A study to assess the effect of intravenous dexmedetomidine oncis-atracurium induced neuromuscular blockade -A prospective double blind randomized controlled study

Introduction: Ideal neuromuscular blocking agent should act through the mechanism of nondepolarizing agent, have rapid onset of action, be highly potent, have rapid recovery and completely reversible by cholinesterase inhibitors, should not release histamine, should have good hemodynamic stability, with pharmacologically inactive metabolites and effects should be non-cumulative. Materials and Methods: Sixty patients of ASA physical status 1 &2 aged 18-60 years of both gender undergoing general anaesthesia for surgery lasting less than 2 hours were randomly allocated into two groups (n=30), group D received dexmedetomidine 1μg/kg iv diluted to 10 ml infusion and group C received equal volume of normal saline infusion ten mins prior to propofol induction and both groups were relaxed with Inj cisatracurium 0.15mg/kg. Neuromuscular transmission was assessed by NMT (Avance GE). Time of onset of neuromuscular blockade i.e time to achieve TOF count 0, duration of neuromuscular blockade ( till TOF ratio of 0.6 / TOF count of 2) and recovery time that is time from administration of reversal at TOF ratio of ≥0.65/TOF 3 till extubation was noted. Infusion of normal saline or Inj dexmedetomidine 0.5μg/kg was started at the same rate via infusion pump during maintenance. Anaesthesia was maintained with oxygen, nitrous, isoflurane and Inj cisatracurium 0.03 mg/kg iv boluses for muscle relaxation. Results: In the control group mean duration was 46.80 ± 6.74 min and recovery time was 15.93 ± 2.79 min and in dexmedetomidine group mean duration was 60.40 ± 9.36 min and recovery time was 19.60 ± 2.82 min, which is statistically significant however there was no significant difference in mean time taken for onset of neuromuscular blockade. Conclusion: Intravenous dexmedetomidine prior to induction and during maintenance prolongs duration and recovery of cisatracurium induced neuromuscular blockade

A study to evaluate the effect of subcutaneous infiltration of ketamine at incisional site on post operative analgesia in patients undergoing abdominal hysterectomy under spinal anaesthesia

Background: Postoperative pain is often perceived by patient as natural consequences of surgery. If poorly treated it triggers neuroendocrine stress response which may increase morbidity and mortality. Ketamine acts as non-competitive antagonist at NMDA receptors having local analgesic effect. If given subcutaneously the side effects are significantly lower. Aims and Objectives: To evaluate the analgesic effects of subcutaneous infiltration of ketamine at incisional site in elective abdominal hysterectomy under spinal anaesthesia. Materials and Methods: Fifty patients of ASA physical status 1 & 2 aged 35-60 years undergoing abdominal hysterectomy were allocated into two groups as group K and group C, using computer generated random number list each consisting 25 patients (n=25), group K received ketamine 0.5mg/kg subcutaneously and group C 0.9% normal saline subcutaneously in surgical wound site post operatively. Patients were monitored at 0 minutes, 30 minutes,1,2,4,6,8,12,16,20,24 hours interval for changes in HR, BP, SPO2,VAS. Also side effects if any are noted. Time for the first request for analgesia and total amount of rescue analgesic consumed in 24 hours noted and compared between both groups statistically. Results: The time for first request for analgesia in group C was 149.60+7.27 minutes whereas it was longer in group K 245.80+15.27minutes (P<0.001), the mean VAS scores in group K at 2,4,6,8, and 12 hours was less compared to group C recorded during same time interval, which is statistically significant and the total amount of rescue analgesia consumed during 24 hours in group C was 86.0+30.69 whereas in group K it was 46+24.66.significantly lower in group K compared to group C(P<0.001). Conclusion: Patient who were given ketamine subcutaneously at incision site postoperatively had lower pain intensity and less analgesic consumption than patients who were given placebo without increase in the risk of complications

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field