Background:Clonidine has emerged as an attractive premedication desirable in laparoscopic surgery wherein significant hemodynamic stress response is seen. The minimum safe and effective dose of intravenous clonidine to attenuate the hemodynamic stress response during laparoscopic surgery has however not yet been determined.Materials and Methods:This prospective, randomized, double-blind controlled study was conducted on 90 adults of ASA physical status I and II, scheduled for laparoscopic cholecystectomy under general anesthesia. Patients were randomized to one of the three groups (n= 30). Group I received 100 ml of normal saline, while groups II and III received 1 μg/ kg and 2 μg/ kg of clonidine respectively, intravenous, in 100 ml of normal saline along. All patients received glycopyrrolate 0.004 mg/kg and tramadol 1.5 mg/kg intravenously, 30 min before induction. Hemodynamic variables (heart rate, systolic, diastolic, mean arterial pressure), SpO2, and sedation score were recorded at specific timings. MAP above 20% from baseline was considered significant and treated with nitroglycerine.Results:In group I, there was a significant increase in hemodynamic variables during intubation pneumoperitoneum and extubation (P<0.001). Clonidine given 1 μg/kg intravenous attenuated hemodynamic stress response to pneumoperitoneum (P<0.05), but not that associated with intubation and extubation. Clonidine 2 μg/kg intravenous prevented hemodynamic stress response to pneumoperitoneum and that associated with intubation and extubation (P<0.05). As against 14 and 2 patients in groups I and II respectively, no patient required nitroglycerine infusion in group III.Conclusions:Clonidine, 2 μg/ kg intravenously, 30 min before induction is safe and effective in preventing the hemodynamic stress response during laparoscopic cholecystectomy.
Background and Aims:Postoperative pain relief following total knee arthroplasty (TKA) is a major concern as it will help to achieve an effective functional outcome. The present study was conducted to compare continuous femoral nerve block (CFNB) and continuous epidural infusion (CEI) techniques using ropivacaine.Material and Methods:Forty patients were randomly allocated into group F and group E to receive 0.2% ropivacaine through femoral catheter or epidural catheter respectively. An infusion was started @6 ml/h post-operatively when VAS was ≥4. The dose was titrated to keep VAS <4 (with minimum rate 2 ml/h and maximum rate 10 ml/h). If VAS ≥4 occurred despite maximum rate of infusion, a rescue analgesic was given. Primary objectives were to compare visual analogue score (VAS), rehabilitation indices, and rescue analgesic requirement. Secondary objectives were to assess patient and surgeon's satisfaction score, motor blockade, and complications if any.Results:The mean VAS score, rehabilitation goals, rescue analgesic requirement, and patient's and surgeon's mean satisfaction scores were comparable in both the groups. Motor blockade was not seen and though the number of side effects were more in group E, they did not achieve statistical or clinical significance.Conclusion:CFNB can be used as an alternative, effective postoperative analgesic technique for TKA.
The Upper respiratory tract infection is mainly attributed to viral infections so focus should be given to
inhibition of viral-host interaction, their entry and replication in the host cells and release of inammatory
st cytokines, resulting physiological disturbances. The host's immune system is the 1 line of defence against such threats so multitargeted herbal immune-boosters, with antioxidant, anti-inammatory and tissue repair potential would be preferred. The
natural cocktail of medicinal plants has shown promising results both by using bioinformatics based drug docking studies, in
animal experiments and in clinical trials. Here we have reviewed the 6-medicinal plants, used in making “Immuhelp”, towards
their established role in management of viral-host interaction, activation of innate and adaptive immunity, inhibition-potential
against release of inammatory cytokines, immunosuppressive and chemoattractant agents and antioxidant potentials.
Background:Laryngeal mask airway (LMA) C Trach is a novel device designed to intubate trachea without conventional laryngoscopy. The aim of the study was to evaluate the clinical efficacy of C trach in the simulated scenario of cervical spine injury where conventional laryngoscopy is not desirable.Methods:This prospective pilot study was carried out in 30 consenting adults of either gender, ASAPS I or II, scheduled for surgery requiring endotracheal intubation. An appropriate sized rigid cervical collar was positioned around the patient's neck to restrict the neck movements and simulate the scenario of cervical spine injury. After induction of anesthesia, various technical aspects of C Trach facilitated endotracheal intubation, changes in hemodynamic variables, and complications were recorded.Results:Mask ventilation was easy in all the patients. Successful insertion of C Trach was achieved in 27 patients at first attempt, while 3 patients required second attempt. Majority of patients required one of the adjusting maneuvers to obtain acceptable view of glottis (POGO score >50%). Intubation success rate was 100% with 26 patients intubated at first attempt and the rest required second attempt. Mean intubation time was 69.8±27.40 sec. With experience, significant decrease in mean intubation time was observed in last 10 patients as compared to first 10 (46±15.77 sec vs. 101.3±22.91 sec). Minor mucosal injury was noted in four patients.Conclusion:LMA C Trach facilitates endotracheal intubation under direct vision and can be a useful technique in patients with cervical spine injury with cervical collar in situ.
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