Efficacy of phenytoin for 7 days versus 21 days as prophylactic anticonvulsant in traumatic brain injury patients - A comparative study.

Background: Post traumatic seizures (PTS) are very common after traumatic brain injury and occur more common in severe form of injury. Prophylactic treatment with phenytoin has been found to be effective however till now no uniform internationally agreed guideline is available for the duration of anticonvulsant prophylaxis for traumatic brain injury patients. Methods: 100 patients of either sex between age group of 18-65 years who have suffered intracranial injury identified by CT scan, admitted in Trauma ICU were enrolled in this prospective randomized single blinded clinical study. Group 1 (n = 50) received 7 days prophylactic anticonvulsant therapy with phenytoin and Group 2 (n = 50) received for 21 days. The primary end point was the occurrence of seizures, which were classified as early (occurring from time of drug loading to day 7) or late (occurring on day 8 or later after loading of drug). Patients were also assessed for the possible adverse side effects of phenytoin. Result: Out of 100 patients, 90 completed the study successfully as 5 patients from each group expired during the duration of the study. On comparing the frequency of seizure from 1st to 7th day after loading dose of phenytoin between two groups, out of 45 patient, 2 (4.4%) developed seizure in group 1 and 3 (6.7%) developed seizure in group 2 and found to be statistically insignificant (P = 0.645). On comparing the frequency of seizure from 1st to 21st day after loading dose of phenytoin between two groups, out of 45 patient, 4 (8.9%) developed seizure in groups 1 and 3 (11.1%) developed seizure in group 2 and found to be statistically insignificant (P = 0.725). Conclusion: A 21-day prophylactic anticonvulsant therapy with phenytoin was not more effective than a 7-day prophylactic therapy with phenytoin to reduce the frequency of seizure in a TBI patient in trauma ICU and was also associated with more adverse side effects that were insignificant.

Comparative Study of Efficacy of Buprenorphine and Fentanyl on Attenuation of Hemodynamic Changes to Laryngoscopy and Intubation: A Prospective, Randomized Double-Blind Study.

BACKGROUND: Hemodynamic changes are the most common predicted response after laryngoscopy and intubation during general anesthesia. We compared the efficacy of buprenorphine with fentanyl to attenuate this stress response. METHODS: One hundred and thirty patients of either sex between the age group of 18-70 years, admitted for the routine surgical procedure under general anesthesia were enrolled in this double blind, randomized, clinical study. Patients were randomly assigned into two equal groups (60 patients in each group): group F received fentanyl 2 µg/kg, and group B received buprenorphine 2.5 µg/kg; both via intravenous route. Each group received a total volume of 10 mL by adding normal saline to the total drug volume, given over 60 seconds, 5 minutes before intubation. Thereafter patients were induced using routine balanced anesthesia technique, and the hemodynamic parameters were observed at baseline (0 minute), 1, 3, and 5 minutes after the administration of the study drug and again at 1, 3, 5, 7, and 10 minutes after intubation. Continuous variables were presented as mean with an 80% confidence interval, and a t-test was applied for comparing the difference of means between two groups after we checked the normality condition. Chi-square test was applied to test the independence of attributes of categorical variables. Repeated measures two-way analysis of variance was performed to compare the outcome variables between the two groups. RESULTS: In both groups, mean arterial blood pressure (MAP) and heart rate (HR) were statistically insignificant up to 5 minutes after study drug, thereafter mean HR and MAP at 1, 3, 5, 7, and 10 minutes after intubation, were statistically significant between the two groups, and P value was less than 0.05. CONCLUSIONS: The dose of 2.5 µg/kg buprenorphine is an effective alternative to fentanyl 2 µg/kg for attenuating the hemodynamic response accompanying laryngoscopy and tracheal intubation without causing any hemodynamic adverse effect.

Comparison of Intranasal Dexmedetomidine and Midazolam as Premedication in Pediatric Surgical Patients: A Prospective, Randomized Double-Blind Study.

INTRODUCTION: To relieve anxiety and fear is a major concern for pediatric anesthesiologist, and intranasal dexmedetomidine seems to be better alternative to midazolam to provide sedation and allay anxiety in children. AIMS AND OBJECTIVES: We compare the sedative effects, anxiety level, successful child-parental separation, and hemodynamic parameters of either intranasal dexmedetomidine or midazolam as a premedication in children undergoing pediatric surgery. SETTING AND DESIGN: This is a prospective, randomized, double-blind study conducted on 60 patients belonging to the American Society of Anesthesiologists Physical Status Classes I and II, undergoing pediatric surgical procedures with the use of intranasal dexmedetomidine and midazolam as premedication. MATERIALS AND METHODS: Sixty children were randomly allocated into two groups of 30 each: dexmedetomidine group received intranasal dexmedetomidine (1 µg.kg-1), and midazolam group received intranasal midazolam (0.2 mg.kg-1), 30 min before induction. The sedation score, anxiety score, and successful child-parent separation were recorded till 30 min of drug administration, and then, the child was taken to the operating room (OR). STATISTICAL ANALYSIS: The Statistical Software, namely Statistical Package for the Social Science 17.0, was used for the analysis of the data. A P < 0.05 was considered statistically significant. RESULTS: Children premedicated with intranasal dexmedetomidine achieved significantly lower sedation score (P < 0.001), lower anxiety levels (P = 0.001), and easier child-parent separation (P = 0.003) than children who received intranasal midazolam. CONCLUSION: Intranasal dexmedetomidine was associated with lower sedation levels, lower anxiety levels, and easier child-parent separation at the time of transferring patients to the OR than children who received intranasal midazolam.