Haemodynamic stability is an integral and essential goal of any anaesthetic management plan. Laryngoscopy and intubation can cause striking changes in haemodynamics. Increase in blood pressure and heart rate occurs most commonly from reflex sympathetic and vagal discharge in response to laryngotracheal stimulation, which in turn leads to increased plasma norepinephrine concentration. This study was designed to compare efficacy of esmolol and lignocaine for attenuating haemodynamics response due to laryngoscopy and endotracheal intubation. The aim of this study was to compare the effects of Esmolol with that of Lignocaine to attenuate the detrimental rise in heart rate and blood pressure during laryngoscopy and tracheal intubation. One hundred and twenty adult patients randomized into group-L and group-E, were received lignocaine 1.5 mg/kg and Esmolol 1.5 mg/kg I.V. respectively. Heart rate and blood pressure in each minutes for the 10 minutes after intubation was recorded. Time span around intubation up to 4 minutes has been looked specifically to isolate the effect of the study drugs at the time of intubation. For statistical analysis Student's 't' test was used for comparing means of quantitative data and chi-square test was used for qualitative data. Difference was considered statistically significant if p<0.05. The mean heart rate, systolic, diastolic, and mean blood pressure, and rate-pressure product before starting anesthesia were similar in group-L (Lignocaine group) and in group-E (Esmolol group) (p>0.05). The mean values of heart rate, systolic, diastolic, and mean blood pressure, and rate-pressure product at 2, 3 and 4 minutes after intubation were significantly lower in group-E than group-L (p<0.05). In conclusion, esmolol 1.5 mg/kg is superior to lignocaine (1.5 mg/kg) for attenuation of haemodynamic response to laryngoscopy and endotracheal intubation.
Khatun UHF, Malek MA, Black RE, Sarkar NR, Wahed MA, Fuchs G, Roy SK. A randomized controlled clinical trial of zinc, vitamin A or both in undernourished children with persistent diarrhea in Bangladesh. Acta Paediatr 2001; 90: 376-380. Stockholm ISSN 0803-5253 In a double-blind randomized controlled clinical trial, moderately malnourished Bangladeshi children (61-75% of the median weight/age) were studied for the effect of zinc and/or vitamin A supplementation on the clinical outcome of persistent diarrhea. Children 6 mo to 2 y of age with diarrhea for more than 14 d were randomly allocated into 4 groups of 24 receiving a multivitamin syrup and (i) zinc (20 mg elemental), (ii) vitamin A, (iii) both zinc and vitamin A, or (iv) neither, in 2 doses daily for 7 d. Clinical data on recovery and on stool output, consistency and frequency were recorded for 7 d, and weight change from day 1 to day 7 was assessed. The baseline characteristics of the four study groups were comparable. The mean daily stool outputs from days 2 to 7 of therapy were signi cantly less in the zinc and zinc plus vitamin A groups, but not in the vitamin A group, in comparison with the control group. In children receiving zinc, the cumulative stool weight in the 7 d was 39% less than in the control group (p < 0.001) and 32% less than in the vitamin A group (p = 0.006). The cumulative stool weight in the zinc plus vitamin A group was 24% less than in the control group (p < 0.001), but the 14% lower output than in the vitamin A group was not statistically different. The change in body weight over the 7 d study period was signi cantly different between the group receiving zinc and the control group ( ‡111 g vs ¡90 g, p = 0.045). The rate of clinical recovery of children within 7 d was signi cantly greater in the zinc group (88%) compared with the control group (46%, p = 0.002) or vitamin A group (50%, p = 0.005), but not statistically different from the zinc plus vitamin A group (67%, p = 0.086). Conclusion:The results indicate that zinc, but not vitamin A, supplementation in persistent diarrhea reduces stool output, prevents weight loss and promotes earlier recovery.
Background: In Bangladesh, although OPCAB surgery are done, the number of centers are limited and as a result, studies on this subject are also few. Consequently, there are no exclusive data regarding the best anaesthetic technique in the context of superior haemodynamic stability. This study has been undertaken with a view to find out whether a combined HTEA with GA (TIVA) is safe and more efficient in providing overall cardiovascular stability. The common challenges for the cardiac anaesthesiologist during off pump coronary artery surgery (OPCAB) to maintain optimal cardiovascular parameters such as heart rate, blood pressure, CVP and arrhythmias during the different stressful surgical events and multiple cardiac manipulations, providing adequate myocardial protection, are sometimes difficult. This study has been undertaken with a view to find out whether a combined HTEA with TIVA is safe and more efficient in providing overall cardiovascular stability. Method: Sixty patients aged between 40-70 years, without having any coagulopathy disorder , any emergency surgery or left main disease scheduled for CABG on beating heart were enrolled in prospective, randomized observational comparative study. Patients were divided in two groups. In group A patients received TIVA alone and in group B patients received high thoracic epidural anaesthesia with TIVA. The parameters including heart rate , SPO2 , CVP , arterial blood pressure , rate pressure product , arrhythmia in ECG, were recorded before induction, during induction , intubation and during different events of the surgery ( skin incision, sternotomy, pericardiotomy, coronary artery anastomosis with graft , sternum closure and wound closure) was recorded. Result: Significant per-operative mean heart rate changes were observed all the events except at wound closure and during anastomosis with D1/D2 and the mean difference of mean of mean arterial pressure at intubations, skin incision, sternotomy, pericardiotomy, during anastomosis of distal end of the graft with RCA, PDA, LCX and D1/D2 were observed statistically significant (p<0.05) . No incidence of different arrhythmia occurred in group B, premature ventricular complex (PVC) was statistically significant (p<0.05) between two groups. Conclusion: HTEA with TIVA appeared to be most comprehensive, allowing for revascularization of any coronary artery, providing good cardiovascular stability during OPCAB.Key Words: CABG; OPCAB; HTEA; TIVA DOI: 10.3329/cardio.v2i2.6633Cardiovasc. j. 2010; 2(2) : 163-167
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