RESUMO
BACKGROUND: Esmolol has an established role in attenuation of hemodynamic response to laryngoscopy and endotracheal intubation. We studied the effect of dexmedetomidine compared to that of esmolol in this study. AIM: To study the role of dexmedetomidine in attenuation of hemodynamic response to laryngoscopy and oral endotracheal intubation compared to that of esmolol hydrochloride in patients posted for elective surgery under general anesthesia. STUDY DESIGN: Prospective randomized study double-dummy blinding method. MATERIALS AND METHODS: A total of 60 American Society of Anesthesiologists I patients, aged 18-60 years randomly divided into two groups; Group A patients received dexmedetomidine 1 mcg/kg diluted in 50 ml with normal saline and infused over 10 min before induction and also 20 ml of normal saline intravenous (IV) 2 min before endotracheal intubation. Group B patients received 50 ml IV infusion of normal saline over 10 min before induction and IV bolus of esmolol 0.5 mg/kg diluted in 20 ml with normal saline given 2 min before intubation. Standard induction technique followed. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded just before induction and after intubation at 1 min, 3 min, and 5 min after intubation. STATISTICAL ANALYSIS: Independent samples t-test and repeated measures of analysis of variance. RESULTS: Dexmedetomidine group showed statistically significant reduction in all the study parameters at all study time intervals following intubation. While esmolol group showed significant attenuation of HR, SBP, and MAP following intubation but failed to produce significant reduction in DBP. CONCLUSION: Dexmedetomidine is more effective in attenuating the hemodynamic response to oral endotracheal intubation compared to that of esmolol hydrochloride.
RESUMO
BACKGROUND: Gastroenteritis is a major cause of pediatric morbidity. We describe temporal, spatial and seasonal trends in age-specific gastroenteritis hospitalizations among Aboriginal and non-Aboriginal Australian children during 2 decades, providing a baseline to evaluate the impact of a rotavirus vaccine program begun in 2007. METHODS: We conducted a population-based, data linkage study of Aboriginal and non-Aboriginal births in Western Australia, 1983 to 2006, and analyzed gastroenteritis-coded hospitalizations before age 15 years in the cohort of 596,465 births. Hospitalization rates in Aboriginal and non-Aboriginal children and between geographical regions were compared between 1983 to 1994 and 1995 to 2006. RESULTS: Gastroenteritis rates were highest in children 6-11 months of age (Aboriginal: 259.3/1000/annum; non-Aboriginal: 22.7/1000/annum). Rates declined in Aboriginal children between 1983 to 1994 and 1995 to 2006, particularly in those 12-17 months of age (309/1000 to 179/1000). Rates in non-Aboriginal children<5 years increased 10-40%. The disparity for gastroenteritis rates between Aboriginal and non-Aboriginal children<5 years declined from being 15.4 times higher to 7.6 times higher in those aged 12-17 months and from 8.4 to 4.4 in those aged 2-4 years. Rates were highest in rural and remote regions, and diverging temporal trends were seen in different geographical regions. Seasonality varied between Aboriginal and non-Aboriginal children and climatic zones. CONCLUSIONS: This is the largest study of gastroenteritis hospitalization trends in children. We found diverging trends of gastroenteritis hospitalization rates in Aboriginal and non-Aboriginal children. Although rates have declined in Aboriginal children, disparity between Aboriginal and non-Aboriginal children continues. Our findings highlight the need to consider age, ethnicity, seasonality and climate when evaluating rotavirus vaccine programs.
