A comparative study of clinical effects and recovery characteristics of intraoperative dexmedetomidine infusion with ketamine versus fentanyl as adjuvants in general anaesthesia.

Background and Aims: Intraoperative dexmedetomidine infusion decreases the concurrent anaesthetic and analgesic requirement. However, because of slow onset and offset, it is often used with other drugs. Opioids have a depressant effect on the cardiorespiratory system while ketamine has the opposite pharmacodynamics. Hence, it was hypothesised that ketamine will have a better intraoperative haemodynamic profile compared to fentanyl. This study compared the clinical effects and recovery characteristics of ketamine versus fentanyl when used as an adjuvant along with dexmedetomidine infusion intraoperatively. Methods: A total of 80 patients (18-60 years) undergoing major surgeries were divided into two groups: Group (D + K) received an intraoperative infusion of ketamine 0.5 mg/kg/h, while group (D + F) received fentanyl 0.5 µg/kg/h along with intravenous dexmedetomidine 0.5 µg/kg/h. Intraoperative heart rate (HR), mean blood pressure, and oxygen saturation were recorded at 0 min, 10 min of induction, and thereafter every 30 min throughout the procedure. Ramsay sedation score (RSS) and visual analogue scale (VAS) score were measured at the end of the surgery, at 2 hours, 4 hours, and 6 hours. Results: Reduction in HR and mean blood pressure was more with a tendency of developing hypotension in the fentanyl group compared to the ketamine group. Post-anaesthesia care unit (PACU) stay, need for muscle relaxant and VAS score for pain were also significantly lesser in the ketamine group. Conclusion: Dexmedetomidine with ketamine provided better haemodynamic stability and reduced PACU stay compared to dexmedetomidine with fentanyl.

Evaluation of treatment outcome and adverse drug reaction of directly observed treatment (DOT) plus regimen in multidrug-resistant tuberculosis (MDR-TB) patients at district tuberculosis centre Rajkot.

BACKGROUND: The emergence of drug-resistant mycobacteria becomes a significant public health problem globally creating an obstacle to effective tuberculosis (TB) control. Gujarat, Maharashtra, and Andhra Pradesh DRS survey estimated that the proportion of multidrug-resistant TB (MDR-TB) is 2.1% (in new TB cases) and 15% (in previously treated cases). Programmatic management of MDR-TB implemented under Revised National Tuberculosis Control Programme in India in 2007. OBJECTIVES: The objective of this study is to evaluate treatment outcome and adverse drug reactions (ADRs) of category IV. MATERIALS AND METHODS: A total of 108 MDR-TB patients were analyzed retrospectively who registered and received treatment during the year of 2014 and 2015 at district TB centre, Rajkot. MDR patients who died or transferred out or defaulter before completion of intensive phase were excluded from the analysis. RESULTS: Of total 108 patients majority patients (64.81%) were in young (20-39 years) with m:f: 2:1. All MDR-TB patients were retreated cases and 69.44% were "undernutrition category". Culture conversion rate was 86.91% at 4 months of treatment. Cure rate was 50.93% while defaulter rate and died rate was same (17.59%). Failure rate was 18.51%. Weight improvement was significantly associated with cure rate. The incidence of ADR was 32.71%. Most frequent ADRs were related to gastrointestinal system (34.42%), ototoxicity (13.11%), and central nervous system (8.1%). Aminoglycosides, cycloserine, and ethambutol were discontinued due to ADR. Majority ADRs (77.04%) were "possible" category by causality assessment and "mild" in severity assessment. Ototoxicity was only severe ADRs observed. CONCLUSION: Cure rate was improved than previous years at same center. Attention should be paid for defaulters.

Adverse drug reactions and treatment outcome analysis of DOTS-plus therapy of MDR-TB patients at district tuberculosis centre: A four year retrospective study.

BACKGROUND: Treatment of multidrug-resistant tuberculosis (MDR-TB) requires the use of expensive and toxic second-line anti-tubercular drugs which are given for a longer duration. Adverse drug reactions (ADRs) of second-line antitubercular drugs affect compliance and thereby treatment outcome. We set out to analyze ADRs and treatment outcome of MDR-TB patients receiving directly observed treatments plus therapy. MATERIALS AND METHODS: A retrospective study of registered MDR-TB cases at district tuberculosis center during 2010-2014 was performed. Data regarding sociodemographic profile, diagnosis, and treatment as well as ADRs were recorded and evaluated. ADRs were evaluated for causality, severity assessment, management aspects, and impact on treatment outcome. RESULTS: In total 147 ADRs were reported among 72 cases. Most commonly observed ADRs were gastrointestinal (24.5%) followed by self reported weakness (21.23%), psychological (14.38%), joint pain (14.38%), and respiratory symptoms. Discontinuation of the drugs due to ADRs was required in 36 (24.48%) events. ADRs were significantly associated with nontreatment adherence and defaulter outcome. Cure rate was higher in MDR-TB cases with ADRs (59.72%) than MDR-TB cases without ADRs (30.18%). CONCLUSION: Attention needs to be paid for timely recognition and treatment of ADR with minimum modification of treatment regimen. Equal attention should be paid to MDR-TB without ADR cases to raise over all cure rate.

Postoperative analgesic efficacy of epidural tramadol as adjutant to ropivacaine in adult upper abdominal surgeries.

BACKGROUND: Postoperative pain control after major abdominal surgery is the prime concern of anesthesiologist. Among various methodologies, epidural analgesia is the most preferred technique because of the excellent quality of analgesia with minimum side-effects. AIM: The present study was designated to compare postoperative analgesic efficacy and safety of epidural tramadol as adjuvant to ropivacaine (0.2%) in adult upper abdominal surgery. SETTINGS AND DESIGN: Prospective, randomized-controlled, double-blinded trial. MATERIALS AND METHODS: Ninety patients planned for upper abdominal surgery under general anesthesia were randomized into three equal groups to receive epidural drug via epidural catheter at start of incisional wound closure: Group R to receive ropivacaine (0.2%); Group RT1 to receive tramadol 1 mg/kg with ropivacaine (0.2%); and RT2 to receive tramadol 2 mg/kg with ropivacaine (0.2%). Duration and quality of analgesia (visual analog scale [VAS] score), hemodynamic parameters, and adverse event were recorded and statistically analyzed. STATISTICAL ANALYSIS: One-way analysis of variance test, Fisher's exact test/Chi-square test, whichever appropriate. A P < 0.05 was considered significant. RESULTS: Mean duration of analgesia after epidural bolus drug was significantly higher in Group RT2 (584 ± 58 min) when compared with RT1 (394 ± 46 min) or R Group (283 ± 35 min). VAS score was always lower in RT2 Group in comparison to other group during the study. Hemodynamic parameter remained stable in all three groups. CONCLUSION: We conclude that tramadol 2 mg/kg with ropivacaine (0.2%) provides more effective and longer-duration analgesia than tramadol 1 mg/kg with ropivacaine (0.2%).

Comparative evaluation of cost effectiveness and recovery profile between propofol and sevoflurane in laparoscopic cholecystectomy.

BACKGROUND: Anesthetic agents should be chosen not only on the basis of safety-efficacy profile, but also on the economic aspect. Propofol and sevoflurane are commonly utilized anesthetic agent for general anesthesia. AIM: The present study was designated to compare cost-effectiveness and recovery profile between propofol and sevoflurane for induction, maintenance or both. SETTINGS AND DESIGN: Randomized controlled, participant and data operator blinded trial. MATERIALS AND METHODS: Ninety patients undergoing laparoscopic cholecystectomy were randomized into three equal groups to receive: Group P to receive injection propofol for both induction and maintenance; Group PS to receive injection propofol for induction and sevoflurane for maintenance; and Group S to receive sevoflurane for both induction and maintenance of general anesthesia, respectively. Cost analysis, hemodynamic parameter, and recovery profile were compared between these groups. STATISTICAL ANALYSIS: One-way analysis of variance test or Fisher's exact test/Chi-square test whichever appropriate. RESULTS: Total cost of anesthesia was highest in Group P and lowest in Group S. Mean time to extubation and time to follow verbal commands was lowest in Group S than Group P or Group P/S. Hemodynamic parameter was more stable in Group S. CONCLUSION: We conclude that sevoflurane appears to be better anesthetic agents in terms of cost-effectiveness and recovery profile.

Nebulised fentanyl for post-operative pain relief, a prospective double-blind controlled randomised clinical trial.

BACKGROUND AND AIM: Intravenous (IV) route for fentanyl administration is the gold standard for post-operative pain relief, but complications such as respiratory depression, bradycardia and hypotension have limited this route. The aim of this randomised controlled trial was to compare the efficacy of nebulised fentanyl with IV fentanyl for post-operative pain relief after lower abdominal surgery. METHODS: In the post-operative care unit, at the time of first onset of pain (visual analogue scale- VAS score > 4) patients were randomised into three groups and fentanyl was administered either IV 2 µg/kg or by nebulisation of solution containing 3 or 4 µg/kg fentanyl over 8 min in 90 patients divided into three groups of 30 each. Observation were made for pain relief by visual analogue scale score 0-10. Adverse effects such as respiratory depression, bradycardia and hypotension were also recoded. Statistical analysis was performed using Medcalc software version 12, 2012. (MedCalc Software, Ostend, Belgium). RESULTS: In the nebulisation group, it was observed that the analgesic efficacy of fentanyl was dose dependent with a delayed onset of analgesia (10 min vs. 5 min). Nebulisation with 4 µg/kg fentanyl produced analgesia at par to 2 µg/kg IV fentanyl with prolonged duration (90 min vs. 30 min) and with significantly less adverse effects. CONCLUSIONS: This study shows that nebulisation with 4 µg/kg fentanyl may be used as an alternative to IV 2 µg/kg fentanyl for adequate post-operative pain relief.

Antihyperglycemic activity, antihyperlipedemic activity, haematological effects and histopathological analysis of Sapindus mukorossi Gaerten fruits in streptozotocin induced diabetic rats.

OBJECTIVE: To investigate the antihyperglycemic and antihyperlipidemic properties of hydroalcoholic extract of fruits of Sapindus mukorossi Gaerten and its beneficial effect on haematological parameters with histopathological analysis in streptozotocin induced diabetic rats. METHODS: Sapindus mukorossi fruits extract (250 and 500 mg/kg body weight) and standard drug glybenclamide (0.5 mg/kg body weight) were administered to diabetic rats. Effect of extract on hyperglycemia, hyperlipidemia and hematological parameters was studied in diabetic rats. Histopathological changes in diabetic rat pancreas were also observed after extract and glybenclamide treatment. RESULTS: Daily oral administration of Sapindus mukorossi fruits extract (250 and 500 mg/kg body weight) and glybenclamide for 20 days showed beneficial effects on blood glucose level (P<0.01) and lipid level. The extract has a favorable effect on the histopathological changes of the pancreas in streptozotocin induced diabetes. CONCLUSION: These findings reveal that the hydroalcoholic extract of Sapindus mukorossi fruits extract possesses antihyperglycemic and antihyperlipidemic properties. In addition, the extract can prevent various complications of diabetes and improve some haematological parameters.

Hepatoprotective potential of ethanolic extract of Ziziphus oenoplia (L.) Mill roots against antitubercular drugs induced hepatotoxicity in experimental models.

OBJECTIVE: To evaluate the hepatoprotective potential of ethanolic (50%) extract of Ziziphus oenoplia (L.) Mill (Z. oenoplia) root against isoniazid (INH) and rifampicin (RIF) induced liver damage in animal models. METHODS: Five groups of six rats each were selected for the study. Ethanolic extract at a dose of 150 and 300 mg/kg as well as silymarin (100 mg/kg) were administered orally once daily for 21 d in INH + RIF treated groups. The serum levels of glutamic oxaloacetic transaminase (SGOT), glutamate pyruvate transaminase (SGPT), alkaline phosphatase (SALP), and bilirubin were estimated along with activities of superoxide dismutase, catalase, glutathione S-transferase, glutathione peroxidase, and hepatic melondialdehyde formation. Histopathological analysis was carried out to assess injury to the liver. RESULTS: The considerably elevated serum enzymatic activities of glutamic oxaloacetic transaminase, glutamate pyruvate transaminase, alkaline phosphatase and bilirubin due to INH + RIF treatment were restored towards normal in a dose dependent manner after the treatment with ethanolic extract of Z. oenoplia roots. Meanwhile, the decreased activities of superoxide dismutase, catalase, glutathione S-transferase and glutathione peroxidase were also restored towards normal dose dependently. In addition, ethanolic extract also significantly prevented the elevation of hepatic melondialdehyde formation in the liver of INH + RIF intoxicated rats in a dose dependent manner. The biochemical observations were supplemented with histopathological examination of rat liver sections. CONCLUSIONS: The results of this study strongly indicate that ethanolic extract of Z. oenoplia has a potent hepatoprotective action against INH + RIF induced hepatic damage in rats.

Antidiarrheal potential of standardized extract of Rhododendron arboreum Smith flowers in experimental animals.

OBJECTIVE: To investigate standardized ethyl acetate fraction of Rhododendron arboreum (EFRA) flowers for antidiarrheal activity in experimental animals. MATERIALS AND METHODS: A simple sensitive high performance thin layer chromatography (HPTLC) method was used for the determination of hyperin in EFRA. The standardized fraction was investigated for castor oil, magnesium sulfate-induced diarrhea, measurement of gastrointestinal transit using charcoal and castor oil-induced enteropooling. RESULTS: The concentration of hyperin in flowers of R. arboreum was found to be 0.148% by HPTLC. Oral administration of EFRA at 100, 200 and 400 mg/kg exhibited dose-dependent and significant (P<0.05-0.001) antidiarrheal potential in castor oil and magnesium sulfate-induced diarrhea. EFRA at doses of 100, 200 and 400 mg/kg also produced significant (P<0.05-0.001) dose-dependent reduction in propulsive movement in castor oil-induced gastrointestinal transit using charcoal meal in rats. EFRA was found to possess an antienteropooling in castor oil-induced experimental animals by reducing both weight and volume of intestinal content significantly. CONCLUSION: These findings demonstrate that standardized ethyl acetate fraction of R. arboreum flowers has potent antidiarrheal activity thus justifying its traditional use in diarrhea and have great potential as a source for natural health products.

Protective effect of ethyl acetate fraction of Rhododendron arboreum flowers against carbon tetrachloride-induced hepatotoxicity in experimental models.

OBJECTIVE: To evaluate the hepatoprotective potential of ethyl acetate fraction of Rhododendron arboreum (Family: Ericaceae) in Wistar rats against carbon tetrachloride (CCl(4))-induced liver damage in preventive and curative models. MATERIALS AND METHODS: Fraction at a dose of 100, 200, and 400 mg/kg was administered orally once daily for 14 days in CCl(4)-treated groups (II, III, IV, V and VI). The serum levels of glutamic oxaloacetic transaminase (SGOT), glutamate pyruvate transaminase (SGPT), alkaline phosphatase (SALP), γ-glutamyltransferase (γ -GT), and bilirubin were estimated along with activities of glutathione S-transferase (GST), glutathione reductase, hepatic malondialdehyde formation, and glutathione content. RESULT AND DISCUSSION: The substantially elevated serum enzymatic activities of SGOT, SGPT, SALP, γ-GT, and bilirubin due to CCl(4) treatment were restored toward normal in a dose-dependent manner. Meanwhile, the decreased activities of GST and glutathione reductase were also restored toward normal. In addition, ethyl acetate fraction also significantly prevented the elevation of hepatic malondialdehyde formation and depletion of reduced glutathione content in the liver of CCl(4)-intoxicated rats in a dose-dependent manner. Silymarin used as standard reference also exhibited significant hepatoprotective activity on post-treatment against CCl(4)-induced hepatotoxicity in rats. The biochemical observations were supplemented with histopathological examination of rat liver sections. The results of this study strongly indicate that ethyl acetate fraction has a potent hepatoprotective action against CCl(4)-induced hepatic damage in rats.

Ultrasonography: a novel approach to central venous cannulation.

BACKGROUND: Portable ultrasound machines are highly valuable in ICUs, where a patient's condition might not permit shifting the patient to the USG department for imaging. Traditionally central lines are put blindly using anatomical landmarks, which often result in complications such as difficulty in access, misplaced lines, pneumothorax, bleeding from inadvertent arterial punctures, etc. Ultrasonography provides "real time" imaging, i.e., the needle can be visualized entering the vein. AIMS: We performed a study to compare USG guided central venous cannulation (CVC) and conventional anatomical landmark approach to CVC, in terms of ease of cannulation, time consumed, and associated complications. SETTINGS AND DESIGN: The study was performed in a 16-bed open ICU. Eighty patients were randomly divided in two groups. MATERIALS AND METHODS: The right internal jugular vein (IJV) was cannulated in all. In Group I, a portable ultrasound machine was used during cannulation. The vessels were visualized in the transverse section with the internal carotid artery (ICA) identified as a circular pulsatile structure, while the IJV as a lateral, oval nonpulsatile structure). The needle was inserted perpendicular to the skin under visualization on the US screen. Central venous line was then inserted by the Seldinger technique. In Group II, CVC was performed by the conventional landmark approach. The parameters studied included time for insertion, attempts required, and complications encountered. STATISTICAL ANALYSIS: The database of all parameters was analyzed using SPSS software version 10.5. RESULTS: The mean time to successful insertion was 145 and 176.4 sec in groups I and II, respectively (p = 0.00). An average of 1.2 attempts per cannulation was required for group I, while 1.53 for group II (p = 0.03): 10% witnessed arterial puncture and 2.5% pneumothorax in group I and none in group II. CONCLUSION: USG-guided CVC is thus easier, quicker, and safer than landmark approach.