Efficacy of Anxiolytic and Preoperative Counseling on Preoperative Anxiety Reduction: A Randomized Comparison Study

Background: The incidence of preoperative anxiety is high. Anxiolytic agents have been used to reduce preoperative anxiety for many years. Recently the role of non-pharmacological interventions like preoperative information through interviews, counseling, and verbal reassurance for the reduction in preoperative anxiety has been established. But, the efficacy of these non-pharmacological interventions and the anxiolytic agent has not been compared previously. In this study, we compared the effectiveness of oral alprazolam and preoperative counseling by an anesthesiologist for the reduction of preoperative anxiety. Materials and Methods: A total of 110 patients were randomly divided into two groups. Group A received 0.5 mg oral Alprazolam tablets, the night before surgery. Group C received counseling from an anesthesiologist with a fixed protocol the night before surgery. Anxiety was assessed with a state-trait anxiety inventory (STAI) scale, and scores were assessed in the pre-anesthetic assessment room, at night before surgery before giving study interventions, and on the day of surgery before shifting to the operation room. Hemodynamic parameters and respiratory rate were monitored along with anxiety scores. Data were analyzed using an independent t-test, Chi-square test, and repeated variance analysis measures (ANOVA). Results: Anxiety scores and hemodynamic parameters were comparable between the groups at all times of measurement. Anxiety scores in the alprazolam group were less than counseling group on the day of surgery, but this difference was not statistically significant. Conclusion: Although treatment with Alprazolam resulted in lesser anxiety scores, overall, both the methods were ineffective in reducing preoperative anxiety

Comparison of dexamethasone, granisetron and haloperidol in prevention of postoperative nausea and vomiting following laparoscopic surgeries: A prospective, double-blinded study

Background: Laparoscopic surgeries are most commonly performed surgeries. However, they are associated with increased incidences of postoperative nausea and vomiting.&nbsp;Aim: We aimed to compare the effectiveness of dexamethasone, haloperidol, granisetron in prevention of postoperative nausea and vomiting following laparoscopic surgeries.&nbsp;Methods: We conducted a randomized, double-blinded study including 90 patients both males and females undergoing laparoscopic surgeries in a tertiary hospital over 18 months. The subjects were randomized into three groups. Group I Dexamethasone 8mg, Group II Granisetron 2mg, Group III Haloperidol 1mg (n=30 each group). The study drugs were administered intravenously immediately after intubation. Patients were observed every 4th hourly till 24 hours for incidence of nausea, vomiting, pain and sedation.&nbsp;Results: Incidence of vomiting was significantly less in dexamethasone group (p=0.047) as compared to granisetron and haloperidol and was statistically significant (p&lt;0.047).There was no significant difference in the incidence of vomiting between other two groups. All other parameters were comparable in all the groups.&nbsp;Conclusion: Dexamethasone in the dose of 8mg significantly reduces incidence of vomiting in laparoscopic surgeries than haloperidol and granisetron.&nbsp;Trial Registry: Clinical Trial Registry of India 2018/03/018324</p

Comparative evaluation of intrathecal morphine and intrathecal dexmedetomidine in patients undergoing gynaecological surgeries under spinal anaesthesia: A prospective randomised double blind study

Background and Aims: Inrathecal opioids like morphine added to local anaesthetic agents have been found to be effective in achieving prolonged post-operative analgesia. Intrathecal dexmedetomidine may be devoid of undesirable side effects related to morphine and hence, this study was designed to evaluate analgesic efficacy, haemodynamic stability and adverse effects of both these adjuvants in patients undergoing gynaecological surgeries. Methods: This was a prospective, randomised, double blind study involving 25 patients in each group. Group M received 15 mg of 0.5% hyperbaric bupivacaine with 250 μg of morphine while Group D received 15 mg of 0.5% hyperbaric bupivacaine with 2.5 μg of dexmedetomidine. Characteristics of spinal block, time for first rescue analgesic and total dose of rescue analgesics were noted. Vital parameters and adverse effects were noted perioperatively. Data analysis was done with independent two sample t-test and Mann–Whitney U test. Results: Time for first rescue analgesic (P = 0.056) and total analgesic demand were similar in both groups. Duration of sensory (P = 0.001) and motor (P = 000) block was significantly higher in dexmedetomidine group. Itching was noticed in 36% and nausea in 52% of patients in the morphine group, either of which was not seen in dexmedetomidine group. Conclusion: Intrathecal dexmedetomidine produces prolonged motor and sensory blockade without undesirable side effects but intraoperative hypotension was more frequent in dexmedetomidine group

An unusual presentation of Goodpasture syndrome

Goodpasture disease is an anti–glomerular basement membrane (anti-GBM) disease that manifests as progressive glomerulopathy and alveolar hemorrhage. Our case was a 68-year-old female who presented with decompensated liver disease (DCLD) with no prior history suggestive of liver disease. She had dyspnea, bilateral pitting edema, icterus with normal renal parameters, and elevated liver enzymes. Ultrasonogram revealed shrunken liver, ascites, and portal hypertension with normal renal cortex echogenicity. Over the next three days, she developed progressive oliguria, hematuria, and breathlessness, with arterial blood gas showing hypoxia with acidosis and hyperkalemia. Bronchoscopic alveolar lavage was suggestive of hemorrhagic fluid. The patient succumbed to the disease in 24 hours. Anti-GBM antibodies came positive by immunofluorescence assay which confirmed the diagnosis of Goodpasture syndrome. Unusual presentation of DCLD in our case resulted in a delay in diagnosis that could have been crucial in altering the outcome

Randomized comparison between dexmedetomidine and midazolam for prevention of emergence agitation after nasal surgeries

Background: Emergence agitation (EA) in nasal surgeries is seen in around 22% of patients, which can go to dangerous levels. Dexmedetomidine is effective in prevention of EA in such patients. Midazolam given as premedication fails to prevent EA due to its short half-life. In this study, we compared efficacy of dexmedetomidine and midazolam by intravenous infusion for prevention of EA in adult nasal surgeries. Materials and Methods: Seventy patients belonging to American society of anesthesiologist Status I and II, between 18 and 60 years of age posted for elective nasal surgeries were randomly divided into two groups. Group D received intravenous dexmedetomidine 0.5 mcg/kg over 15 min followed by 0.1 mcg/kg/h. Group M received intravenous midazolam 0.02 mg/kg over 15 min followed by 0.02 mg/kg/h. EA scores, emergence times, and hemodynamic parameters were monitored and compared between the groups. Statistical analysis was done by independent t-test, Mann–Whitney U-test, and Chi-square test as applicable. Results: Incidence of EA was comparable between the groups (P = 0.23). Two patients in midazolam group developed dangerous agitation while none in dexmedetomidine group. Patients in midazolam group (12.4%) were agitated even in postoperative period, which was not seen with dexmedetomidine group. Hypotension and bradycardia were seen more in dexmedetomidine group. Conclusion: Efficacy of midazolam when given as an intravenous infusion is comparable to dexmedetomidine in prevention of EA in nasal surgeries