Clonidine versus fentanyl as adjuvant to 0.75% ropivacaine for epidural anesthesia for lower limb surgeries: a comparative evaluation

Background: Epidural adjuvants to local anaesthetic are used to enhance the quality and duration of surgical anaesthesia. The present study was aimed to compare the clinical efficacy of clonidine with fentanyl as adjuvant to epidural ropivacaine for block characteristics and hemodynamic changes during lower limb surgeries.Methods: Sixty adult consenting patients of both gender of ASA physical status I and II scheduled for lower limb surgeries under epidural anaesthesia, were randomized into   two groups of 30 patients each to receive either 15 ml of 0.75% ropivacaine with 1 ml of clonidine, 50 µg (Group RC) or with 1 ml of fentanyl 50 µg (Group RF). All patients were assessed for onset and duration of sensory and motor blockade and time to first rescue analgesia as primary end points. The hemodynamic variations, sedation, pruritus, respiratory depression or any other adverse events were recorded as secondary end points.Results: Onset of sensory block to T10 was comparable between the groups. Time to achieve maximum sensory level at T6-7 and maximum motor block was faster when fentanyl was used as compared to clonidine with statistically significant difference between the group (p<0.05). Duration of sensory analgesia was enhanced with epidural clonidine, delaying the need for rescue analgesia. In clonidine group, side effects of sedation, bradycardia and hypotension were also observed. Only 5 patients of fentanyl group suffered from pruritus.Conclusions: Clonidine was more effective than fentanyl as epidural adjuvant to 0.75% ropivacaine for prolonging the duration of analgesia with fewer manageable side effects.

Clinical benefits of preemptive oral clonidine versus oral tramadol for abdominal hysterectomy conducted under subarachnoid block with 0.5% hyperbaric bupivacaine: a comparative evaluation

Background: Neuraxial techniques possess many benefits for elective abdominal hysterectomy due to profound surgical anesthesia and muscle relaxation. The present study was aimed to compare the clinical benefits of pre-emptive oral clonidine with oral tramadol for abdominal hysterectomy conducted under subarachnoid block with 0.5% hyperbaric bupivacaine.Methods: Sixty adult female patients of American Society of Anaesthesiologists (ASA) physical status I and II, aged 42 to 65 years, were randomized into two groups of 30 patients each to receive either oral clonidine, 100 µg (Group C) or oral tramadol 50 mg tramadol (Group T), 90 min before initiation of subarachnoid block with 3.5 mL of 0.5% hyperbaric bupivacaine. Intraoperative hemodynamic changes, duration of analgesia and incidence of shivering were recorded as primary end points. Drug related effects of pruritus, sedation, nausea, vomiting, and respiratory depression were recorded as secondary outcomes.Results: The onset of sensory and motor block was comparable between the groups but the time to two dermatome regression were prolonged in patients of Group C with statistical significant difference (p=0.05). Duration of analgesia was also enhanced in patients of Group C (268.27±12.18 min versus 223.15±14.31 min in Group T) with statistically highly significant difference (p=0.000). The incidence of shivering was lower in the patients of clonidine group. The heart rate was lower in patients of clonidine throughout intraoperative period and no incidence of bradycardia, hypotension or sedation occurred in any patient.Conclusions: Both drugs showed clinical benefits as pre-emptive oral medication for abdominal hysterectomy conducted under subarachnoid block but oral clonidine (100 µg) proved to be more beneficial

Clinical efficacy of clonidine versus nalbuphine as intrathecal adjuvants to 0.5% hyperbaric bupivacaine for subarachnoid block during gynaecological procedures: a double blind study

Background: Regional anesthesia techniques for gynaecological procedures are on increasing trends due to their advantage of postoperative analgesia owing to intrathecal adjuvants. The present study was aimed to comparatively evaluate the clinical efficacy of clonidine with nalbuphine when co-administered intrathecally with 0.5% hyperbaric bupivacaine for gynaecological procedures.Methods: Regional anesthesia techniques for gynaecological procedures are on increasing trends due to their advantage of postoperative analgesia owing to intrathecal adjuvants. The present study was aimed to comparatively evaluate the clinical efficacy of clonidine with nalbuphine when co-administered intrathecally with 0.5% hyperbaric bupivacaine for gynaecological procedures.Results: The onset of sensory block was earlier in patients of Group BN (3.91±2.25 min vs 4.30±0.87 min, p=0.039). The onset of motor block was also earlier in patients of Group BN (p=0.042). The time to first rescue analgesia in patients receiving intrathecal clonidine was significantly delayed (283±14.18 min vs 231.50±26.18 min, p=0.001). Intraoperative hemodynamic changes were comparable and none of the patient suffered from respiratory depression, shivering, nausea or vomiting.Conclusions: Intrathecal clonidine as adjuvant to bupivacaine provided was clinically more effective than nalbuphine for prolonging the duration of analgesia for gynaecological procedures

Role of color doppler in the diagnosis of intra uterine growth restriction (IUGR)

Background: The purpose of our study was to evaluate the diagnostic efficacy of the pulsatility index (PI) and resistive index (RI) in uterine artery, umbilical artery and middle cerebral artery in the diagnosis of IUGR and prediction of adverse perinatal outcome.Methods: A total of 100 clinically suspected IUGR cases were enrolled in the study. A detailed history and examination was done, color doppler carried out serially every three weeks starting from 30 weeks till delivery, subsequently confirmation of fetal growth restriction (FGR) was done by assessing the newborn parameters for growth restriction.Results: Doppler measurement for uterine artery showed higher efficacy as compared to umbilical artery and middle cerebral artery findings. The uterine artery RI was found to be 84.6% sensitive and 82.9% specific even at 30 weeks. Uterine artery PI too showed a good diagnostic efficacy with an accuracy of 79%, a sensitivity of 76.9%, a specificity of 82.9%.Both PI and RI for uterine artery showed a relatively higher specificity.Conclusion: Here we concluded that once IUGR is suspected, Doppler velocimetry may be useful as a part of evaluation and uterine artery analysis identifies a subgroup with an increased risk for developing IUGR.

No evidence for association of ataxia-telangiectasia mutated gene T2119C and C3161G amino acid substitution variants with risk of breast cancer

BACKGROUND: There is evidence that certain mutations in the double-strand break repair pathway ataxia-telangiectasia mutated gene act in a dominant-negative manner to increase the risk of breast cancer. There are also some reports to suggest that the amino acid substitution variants T2119C Ser707Pro and C3161G Pro1054Arg may be associated with breast cancer risk. We investigate the breast cancer risk associated with these two nonconservative amino acid substitution variants using a large Australian population-based case–control study. METHODS: The polymorphisms were genotyped in more than 1300 cases and 600 controls using 5' exonuclease assays. Case–control analyses and genotype distributions were compared by logistic regression. RESULTS: The 2119C variant was rare, occurring at frequencies of 1.4 and 1.3% in cases and controls, respectively (P = 0.8). There was no difference in genotype distribution between cases and controls (P = 0.8), and the TC genotype was not associated with increased risk of breast cancer (adjusted odds ratio = 1.08, 95% confidence interval = 0.59–1.97, P = 0.8). Similarly, the 3161G variant was no more common in cases than in controls (2.9% versus 2.2%, P = 0.2), there was no difference in genotype distribution between cases and controls (P = 0.1), and the CG genotype was not associated with an increased risk of breast cancer (adjusted odds ratio = 1.30, 95% confidence interval = 0.85–1.98, P = 0.2). This lack of evidence for an association persisted within groups defined by the family history of breast cancer or by age. CONCLUSION: The 2119C and 3161G amino acid substitution variants are not associated with moderate or high risks of breast cancer in Australian women

Introduction: Toward an Engaged Feminist Heritage Praxis

We advocate a feminist approach to archaeological heritage work in order to transform heritage practice and the production of archaeological knowledge. We use an engaged feminist standpoint and situate intersubjectivity and intersectionality as critical components of this practice. An engaged feminist approach to heritage work allows the discipline to consider women’s, men’s, and gender non-conforming persons’ positions in the field, to reveal their contributions, to develop critical pedagogical approaches, and to rethink forms of representation. Throughout, we emphasize the intellectual labor of women of color, queer and gender non-conforming persons, and early white feminists in archaeology

Assessment of difficult laryngoscopy by electronically measured maxillo-pharyngeal angle on lateral cervical radiograph: A prospective study

<b>Background:</b> Difficult airway continued to be a major cause of anesthesia-related morbidity and mortality. Successful airway management depends on direct laryngoscopy and tracheal intubation. Difficult laryngoscopy is a resultant of incomplete structural arrangements during the process of head positioning. Through clinical history,examination of the patients along with craniofacial indices alerts the anesthetist for difficult laryngoscopy. But it does not predict all causes of difficult laryngoscopy during pre-anesthetic evaluation. The maxillo-pharyngeal angle, an upper airway anatomical balance, was proposed for better understanding the pathophysiology of difficult laryngoscopy. In our study we have assess difficult laryngoscopy by electronically measuring maxillo-pharyngeal angles on a lateral cervical radiograph. This angle is normally greater than 100 ^o . Less than 90 ^o angle suggests either impossible or difficult direct laryngoscopy when all known craniofacial indices were within the normal range. Cervical radiographic assessment is a simple, economical, and non-invasive predictive method for difficult laryngoscopy. It should be used routinely along with other indices as pre-anesthetic airway assessment criteria to predict the difficult laryngoscopy. <b>Context:</b> Difficulties with airway management continue to be a major cause of anesthesia-related morbidity, mortality, and litigation. Pre-operative assessment of difficult laryngoscopy by the simple and non-invasive radiological method can help to prevent them. <b>Aims:</b> To assess the difficult laryngoscopy pre operatively by a simple and non invasive radiological method by electronically measuring maxillo-pharyngeal angle on a lateral cervical radiograph and it&#x2032;s correlation with Cormack and Lehane grading. <b>Settings and Design:</b> This is a controlled, nonrandomized, prospective, cohort observation study. <b>Patients and Methods:</b> The 157 adult consented patients of ASA grade I to III of either sex, scheduled for elective surgery under general anesthesia with endo-tracheal intubation, were studied. The patients with identified difficult airway indices were excluded from the study. The maxillo-pharyngeal angle was electronically measured on a lateral cervical radiograph and was correlated with ease or difficulty of laryngoscopy under general anesthesia. Their degree of laryngeal exposure according to Cormack and Lehane classification grade was also noted. <b>Statistical Analysis used:</b> We performed univariate analyses to evaluate the association between the covariates and direct laryngoscopy. <b>Results:</b> In 148 patients (94.28&#x0025;), the maxillo-pharyngeal angle was more than 100 ^o , in 7 patients (4.45&#x0025;) it was less than 90 ^o , and in 2 patients (1.27&#x0025;) the M-P angle was less than 85 ^o with normal craniofacial indices. When the MP angle was less than 90 ^o , the direct laryngoscopy was difficult which could be compared with to Cormack and Lehane classification grade III and IV. <b>Conclusions:</b> Lateral cervical radiographic assessment should be used as pre-anesthetic airway assessment criteria to predict the difficult laryngoscopy as it is a simple, safe and non-invasive method

Oral premedication with pregabalin or clonidine for hemodynamic stability during laryngoscopy and laparoscopic cholecystectomy: A comparative evaluation

Background: Hemodynamic responses of laryngoscopy and laparoscopy should be attenuated by the appropriate premedication, smooth induction, and rapid intubation. The present study evaluated the clinical efficacy of oral premedication with pregabalin or clonidine for hemodynamic stability during laryngoscopy and laparoscopic cholecystectomy. Methods: A total of 180 healthy adult consented patients aged 35 to 52 years with American Society of Anesthesiologist (ASA) physical status I and II of both gender, who met the inclusion criteria for elective laparoscopic cholecystectomy, were randomized to receive placebo Group I, pregabalin (150 mg) Group II, or clonidine (200 μg) Group III, given 75 to 90 minutes before surgery as oral premedication. All groups were compared for preoperative sedation and anxiety level along with changes of heart rate and mean arterial pressure prior to premedication, before induction, after laryngoscopy, pneumoperitoneum, release of carbon dioxide, and extubation. Intraoperative analgesic drug requirement and any postoperative complications were also recorded. Results: Pregabalin and clonidine proved to have sedative and anxiolytic effects as oral premedicants and decreased the need of intraoperative analgesic drug requirement. Clonidine was superior to pregabalin for attenuation of the hemodynamic responses to laryngoscopy and laparoscopy, but it increased the incidence of intra-and postoperative bradycardia. No significant differences in the parameters of recovery were observed between the groups. None of the premedicated patient has suffered from any postoperative side effects. Conclusion: Oral premedication with pregabalin 150 mg or clonidine 200 μg causes sedation and anxiolysis with hemodynamic stability during laryngoscopy and laparoscopic cholecystectomy, without prolongation of recovery time and side effects