Comparative efficacy of 600 mg oral gabapentin and 300 mcg oral clonidine in attenuation of pre-operative anxiolysis and hemodynamic response to endotracheal intubation and laryngoscopy

Background: Endotracheal intubation and laryngoscopy are harmful stimulus, which can trigger unwanted cardiovascular conditions such as hypertension, dysrhythmia, and tachycardia. Various drugs have been used to attenuate the cardiovascular response. Drugs such as clonidine and Gabapentin are in extensive usage to stabilize the hemodynamic responses. Aim and Objectives: The aim of the study was to assess the efficacy of 600 mg oral Gabapentin and 300 mcg oral clonidine in attenuating pre-operative anxiolysis and hemodynamic response to endotracheal intubation and laryngoscopy. Materials and Methods: This prospective randomized study consists of 100 cases between the age group 21 and 65 years posted for elective surgery under general anesthesia. The study cases were randomly divided into two groups. Group 1 (n = 50) administered with 600 mg oral Gabapentin and Group 2 (n = 50) administered with 300 mcg oral clonidine. The baseline and pre-operative hemodynamic parameters and levels of sedation score and anxiety scores were recorded. Results: The total duration of intubation was 26.53 min in Group 1 and 26.86 min in Group 2. The systolic blood pressure, diastolic blood pressure, mean heart rate, mean arterial pressure, sedation score, and anxiety score were comparable between the two study groups and the mean difference between the two study groups was statistically significant (P < 0.05). Conclusion: Both study drugs had similar significant anxiolysis and sedation scores. However, 300 ?g oral clonidine has better hemodynamic stability to laryngoscopy and intubation than 600 mg oral gabapentin.

Psychosocial assessment among ophthalmic patients attending tertiary eye care centre during the lockdown in times of COVID-19 pandemic

Purpose: The coronavirus disease (COVID?19) pandemic continues to play havoc in our lives. During the first “ lockdown” in 2020, we were keen on assessing the anxiety levels of patients who sought ophthalmic care despite the lockdown. Public health actions, such as social distancing, were necessary to reduce the spread of COVID?19. As a result, most people felt isolated and lonely, thereby causing increased levels of stress and anxiety in them. We aimed to assess the anxiety levels using the Hamilton Anxiety Scale and personality assessment using the 57?point Eysenck’s Personality Inventory (EPI) questionnaire among patients visiting a tertiary eye care hospital during the lockdown period. Methods: Consecutive patients attending an ophthalmic tertiary care hospital during the COVID?19 pandemic and lockdown were approached to be a part of this prospective cross?sectional survey. Results: In total, 1,088 responses were analyzed during the 2?month study period with the mean age being 45.7 + 16.9 years. The majority had completed graduation (78%) with 15 years or more of formal education. The purpose of the visit was an emergency consultation in 42% (n = 455), a review appointment in 42% (n = 457), and the remaining (16%, n = 176) came for a routine consultation. The majority of the patients (>90%) did not report experiencing any of the 14 sets of symptoms. A mild level of anxiety was noted in 1,086 (>99%) respondents, whereas only 2 (<1%) respondents showed mild–moderate levels of anxiety. Financial concerns such as affordability of medications (6% vs. 3%, P = 0.05) and fear of losing their job (16% vs. 11%, P = 0.02) were significantly more in those experiencing any anxiety compared to those with no anxiety. Conclusion: Our study revealed that patients visiting a tertiary ophthalmic center during lockdown were graduates, sought eye consultation primarily for emergency or a review, and had no major anxiety symptoms. In those with anxiety, the affordability of medicines and loss of jobs were the main concerns.

Effect of Vitamin E on oxidative stress and outcome of treatment in patients of anxiety disorder

Background: The purpose of present study was to assess effect of Vitamin E administration on oxidative stress and outcome of treatment of anxiety disorder.Methods: 80 newly diagnosed patients of anxiety disorder of age 20 to 60 years were included in the study. They were divided in to two groups containing 40 patients in each group. Group-I patients were given treatment with Tablet Clonazepam 0.5mg orally daily at night for six months. Group-II patients were treated with Tablet Clonazepam 0.5mgand Capsule Vitamin E 400 mg twice a day for 6 months. Levels of Mean MDA, SOD and anxiety score were assessed monthly for six months.Results: Group-I (N=38) patients treated with Tablet Clonazepam 0.5mg orally at night show significant increase in Oxidative stress. Mean MDA- 18.80�37 increased to 27.97�81, SOD- 0.143�004 decreased to 0.111�004 and decrease in mean anxiety score from first month 12.44�24 to last month of treatment 2.55�72. In group-II patients(N=37) treated with Clonazepam and Vitamin E there was decrease in mean MDA levels from 18.78�45 to 12.56�54 and increase in mean SOD levels from 0.141�007 to 0.180�000. There was reduced anxiety score in group-I from 12.44�24 to 2.55�72 and in group II from 12.54�26 to 1.86�58 which was statistically significant. p value <0.05.Conclusions: Treatment of patients treated with Clonazepam showed a significant increase in oxidative stress. In patients treated with Clonazepam and Vitamin E there was more reduction in overall oxidative stress and anxiety.

Evaluation of examination stress in I MBBS medical students.

Background : As academic examination stresses are associated with changes in the mental and physical health such as increasing anxiety, increasing negative mood. Objective : The objectives for the study were to assess anxiety and sympathetic activity using TMAS and CPT respectively one month before examination and hour before examination .Both these parameters were compared and analysed. Method: Parameters were recorded with the help of Taylor manifest anxiety scale questionnaire and cold pressor test. Students were subjected to the tests between 9:30 to 10:30am one month prior to examination and one hour prior to preliminary practical examination in Physiology. Collected data was analysed using MW test and paired ‘t’test. Result : It was observed that students were having high level of anxiety even before one month of examination. Approximately 64 % of males and 53% of females were having high anxiety one month before examination. However, only 54% males and 53% females were having high anxiety one hour prior to examination. Another finding was increase in systolic and diastolic BP one hour before to examination compared to one month before examination, though the difference was not statistically significant. Conclusion: It is evident from the study that thought the results are not statistically significant basal increase in anxiety score indicates that medical students exhibit higher anxiety levels even in the absence of examination.

Effect of yoga on anxiety score and resting heart rate in young healthy individuals.

Background : Modern age is the age of ‘anxiety and stress’, which is posing a great challenge to the health of society. Stresses of modern life precipitate various cardiovascular and other disorders by distorting basic neuroendocrine mechanism and poses risk to cardiovascular system. Objectives : The objectives for the study were to assess effect of yoga practices on anxiety score (using Taylor’s manifest anxiety scale) and resting heart rate. Methods: Study group included subjects who participated in yoga practices for a period of 3 months. Control group included subjects who did not perform yoga or any exercise. Anxiety score and resting heart rate were recorded in both the groups before start of study and at end of the study. Anxiety score was estimated with the help of Taylor’s manifest anxiety scale questionnaire and resting heart rate was estimated by using electrocardiogram (ECG). Collected data was analysed using Mann Whitney test and paired ‘t’test. Results: At the end of three months statistically significant decrease in anxiety score and resting heart rate was observed in the study group. Whereas, there was no statistically significant difference in anxiety score and resting heart rate of control group. Conclusion& Interpretation: It is evident from the study that yoga practices of even short duration (3 months) can reduce anxiety status and decrease resting heart rate. This probably indicates that parasympathetic activity was increased while sympathetic activity was decreased with yoga practices in young subjects.

The Effect of Music on Intraoperative Anxiety during Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Most surgical patients experience perioperative anxiety. This anxiety can effect the amount of preanesthetic medication and anesthetic agents needed, and contributes to postoperative pain. The effect of music on perioperative patient anxiety was studied. METHODS: Forty patients undergoing surgery with spinal anesthesia, were divided into two groups. Group I (n = 20) did not listen to music, and Group II (n = 20) listened to music selected by the patient. At ward, hemodynamic variables including systolic and diastolic blood pressures and pulse rates were measured as control values. Hemodynamic variables and the anxiety scores by the Hamilton anxiety rating scale and the Visual Analogue Scale (VAS) were prepared for Group I and Group II in the operating room. RESULTS: No difference was observed between the groups with regard to systolic blood pressure, diastolic blood pressure, mean arterial pressure, or pulse rate when patients arrived at the operating room. In Group II, 30 minutes after listening to music, anxiety scores, VAS, systolic blood pressures, and mean arterial pressures were significantly lower than in Group I. CONCLUSIONS: Music was found to effectively reduce intraoperative anxiety.

Effect of Hymn and Sutra-Chanting on the Preanesthetic Patient Anxiety in the Operating Room / 대한마취과학회지

BACKGROUND: Most surgical patients experience preoperative anxiety. This anxiety can effect the amount of preanesthetic medication and anesthetic agents needed, and contribute to postoperative pain. Music has been recognized as a way to reduce anxiety and fear. The effect of hymn and sutra-chanting on the preanesthetic patient's anxiety in the operating room were studied. METHODS: 98 patients were divided into two groups according to the religionist or atheism. Group I(n=50, religionist) and Group II(n=48, atheism) listened to hymn or sutra-chanting according to the patient's religion and choice. At ward, hemodynamic variables including systolic and diastolic blood pressure and pulse rate were measured as control values. Hemodynamic variables and measurements of anxiety score with Hamilton anxiety rating scale were made at pre-music and post-music in the operating room. Also, patient's response to the music was measured on the postoperative 5-6th day. RESULTS: There were no difference between ward, pre-music, and post-music in terms of systolic pressure, diastolic pressure and pulse rate except the systolic pressure at pre-music that is grater than that of controls in both groups. Both group, anxiety score at post-music was significantly lower than that of pre-music (10.2+/-3.4 vs 4.4+/-2.9, 11.0+/-3.2 vs 5.7+/-3.1). At post-music, anxiety score in Group I showed significant reduced compaired with Group II (p<0.05). Patients showed relatively good satisfaction with music in both groups. CONCLUSION: The results suggest that music with hymn and Sutra-chanting were effective to reduce preanesthetic anxiety in both religionist group and atheism group.