days regular menstrual cycle, further subdivided into 3 groups having equal number (n=20) of subjects-group A (no intervention), group B (Anuloma-viloma) and group C (yogic asanas). Age-matched 30 healthy female subjects were taken as control. In all the subjects, a baseline recording of the systolic (SBP) and diastolic blood pressure (DBP) from the right arm was taken using an automated sphygmomanometer. The heart rate (HR/min), electromyogram (EMG; mV), galvanic skin response (GSR;kΩ), respiratory rate (RR/min), peripheral temperature (T;°F), were recorded simultaneously, on an automated biofeedback apparatus Relax 701. The subjects of group A and group B performed yogic exercises, regularly for 7 days prior to the expected date of menstruation for 3 consecutive menstrual cycles. The parameters were recorded again at the end of 7 days in each menstrual cycle. We observed that, in the group A and group B, HR, SBP, DBP, EMG, GSR and RR showed a very significant reduction (P<0.001) and T rose more significantly (P<0.001) after the 3rd menstrual cycle, when compared with their basal levels. On computing the percentage difference between the baseline and post values in all the three groups and than comparing this percentage difference, we found a y significant difference (P<0.05) between the groups. In the present study, the relaxation response in the females suffering from PMS showed a reduction in an abnormally high basal sympathetic activity and a heightened relaxation response in both the study groups (group B and Group C) in comparison with group A.

Cardiac autonomic activity in young females with primary dysmenorrhea.

Various studies have reported the effect of different phases of normal menstrual cycle on the autonomic control over the cardiac activity using heart rate variability (HRV) analysis. However, information on cardiac autonomic activity in young females suffering from primary dysmenorrhea (PD) is scant. Hence, the aim of the present study was to assess the HRV and blood pressure (BP) in different phases of menstrual cycle in women with PD and to compare these findings with eumenorrheic females. Sixty healthy unmarried female subjects (30 females with PD and 30 control subjects), in the age group of 18-25 years, having regular 28-32 days menstrual cycle were recruited for the study. Anthropometric measurements such as height, weight, BMI and WHR were measured. Blood pressure was measured with automatic blood pressure monitor and lead II ECG recordings were done to obtain HRV, during menstrual, follicular and luteal phases of menstrual cycle in both groups. The data recorded were subjected to time and frequency domain analysis. The results showed that dysmenorrheic women had significantly high BMI (P<0.05). Analysis of HRV during the different phases of the menstrual cycle between two groups revealed significantly increased (P<0.01) mean HR and significantly reduced (P<0.01) mean RR and RMSSD in all the 3 examined phases, SDNN significantly less (P<0.05) and systolic BP significantly higher (P<0.001) during the luteal phase in study group compared to control. Also, we observed a statistically significant decrease in TP and LF ms2 (P<0.05), HF ms2 & nu (P<0.01) in menstrual phase, HF ms2 (P<0.05) and HF nu (P<0.01) in luteal phase, while LF nu and LF-HF ratio were found to be significantly higher (P<0.01) in menstrual and luteal phases in women with PD compared to control group. This study has shown decreased HRV in the form of increased sympathetic tone and decreased parasympathetic activity in dysmenorrheic women which may be considered an important cardiovascular risk factor.

Comparison of cardiac autonomic activity between malnourished and healthy children.

Severe malnutrition can significantly compromise autonomic nervous system. However, less is known about the cardiac autonomic activity in mild and moderate grades of malnutrition in children. Therefore, the objective of this study was to assess the effect of mild/moderate malnutrition on heart rate variability (HRV), a non invasive tool to estimate the cardiac autonomic activity. A cross sectional, community based study was conducted in which 35 malnourished children (mean age: 6.06±2.04 yrs), on the basis of anthropometric parameters, were enrolled in the study group by random samplings, who were the children of urban slum dwellers and 35 age and sex matched healthy children, were taken as controls. Grading of malnutrition was done according to Indian Academy of Pediatrics (IAP) classification. Anthropometry, basal heart rate (BHR), blood pressure were determined. Time domain and frequency domain indices of HRV were assessed using RMS Polyrite D (version 2.4). Weight, height, mid arm circumference (MAC) and body mass index (BMI) were found to be statistically lower in the study group. There was a strong negative correlation between MAC and LF component (P<0.01). BHR was found to be increased in the malnourished group (P=0.027). Low frequency (LFnu) & LF-HF ratio were found to be increased (P=0.000 & P=0.001 respectively) while high frequency (HFnu) component was decreased (P=0.000) in malnourished group. Our results suggested that impaired cardiac autonomic nerve function characterized by sympathetic over activity may occur in malnourished children. This study also enables us to compare, in future works, HRV in pediatric subjects with different grades of malnutrition.

Correlation of anthropometric parameters with QTc interval in malnourished children.

Various studies have reported the effect of severe malnutrition on electrolyte levels and electrocardiographic parameters. However, only a few have reported these findings in mild and moderate grades of malnutrition in children. Therefore, the objective of this study was to assess the effect of malnutrition (mainly mild and moderate grades) on corrected QT interval (QTc) and QT dispersion (QTcd) and electrolyte changes. A total of 20 malnourished children in the age group of 2-11 yrs were enrolled in the study group and 20 age and sex matched healthy children were taken as controls. Anthropometry, serum levels of albumin & electrolytes were determined. QTc and QTcd (difference between maximum & minimum corrected QT interval) were measured with the help of RMS Polyrite D. Our results have shown that body weight, height, body mass index (BMI), serum levels of albumin, potassium & calcium were lower (P<0.01) in malnourished children. QTc (P<0.01) & QTcd (P<0.01) were significantly greater in malnourished children than controls. We concluded that increase in QTc and QTcd intervals is associated with electrolyte disturbances in malnourished children. Electrolyte disturbance correction and appropriate nutrition therapy followed by further cardiac evaluation must be taken into account in the management of these patients.