Background:Head injury presents a major worldwide social, economic, and health problem. Hyperglycemia is a significant indicator of the severity of injury and predictor of outcome, which can easily be prevented. There has been a long-standing controversy regarding the use of inhalational or intravenous (i.v.) anesthetic agents for surgery of head injury cases and impact of these agents on blood sugar level.Aims and Objectives:The aim of this study is to find out anesthetic drugs and technique having minimal or no effect on the blood sugar, and Glasgow Coma Scale (GCS) of patients with a head injury by comparing two types of anesthetic techniques in surgery of head injury patients.Materials and Methods:This was a prospective, randomized, and comparative study, conducted on 60 adult head injury patients. The patients were divided into two groups of 30 each. Group I patients received induction with sevoflurane and then had O2 + air + sevoflurane for maintenance with controlled ventilation. Group II patients received induction with i.v. propofol and then had O2 + air + propofol for maintenance with controlled ventilation. Injection fentanyl was used in both the groups at the time of induction and in intermittent boluses in maintenance. In observation, blood sugar level and mean arterial pressure were assessed at different time periods perioperatively in both groups while GCS was analyzed pre- and post-operatively.Statistical Analysis:Statistical analysis was performed by Microsoft Excel 2010 using t-test for comparison between the two groups and Z-test for comparison of proportions.Results and Conclusion:Blood sugar level was found significantly higher in patients of sevoflurane group at 30 min after induction, at the end of surgery, and 1 h after the end of anesthesia than propofol group patients. This increase of blood sugar level did not have any significant alteration in the GCS profile of the patients in sevoflurane group as compared to propofol group patients. Nausea and vomiting were found more in sevoflurane group while hypotension and bradycardia were found more with propofol group.
Background: Shivering is a common problem faced by an anaesthesiologist during perioperative period. Shivering occurs during both general anaesthesia and regional anaesthesia but it is more troublesome during neuraxial anaesthesia. To evaluate the effectiveness of intravenous Midazolam, Ketamine and combination of Midazolam with Ketamine in control of shivering.Methods: The study was conducted in 90 ASA I and II patients receiving neuraxial anaesthesia with comparable dose of hyperbaric bupivacaine. The patients were allocated in three groups of 30 each to receive Midazolam 75 mcg/kg, ketamine 0.5 mg/kg and Midazolam 37.5 mcg/kg plus Ketamine 0.25 mg/kg IV after the appearance of shivering. Disappearance and recurrence of shivering as well as temperature and haemodynamics were recorded with scheduled intervals.Results: IV Midazolam plus Ketamine at the dose of 37.5 mcg/kg and 0.25 mg/kg is more effective in prophylaxis of shivering than IV Midazolam 75 mcg/kg or IV Ketamine 0.5 mg/kg. Small number of patients showed, clinically as well as statistically insignificant, incidence of hypotension, bradycardia and respiratory depression of various degrees at various time intervals.Conclusions: Thus, IV Midazolam plus Ketamine at the dose of 37.5 mcg/kg and 0.25 mg/kg IV is more effective in prophylaxis of shivering than IV Midazolam 75 mcg/kg or IV Ketamine 0.5 mg/kg following subarachnoid blockade for infra umbilical surgery. The side effects like Hypotension, nausea, vomiting and pruritus are also very less with combination and prove that it is a better agent for prophylaxis of shivering following regional anesthesia.
Background: Dyslipidemia is thought to associated with the risk of cardiovascular disease development. Overt hypothyroidism is associated with lipid abnormalities. However, the relationship between subclinical hypothyroidism (SCH) and pattern of lipid abnormalities is not well eastablished. The aim of this study was to find the lipid abnormalities in patients of subclinical hypothyroidism (SCH) and determine relationship between lipid level and TSH. Methods: Serum lipid levels of 92 patients with subclinical hypothyroidism (SCH) and 110 age and sex matched healthy controls were evaluated in this cross sectional case control study. Results: In this study total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) were significantly higher (p value<0.05) in patients with subclinical hypothyroidism (SCH) as compared to control group. Triglycerides (TG) and very low density lipoprotein cholesterol (VLDL-C) were also increased in these patients as compared to control but the difference was not statistically significant. High density lipoprotein cholesterol (HDL-C) was found to be marginally lower in these patients than control. Conclusions: Total cholesterol (TC) and low density lipoprotein (LDL-C) are higher in patients with subclinical hypothyroidism (SCH) as compared to healthy controls.
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