Role of melatonin in attenuation of hemodynamic response to intubation and anesthetic requirements: a randomized, controlled, double-blind study.

BACKGROUND: Melatonin has been studied to have anxiolytic, sedative, and analgesic effects. However, there is limited data on the effect of melatonin in the attenuation of hemodynamic response to intubation. We aimed to study whether preanesthetic oral melatonin attenuates hemodynamic responses to intubation and anesthetic requirements. METHODS: Sixty-four patients scheduled for laparoscopic cholecystectomy were randomized into melatonin or placebo group (n...=...32 each). Melatonin group received two tablets (3...mg each) of melatonin, and the placebo group received two tablets of vitamin D3 120...min before induction. Hemodynamic parameters were recorded during induction and postintubation for 15...minutes. Total induction dose of propofol, total intraoperative fentanyl consumption, and adverse effects of melatonin were also noted. RESULTS: Postintubation rise in heart rate (HR) was less in the melatonin group compared to the placebo group (10.59% vs. 37.08% at 1...min, respectively) (p...<...0.0001). Maximum percentage increase in systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean blood pressure (MBP) was lesser in melatonin group than placebo group (SBP 9.25% vs. 37.73%, DBP 10.58% vs. 35.51%, MBP 9.99% vs. 36.45% at 1 min postintubation. respectively) (p...<...0.0001). Induction dose of propofol (1.42 mg.kg-1 vs. 2.01...mg.kg-1) and the number of patients requiring additional fentanyl intraoperatively (3 vs. 11) were also significantly reduced in the melatonin group. CONCLUSION: Premedication with 6...mg of oral melatonin resulted in significant attenuation of postintubation rise in HR, SBP, DBP, and MBP. It also reduced the induction dose of propofol, total intraoperative fentanyl consumption without any adverse effects.

Role of melatonin in attenuation of hemodynamic response to intubation and anesthetic requirements: a randomized, controlled, double-blind study

Abstract Background Melatonin has been studied to have anxiolytic, sedative, and analgesic effects. However, there is limited data on the effect of melatonin in the attenuation of hemodynamic response to intubation. We aimed to study whether preanesthetic oral melatonin attenuates hemodynamic responses to intubation and anesthetic requirements. Methods Sixty-four patients scheduled for laparoscopic cholecystectomy were randomized into melatonin or placebo group (n = 32 each). Melatonin group received two tablets (3 mg each) of melatonin, and the placebo group received two tablets of vitamin D3 120 min before induction. Hemodynamic parameters were recorded during induction and postintubation for 15 minutes. Total induction dose of propofol, total intraoperative fentanyl consumption, and adverse effects of melatonin were also noted. Results Postintubation rise in heart rate (HR) was less in the melatonin group compared to the placebo group (10.59% vs. 37.08% at 1 min, respectively) (p< 0.0001). Maximum percentage increase in systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean blood pressure (MBP) was lesser in melatonin group than placebo group (SBP 9.25% vs. 37.73%, DBP 10.58% vs. 35.51%, MBP 9.99% vs. 36.45% at 1 min postintubation. respectively) (p< 0.0001). Induction dose of propofol (1.42 mg.kg-1 vs. 2.01 mg.kg-1) and the number of patients requiring additional fentanyl intraoperatively (3 vs. 11) were also significantly reduced in the melatonin group. Conclusion Premedication with 6 mg of oral melatonin resulted in significant attenuation of postintubation rise in HR, SBP, DBP, and MBP. It also reduced the induction dose of propofol, total intraoperative fentanyl consumption without any adverse effects.

Multimodal cocktail analgesic injection in PIVD with lower limb radiculopathy - A mixed design cohart study.

Background: The role of Sodium Channel Blocker and steroid is well established for pain relief in neuropathic pain by reducing inflamation and desensitization of nerve roots. Our study aims at analyzing the effectiveness of multimodal cocktail injections for redicular pain relief & functional outcome in patients with intervertebral disc herniation. Material and method: This was a Mixed design (prospective & retrospective) cohort study; we included 113 patients between the age group of 18-70 years, diagnosed with Prolapse of intervertebral disc (PIVD) with lower limb radiculopathy with MRI finding L4-L5/L5-S1 vertebral disc involvement. Patients were injected with total 15 ml of cocktail injection in 3 divided doses at 3 identified sites in affected lower limb. . Patient was examined & evaluated clinically for VAS pain score, SLRT, Sensory, Motor Examination on day 2, day 7, day 15 & after 1 month. Result: We found that the mean pre-VAS score was 7.83 followed by the mean VAS score on post 2 days was 1.05, post 7 days was 3.47, post 15 days was 3.9 and post 30 days was 3.81. There was a statistically significant difference in the mean VAS score (p-value<0.0001). After one month majority of patients (54.62%) had comfortable painless walk and comfortable walking distance increased up to 1 km in 45.37% of them. Conclusion: Use of cocktail multimodal injections for radiculopathy pain suggests that this non-operative,OPD based technique could be reasonable, efficient, and safe.

Psychosocial impact and coping strategies of frontline healthcare workers in Western Rajasthan during COVID-19 pandemic.

Background and Aims: Coronavirus disease-2019 (COVID-19) pandemic-related stress is an important but under-rated issue needing attention. Stress and causative factors vary between the regions and individuals depending on the availability of resources, socio-cultural differences, and individual perceptions. We aimed to study the psychosocial impact and coping strategies among the healthcare workers (HCWs) in Western Rajasthan during COVID-19 pandemic. Material and Methods: This questionnaire-based observational study, consisting of 59 questions in 6 sections, was conducted to identify stress, causative factors, coping strategies, and experiences of HCWs working in personal protective equipment (PPE). Chi-square test was used to compare the responses between different subgroups. Results: Majority of the HCWs felt responsible for treating COVID-19 patients (98.8%), but also felt that it was affecting their safety (81.4%). On subgroup analysis, doctors were found to be more stressed than nursing staff (P = 0.004). Major stressors included concerns about infecting family members and lack of specific treatment for COVID-19 (87.5%). Family support was found to be a major stress-relieving factor (97.3%). Most HCWs suggested that comfortable quarantine stay, adequate supply of PPE, and equipments would help in reducing stress. Conclusion: Frontline HCWs in Western Rajasthan were under significant stress during COVID-19 pandemic. We found that stress-causing factors and coping strategies varied between different subgroups based on profession, gender, and age. We recommend conducting such studies in different regions of the world to develop relevant and region-specific strategies to help HCWs cope with stress more efficiently, thereby, strengthening the healthcare system to deal with future pandemics.

Bi-Spectral Index-Guided Comparison of Propofol versus Etomidate for Induction in Electroconvulsive Therapy.

BACKGROUND: Previous studies have compared varying doses of propofol and etomidate for electroconvulsive therapy (ECT) without monitoring the depth of anesthesia. Seizure duration may vary with the depth of anesthesia. AIM: This study aimed to compare the effects of bi-spectral index (BIS)-guided induction with propofol and etomidate on various parameters of ECT. SETTINGS AND DESIGN: This was a prospective, randomized, double-blind study. MATERIALS AND METHODS: Sixty patients undergoing ECT were randomly allocated to two groups. Group P received intravenous propofol 1-2 mg.kg -1 and Group E received etomidate 0.1-0.3 mg.kg -1 to attain a BIS of 40-60. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and BIS were recorded at various time points intraoperatively till 30 min following ECT. Seizure duration, recovery time, and adverse effects were also recorded. STATISTICAL ANALYSIS: Quantitative data were compared using unpaired t-test. Chi-square test or Fisher's exact test was used to compare categorical data. P < 0.05 was considered statistically significant. RESULTS: The mean induction time and seizure duration were shorter (P < 0.001), and recovery time to obey commands was longer in Group P as compared to that of Group E (P = 0.031). HR, SBP, and DBP for 10 min after ECT had elevated more in Group E than that in Group P (P < 0.05). The incidence of myoclonus was higher in Group P compared to that of Group E (P = 0.012). CONCLUSION: During ECT, BIS-guided induction with propofol provides more stable hemodynamics than etomidate, but reduces induction time, seizure duration, and recovery time more as compared to that of etomidate.

Effect of epidural levobupivacaine with or without dexamethasone soaked in gelfoam for postoperative analgesia after lumbar laminectomy: A double blind, randomised, controlled trial.

BACKGROUND AND AIMS: Postoperative pain results in prolonged hospital stay and delayed return to normal activity. This study was conducted with the aim of evaluating the analgesic efficacy of gelfoam soaked in levobupivacaine with or without dexamethasone placed in the epidural space in patients undergoing lumbar laminectomy. METHODS: Ninety adult patients were randomised into three groups. Gelfoam was soaked in 12 mL of 0.9% sodium chloride in Group P, 10 mL of 0.25% levobupivacaine + 2 mL of 0.9% sodium chloride in Group L, and 10 mL of 0.25% levobupivacaine + 2 mL of dexamethasone in group LD. The primary outcome was time to first request for rescue analgesia. Total 24-h tramadol consumption, and postoperative visual analog scale (VAS) scores were recorded. Chi-square test and analysis of variance test were used, and P < 0.05 was considered significant. RESULTS: 75 patients completed the study. Time to first rescue analgesia was longer in group LD [10.11 ± 3.10 h] compared with group L [6.48 ± 2.36 h] and group P [1.76 ± 1.13 h]. Total 24-h tramadol consumption was lower in group LD (88 ± 66.58 mg) and group L (120 ± 70.7 mg) compared with group P (280 ± 64.5 mg). Postoperative VAS scores were lower in group LD and group L compared with group P, both at rest and on movement. CONCLUSION: Epidural gelfoam soaked in levobupivacaine and dexamethasone prolongs the duration of analgesia and decreases rescue analgesic consumption and VAS score postoperatively, in patients undergoing lumbar laminectomy.

Conjoined bicondylar coronal plane fracture of the distal femur associated with incarcerated patella.

Conjoint bicondylar coronal plane fracture is a rare orthopaedic injury, associated with high-velocity trauma. The proposed mechanism is axially directed shear forces in a flexed knee. To the best of our literature search, only 2 cases of conjoint bicondylar coronal fracture have been published in English literature-1 each in adult and paediatric age group. Conjoint bicondylar coronal plane fracture with incarcerated patella has not yet been reported and hence this is the first report of its kind. We report on the clinical presentation, management and outcome of such a complex injury, along with a comprehensive, up-to-date literature review. Prompt open reduction and internal fixation coupled with early knee mobilisation is the key to achieve good functional outcome.

Iatrogenic brachial artery injury during pinning of supracondylar fracture of humerus: A rare injury / 中华创伤杂志(英文版)

Complications following supracondylar fracture of humerus are well-known. Pre- and post-operative complications have been documented in the literature. Neurovascular injury due to fracture fragments following this type of fracture is described. Iatrogenic brachial artery during surgical treatment of this fracture is unknown to the literature. So we report a rare case of iatrogenic brachial artery injury during pinning of supracondylar fracture of humerus and try to create awareness to the surgeons that such injuries can occur with improper operative techniques.