Post graduate survey and evaluation of role of animal experimentation, status and relevance of current syllabus, and challenges for alignment with requirements of the pharmaceutical industry

Background: The current scenario has brought the validity of animal experimentation (AE) under scrutiny. The requirements from an academician in the pharmaceutical industry are not sufficiently handled. A gnawing need was felt to conduct a study amongst the post graduate MD pharmacologists regarding the role of AE, relevance of current syllabus and challenges faced in the pharmaceutical industry.Methods: This questionnaire-based survey was carried out amongst post graduate (PG) residents pursuing MD pharmacology. Students were enrolled via social contacts, email, and in 2 workshops/conferences. The survey questionnaire consisted of 20 questions in total. 47 completed questionnaires were returned from a total 60. The data was collected in an anonymous fashion to avoid bias.Results: From the study we observe that PG residents were aware of the current MCI/University guidelines on AE. Only 42.5% (n=20) of the volunteers replied that they had access to simulator software. Participants were of the opinion that the current PG teaching curriculum is ill-adapted to tackle challenges encountered in the pharmaceutical industry. Compulsory industry rotation (31.9%) was one of the favoured suggested changes. Overall satisfaction with MD pharmacology was obtained in the positive.Conclusions: We conclude that the importance of AE in pharmacology is irrefutable, although advent of alternatives is the direction to be headed in. The curriculum is archaic at times, thus warrants changes. Preparedness for pharmaceutical industry is also low and needs to be addressed

Comparative assessment of efficacy of lignocaine (1.5 mg/kg), esmolol (300 µg/kg), and dexmedetomidine (0.5 µg/kg) in minimizing the pressor response to laryngoscopy and intubation

Background: The objectives of the present study were to compare the effect of lignocaine (1.5 mg/kg IV given 3 mins before laryngoscopy and intubation), esmolol (300 µg/kg as a bolus 2 mins before intubation), and dexmedetomidine (0.5 µg/kg IV over 10 mins) on the pressor response in non-hypertensive American Society of Anesthesiologists (ASA) Grade I and II patients posted for elective surgery and the pharmacoeconomic and pharmacoepidemiological inferences drawn on comparison of these drugs.Methods: After approval by the Institutional Ethics Committee, 90 consenting adult patients aged 18-65 years of age of either sex of non-hypertensive ASA Grade I or II undergoing elective surgery under general anesthesia with endotracheal intubation were included in this randomized, prospective study protocol. (1) Group L: Patients were given IV lignocaine 1.5 mg/kg. (2) Group E: Patients were given IV esmolol 300 µg/kg. (3) Group D: Patients were given IV dexmedetomidine 0.5 μg/kg. Adequate monitoring, oxygenation, and hydration were established on the entry in the operating room (OR). All hemodynamic data were measured on arrival in OR, before induction, before intubation, and at 1, 3, 5 mins after intubation by an independent observer. Anesthesia was induced with thiopental sodium and fentanyl 2 μg/kg; intubation was performed with cuffed oral endotracheal tube of appropriate size for airway management. Surgery was allowed to start only after 5 mins of intubation.Results: Esmolol effectively blunted the blood pressure response to intubation, but incompletely attenuated the increase in heart rate (HR). Dexmedetomidine was more effective than lignocaine in minimizing the increase in HR, systolic blood pressure (SBP), and diastolic blood pressure (DBP) subsequent to endotracheal intubation.Conclusion: Dexmedetomidine 0.5 µg/kg has manifested to maintain hemodynamic stability associated with intubation and hence may prove beneficial for cardiac patients where the stress response to laryngoscopy and intubation is highly undesirable

Stroke Volume Variation Directed Versus Conventional Fluid Therapy for Postoperative Acute Kidney Injury after Percutaneous Nephrolithotomy - A Randomized Pilot Study

Background: Percutaneous nephrolithotomy (PCNL) surgery may be associated with postoperative Acute Kidney Injury (AKI). Commonest intraoperative risk factors for postoperative AKI include hypotension and hypoperfusion. Intravenous fluids are administered during surgery to optimize intravascular status and thus prevent hypotension. Conventionally, intravenous fluids are administered during surgery using pre-calculated volumes based on maintenance needs. Alternatively, goal-directed fluid therapy using Stroke Volume Variation (SVV) can be used to decide the volume of intravenous fluids. We compared early postoperative AKI following intraoperative use of conventional (group C, n=15) versus SVV directed fluid therapy (group S, n = 17) in patients undergoing PCNL surgery. Methods: This double-blinded pilot study involved 32 adult patients, randomised to two groups according to type of intraoperative fluid therapy (group C or group S). Postoperative AKI was diagnosed as per KDIGO guidelines. Results: Incidence of early postoperative AKI was clinically higher for group S, though statistically similar, as compared to group C (47.1% versus 26.7%) (P = 0.234). Postoperative increase in eGFR, and 24-hour urine output were clinically greater for group S (P > 0.05). Volume of intraoperative fluids infused was significantly lesser for group S (P = 0.000). The incidence of hypotension and requirement of vasopressor to maintain blood pressure was clinically lesser, though statistically similar for group S as compared to group C (P = 0.659). Conclusions: There appears to be a clinical trend of greater incidence of AKI with use of SVV guided therapy despite better intraoperative hemodynamic stability and greater improvement in postoperative urine output and eGFR in the first postoperative day. Keywords: Percutaneous nephrolithotomy, Acute kidney injury, Fluid therapy, General anesthesia, Blood pressur

Comparative assessment of ProSeal™ laryngeal mask airway intervention versus standard technique of endotracheal extubation for attenuation of pressor response in controlled hypertensive patients

Background and Aims: Swapping of the endotracheal tube with laryngeal mask airway (LMA) before emergence from anaesthesia is one of the methods employed for attenuation of pressor response at extubation. We decided to compare the placement of ProSeal ™ LMA (PLMA) before endotracheal extubation versus conventional endotracheal extubation in controlled hypertensive patients scheduled for elective surgeries under general anaesthesia. Methods: Sixty consenting adult patients were randomly allocated to two groups of thirty each; Group E in whom extubation was performed using standard technique and Group P in whom PLMA was inserted before endotracheal extubation (Bailey manoeuvre). The primary outcome parameter was heart rate (HR). The secondary outcomes were systolic, diastolic and mean blood pressure (MBP), electrocardiogram, oxygen saturation and end-tidal carbon dioxide. Two-tailed paired Student's t-test was used for comparison between the two study groups. The value of P< 0.05 was considered as statistically significant. Results: The patient characteristics, demographic data and surgical procedures were comparable in the two groups. A statistically significant decrease was observed in HR in Group P as compared to Group E. Secondary outcomes such as systolic, diastolic and MBP depicted a statistically insignificant difference. Conclusion: Bailey manoeuvre was not effective method to be completely relied upon during extubation when compared to standard extubation

Comparative assessment of different doses of midazolam to prevent etomidate-induced myoclonus – A randomized, double-blind, placebo-controlled trial

Background: Etomidate is a popular induction agent, due to its several advantages for example, an extremely stable hemodynamic profile with no effects on sympathetic nervous system and baroreceptors, minimal effect on respiration and also prevents histamine release in healthy patients or in those with reactive airway disease. It, however, may be associated with myoclonus whose incidence has been reported as 50%–80% in nonpremedicated patients. Ideally, a pretreatment drug for preventing myoclonic movements should be short acting, not have significant effects on respiration and hemodynamics, and not prolong recovery from anesthesia. Midazolam has been used as a pretreatment to attenuate myoclonus in different doses with varied results, but the optimal dose has not been established. The present study was planned to compare the effect of three doses of midazolam, i.e., 0.015 mg/kg, 0.03 mg/kg, and 0.05 mg/kg in preventing etomidate-induced myoclonus. Materials and Methods: This study comprised 164 American Society of Anesthesiologists I/II consenting patients between 18 and 60 years. They were randomly divided into four groups after which pretreatment with normal saline in group M0, midazolam 0.015 mg/kg in group M0.015, 0.03 mg/kg in group M0.03, and 0.05 mg/kg in group M0.05 was administered. The primary outcome was the incidence of myoclonus after etomidate. The secondary outcome measures included severity of myoclonus and changes in hemodynamic parameters. One-way analysis of variance with Bonferroni's correction was used to compare quantitative data. Chi-square test was applied for qualitative data. Further, as there were four groups with multiple comparisons, Bonferroni's correction was applied and P < 0.01 was considered statistically significant. Results: We observed a significant reduction in the incidence of myoclonus of group M0.015 as compared to group M0 (P < 0.001). A significant reduction in severity of myoclonus was observed in all the three midazolam groups compared to the control group (P < 0.001) without any significance among the patients receiving different doses of midazolam. Conclusion: We recommend using midazolam pretreatment in a dose of 0.015 mg/kg for prevention of etomidate-induced myoclonus

Effect of intra-abdominal pressure on maximum level of intrathecal sensory block: A preliminary randomized controlled trial

Objectives: Increase in Intra-Abdominal Pressure (IAP) is commonly accepted as a cause for intrathecal dose sparing and consequently higher level of sensory block during pregnancy. There is however very little actual data evaluating the relationship. Thus, we aimed to evaluate association between IAP and maximum level of sensory block following intrathecal injection of hyperbaric bupivacaine as well as plain levobupivacaine for cesarean section. Methods: Preliminary randomized controlled blinded trial included females aged 18-40 years, scheduled for elective cesarean section under single-shot subarachnoid block. After randomization, they received either intrathecal hyperbaric bupivacaine (group H) or plain (isobaric) levobupivacaine (group P) in a dose of 12.5 mg (n = 40 each). IAP was measured before and after the spinal block, using the recommended intravesical technique. The maximum level of sensory block and the IAPs were measured in each patient. Results: There was no significant correlation of IAPprespinal with maximum level of sensory block for group H (P = 0.334; rs = -0.157) or group P (P = 0.637; rs = -0.078). Similarly, there was no significant correlation of the IAPpostspinal: group H (P = 0.370; rs = -0.145); and group P (P = 0.714; rs = -0.061). Both group H and group P had similar IAPprespinal (15.9 [14.3-18.2] and 15.3 [14.3-17.4] mmHg, respectively) (P = 0.474); as well as IAPpostspinal (15.2 [13.8-17.2] and 14.6 [13.4-16.0] mmH, g respectively) (P = 0.239). Among ancillary observations, duration of sensory block was significantly longer for group P versus group H (133.6 ± 24.2 and 103 ± 23.4 mins; P 0.05). Conclusions: The IAP was raised to the level of conventionally defined intra-abdominal hypertension (>12 mmHg) in patients scheduled for elective cesarean section. However, despite being increased, the IAPprespinal or IAPpostspinal did not show any significant association with the maximum level of sensory block (P > 0.05)