ABSTRACT
Objetivo: Diversos fármacos han tratado de atenuar la respuesta vasopresora en los pacientes de colecistectomía laparoscópica. Comparamos la inyección intravenosa preinducción única de dexmedetomidina y de labetalol para atenuar la respuesta de estrés hemodinámico. Métodos: Consideramos a un total de 160 pacientes para este estudio prospectivo, aleatorizado y doble ciego, realizado en un único centro de atención terciaria. Incluimos a los pacientes en el grupo D, quienes recibieron 1μg/kg iv de dexmedetomidina, o el grupo L, quienes recibieron 0,3 mg/kg iv de labetalol en 100ml de suero salino normal antes de la inducción de anestesia. Se anotaron preoperatoriamente los parámetros hemodinámicos de los pacientes, antes de iniciar la infusión, y a intervalos fijos, hasta la extubación. Resultados: Tras la intubación, la presión arterial sistólica (PAS) fue más alta en los pacientes del grupo L (128 +/- 13,866) en comparación con el grupo D (123,2 +/- 10,672). Posteriormente, la PAS fue comparable hasta la extubación. De igual modo, tras la intubación los pacientes del grupo D tendieron a tener una presión arterial diastólica más baja (73,1 +/- 9,683 vs. 79,2 +/- 14,153, valor p de 0,0017) en comparación con los pacientes del grupo L. También la incidencia relativa de bradicardia e hipotensión fue mayor en los pacientes que habían recibido labetalol. Conclusión: En los pacientes con predisposición a fluctuaciones significativas de la presión arterial, o de la frecuencia cardiaca, la administración de dexmedetomidina puede resultar más adecuada que labetalol, debido a una mejor conservación de la hemodinámica normal, especialmente durante el periodo de estrés, habiendo reflejado una menor incidencia relativa de efectos colaterales
Objective: Various pharmacological agents have been tried to attenuate the pressor response in laparoscopic cholecystectomy patients. We have compared single pre-induction intravenous injection of dexmedetomidine with labetalol for attenuation of haemodynamic stress response. Methods: A total of 160 patients were considered for this prospective, randomized, double blind clinical study done in a single tertiary care institution. Patients were either included in group D, to receive 1.0μg·kg−1 i.v. dexmedetomidine or group L, to receive 0.3 mg·kg−1 i.v. labetalol in 100ml of normal saline before induction of anaesthesia. Patient's hemodynamic parameters were noted pre-operatively before starting infusion and at fixed intervals afterwards till extrubation. Results: After intubation, mean systolic blood pressure (SBP) was higher in patients of group L (128.0 +/- 13.866) as compared to group D (123.2 +/- 10.672). Afterwards the SBP was comparable until extrubation. Similarly, after intubation patients in group D tended to have lower diastolic pressure (73.1 +/- 9.683 vs. 79.2+/- 14.153, P value .0017) compared to patients in group L. Also, the relative incidence of bradycardia and hypotension was higher in patients who had received inj. labetalol. Conclusion: In patients predisposed to significant fluctuations in blood pressure or heart rate dexmedetomidine may be more suitable than labetalol due to better preservation of normal haemodynamics especially during periods of stress showing a relatively lower incidence of side effects
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Dexmedetomidine/pharmacokinetics , Labetalol/pharmacokinetics , Stress, Physiological/drug effects , Hemodynamics/drug effects , Cholecystectomy, Laparoscopic/methods , Hypertension/complications , Prospective Studies , Treatment Outcome , Laryngoscopy/methods , Intubation, Intratracheal/methods , Airway Extubation/methodsABSTRACT
OBJECTIVE: Various pharmacological agents have been tried to attenuate the pressor response in laparoscopic cholecystectomy patients. We have compared single pre-induction intravenous injection of dexmedetomidine with labetalol for attenuation of haemodynamic stress response. METHODS: A total of 160 patients were considered for this prospective, randomized, double blind clinical study done in a single tertiary care institution. Patients were either included in group D, to receive 1.0µg·kg-1 i.v. dexmedetomidine or group L, to receive 0.3 mg·kg-1 i.v. labetalol in 100ml of normal saline before induction of anaesthesia. Patient's hemodynamic parameters were noted pre-operatively before starting infusion and at fixed intervals afterwards till extrubation. RESULTS: After intubation, mean systolic blood pressure (SBP) was higher in patients of group L (128.0 ± 13.866) as compared to group D (123.2 ± 10.672). Afterwards the SBP was comparable until extrubation. Similarly, after intubation patients in group D tended to have lower diastolic pressure (73.1 ± 9.683 vs. 79.2± 14.153, P value .0017) compared to patients in group L. Also, the relative incidence of bradycardia and hypotension was higher in patients who had received inj. labetalol. CONCLUSION: In patients predisposed to significant fluctuations in blood pressure or heart rate dexmedetomidine may be more suitable than labetalol due to better preservation of normal haemodynamics especially during periods of stress showing a relatively lower incidence of side effects.
Subject(s)
Adrenergic alpha-2 Receptor Agonists/therapeutic use , Cholecystectomy, Laparoscopic/adverse effects , Dexmedetomidine/therapeutic use , Hemodynamics/drug effects , Hypertension/complications , Labetalol/therapeutic use , Adrenergic alpha-2 Receptor Agonists/adverse effects , Adult , Blood Pressure/drug effects , Blood Pressure/physiology , Bradycardia/chemically induced , Dexmedetomidine/adverse effects , Double-Blind Method , Female , Heart Rate/drug effects , Humans , Hypertension/drug therapy , Hypotension/chemically induced , Labetalol/adverse effects , Male , Preanesthetic Medication/methods , Prospective StudiesABSTRACT
Ciprofloxacin has been widely used for treating infections and has been found to have very low cardiovascular side effects. QTc prolongation with the use of ciprofloxacin is yet to be reported in literature. A case report highlighting QTc prolongation by use of ciprofloxacin is being presented.
Subject(s)
Anti-Infective Agents/adverse effects , Ciprofloxacin/adverse effects , Electrocardiography/drug effects , Adult , Electric Countershock , Female , Humans , Tachycardia, Ventricular/therapyABSTRACT
OBJECTIVE: This study was performed to compare the efficacy of aminophylline and insulin-dextrose infusion as acute treatment modality of hyperkalemia in patients with end-stage renal disease (ESRD). METHODS: This study was conducted on 30 ESRD patients with serum potassium > 6.0 mEq/L. These patients were divided in two groups of 15 each. Group A patients were treated with aminophylline infusion, whereas group B patients were treated with insulin-dextrose infusion. Serum potassium and other biochemical parameters such as blood sugar were measured at beginning of treatment followed by at 60 minutes, 180 minutes, and 360 minutes after treatment. RESULTS: Intervenous infusion of aminophylline lowered plasma potassium from 6.48 +/- 0.39 mEq/L to 5.92 +/- 0.40 mEq/L at 180 minutes (p < 0.001 Vs basal) and 6.05 +/- 0.53 mEq/L at 360 minutes (p < 0.01 Vs basal). Whereas, intravenous infusion of insulin-dextrose decreased plasma potassium from 6.59 +/- 0.31 mEq/L to 5.76 +/- 0.32 mEq/L (p < 0.001 Vs basal) and 5.84 +/- 0.21 mEq/L (p < 0.001 Vs basal). Thus in both groups, plasma potassium levels were significantly less than basal levels throughout the study. The decrease in plasma potassium was significantly more in group B patients (p value is < 0.001 after 60 minutes, < 0.05 after 180 minutes and < 0.05 after 360 minutes) when compared to group A patients. There was one episode of hypoglycemia (blood sugar < 60 mg%) in insulin-dextrose infusion group. No other side effects were observed throughout the study. CONCLUSION: Aminophylline is an effective modality for acute treatment of hyperkalemia, though it is less effective than insulin-dextrose infusion. However, more studies are required to confirm these results.
