Development of Ficus religiosa extract-loaded emulsion system for topical application: Characterization and stability evaluation

Purpose: To develop, optimize and characterize a topical (W/O) emulsion containing 4 % Ficus religiosa extract for cosmeceutical purposes. Methods: The ethanol extract of Ficus religiosa was obtained by Soxhlet method. Various formulations were developed using paraffin oil, emulsifier (Abil®-EM 90) and purified water at different proportions, and their physical stability was assessed under different stress conditions, to enable selection of the most stable formulation. The optimized formulation based on stability studies was chosen for evaluation of different physical properties, i.e., color, liquefaction, phase separation, centrifugation, pH, droplet size and rheology, under accelerated conditions for 12 weeks. Results: The optimized formulation (F4) contained ethanol extract (4.0 %), Abil®-EM 90 (3.5 %), paraffin oil (14.0 %) and purified water (78.5 %), and remained stable on centrifugation under all stress conditions. The pH of the formulation remained within the specified range for human skin pH i.e. 4.5 – 6.0, and droplet size of dispersed phase also persisted within the size range of macroemulsion (1 – 100 μm) throughout the study period. Rheological properties of the formulation showed shear thinning response, and flow index value less than 1 resulted in pseudoplastic flow of emulsion. Conclusion: These results suggest that the optimized emulsion system was stable and can serve as a good medium for topical delivery of various natural substances

Anaesthetic challenges in emergency surgical repair of acute aortic dissection rupturing into the pericardium in a pregnant patient

Acute aortic dissection in pregnancy is a serious situation, because rapid and appropriate surgical decision making is required to save the life of both mother and baby. Aortic dissection is rare in young women but is likely during pregnancy (third trimester) secondary to the hyperdynamic and hypervolaemic circulatory state associated with pregnancy. A 35 years old 27 weeks pregnant patient weighing 90 kg presented in the emergency with severe chest pain. In the immediate post cardiopulmonary bypass period, the patient started bleeding profusely from the anastamotic sites irrespective of utilization of all the conventional methods of haemostasis including multiple units of whole blood, fresh frozen plasma, platelets, calcium and cryoprecipitates. As a last resort she was given low dose r FVIIa (1.2 mg containing 60 KIU of Factor VII). This stopped the bleeding and the haemodyramics were stabilized

Success and failure of fast track extubation in cardiac surgery patients of tertiary care hospital: one year audit

OBJECTIVE: To identify the causes of delayed extubation in patients planned for fast tract extubation during cardiac surgery. METHODS: A prospective observational study was conducted at cardiothoracic unit of Aga Khan University Hospital for the period of one year. All elective coronary artery bypass graft (CABG) surgery patients, between the ages of 35-75 years with LVEF \u3e or = 40 percent were included. Patients with Intra aortic balloon pump, chronic renal failure, respiratory compromise and requiring high ionotropic support were excluded from this audit. A performa was designed and later filled by the primary investigator. Patient demographics and various reasons for delayed extubation were noted in this proforma. RESULTS: Total 614 patients underwent CABG surgery and 388 (63.19%) patients were planned for fast track extubation. A total of 196 (49.5%) patients could be extubated within six hours of arrival in the cardiac ICU. Common reasons for delayed extubation included deep sedation in 80 (46.5%), confusion 44 (25%), excessive bleeding in 20 (11.3%) and high inotropic support in 10 (5.68%). CONCLUSION: Major contributing factors for delayed extubation were identified by this audit. These factors need to be targeted accordingly by modifications in intra operative management

Wound infiltration with Bupivacaine versus Ketorolac for postoperative pain relief in minor to moderate surgeries

OBJECTIVE: To compare the analgesic efficacy of Bupivacaine 0.25% wound infiltration with Ketorolac incisional infiltration in relieving postoperative pain for first twenty-four hours. METHODOLOGY: Analytical, interventional and comparative study was performed on seventy patients, of both sexes, with varied age groups. Patients underwent minor and moderate surgeries, confined to American Society of Anaesthesiologist ASA category 1-II. Patients were selected by convenience sampling and were divided into two groups i.e. Group I and Group II. Group-I comprised of thirty five patients and were infiltrated with Bupivacaine 0.25% at wound margins postoperatively. Group-II also comprised of thirty-five patients and were infiltrated with Ketorolac at wound margins 60 mg postoperatively. RESULTS: Bupivacaine 0.25% wound infiltration had onset of action within 4 +/- 2 minutes. Percentage pain relief was 80% in minor surgeries and 60% in moderate surgeries. Duration of action lasted for 8 +/- 2 hours regarding minor surgeries while it was 6 +/- 1 hours for moderate surgeries. Ketorolac incisional infiltration had onset of analgesic action within 10 +/- 5 minutes. Duration of action lasted for 6 +/- 1 hours regarding minor surgeries while it was 4 +/- 2 hours regarding moderate surgeries. Percentage pain relief was 60% in minor surgeries and 50% in moderate surgeries. CONCLUSION: Wound infiltration with Bupivacaine 0.25% was better for postoperative pain relief in comparison with Ketorolac regarding percentage pain relief, onset and duration of action

Magnesium, a drug of diverse use

Magnesium has evolved as a drug with diverse clinical applications. Mg++ is an important caution and its homeostasis is very important for normal body functioning. The physiological role of Mg is due to its calcium channel blocking properties at smooth muscle, skeletal muscle and conduction system levels. The analgesic properties are due to NMDA receptor blocking action. Mg++ is beneficial in acute Myocardial Infarction, protection during open heart surgery and treatment and prevention of heart rhythm disturbances. Mg has an established role in the management of preeclampsia and eclampsia. Magnesium prevents or controls convulsions by blocking neuromuscular transmission and decreasing the release of acetylcholine at the motor nerve terminals. The use of MgSO4 in treating tetanus and acute asthma is established. In conclusion, Mg is a cost effective, widely used drug with multidisciplinary applications. Its majority of physiological effects are attributed to calcium channel blocking properties

Immediate changes in hemodynamics and gas exchange after initiation of noninvasive ventilation in cardiac surgical patients

Introduction: Cardiac surgery is associated with pulmonary dysfunction and complications such as prolonged intubation and reintubation. Bilevel positive airway pressure (BiPAP) machine has been used in the clinical settings to improve oxygenation, reduce work of breathing, and avoid reintubation. The effect of BiPAP on cardiovascular parameters is not well established, and very few studies have targeted hemodynamic changes. The aim of the study was to assess the immediate effect of BiPAP on respiratory and hemodynamic parameters in post-cardiac surgery patients.Materials and methods: This quasi-experimental study was done on 33 adult cardiac surgery patients. Ethical review committee approval was sought and consent was taken. All patients who were in respiratory distress with respiratory rate of \u3e30/min and/or PaO2:FiO2 ratio of variables, PaO2:FiO2 ratio.Results: A total of 33 patients were included in the study. The average age of the patients was 60.97 ± 10.8, of which 23 (69.7%) were males and 10 (30.7%) females. BiPAP application leads to statistically significant improvement in ventilator parameters including SaO2 29 (87.7%), PaO2 29 (87.8%), PaCO2 21 (63.6%), and PaO2:FiO2 ratio in 27 (81.8%).Conclusion: Ventilatory parameters were significantly improved after BiPAP application in this study, but hemodynamic parameters showed no statistically significant change. BiPAP application was also able to decrease the need for reintubation in post-cardiac surgery patients

Sleeping pattern before thoracic surgery: A comparison of baseline and night before surgery

Background: Sleep deprivation is considered a stress factor in the perioperative period. There are several studies on sleep disturbance after surgery but very limited literature available on preoperative sleep patterns, predictors of sleep disturbance and its effect on surgical outcome.Methodology: Patients scheduled for thoracic surgery were asked to fill out a written Pittsburgh Sleep Quality Index (PSQI) questionnaire. The primary investigator explained this form to all the patients. This was filled out before premedication for subjective assessment of sleeping pattern at two different time point. Only those patients included who spent the previous night at home. Participants were asked to respond to the questions regarding their baseline sleeping pattern and compare it with last night.Results: Total eighty-three patients with a mean age of 47.83 ± 17.88 were included in the study. Overall mean PSQI scores were significantly higher (p-value \u3c 0.01) during the night before surgery (6.94 ± 2.115) when compared with baseline (3.88 ± 1.877). Sleep latency was also significantly affected when last night-1 (the night before admission) was compared with usual sleep latency. Twenty patients were unable to sleep more than 5 hrs at night before admission which was significant when compared with their last month status (20 vs 3). Logistic regression model demonstrated the age and Timing of surgery as a strong predictors of poor sleep (defined as PSQI ≥ 5).Conclusion: Quality of sleep was profoundly affected at night before thoracic surgery, mainly due to a significant change in sleep latency and sleep duration. Although age and Timing of surgery were strong predictors of poor sleep we were unable to find any association between quality of sleep and type of surgery