Effectiveness of Granisetron in Prevention of Hypotension Following Spinal Anaesthesia in Patients Undergoing Elective Caesarean Section.

BACKGROUND AND AIM: Spinal anesthesia is the most common type of anesthesia administered for caesarean section and it is frequently associated with hypotension. When post-spinal hypotension is accompanied with bradycardia, the condition may become more complicated. Numerous pharmacological agents have therefore been tried for prevention of hypotension and 5HT3 antagonists are the latest in the armamentarium. However, studies have shown conflicting evidence regardings the effectiveness of 5HT3 inhibitors (ondansetron and granisetron) in preventing spinal hypotension. We have tried to address this controversy and also wanted to explore the adverse effects of granisetron on the foetus, if any. MATERIALS AND METHODS: Two hundred patients were included in the study and divided into two groups of 100 patients each. Group S patients received 5ml of 0.9% normal saline while Group G patients received IV granisetron 1mg (diluted to 5ml) 10 minutes prior to administration of spinal anesthesia. Analysis of variance (ANOVA) test was used for comparing the data, Student t-test was applied to compare the difference between the two means and Chi-Square test was used to test significance of difference of proportions. RESULTS: The incidence of hypotension in Group S was 69%, whereas it was 37% in Group G (p<0.001), hence patients of Group S required a significantly higher (p=0.001) amount of mephentermine. Haemodynamic parameters were well maintained throughout the study period in patients of Group G. The neonatal outcome was assessed by Apgar score at 0 minutes, one minute, and five minutes after delivery, and it was comparable between the two study groups. CONCLUSION: Intravenous granisetron 1mg if administered before administering spinal anesthesia can effectively attenuate hypotension in parturients without any adverse effects on the mother and the neonate.

Comparison of toxicity associated with early morning versus late afternoon radiotherapy in patients with head-and-neck cancer: a prospective randomized trial of the National Cancer Institute of Canada Clinical Trials Group (HN3).

PURPOSE: Based on our demonstration of a circadian rhythm in the human oral mucosa cell cycle, with most cells in the G(1) phase in the morning and M phase at night, we hypothesized that morning radiotherapy (RT) would lead to less oral mucositis than afternoon RT. METHODS AND MATERIALS: A total of 216 patients were randomized to morning (8-10 AM) vs. afternoon (4-6 PM) RT and stratified by radiation dose, smoking status, and center. Patients receiving primary or postoperative RT alone were eligible. Oral mucositis was scored using the Radiation Therapy Oncology Group (RTOG) criteria and a validated scoring system. RESULTS: Of 205 evaluable patients, 52.9% vs. 62.4% developed RTOG Grade 3 or greater mucositis after morning vs. afternoon RT, respectively (p = 0.17). Morning RT was also associated with significantly less weight loss after 5 months (p = 0.024). In a subgroup of 111 patients treated to a dose of 66-70 Gy in 33-35 fractions, exploratory analyses revealed a significant reduction in Grade 3 or greater mucositis with morning RT (44.6% vs. 67.3%, p = 0.022) and a longer interval to the development of Grade 3 or greater mucositis (median, >7.9 vs. 5.6 weeks, p = 0.033). In 53 patients, who smoked during therapy, a significant reduction was found in Grade 3 or greater mucositis with morning RT (42.9% vs. 76%, p = 0.025). CONCLUSION: In this proof of principle study, morning RT was associated with significantly less weight loss after 5 months and an apparent reduction in oral mucositis in a subset of patients receiving >/=66 Gy and in patients who smoked during therapy.

Prevention of postlaryngectomy pharyngocutaneous fistula: the Memorial University experience.

OBJECTIVES: The purpose of this study was to compare the efficacy of a pectoralis major myogenous flap in the prevention of pharyngocutaneous fistula in patients who have undergone total laryngectomy. Our secondary objective was to estimate the economic saving to our health care system. DESIGN: Retrospective clinical study. SETTING: Grace General Hospital, St. Clare's Mercy Hospital, H. Bliss Murphy Cancer and Research Centre, St. John's, Newfoundland. MATERIALS AND METHODS: Two hundred and twenty-three consecutive total laryngectomy procedures performed between June 1978 and December 2001 were reviewed. The fistula rate in laryngectomy patients prior to 1988 without pectoralis major myogenous flaps (group A) was compared with that of patients after June 1988 who had this flap routinely used at primary surgery (group B). Analysis of risk factors within those two groups was essentially similar. RESULTS: In group A, the overall pharyngocutaneous fistula rate was 22.9%. The fistula rate in group B was less than 1%. CONCLUSION: Our study has demonstrated that at our tertiary care head and neck oncology centre, we have dramatically decreased the incidence of postlaryngectomy pharyngocutaneous fistula. By the routine addition of a pectoralis major myogenous flap to cover the pharyngeal defect at surgery, we have substantially and dramatically reduced patient morbidity and mortality and reduced hospital stay, with major financial savings to the health care system.