Background:
Endoscopic retrograde cholangiopancreatography (ERCP) is used to diagnose and treat pancreaticobiliary diseases. It is a potentially uncomfortable procedure that needs to be performed under conscious sedation. Safe and effective sedation protocol is the need of an hour.
Aims:
This study aims to evaluate the requirement of propofol using midazolam and dexmedetomidine as premedication for ERCP. The degree of comfort experienced by endoscopist and the patients was also assessed.
Materials and Methods:
A total of sixty patients were enrolled in a randomized, assessor-blinded study in the age group of 40–80 years, American Society of Anesthesiologists physical class II–III undergoing elective ERCP procedures. They were divided into two groups of 30 each. Group D (
n
= 30): Dexmedetomidine (100 μg/mL + 18 mL saline) loading dose at 1 μg/kg intravenous (IV) over 10 min followed by 0.5 μg/kg/h infusion, and Group M (
n
= 30): Midazolam at 0.05 mg/kg IV bolus over 10 min followed by normal saline infusion under hemodynamic monitoring. Satisfaction scores, total propofol requirement, and complications such as gagging, restlessness, agitation, postoperative nausea and vomiting were noted and analyzed statistically.
Statistical Analysis:
Statistical analysis was performed using SSPS 17.0 software (SPSS Inc., 233 South Wacker Drive, Chicago, USA). The Chi-square test was applied for nonparametric data and parametric numerical data, unpaired
t
-test for intergroup comparison, and repeated measures ANOVA for intragroup comparison. Results were expressed as a mean ± standard deviation. Value of
P
< 0.05 was considered statistically significant and <0.001 as highly significant.
Results:
Surgeons and patients were more satisfied and comfortable along with less requirement of propofol in the dexmedetomidine group. The incidence of complications was also less in the dexmedetomidine group as compared to that of midazolam group.
Conclusion:
Both dexmedetomidine and midazolam can be safely administered as an anesthetic adjuvant to propofol for short procedures like ERCP's. Dexmedetomidine provided intense and better sedation quality along with lesser requirement of propofol doses. Moreover, it provided stable hemodynamic conditions and good recovery characteristics as compared to midazolam group.
Objectives: The objectives of the study were to establish normal reference values of total and differential leukocyte count (DLC) in Indian neonatal population.
Methods: The study was conducted on 200 healthy newborns admitted to neonatology section of Department of Paediatricsa. Maternal and Neonatal data was recorded on a pretested pro forma. Thin-layer chromatography (TLC) was done by manual method (hemocytometer method) using improved Neubauer Chamber. For calculating DLC smear was made from the EDTA blood and was stained by Leishman stain (Romanowsky group). DLC was done in body and tail part of the stained smears by following Z pattern.
Statistical Analysis: Descriptive statistical analysis was carried out in the present study. Mean, standard deviation, t-test, and analysis of variance tests were used to test the significance of the differences among sample means.
Results: Mean TLC at various period of gestations were 4500/cumm at 31 weeks, 7627±2320/cumm at 33 weeks, 8325±1943/cumm at 34 weeks, 8141±1538/cumm at 35 weeks, 8455±904/cumm at 36 weeks, 8840±658/cumm at37 weeks, 9380±896/cumm at 38 weeks, 10143±1369/cumm at 39 weeks, 9155±2444/cumm at 40 weeks, and 11750±353/cumm at 41 weeks.
Conclusion: TLC showed increase with gestation except at 35 weeks and 40 weeks. Neutrophils shows increase with gestation except at 35 weeks and 40 weeks lymphocytes shows increase with gestation except at 34 weeks, 39 weeks, and 40 weeks.
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