A prospective, randomized, double blind study to evaluate and compare the efficacy of lidocaine, ramosetron and tramadol pre-medication, in attenuating the pain caused due to propofol injection

Background: Propofol is a popular induction agent, especially for short cases, day care surgeries and when a laryngeal mask is to be used. It produces a good quality of anaesthesia and rapid recovery. Pain on injection of propofol has been reported and is an important limitation of its use. A multitude of interventions: pharmacological as well as non-pharmacological, have been tried for the attenuation of pain caused due to propofol injection. In our study, we evaluated and compared the efficacy of lidocaine, ramosetron and tramadol in attenuating pain on propofol injection.Methods: A total of 180 patients belonging to American Society of Anesthesiologists (ASA) grade I and II,  of either sex, aged between 21 to 50 years undergoing elective surgery under general anaesthesia, were taken up for the study and were divided into group A, B and C. Group A received 2ml of 2% (40mg) lidocaine, Group B received 2ml of ramosetron (0.3mg) and Group C received 1mg/kg of tramadol in 0.9% normal saline to make a total solution of 2ml. Venous occlusion was done by compressing forearm with tourniquet to increase the local concentration of drug after establishing an intravenous access. The study drug was injected over 10 seconds and then occlusion was removed after 60 seconds, followed by giving 25% of the total calculated dose (2.5mg/kg) of propofol (1% w/v in lipid base) injected over 20 seconds. This was followed by asking the patient about the severity of pain felt. The intensity of pain was graded using verbal rating scale (McCrirrick and Hunter) and was assessed at 0, 5, 10, 15 and 20 seconds, as after 20 seconds, the patient would be under the influence of propofol.Results: Lidocaine showed the best efficacy in attenuating propofol injection pain amongst the 3 groups recorded at 5 (95%), 10 (91.7%) and 15 seconds (98.3%). In addition to reducing the incidence of pain, it also reduced its severity, with majority of patients experiencing only mild pain. Ramosetron ranked 2nd in the overall reduction of propofol pain, with lowest incidence of propofol pain amongst 3 groups, recorded at 0 (98.3%) and 20 seconds (95%) of propofol injection. However, ramosetron failed in reducing severity of pain, with a significant number of patients experiencing moderate and severe pain. Tramadol ranked 3rd in the overall attenuation of propofol pain and showed lowest incidence of pain at 0 seconds (93%) of propofol injection.Conclusions: All the three study drugs viz lidocaine, ramosetron and tramadol cause a significant decrease in propofol injection pain with lidocaine as the most efficacious drug amongst the 3 drugs followed by ramosetron and tramadol. Lidocaine has an added advantage of decreasing incidence and severity of pain associated with propofol and ramosetron prevents postoperative nausea and vomiting

Sustainable Transport for a Central Business District

It’s high time to shift from Conventional Planning to Compressive and Multi Modal Planning. The present paradigm shift in Europe to focus on mobility as a service has to be acknowledged and incorporated in the Transportation system of developing country such as India. The travel has to be now smarter and sustainable. All the three pillars of sustainability i.e. economic, social and environmental have to be equally carried forward. Proper planning or design is the one which always takes into account the needs of people and also the environment associated with it. The sole purpose of a Central business district is economic activity and any measure should depict this. The paper looks at the transportation system of the Kashmir valley in depth in relation with the central business district. Modal share and variation of Mass transit in the morning and evening peak hour is determined and studied. Based upon the analysis and keeping in view the ageing population as well as needs of disabled a new smarter and sustainable transport is designed for the Kashmir valley having its own bespoke bus service. The bus service is then designed for headway, seating capacity as well as field and management staff. This paper emphasises that public transport is the only solution to the various transportation problems and their allied effects such as Environmental Impact, Social Inclusion, Old aged population, et

Nexus between Leader–Member Exchange, Paternalistic Leadership, and Creative Behavior in the Construction Industry

Effective leadership and creative performance are the predominant factors for the success of modern projects in the global construction industry. However, rigorous research has not explored the nexus between such factors and the leader–member exchange (LMX). To address this gap, this study explores the relationship between dimensions of paternalistic leadership and employee creativity achieved through LMX in the context of the construction industry. Based on social exchange theory (SET), six relevant hypotheses were proposed in this study. The data were collected through a structured questionnaire. An online survey form was used for data collection, through which 288 responses were collected from the construction industry employees working in Pakistan. The collected data were analyzed using Smart PLS in two stages, i.e., measurement model evaluation (reliability analysis, convergent and discriminant validity) and structural model evaluation (R2, F2, and path coefficient). The findings of the current study reveal a positive association of authoritarian, benevolent, and moral leadership with employee creativity. In addition, LMX significantly mediates the relationship between the two dimensions of paternalistic leadership (benevolent and moral leadership) and creativity, except for authoritarian leadership. Based on the results, this study contributes to the body of knowledge related to the appropriate leadership style in the local construction industry that can be extended to other developing countries with similar dynamics. It also helps the managers target and develops relevant skills to acquire positive outcomes from their team members

A review on extraction technique and immune-boosting properties of Moringa oleifera Lam

ABSTRACTMoringa oleifera Lam. (Moringa) plant, which belongs to the Moringaceae family, is an important crop in Asia and Africa. Moringa has been investigated for its health benefits, which are related to several bioactive components found in the plant, including flavonoids, vitamins, phenolic acids, isothiocyanates, saponins, and tannins. The leaves of moringa have been researched extensively and hence proven to be effective in various chronic illnesses such as insulin resistance, hypercholesterolemia, diabetes, cancer, nonalcoholic liver disease, high blood pressure, and general inflammation. Moringa includes a variety of dietary phytonutrients, notably flavonoids, the secondary plant metabolites which have health-enhancing effects, such as avoiding damage to normal cellular DNA and stimulating the death of cancer cells, therefore reducing the prevalence of non-communicable disorders (NCDs). Flavonoids are phenolic chemicals, which are plant elements that correlate to the non-energy portion of a person’s diet. Flavonoids are often removed chemically using solvents and conventional techniques that, in addition to being costly, take a long time and have an impact on the bioactivity of these substances. As a consequence, there is no universally applicable extraction procedure, and each best practice is adapted to the specific plants involved. To be selective, an extraction technique must have combined an ideal solvent or mixture of solvents with an optimum procedure. In this study, we provide information on the improved and standardized extraction process from Moringa leaf extract concerning flavonoids and its good consequences on immune system efficacy that have been documented