Comparative study between intravenous ramosetron and dexamethasone as pre-treatment to attenuate pain during intravenous propofol injection

Background: Propofol as an induction agent has disadvantage of pain on intravenous injection (IV). Objective: The aim of this study was to compare the efficacy of ramosetron and dexamethasone as a pretreatment drug for attenuation of pain due to propofol injection. Methods: This randomized comparative study was conducted at a tertiary care hospital in Eastern India, over a period of one year (March 2016-February 2017). Total 90 American Society of Anesthesiologists (ASA) grade I and II patients were randomly assigned into three groups (30 in each). Group R received 2 ml (0.3mg) of ramosetron, Group D received 2 ml (0.1mg/kg) of dexamethasone, and Group N received 2 ml of 0.9% normal saline. Venous drainage was occluded by using a tourniquet in mid-forearm before injecting the pre-treatment solution and released after 1 min and then 2 ml of propofol was injected over 5 sec. Patients were observed and questioned 15 sec later, if they had pain in the arm or discomfort during drug injection. The pain was scored on a four-point scale: 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain. Pearson’s Chi Square test/Fisher's Exact Test and Mann-Whitney U test/Kruskal Wallis Test were used to analyze the results. Results: The overall incidence of pain was 90% in the saline group, 17% in the ramosetron group and 10% in the dexamethasone group. The intensity of pain was significantly less in patients receiving ramosetron and dexamethasone than those receiving saline (P < 0.05). Haemodynamic parameters like heart rate (HR) and mean blood pressure (MBP) were recorded at different points of time. No significant inter group differences in MBP and HR were noted at any point of time. Conclusion: Pre-treatment with intravenous ramosetron and dexamethasone both lead to relief of pain on injection of IV propofol without any significant difference between their effects

Failure diagnosis in real time stochastic discrete event systems

Discrete Event System (DES) has been used for Failure Detection and Diagnosis (FDD) of a wide range of systems. For real time systems, timed DES based frameworks diagnose failures leading to violation of delays or deadlines. These schemes declare a failure to be diagnosable if it always i.e., in all timed-traces, results in timing violations within finite time of its occurrence. The basic assumption is, probability of any trace can be 1 or 0. So, even if there is a trace where failure is manifested, still its probability can be 0, leading to non-diagnosability. However in many systems this basic assumption may not hold. To address this issue, Thorsley et al. have augmented probability values to transitions and termed the framework as stochastic DES. Here, failure is diagnosable if there are traces where failure effect is manifested and probability of occurrence of those traces increase with time and cross a threshold. However, the scheme was for un-timed systems. In the present paper we propose a DES based FDD framework for stochastic timed systems. The scheme is illustrated with an example of a hydraulic punching machine

Stability and dynamic analyses of hybrid laminates using refined higher-order zigzag theory

This article presents a comparative study on the stability and dynamic response of hybrid laminated composite plates over monolithically produced laminated composite plates. A Refined Higher-order Zigzag Theory (RHZT) is formulated and implemented using finite element method for the analysis of hybrid laminates. This formulation considers both the interlaminar shear stress continuity and shear-free boundary conditions at surfaces of the plates. The numerical implementation employs C 0 continuous eight-noded isoparametric plate elements considering geometric nonlinearity. The element stiffness matrix is formulated to consider both the linear and nonlinear terms of the strain-displacement equations. Derivation of the consistent mass matrix for a plate element is presented following the approximation of total kinetic energy and utilising Hamilton's principle. Numerical examples are provided to demonstrate buckling and free vibration analyses (as eigenvalue problems). The results are numerically verified and validated using data from published literature. Finally, parametric studies are presented to demonstrate the effectiveness of fibre hybridisation approach on the buckling and free vibration behaviour of laminated composites

Computer simulation of protein—carbohydrate complexes: application to arabinose-binding protein and pea lectin

The CCEM method (Contact Criteria and Energy Minimisation) has been developed and applied to study protein-carbohydrate interactions. The method uses available X-ray data even on the native protein at low resolution (above 2.4 Å) to generate realistic models of a variety of proteins with various ligands.The two examples discussed in this paper are arabinose-binding protein (ABP) and pea lectin. The X-ray crystal structure data reported on ABP-β-l-arabinose complex at 2.8, 2.4 and 1.7 Å resolution differ drastically in predicting the nature of the interactions between the protein and ligand. It is shown that, using the data at 2.4 Å resolution, the CCEM method generates complexes which are as good as the higher (1.7 Å) resolution data. The CCEM method predicts some of the important hydrogen bonds between the ligand and the protein which are missing in the interpretation of the X-ray data at 2.4 Å resolution. The theoretically predicted hydrogen bonds are in good agreement with those reported at 1.7 Å resolution. Pea lectin has been solved only in the native form at 3 Å resolution. Application of the CCEM method also enables us to generate complexes of pea lectin with methyl-α-d-glucopyranoside and methyl-2,3-dimethyl-α-d-glucopyranoside which explain well the available experimental data in solution

Idiopathic Spinal Epidural Abscess: A Case Report

Epidural abscess is a potentially life-threatening disease which can lead to medical-surgical emergency. Idiopathic spinal epidural abscess (SEA) with atypical manifestations is extremely rare. We describe such a case which led to severe neurological compromise and was not associated with any known risk factors

Role of nebulised dexmedetomidine, midazolam or ketamine as premedication in preschool children undergoing general anaesthesia—A prospective, double-blind, randomised study

Background and Aims: Preschool age children are psycho-biologically vulnerable to all surgical procedures. In this study, we investigated the effect of nebulised dexmedetomidine, midazolam and ketamine as sedative premedication for alleviating parental separation anxiety, facilitating face mask acceptance and reducing emergence agitation in paediatric patients undergoing general anaesthesia. Methods: A prospective, randomised, double-blind study was done involving 96 children of age 3–7 years, randomly allocated into three equal groups and pre-medicated with either nebulised dexmedetomidine 2 μg/kg (GroupD), midazolam 0.2 mg/kg (GroupM) or ketamine 2 mg/kg (Group K). The scores of sedation scale, parental separation anxiety scale, mask acceptance scale and emergence agitation scale were recorded along with haemodynamic parameters. Two-way repeated measures analysis of variance (ANOVA), post hoc test and Kruskal–Wallis test were used for statistical analysis. Results: A statistically significant difference in sedation score was seen between the different study groups, χ2(2) = 8.561, P = 0.014 with mean rank sedation score of 56.50 for Group D, 38.92 for Group M and 43.84 for Group K. Parental separation anxiety scale score and Mask acceptance scale score also showed statistically significant difference between the different study groups, χ2(2) = 9.369, P = 0.009 and χ2(2) = 11.97, P = 0.003, respectively. Conclusion: Nebulisation with dexmedetomidine produced easy parental separation, more satisfactory sedation and face mask acceptance with less postoperative agitation than nebulisation with midazolam or ketamine