Effect of dexmedetomidine on attenuation of hemodynamic response to intubation, skin incision, and sternotomy in coronary artery bypass graft patients: A double-blind randomized control trial.

BACKGROUND AND AIMS: Coronary artery bypass grafting (CABG) surgery involves various noxious stimuli resulting in stress response, which in turn increases the risk of perioperative myocardial ischemia. The present study was conducted to evaluate the effect of dexmedetomidine on the attenuation of hemodynamic response to intubation, skin incision, and sternotomy in CABG surgery. MATERIAL AND METHODS: Sixty patients were randomized into two groups of 30 each. Group D patients received dexmedetomidine 1 µg/kg as loading dose over 10 min, followed by continuous infusion of 0.5 µg/kg/h. In group P, normal saline was infused as loading and maintenance dose at similar rate. Hemodynamic parameters, total induction dose of thiopentone, and adverse effects were recorded. Statistical analysis was performed using SPSS version 20.0. Chi-square test and ANNOVA test were used and P < 0.05 was considered significant. RESULTS: The percentage increase in heart rate was significantly lesser in group D than group P after intubation (7.04% v/s 15.08%), skin incision (5.91% v/s 10.11%), and sternotomy (5.33% v/s 11.65%). Similarly increase in systolic, diastolic, and mean blood pressure were significantly lesser in group D than group P after intubation, skin incision, and sternotomy. There was a significant reduction of mean total of thiopentone in group D in comparison to group P. (1.16 mg/kg v/s 2.44 mg/kg) (P<0.001). CONCLUSION: Dexmedetomidine resulted in significant attenuation of hemodynamic response to intubation, skin incision, and sternotomy in CABG surgery without significant adverse effects. It also significantly reduced the dose of thiopentone required for induction.

Visual outcomes after toric intraocular lens implantation in pediatric eyes undergoing cataract surgery.

PURPOSE: To evaluate long-term visual outcomes and complications after toric intraocular lens (IOL) implantation in children with preexisting corneal astigmatism undergoing cataract surgery. SETTING: Iladevi Cataract & IOL Research Center, Ahmedabad, India. DESIGN: Prospective, interventional case series. METHODS: Children with regular corneal astigmatism of at least 1.5 diopters (D) were included. A standardized surgical technique with in-the-bag implantation of a toric IOL was performed. All children were followed up on postoperative day 1 and periodically thereafter, until 36 months postoperatively. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and residual refractive astigmatism were documented 36 months postoperatively. Rotational stability of toric IOL was also evaluated through the follow-up duration. Complications, particularly visual axis obscuration (VAO) and glaucoma, were documented. RESULTS: In total, 76 eyes (51 children) were included in the study. Mean age at surgery was 7.41 ± 2.82 years (SD) and mean preoperative keratometric astigmatism was 1.56 ± 2.13 D. The CDVA (logarithm of the minimum angle of resolution [logMAR]) improved significantly from 0.59 ± 0.43 preoperatively to 0.23 ± 0.27 36 months postoperatively (P = .03). Mean postoperative UDVA was 0.32 ± 0.26 logMAR. Mean refractive astigmatism at final follow-up was -0.55 ± 0.40 D, with 74% patients having a UDVA of at least 20/40; 5% of eyes needed VAO treatment and none developed glaucoma. No eye required repositioning of toric IOL until final follow-up. CONCLUSIONS: Toric IOL implantation reduced postoperative refractive astigmatism and gave excellent UDVA at 36 months follow-up in pediatric eyes undergoing nontraumatic cataract surgery.

The estimation of minimum effective volume of 0.5% ropivacaine in ultrasound-guided interscalene brachial plexus nerve block: A clinical trial.

BACKGROUND AND AIMS: Interscalene brachial plexus block (ISB) is the most commonly used mode of anesthesia for upper limb surgeries. Higher volume of local anesthetic used in ISB is associated with increased incidence of side effects, particularly phrenic nerve palsy. The aim of this study was to determine the minimum effective volume of 0.5% ropivacaine in 90% patients (MEV90) in ISB. MATERIAL AND METHODS: With target of 45 successful cases, phase 1 clinical trial was conducted based on the principles of biased coin design up-and-down method. After obtaining Ethical Committee's approval and patient's consent, patients with American Society of Anesthesiologist physical status (ASA PS) I and II, aged 18-60 years of either sex, undergoing upper arm surgery were recruited into the study until 45 successful cases. A 7 ml of 0.5% ropivacaine was used as starting dose, with patients receiving a higher or lower dose depending on previous patient's response. R package, SPSS 23, and Microsoft Excel were used for statistical analysis. RESULTS: MEV90 of 0.5% ropivacaine for ISB was determined as 8.64 ml [confidence interval (CI) 95%, 8.28-9.02 ml]. Time for onset of sensory block and motor block was 5 min (5-15 min) and 10 min (5-20 min), respectively, while duration of analgesia was observed as 8.2 (4.8-12.5) h. CONCLUSIONS: This study observes that surgical anesthesia can be accomplished with 8.64 ml (95% CI: 8.28-9.02 ml) of 0.5% ropivacaine with ultrasound-guided ISB with multiple injection technique, without clinical deterioration in block onset and duration of analgesia.

The impact of nitrogen gas flushing on the stability of seasonings: volatile compounds and sensory perception of cheese & onion seasoned potato crisps.

The impact of natural cheese and onion seasoning on the sensory perception and shelf life stability of potato crisps was studied. This study was carried out to evaluate the impact of nitrogen (N2) gas flushing on the shelf-life stability and sensory attributes of cheese & onion seasoned potato crisps. Markers of lipid oxidation and flavour volatile compounds were evaluated in sliced, unwashed, batch fried potato crisps during accelerated storage at 45 °C for 10 weeks. Volatile flavour compounds were evaluated by headspace gas analysis using solid phase microextraction (SPME) GC-MS and correlated with sensory perception. Gas flushing significantly increases the shelf life of both unsalted and cheese & onion seasoned potato crisps in terms of the stability of volatile compounds and sensory perception. Further to this, the addition of the cheese & onion seasoning increased the shelf life of the base potato crisp; this is proposed to be explained by the antioxidant properties of milk proteins in the seasoning. Sensory evaluation indicated that the key negative sensory attributes reported were rancidity and stale attributes, which were correlated to the progression of lipid oxidation and loss of flavour over storage time irrespective of the packaging environment (with/without gas flushing).

Bariatric surgery as an option for diabetes mellitus prevention and treatment in obese persons.

Bariatric surgery has been found to be very useful in treating established type-2 diabetes in obese persons, as well as in borderline diabetics, besides giving a good weight loss. Various modifications of the primary bariatric procedures have been introduced, with differ advantages and better efficacy. Good incretin responses from the distal gut give the best results and combining medical treatment are helping patients to get very good glycemic control over a longer term.

Reaching the unreached: Mobile surgical camps in a remote village of Himachal Pradesh.

AIMS: The aim was to study the epidemiological factors responsible for pelvic organ prolapse (POP) in poor women of the remote village Shillai, do their POP quantification staging, to study the variety of surgeries conducted in mobile surgical camps in this area. MATERIALS AND METHODS: Retrospective analysis of surgeries conducted in five mobile surgical camps in Shillai, Himachal Pradesh from 2009 to 2013, under "Project Prolapse". RESULTS: A total number of surgeries conducted in five camps from 2009 to 2013 were 490 including 192 gynecological surgeries. Eighty-two percent of gynecological surgery was conducted for POP. Poor nutritional status (mean weight 41.1 kg), multiparty (mean 3.5), early marriage (mean age 18.2 years), unassisted home deliveries (100%), premature bearing down (23.8%), early postpartum resumption of strenuous activity (54.7%) and smoking (33%) contribute to the high incidence of POP. Anterior compartment prolapse was seen in 99% of patients undergoing surgery while posterior compartment prolapse was seen in 4% of patients. Vaginal hysterectomy with anterior repair with culdoplasty was the most common procedure performed (73.4%), and vault suspension was done in 3.6% subjects. The complication rate was negligible. CONCLUSION: Uterovaginal prolapse is not only socially embarrassing and disabling; its surgical treatment is complex and costly too. The free mobile surgical camps under Project Prolapse in Shillai, Himachal Pradesh has provided relief to old neglected, disabled women suffering from prolapse in this remote village. Parallel counseling of women and dais for safe hospital delivery and training subordinates in prolapse surgery may help in addressing the problem of POP in this area in the long run.