Comparative study on sedative effects of midazolam and propofol in conscious, agitated, uncooperative patients those admitted in the Emergency Department of Rajah Muthiah Medical College and Hospital

Background: Sedation is the depression of a patient’s awareness of the environment and reduction of his or her responsiveness to external stimuli. Some decades ago, the emergency room procedures were conducted without adequate sedation of the patient, which landed upon various bitter events, like uncomfortableness for the patient, uncomfortableness for the doctor, failure of the procedure, high rate of complications. Aim of the study: To study the onset of action, duration of action, and necessity of additive doses of sedation requirement of midazolam and propofol, to compare the sedative effects of OD midazolam and propofol. Materials and methods: This observational study was conducted in the division of Emergency Medicine at Rajah Muthiah Medical College and Hospital, Chidambaram in the year October 2017 to August 2018. After formal approval from the Ethical committee, this study was conducted on 40 G. Balaji, C.R. Ramachandran. Comparative study on sedative effects of midazolam and propofol in conscious, agitated, uncooperative patients those admitted in the Emergency Department of Rajah Muthiah Medical College and Hospital. IAIM, 2019; 6(5): 154-159. Page 155 patients of either sex between age 20 – 50 years old. After proper IV access is acquired, calculated doses of Midazolam or Propofol were administered intravenously and data was collected. Selection of drug (either midazolam or propofol) was random. The patients were sorted into two groups namely, Group M – Midazolam received patients. Group P – Propofol received patients. Then the data were collected regarding the onset of action, duration of action, sedation scales, and vitals. Scales used to evaluate the effect of drugs were the Richmond Agitation Sedation Scale (RASS), and Ramsay scale. Results: 32.5% of patients belong to toxicology by diagnosis and 30% of patients were pure medical cases, 15% belongs to hanging, and 7.5% of patients are trauma cases. 50% of patients were sedated for securing the airway, and 37.5% of patients were sedated to do procedures. 7.5% of patients received sedation to control seizures and 5% for Cardioversion. In Group P only 15% of patients required top-up dose, whereas in Group M 25% of patients required top-up dose. In Group P, the mean score was 4.35 and in Group M is 3.9, and so there is a statistically significant difference in the Ramsay scale. The difference in fall in systolic BP and respiratory rate between Group P and Group M was statistically significant. Also, there is a significant rise in SpO2 in Group P compared to Group M. Conclusion: Propofol-induced sedation is quicker and effective than that of midazolam. The side effects produced by propofol are negligible and it is even safer when top-up doses are used. The recovery from propofol-induced sedation is faster, and it is even smoother than that of midazolam. So propofol can be safely used for effective sedation in ER.

Unusual presentation of nasopharyngeal (juvenile) angiofibroma in a 45 year old female.

Juvenile nasopharyngeal angiofibroma is a rare tumour, comprising 0.05% of the head and neck tumours, histologically benign, locally invasive, and has a specific predilection for nasopharynx and adolescent males. This article presents an unusual case of nasopharyngeal angiofibroma in a 45-year-old female patient, manifesting as a destructive maxillary lesion and discusses the two most important factors regarding this tumour, the etio-pathogenesis and spread.

Canalicular adenoma of the upper lip mimicking mucocele.

Salivary gland neoplasms are relatively rare. Among the salivary gland neoplasms minor salivary gland neoplasms are often deceptive to the clinician and challenging to the pathologist because of their varied morphology and diverse histopathological pattern. This article documents a case of canalicular adenoma of the upper lip mimicking mucocele and discusses the differential diagnosis of minor salivary gland neoplasms.