A study of comparing single dose granisetron with combination of granisetron with dexamethasone in preventing postoperative nausea vomiting in laparoscopic cholecystectomies

Background: Postoperative nausea and vomiting (PONV) remains a vexing problem despite of advances in anaesthesia care. PONV is distressing adverse effect after anaesthesia and surgery, resulting in significant morbidity due to acute discomfort associated with emetic symptoms and longer stays in the recovery room or unexpected hospital admission in ambulatory settings.Methods: A prospective, randomized, double blind comparative study was conducted to compare the efficacy and adverse effects of injection granisetron 40µg/kg as a single dose and injection granisetron in two different doses (20µg/kg and 40µg/kg) in combination with dexamethasone 160µg/kg for prevention of postoperative nausea and vomiting in patients undergoing general anaesthesia for elective laparoscopic cholecystectomy.Results: Nausea and vomiting were observed postoperatively at 0, 1, 2, 4, 8, and 24 consecutive hours after patient responded to verbal commands. Intensity of nausea graded verbally with an eleven point score (0-10) with those patients who scored their nausea as zero were termed nausea free, and 10 being most severe. Nausea scores when patient complains of nausea & if patient demand rescue antiemetic for nausea was noted down along with adverse effects if any. The data was analysed by ANOVA followed by unpaired‘t’ test, Chi-square/Fischer exact test or Kruskal Wallis Test.Conclusions: Granisetron as a single agent in dose 40µg/kg is effective as prophylactic antiemetic in preventing PONV in laparoscopic cholecystectomy whereas addition of dexamethasone 160µg/kg to granisetron significantly increases antiemetic efficacy of the granisetron in both the doses i.e. 20µg/kg and 40µg/kg without increasing any side effect. Granisetron 40µg//kg+injection dexamethasone 160µg/kg is best for antiemetic prophylaxis in highly emetogenic surgeries like laparoscopic cholecystectomy.  Granisetron 20µg/kg + injection dexamethasone can be cost effective alternative for routine antiemetic prophylaxis compared to granisetron 40µg//kg and granisetron 40µg//kg+ injection dexamethasone for all patients undergoing laparoscopic cholecystectomy.

A comparative study of nebulized versus intravenous lignocaine to suppress the haemodynamic response to endotracheal suction in patients on mechanical ventilation

Background: Cardiovascular response to tracheal suction is decreased by intravenous lignocaine. Tracheal suction is a powerful stimulus that causes intense haemodynamic changes in patients on mechanical ventilation. In the present study, we compared the effect of nebulized and intravenous lignocaine on haemodynamic response to tracheal suctioning in patients on mechanical ventilation through an endotracheal tube.Methods: A prospective randomized cross over study was conducted in Lokmanya Tilak Municipal Medical College and Government Hospital, Sion, Mumbai, India during the period of January 2012 to September 2013. Sixty patients requiring tracheal suction through an endotracheal tube received 1.5 mg/kg of lignocaine in the nebulized form or as an intravenous injection on two different occasions. Heart rate (HR), mean arterial pressure (MAP), systolic and diastolic blood pressure (SBP and DBP) and peripheral capillary oxygen saturation (SPO2) were recorded at baseline, after the administration of lignocaine, after two successive suctions and once in two minutes for the next 16 minutesResults: In the present study, SPO2 decreased in response to ETT suctioning in both the study groups as compared to the pre-suctioning value. However the changes in the SPO2 were not significant when compared between the groups. Changes in HR, SBP, DBP and MAP were not significantly different between the two routes of lignocaine administration.Conclusions: From the present study, we can conclude that the abolition of haemodynamic response to tracheal suction is similar with both intravenous and nebulized lignocaine. But the return of MAP towards baseline value was observed to be earlier with nebulized lignocaine than with intravenous lignocaine which favours use of nebulized lignocaine over intravenous lignocaine. With built-in nebulizer facility in the current intensive care ventilators, this technique should be easy, more effective and assure better haemodynamic stability than intravenous lignocaine during tracheal suction.

A comparative study of combined spinal epidural anaesthesia and general anaesthesia in patients undergoing percutaneous nephrolithotomy

Background: Our primary aim was to study the efficacy, safety, hemodynamic stability, postoperative pain relief, and complication with combined spinal epidural anaesthesia (CSE) and to compare it with general anaesthesia (GA) for percutaneous nephrolithotomy (PCNL).  Methods: The present study was a prospective, randomized, open, controlled trial to compare the effects of CSE and GA in patients undergoing PCNL. Study was carried out in 100 adult patients, who were randomly divided into two groups of 50 each, Group GA and Group CSE. Post-operative pain relief and amount rescue analgesia required were noted. Postoperatively samples were collected for haemoglobin and arterial blood gases. Incidence of complications were noted and compared among both the groups.Results: Mean arterial pressure in CSE group was less compared to GA group during the procedure. 30 % patients in group GA required first rescue analgesia within first hour of completion of surgery whereas no patient in group CSE required analgesia within first hour indicating better pain relief in CSE group. Mean haemoglobin and the fall in haemoglobin between the groups were comparable. 48.0% of the cases among GA group and 14.0% of the cases among CSE group had postoperative nausea and vomiting. Mean pH in GA group was 7.33±0.05 and in CSE group was 7.36±0.04. There was one case of hydrothorax post operatively.Conclusions: We conclude that CSE is a safe alternative to GA for PCNL with better pain relief, less PONV. Hypotension due to sympathetic blockade is always a possibility

Clonidine as an adjuvant to local anesthetic in supraclavicular brachial plexus block: a randomized, double blinded placebo controlled study

Background: Many drugs have been studied as adjuvants to local anesthetic agents with the aim of improving the quality of anesthesia and to provide profound analgesia. Clonidine has also been used as an adjunct to local anesthetic agents in various regional techniques. The studies regarding clonidine in brachial plexus block have given mixed results. Aim was to determine whether addition of clonidine to the local anesthetic solution for brachial plexus block by supraclavicular approach, prolongs sensory and motor blockade and improves postoperative analgesia. Also to observe side effects if any.Methods: 60 patients aged 18-60 years, were randomly allocated into two groups. Group A received 2 µg / kg of Clonidine diluted to 1 ml with saline and group B received 1 ml of saline added to bupivacaine (10 ml 0.5%) and lignocaine (20 ml 2 %) solution, in the supraclavicular block. The onset and duration of sensory and motor block was compared along with the duration of analgesia, sedation in both the groups. Patients’ pulse rate, blood pressure, saturation was also recorded.Results: Addition of clonidine had no effect on the onset of the block, but was found to increase the duration of sensory and motor block along with the increase in the duration of analgesia. Visual analogue score for pain was significantly lower in the group receiving clonidine.Conclusions: Clonidine 2 µg / kg added to 10 ml of 0.5 % Bupivacaine + 20 ml of 2% lignocaine with adrenaline (1:200000) is a good option for improving the quality and duration of supraclavicular brachial plexus block

A prospective, randomized, double blind, placebo controlled clinical trial to study efficacy and safety of benzydamine 0.15% gargles in prevention of postoperative sore throat

Background: Postoperative sore throat (POST) is an undesirable outcome of general anesthesia. The aim of the study was to evaluate the effectiveness of benzydamine preoperative gargles in reducing the incidence and severity of POST.Methods: A randomized double blind prospective study involving 200 adult male and female patients was performed to assess the incidence of sore throat, cough and hoarseness of voice following tracheal intubation. The patients were randomly divided into two groups (group B and group C) of 100 each. Group B patients received benzydamine 0.15% gargles while group C received placebo. Patients were asked to gargle for 30 seconds, five minutes before induction of anesthesia. The patients were examined for sore throat, cough and hoarseness of voice at intervals of 0, 2, 4, and 24 hours post-extubation.Results: The incidence of POST was significantly high (p<0.05) in the group C (controls) as compared to group B (cases) at all the durations of time after extubation. The peak incidence was noted at 0 and 2 hours post extubation, in both the groups, where 89% in group C and 47% reports of sore throat in group B were observed. The benzydamine group B had no evidence of sore throat at 24 hours duration whereas group C had 36% of patients who still complained sore throat. The incidence and severity of hoarseness of voice was found to be significantly low in group B at all the times as compared to group C (p<0.05).Conclusions: A simple technique of gargling performed preoperatively with benzydamine hydrochloride was effective in reducing POST with no evidence of any side effects.

A comparative study of ropivacaine 0.75% and bupivacaine 0.5% for segmental epidural anaesthesia in patients undergoing percutaneous nephrolithotomy

Background: Percutaneous nephrolithotomy (PCNL) is used for fragmentation and removal of stones from pelvicalyceal system using a nephroscope passed into the kidneys through a track created in the patients back. PCNL is the treatment of choice for larger renal stones of size more than 20 to 30 mm, staghorn stones and stones that are multiple or resistant to extra corporeal shock.Methods: This prospective, randomized, open, controlled trial was carried out in 60 adult patients undergoing elective surgical procedure. The patients were randomly divided into two groups of 30 each. Each group underwent PCNL under segmental epidural.Results: Both the groups were comparable with respect to their demographic data, duration of surgery, size of stone and baseline vital parameters. Nine patients in Ropivacaine group and seven patients in Bupivacaine group developed clinically significant hypotension. The incidence of complications was similar in both the group. The fall in haemoglobin was similar in both the groups and none of the patients required blood transfusion.Conclusions: Segmental epidural anaesthesia is a safe alternative technique to general anesthesia for PCNL. Both the drugs ropivacine and bupivacaine were safe and clinically comparable in segmental epidural for PCNL.

Prospective, randomized, double blind, placebo controlled clinical study to different doses of ketamine for prevention of shivering during spinal anaesthesia

Background: Ketamine has better effect than other drugs like pethidine, fentanyl, clonidine, tramadol, midazolam in prevention of shivering during anaesthesia and has a role in thermoregulation by different means. The objective of this study was to evaluate the safety, efficacy of Ketamine injection and to compare the different doses (0.25 mg/kg and 0.5 mg/kg) of inj. Ketamine in prevention of shivering in operative patients under spinal anaesthesia.Methods: The present study was a prospective, randomized, double blinded and clinical study conducted in L.T.M.M.C & L.T.M.G.H, Mumbai, India during January 2012 to September 2013. 120 patients with American Society of Anesthesiologist (ASA) physical status of I or II, between the age of 18 – 65 years of either sex and height 150-170 cms were randomly selected and included in the study as per eligibility.Results: The study suggests that prophylactic administration of injection Ketamine at doses of 0.25 mg/kg and 0.5 mg/kg was producing a significant antishivering effect but an incidence of sedation and hallucination was observed in the Ketamine 0.5 mg/kg receiving group throughout the perioperative period.Conclusions: From this study we can conclude that prophylactic dose of Ketamine 0.25 mg/kg i.v. has lesser side effects comparison to Ketamine 0.5 mg/kg i.v. in prevention of shivering in patients, undergoing surgical procedure under spinal anaesthesia

Comparison of antiemetic activity of palonosetron with granisetron in postoperative nausea and vomiting after laparoscopic gynaecological surgeries

Background: Granisetron is currently one of the commonly used drugs for prevention of postoperative nausea and vomiting (PONV) which is one of the most common distressing complications of laparoscopic surgeries and anesthesia. Palonosetron has emerged as alternative for PONV in adults. Thus, the study was aimed to conduct a comparison of the efficacy and adverse effects of granisetron with palonosetron to prevent PONV in patients undergoing general anaesthesia for elective laparoscopic gynaecological surgeries.Methods: This was a prospective, randomized, double blinded and a comparative study and was performed in Lokmanya Municipal Medical College and general Hospital, Sion, Mumbai, India on 60 patients undergoing elective laparoscopic gynaecologic surgeries, requiring general anaesthesia with endotracheal intubation.Results: Both granisetron 2.5 mg and palonosetron 75 µg are comparable in all respects. They have almost similar incidences in nausea, retching, vomiting and administration of rescue antiemetic at 0-2 hrs, 3 hrs, 12 hrs and 24 hrs postoperatively. The values were not significantly different. The adverse effects seen with both the drugs were not statistically significant.Conclusions: From the study this can be concluded that both the drugs are effective as prophylactic antiemetic in preventing PONV in laparoscopic gynaecological surgeries which are supposed to be highly emetogenic surgery

Childhood abuse and deprivation are associated with distinct sex-dependent differences in brain morphology

Childhood adversity (CA) has been associated with long-term structural brain alterations and an increased risk for psychiatric disorders. Evidence is emerging that subtypes of CA, varying in the dimensions of threat and deprivation, lead to distinct neural and behavioral outcomes. However, these specific associations have yet to be established without potential confounders such as psychopathology. Moreover, differences in neural development and psychopathology necessitate the exploration of sexual dimorphism. Young healthy adult subjects were selected based on history of CA from a large database to assess gray matter (GM) differences associated with specific subtypes of adversity. We compared voxel-based morphometry data of subjects reporting specific childhood exposure to abuse (n = 127) or deprivation (n = 126) and a similar sized group of controls (n = 129) without reported CA. Subjects were matched on age, gender, and educational level. Differences between CA subtypes were found in the fusiform gyrus and middle occipital gyms, where subjects with a history of deprivation showed reduced GM compared with subjects with a history of abuse. An interaction between sex and CA subtype was found. Women showed less GM in the visual posterior precuneal region after both subtypes of CA than controls. Men had less GM in the postcentral gyms after childhood deprivation compared with abuse. Our results suggest that even in a healthy population, CA subtypes are related to specific alterations in brain structure, which are modulated by sex. These findings may help understand neurodevelopmental consequences related to C