Background:The use of intravenous sedation during cardiac surgery to reduce awareness has been practised routinely during past few years and the two most commonly used drugs include propofol and dexmedetomidine, but their effects on hemodynamics and postoperative outcomes in cardiac surgery is continually being evaluated.Aims:The aim of this study was to compare the effects of anesthesia by dexmedetomidine and propofol on the hemodynamic variables and postoperative outcomes in patients who were planned for elective cardiac surgery.Settings:Cardiac operating room of a tertiary care hospital.Design:A prospective, randomized controlled, double-blind clinical trial.Materials and Methods:Sixty patients were randomized to receive either a continuous infusion of propofol (0.25–1 mg/kg/h) or dexmedetomidine bolus of 1 μg/kg over 10 min followed by infusion (0.2–0.6 μg/kg/h) after induction of anesthesia. The anesthesia technique and physiological monitoring including bispectral index monitoring were similar among both the groups. Hemodynamic variables (mean heart rate [HR], mean arterial pressure [MAP]) were noted at predefined time intervals, intraoperative vasopressor or inotrope requirements and postoperative outcomes including postoperative ventilation time and length of stay in the Intensive Care Unit (ICU) were also recorded.Statistical Analysis:Statistics was done using SPSS V 20 (IBM, NY) using Student's t-test, analysis of variance, and Mann–Whitney U-test, and a P < 0.05 was considered to indicate a significant difference.Results and Conclusions:HR and MAP were significantly less in dexmedetomidine group compared to propofol group (P < 0.05). Both the groups had a similar requirement of vasopressors and inotropes. The duration of postoperative ventilation and length of stay in the ICU were significantly shorter in the dexmedetomidine group (P < 0.05). The risk of delirium was significantly less in dexmedetomidine group (P < 0.05). From our study we concluded, that the perioperative infusion of dexmedetomidine produces better hemodynamic stability, reduces the risk of postoperative delirium, and leads to shorter ICU stay.
BackgroundAwareness during general anesthesia is undesired and unanticipated patient wakefulness during surgery or recall of intraoperative events. Incidence of awareness in patients undergoing cardiac surgery is significantly higher than the overall incidence of 1% during general surgery. Awareness during cardiac surgery can be prevented by a number of methods. One such method is the supplemental, intraoperative use of sedative agents. Propofol, a bisubstituted phenol, is an intravenous general anesthetic that has been shown to reduce the incidence of awareness. Dexmedetomidine—an alpha2-adrenergic agonist with anxiolytic, opioid, and general anesthetic-sparing properties—is being considered for maintaining intraoperative depth of anesthesia. The purpose of this study was to evaluate the effect of dexmedetomidine on depth of anesthesia and to compare it with the effect of propofol in cardiac surgery.MethodsThis was a prospective, randomized, double-blind study conducted in a tertiary-care hospital. Sixty patients with American Society of Anesthesiologists (ASA) physical status I-III planned for elective open heart surgery were randomized into two groups of 30 patients each. Each patient of the dexmedetomidine group received an initial loading dose of dexmedetomidine at 1 mcg kg-1 over 10 minutes followed by infusion at the rate of 0.2–0.6 mcg kg-1 hr-1. Patients of the propofol group received propofol infusion at the rate of 0.25-1 mg kg-1 hr-1. An identical technique—of standard general anesthesia and routine physiological monitoring—was used in both groups. Bispectral scores were recorded at predetermined intervals during surgery and the target bispectral index (BIS) was kept at 50±10. The patients were assessed for awareness and recall 24 hours after tracheal extubation using the Brice Questionnaire.ResultsIntraoperative BIS scores remained within the target range in both groups; however, the BIS scores showed variable trends between the groups and were significantly lower in the dexmedetomidine group (p < 0.001). None of the patients in either group had recall of intraoperative events.ConclusionAdministration of dexmedetomidine was as effective in reducing awareness and recall in cardiac surgery compared to propofol. Thus, dexmedetomidine can be used as an alternative sedative agent to prevent awareness and recall in cardiac surgery.
Background:The purpose of this study was to evaluate the role of antepartum transabdominal amnioinfusion in oligohydramnios with the view to improving pregnancy outcome in oligohydramnios, a serious complication of pregnancy that is associated with a poor perinatal outcome and complicates 1-5% of pregnancies. Methods: The study comprised of a prospective analysis of 130 pregnant women with oligohydramnios, divided into two groups, the study and control group of 65 patients each and were similar with regard to age, gravidity, parity, gestational age. TAA was performed on all patients in the study group and the results were compared and analyzed. Results: Mean gestational age at first treatment was 29.98 weeks in study group. Mean pre-procedure amniotic fluid index was 4.01 and post-procedure was 12.49. A total of 106 infusions were done on 65 patients (mean1.63). Mean latency period in study group was 49.53 and in controls 26.49. There was significant decrease in fetal distress in patients in study group. 30 % of patients needed caesarean section in study group compared to 60% in controls. Number of preterm deliveries was 18 and 45 respectively in study and control groups. 61% of newborns in the study group weighed more than 2.5 kg compared to only 24% in control group. Neonatal ICU admissions and newborn deaths were lesser in study group. Conclusions: Transabdominal amnioinfusion is an extremely useful procedure to reduce complications arising from oligohyramnios. It significantly increases the latency period, decreases the occurrence of fetal distress preterm deliveries, need for caesarean or instrumental deliveries, improves birth weight of the newborns and significantly reduces the neonatal morbidity and mortality.
Introduction:Infertility is a common condition, with important medical economic and psychological implications. We have observed a surge in cases of primary infertility in our OPD of late. Hypothyroidism and hyperprolactinemia have been implicated as a cause of primary infertility. Materials and methods:We conducted a prospective cross-sectional study in our hospital, Government Medical College, on an OPD basis, between May 2017 and January 2019, to check for hypothyroidism and hyperprolactinemia as a cause of primary infertility among females, after ruling out other common implicated factors that may be the cause of infertility. We labeled the study group as group I and the control group as group II. Results: The mean age of patients in group I was 26.21 years, and that in group II was 25.63 years, respectively. The average time since marriage in group I was found to be 1.67 years and that in group II was 1.78 years, respectively. The rural-urban ratio of patients in group I was 23:27 and that in group II was 34:16. The mean TSH level in group I was found to be 7.11 ± 1.91 and that in group II was found to be 3.28 ± 2.11. The mean levels of serum prolactin in group I were 41.62 ± 20.02 and that in group II were 22.36 ± 15.61, respectively. There was a high prevalence of hypothyroidism and hyperprolactinemia in group I when compared with group II. Conclusion: This study showed significantly higher prolactin and TSH levels among the primary infertile female patients. Therefore, for proper management of infertile cases, it may be necessary to look for thyroid dysfunction and treat it accordingly.
Background: The incidence of acute abdomen during pregnancy is approximately 1 in 500 pregnancies. The incidence of symptomatic gallstone disease in pregnancy is reported in approximately 0.2-0.5 per 1,000 pregnancies. Symptoms are similar to those in the nonpregnant state. A delay in diagnosis may increase the risk of perforation. Treatment in most cases is conservative. However, recent trends, newer instrumentation and skilled personnel encourage arranging laparoscopic cholecystectomy at the time of diagnosis.Methods: This study was a retrospective study, included 117 pregnant patients with acute gallstone disease, who were treated and followed-up at Government Medical College, Srinagar, Department of General Surgery and Department of Gynae And Obstetrics, between January 2015 and April 2017.Results: The mean age of patients in our study was 28.6 years. Majority of patients 56 (47.86%) were in is trimester of pregnancy. Parity of the patients varied from 1 to 6, with a mean parity of 2.67. The presentation of majority of patients was colicky pain right upper abdomen,108 (92.30%). All patients had gallstones on USG scan.101(86.32%) patients had acute cholecystitis, while 8 (6.83%) patients had predominant features of acute pancreatitis,8(6.83%) patients had accompanying choledocholithiasis The average wall thickness of gallbladder in our patients was 4.62 mm. Majority 106 (90.59%) patients were managed conservatively. 8 (6.83%) patients underwent cholecystectomy in same admission, after failure of conservative management, 7 patients underwent laparoscopic cholecystectomy and one underwent open cholecystectomy. 3 patients (2.56%), who had features of cholangitis were managed by ERCP. The average length of hospital stay in our patient group was 8.61 days. There was one maternal death reported in our study, there were a total of 8 (6.83%) preterm deliveries.Conclusions: Symptomatic gallstone disease in pregnancy is a common surgical problem. Diagnosis during pregnancy can be difficult, majority of cases can be managed conservatively, intervention whenever indicated must be undertaken.
Background: It is now possible to identify acquired and hereditary risk factors in a substantial percentage of patients presenting with a venous thrombotic event. The objective of the study was to study the clinical and etiological profile of patients with unprovoked thrombosis in young patients.Methods: Twenty-one patients 09 males (42.8%) and 12 females (57.14%) with a mean age of 29.67±5.21 were studied, who presented with unprovoked thrombosis.Results: Among 21 patients studied most common presentation was deep venous thrombosis of lower limbs (38.09%) followed by recurrent abortions with deep venous thrombosis (14.28%) and cerebellar infarction (14.28%). In etiological profile, the most common thrombophilla was factor V Leiden mutation (28.57%) followed by antiphospholipid antibody syndrome (23.8%), protein C deficiency (19.04%), methylene tetrahydrofolate reductase (9.52%) and antithrombin, prothrombin gene mutation, hyperhomocystenemia and janus kinase 2 mutations (4.76%). Among 6 patients of factor V Leiden mutation 3 presented with deep venous thrombosis of lower limbs, 1 patient each with middle cerebral artery infarct, juglar vein thrombosis and subclavian vein thrombosis respectively.Conclusions: Factor V Leiden mutation is the most common inherited thrombophillias which has been "substantiated from various studies.
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