OBJECTIVE: sub arachnoid block is extensively used for the conduction of caesarean section without prophylactic measures; hypotension is a frequent occurrence (in about 80% of the patients). Hypotension is associated with distressing symptoms of dizziness, nausea and vomiting, and may also interfere with the surgical procedure. Present study is a comparison of pre-emptive intramuscular phenylephrine and ephedrine in prevention of spinal anesthesia induced hypotension during caesarian section. METHODS: In this randomized double blind, placebo controlled study, we have evaluated preemptive phenylephrine 2 mg IM; in comparison with ephedrine 45 mg IM and 2 ml saline given just after induction of spinal anesthesia, in terms of hemodynamic stability, development of symptoms like nausea and vomiting and requirement for rescue IV ephedrine vasopressor therapy in patients undergoing lower segment caesarean section. RESULTS: All the groups were comparable with respect to mean age, mean body weight MAP, and mean Pulse rate. In conclusion, pre-emptive use of intramuscular phenylephrine and ephedrine was found to be effective in prevention of spinal anesthesia induced hypotension, nausea and vomiting significantly. However, statistically no difference (p=0.351) was found between the phenylephrine and ephedrine group although the incidence of hypotension, nausea and vomiting was less in phenylephrine group. CONCLUSION: Phenylephrine group seems better to prevent incidence of hypotension, nausea and vomiting among all groups. KEYWORDS: Phenylephrine, ephedrine, MAP, Pulse Rate. INTRODUCTION:Regional anesthesia in the form of epidural or subarachnoid block is extensively used for the conduction of caesarean section and gynecological lower abdominal surgeries. Without prophylactic measures, hypotension is a frequent occurrence (in about 80% of the patients) during spinal anesthesia (Rout CC et al 1993).1 Hypotension is associated with distressing symptoms of dizziness, nausea and vomiting, and may also interfere with the surgical procedure.2 Ideally hypotension should be prevented in patients receiving spinal anesthesia.Prophylactic intravenous hydration has been used as first line measure to prevent hypotension although the place of preloading is now being questioned (Jackson R et al 1995). 2 The management of choice, however, if hypotension occurs is the use of vasopressors as required The usual approach to the use of vasopressors in this clinical setting is reactive rather than proactive; spinal anesthesia induced hypotension is allowed to develop and is then treated accordingly.In this randomized double blind, placebo controlled study, we have evaluated preemptive phenylephrine 2 mg IM; in comparison with ephedrine 45 mg IM and 2 ml saline (IM) given just after induction of spinal anesthesia, in terms of hemodynamic stability, development of symptoms like
Background and objectivesPropofol-based sedation is one of the most commonly used methods for endoscopic retrograde cholangiopancreatography (ERCP). The commonest complications during ERCP are in the form of adverse cardiopulmonary events as a result of sedation. Etomidate has a more stable cardiovascular and respiratory profile than propofol and has been used for sedation in simple gastrointestinal endoscopy but has not been studied for procedural sedation in ERCP. The objective of the present study was to compare the safety and feasibility of etomidate and propofol for sedation during ERCP procedures. MethodsThis single-center, randomized trial included 100 American Society of Anesthesiologists (ASA) physical status class I to II patients who were scheduled for ERCP. All patients received midazolam 0.02 mg/kg, lignocaine (2%) 1 mg/kg, and fentanyl 1 µg/kg intravenously, followed by etomidate or propofol according to the group allocation. The primary outcome was to compare the mean arterial pressure (MAP) at various timepoints between the two groups and secondary outcomes were to compare oxygen saturation, induction and recovery times, and adverse events. Transient hypotension was defined as any decrease in MAP below 60 mmHg or 20% below the baseline. Transient hypoxia was defined as desaturation (saturation of peripheral oxygen (SpO2) <92%) lasting for more than 10 seconds requiring airway intervention. ResultsFifty patients were enrolled in each group (Group E: etomidate and Group P: propofol). Transient hypotension occurred in eight (16%) patients in Group P, and two (4%) patients in Group E (P= 0.045). Baseline MAP was comparable between the two groups but was significantly lower in Group P at three timepoints during the study. Nine (18 %) patients in Group P had a transient hypoxic episode, compared to none in Group E (p= 0.006). The induction and recovery times were similar in the two groups. ConclusionsEtomidate offers better hemodynamic and respiratory stability than propofol and can be recommended for use during ERCP in ASA I/II patients.
In the beginning of his scientific career, he was interested in the development of neuropeptidergic systems in the brain (oxytocin, vasopressin, prolactin) and their regulation by glucocorticoids.Then in the UK, he focused on the role of neuroactive steroids during brain development and their input to the sexual differentiation of brain functions. Back in Germany, he focused his research for several years on novel signal perception and intracellular signal transduction mechanisms of estrogens in the CNS, so-called nongenomic steroid signaling. After moving to Aachen, the scientific orientation of his team turned to the molecular and biochemical understanding of acute neurological and chronic neurodegenerative diseases of the brain.In particular, animal models for multiples sclerosis, amyotrophic lateral sclerosis, and acute ischemic stroke and spinal cord injury were established in his group and served to analyze the underlying neuroinflammatory processes and neuroprotective strategies. Novel and only recently started research projects are concerned with the influence of steroid hormones such as estrogens for the therapeutic treatment of psychiatric disorders such as eating disorders and aggression.
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