Interfacial Growth of Large Area Single-Crystalline Silver Sheets Through Ambient Microdroplets.

The creation of micrometer-sized sheets of silver at the air-water interface by direct deposition of electrospray-generated silver ions (Ag+) on an aqueous dispersion of reduced graphene oxide (RGO), in ambient conditions, is reported. In the process of electrospray deposition (ESD), an electrohydrodynamic flow is created in the aqueous dispersion, and the graphene sheets assemble, forming a thin film at the air-water interface. The deposited Ag+ coalesce to make single-crystalline Ag sheets on top of this assembled graphene layer. Fast neutralization of Ag+ forming atomic Ag, combined with their enhanced mobility on graphene surfaces, presumably facilitates the growth of larger Ag clusters. Moreover, restrictions imposed by the interface drive the crystal growth in 2D. By controlling the precursor salt concentration, RGO concentration, deposition time, and ion current, the dimensionality of the Ag sheets can be tuned. These Ag sheets are effective substrates for surface-enhanced Raman spectroscopy (SERS), as demonstrated by the successful detection of methylene blue at nanomolar concentrations.

Strong and Elastic Membranes via Hydrogen Bonding Directed Self-Assembly of Atomically Precise Nanoclusters.

2D nanomaterials have provided an extraordinary palette of mechanical, electrical, optical, and catalytic properties. Ultrathin 2D nanomaterials are classically produced via exfoliation, delamination, deposition, or advanced synthesis methods using a handful of starting materials. Thus, there is a need to explore more generic avenues to expand the feasibility to the next generation 2D materials beyond atomic and molecular-level covalent networks. In this context, self-assembly of atomically precise noble nanoclusters can, in principle, suggest modular approaches for new generation 2D materials, provided that the ligand engineering allows symmetry breaking and directional internanoparticle interactions. Here the self-assembly of silver nanoclusters (NCs) capped with p-mercaptobenzoic acid ligands (Na4 Ag44 -pMBA30 ) into large-area freestanding membranes by trapping the NCs in a transient solvent layer at air-solvent interfaces is demonstrated. The patchy distribution of ligand bundles facilitates symmetry breaking and preferential intralayer hydrogen bondings resulting in strong and elastic membranes. The membranes with Young's modulus of 14.5 ± 0.2 GPa can readily be transferred to different substrates. The assemblies allow detection of Raman active antibiotic molecules with high reproducibility without any need for substrate pretreatment.

Role of Zinc Oxide in the Compounding Formulation on the Growth of Nonstoichiometric Copper Sulfide Nanostructures at the Brass-Rubber Interface.

Tire technology has evolved substantially by the introduction of brass-coated steel cords (BCSCs) in radial tires. The durability of radial tires is dependent on the integrity of the brass-rubber interface composed predominantly of nonstoichiometric copper sulfide (Cu2-x S, where x = 1 to 2) nanostructures whose morphology and characteristics are dependent upon the crucial rubber additive, ZnO. Its higher concentration impacts environmental sustainability, while at lower levels, there is insufficient bonding between steel and the rubber thus affecting tire's safety. This brings in the need for an optimum ZnO concentration to be used in radial tires and is thus the theme of the present work. The changes in the properties of interfacial nanostructures such as morphology, thickness, crystallinity, and chemical composition were studied at various ZnO concentrations. We adopted our previously reported methodology, the "brass mesh experiment", to investigate the thickness of nanostructures at varied ZnO concentrations using transmission electron microscopy (TEM). Significant results were obtained from field-emission scanning electron microscopy (FESEM), X-ray diffraction (XRD), Raman imaging and X-ray photoelectron spectroscopy (XPS). In conjunction with a more practical experimental technique, namely the measurement of pull-out force (POF), it has been concluded that 9 parts per hundred rubber (PHR) ZnO is essential for the optimum growth of nanostructures and is considered to be the optimum for the composition studied. We believe that the scientific approach outlined in the manuscript would help the tire- and the material science communities to widen the knowledge of understanding sustainability in tire industries. It is estimated that the optimization presented here can save $400-450 million for the tire industry and 2.4 million tons of ZnO per year.

Hierarchical Assembly of Atomically Precise Metal Clusters as a Luminescent Strain Sensor.

We demonstrate the formation of a versatile luminescent organo-inorganic layered hybrid material, composed of bovine serum albumin (BSA)-protected Au30 clusters and aminoclay sheets. X-ray diffraction revealed the intercalation of Au30@BSA in the layered superstructure of aminoclay sheets. Coulombic attraction of the clusters and the clay initiates the interaction, and the appropriate size of the clusters allowed them to intercalate within the lamellar aminoclay galleries. Electron microscopy measurements confirmed the hierarchical structure of the material and also showed the cluster-attached clay sheets. Zeta potential measurement and dynamic light scattering probed the gradual formation of the ordered aggregates in solution. The hybrid material could be stretched up to 300% without fracture. The emergence of a new peak in the luminescence spectrum was observed during the course of mechanical stretching. This peak increased in intensity gradually with the degree of elongation or strain of the material. A mechanochromic luminescence response was further demonstrated with a writing experiment on a luminescent mat of the material, made by electrospinning.

Effect of varying time intervals between fentanyl and propofol administration on propofol requirement for induction of anaesthesia: Randomised controlled trial.

BACKGROUND AND AIMS: Administration of fentanyl before induction of anaesthesia with propofol should facilitate smooth induction, with a reduction in induction dose of propofol and its side effects. This study was designed to examine the effect of varying intervals between fentanyl and propofol administration on the dose of propofol required for induction of anaesthesia. METHODS: After institutional ethical clearance, 129 American Society of Anesthesiologists physical status I--II patients, aged 18--65 years, undergoing elective surgery under general anaesthesia were randomised into three groups. Fentanyl 2 mcg/kg was administered immediately prior to, 3 and 5 min before induction with propofol in Groups 1, 2, and 3, respectively. Requirement of propofol induction dose and haemodynamic parameters was recorded. Statistical analysis was performed using software SPSS (SPSS Inc., Chicago, Illinois, USA). RESULTS: Total dose of propofol required for induction was highest in Groups 1 and lowest Group 3 (Group 1 vs. 2 vs. 3: 86.28 ± 21.12 vs. 71.67 ± 21.68 vs. 59.98 ± 20.35 mg, P < 0.00001). Dose of propofol required per kg body weight was significantly higher in Group 1 (1.41 ± 0.34 mg/kg) compared to both Group 2 (1.14 ± 0.38 mg/kg) and Group 3 (0.97 ± 0.32 mg/kg) (P < 0.00001). Incidence of hypotension during induction was significantly lower in Group 3 (14%) and Group 2 (17.1%) than in Group 1 (35.6%; P = 0.03). CONCLUSION: Administering fentanyl 5 min prior to propofol causes marked reduction in the dose requirement of the latter along with a significantly decreased incidence of hypotension during induction.

Noninvasive Ventilation and Oxygen Therapy after Extubation in Patients with Acute Respiratory Failure: A Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Role of noninvasive ventilation (NIV) following extubation in patients with acute respiratory failure is debatable. NIV may provide benefit in post surgical patients, but its role in nonsurgical patients is controversial. MATERIALS AND METHODS: PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) were searched (from 1946 to 20th November 2017) to identify prospective randomized controlled trials, where postextubation NIV has been compared with standard oxygen therapy in adult patients with acute respiratory failure. RESULTS: Data of 1525 patients from 11 randomized trials have been included in this meta-analysis. Two trials used NIV to manage post-extubation respiratory failure. Pooled analysis found that mortality rate at longest available follow-up [OR (95% CI) 0.84 (0.50, 1.42); p = 0.52] and reintubation rate [OR (95% CI) 0.75 (0.51, 1.09); p = 0.13] were similar between NIV and standard oxygen therapy. NIV did not decrease intubation rate when used as preventive modality [OR (95% CI) 0.65 (0.40, 1.06); p = 0.08]. Duration of ICU stay was also similar in the two groups [MD (95% CI) 0.46 (-0.43, 1.36) days; p = 0.3]. CONCLUSION: Post extubation NIV in non- surgical patients with acute respiratory failure does not provide any benefit over conventional oxygen therapy. HOW TO CITE THIS ARTICLE: Maitra S, Bhattacharjee S, Som A. Noninvasive Ventilation and Oxygen Therapy after Extubation in Patients with Acute Respiratory Failure: A Meta-analysis of Randomized Controlled Trials. Indian J Crit Care Med 2019;23(9):414-422.

Self-propagated combustion synthesis of few-layered graphene: an optical properties perspective.

This paper describes a labour efficient and cost-effective strategy to prepare few-layered of reduced graphene oxide like (RGOL) sheets from graphite. The self-propagated combustion route enables the bulk production of RGOL sheets. Microscopic and spectroscopic analyses confirmed the formation of few-layer graphene sheets of an average thickness of ∼3 nm and the presence of some oxygen functional groups with a C/O ratio of 8.74. A possible mechanistic pathway for the formation of RGOL sheets is proposed. The optical properties of the RGOL sample were studied in detail by means of Spectroscopic Ellipsometry (SE). The experimental abilities of SE in relating the optical properties with the number of oxygen functionalities present in the samples are explored. The data were analysed by a double-layered optical model along with the Drude-Lorentz oscillatory dispersion relation. The refractive index (n = 2.24), extinction coefficient (k = 2.03), and dielectric functions are obtained using point-by-point analysis and are also checked for Kramers-Kronig (KK) consistency.

Atomically Precise Nanocluster Assemblies Encapsulating Plasmonic Gold Nanorods.

The self-assembled structures of atomically precise, ligand-protected noble metal nanoclusters leading to encapsulation of plasmonic gold nanorods (GNRs) is presented. Unlike highly sophisticated DNA nanotechnology, this strategically simple hydrogen bonding-directed self-assembly of nanoclusters leads to octahedral nanocrystals encapsulating GNRs. Specifically, the p-mercaptobenzoic acid (pMBA)-protected atomically precise silver nanocluster, Na4 [Ag44 (pMBA)30 ], and pMBA-functionalized GNRs were used. High-resolution transmission and scanning transmission electron tomographic reconstructions suggest that the geometry of the GNR surface is responsible for directing the assembly of silver nanoclusters via H-bonding, leading to octahedral symmetry. The use of water-dispersible gold nanoclusters, Au≈250 (pMBA)n and Au102 (pMBA)44 , also formed layered shells encapsulating GNRs. Such cluster assemblies on colloidal particles are a new category of precision hybrids with diverse possibilities.

Rapid reaction of MoS2 nanosheets with Pb2+ and Pb4+ ions in solution.

Understanding the chemical changes happening to nanostructures during a process is vital in selecting them for applications. Here, we investigated the difference in the reactivity of the bulk and nanoscale forms of molybdenum disulfide (MoS2) in solution with lead ions (Pb2+ and Pb4+) as probes, at room temperature. While the bulk form did not show any reactivity in the experimental timescale, the two-dimensional (2D) nanoscale form showed not only reactivity but also quite rapid kinetics that resulted in the formation of distinct products, principally PbMoO4 with anion substitution, in a few seconds. Depending on the charge state of the cation, and the pH of the reaction mixture, two different kinds of morphologies of the same reaction product were formed. Furthermore, we demonstrate that this unusual reactivity of the MoS2 nanosheets (NSs) was retained in its supported form and hence, such supported materials can be effective for the abstraction of toxic lead from water, with fast kinetics.

Holey MoS2 Nanosheets with Photocatalytic Metal Rich Edges by Ambient Electrospray Deposition for Solar Water Disinfection.

A new method for creating nanopores in single-layer molybdenum disulfide (MoS2) nanosheets (NSs) by the electrospray deposition of silver ions on a water suspension of the former is introduced. Electrospray-deposited silver ions react with the MoS2 NSs at the liquid-air interface, resulting in Ag2S nanoparticles which enter the solution, leaving the NSs with holes of 3-5 nm diameter. Specific reaction with the S of MoS2 NSs leads to Mo-rich edges. Such Mo-rich defects are highly efficient for the generation of active oxygen species such as H2O2 under visible light which causes efficient disinfection of water. 105 times higher efficiency in disinfection for the holey MoS2 NSs in comparison to normal MoS2 NSs is shown. Experiments are performed with multiple bacterial strains and a virus strain, demonstrating the utility of the method for practical applications. A conceptual prototype is also presented.

Catalytic Paper Spray Ionization Mass Spectrometry with Metal Nanotubes and the Detection of 2,4,6-Trinitrotoluene.

Materials are making inroads into mass spectrometry, and an example is the use of advanced materials for enhanced ionization by transformation of a less-ionizable molecule to an easily ionizable one. Here we show the use of Pt nanoparticle-decorated nanotubes as highly active catalysts for the reduction of 2,4,6-trinitrotoluene to 2,4,6-triaminotoluene and subsequent easy detection of the product by in situ ambient ionization mass spectrometry.

Comparison of LMA Supreme™ with i-gel™ and LMA ProSeal™ in children for airway management during general anaesthesia: A meta-analysis of randomized controlled trials.

STUDY OBJECTIVE: A few randomized trials have compared LMA Supreme™ with LMA ProSeal™ and i-gel™ in children but their conclusions varied widely. This systematic review and meta analysis has compared the former device with the latter two devices. DESIGN: Meta-analysis and systematic review using the Mantel-Haenszel method and pooled mean difference using inverse variance method. SETTING: Meta-analysis of published prospective randomized controlled trials. PATIENTS: Paediatric patients undergoing surgery under general anaesthesia. INTERVENTION: LMA Supreme™ with LMA ProSeal™ or i-gel™ as airway management device. RESULTS: Electronic database searching revealed four randomized trials where LMA Supreme™ has been compared with LMA ProSeal™ and three trials where a comparison was made between LMA Supreme™ and i-gel™ in paediatric population. LMA Supreme™ provided similar oropharyngeal leak pressure when compared to LMA ProSeal™ [mean difference (95% CI) 1.57 (-1.33, 4.47)cm H2O; p=0.29] and i-gel™ [mean difference (95% CI) 1.18 (-2.11, 4.47)cm H2O; p=0.48]. First insertion success rate is also similar when LMA Supreme™ is compared to LMA ProSeal™ [RR (95% CI) 1.03 (0.97, 1.1); p=0.74] and i-gel™ [RR (95% CI) 0.99 (0.95, 1.03); p=0.51]. Device insertion is significantly faster with LMA Supreme™ than i-gel™ [mean difference (95% CI) 1.87 (0.93, 2.81) s; p<0.0001]. CONCLUSION: We suggest that LMA Supreme™ may be an alternative to LMA ProSeal™ and i-gel™ in children for airway management during general anaesthesia.

Interparticle Reactions: An Emerging Direction in Nanomaterials Chemistry.

Nanoparticles exhibit a rich variety in terms of structure, composition, and properties. However, reactions between them remain largely unexplored. In this Account, we discuss an emerging aspect of nanomaterials chemistry, namely, interparticle reactions in solution phase, similar to reactions between molecules, involving atomically precise noble metal clusters. A brief historical account of the developments, starting from the bare, gas phase clusters, which led to the synthesis of atomically precise monolayer protected clusters in solution, is presented first. Then a reaction between two thiolate-protected, atomically precise noble metal clusters, [Au25(PET)18]- and [Ag44(FTP)30]4- (PET = 2-phenylethanethiol, FTP = 4-fluorothiophenol), is presented wherein these clusters spontaneously exchange metal atoms, ligands, and metal-ligand fragments between them under ambient conditions. The number of exchanged species could be controlled by varying the initial compositions of the reactant clusters. Next, a reaction of [Au25(PET)18]- with its structural analogue [Ag25(DMBT)18]- (DMBT = 2,4-dimethylbenzenethiol) is presented, which shows that atom-exchange reactions happen with structures conserved. We detected a transient dianionic adduct, [Ag25Au25(DMBT)18(PET)18]2-, formed between the two clusters indicating that this adduct could be a possible intermediate of the reaction. A reaction involving a dithiolate-protected cluster, [Ag29(BDT)12]3- (BDT = 1,3-benzenedithiol), is also presented wherein metal atom exchange alone occurs, but with no ligand and fragment exchanges. These examples demonstrate that the nature of the metal-thiolate interface, that is, its bonding network and dynamics, play crucial roles in dictating the type of exchange processes and overall rates. We also discuss a recently proposed structural model of these clusters, namely, the Borromean ring model, to understand the dynamics of the metal-ligand interfaces and to address the site specificity and selectivity in these reactions. In the subsequent sections, reactions involving atomically precise noble metal clusters and one- and two-dimensional nanosystems are presented. We show that highly protected, stable clusters such as [Au25(PET)18]- undergo chemical transformation on graphenic surfaces to form a bigger cluster, Au135(PET)57. Finally, we present the transformation of tellurium nanowires (Te NWs) to Ag-Te-Ag dumbbell nanostructures through a reaction with an atomically precise silver cluster, Ag32(SG)19 (SG = glutathione thiolate). The starting materials and the products were characterized using high resolution electrospray ionization mass spectrometry, matrix assisted laser desorption ionization mass spectrometry, UV/vis absorption, luminescence spectroscopies, etc. We have analyzed principally mass spectrometric data to understand these reactions. In summary, we present the emergence of a new branch of chemistry involving the reactions of atomically precise cluster systems, which are prototypical nanoparticles. We demonstrate that such interparticle chemistry is not limited to metal clusters; it occurs across zero-, one-, and two-dimensional nanosystems leading to specific transformations. We conclude this Account with a discussion of the limitations in understanding of these reactions and future directions in this area of nanomaterials chemistry.

Ultra-high sensitivity infra-red detection and temperature effects in a graphene-tellurium nanowire binary hybrid.

The optoelectronic performance of hybrid devices from graphene and optically sensitive semiconductors exceeds conventional photodetectors due to a large in-built optical gain. Tellurium nanowire (TeNW), being a narrow direct band gap semiconductor (∼0.65 eV), is as an excellent potential candidate for near infra-red (NIR) detection. Here we demonstrate a new graphene-TeNW binary hybrid that exhibits a maximum photoresponsivity of ∼106 A W-1 at 175 K in the NIR regime (920 nm-1720 nm), which exceeds the photoresponsivity of the most common NIR photodetectors. The resulting noise-equivalent power (NEP) is as low as 2 × 10-18 W Hz-1/2, and the specific detectivity (D*) exceeds 5 × 1013 cm Hz1/2 W-1 (Jones). The temperature range of optimal operation, which extends up to ≈220 K and ≈260 K for 1720 nm and 920 nm excitation, respectively, is primarily limited by the electrical conductivity of the TeNW layer, and can further be improved by lowering of the defect density as well as inter-wire electronic coupling.

Perioperative gabapentin and pregabalin in cardiac surgery: a systematic review and meta-analysis / Gabapentina e pregabalina no período perioperatório em cirurgia cardíaca: uma revisão sistemática e metanálise

Abstract Objectives: Sternotomy for cardiac surgeries causes significant postoperative pain and when not properly managed may cause significant morbidity. As neuropathic pain is a significant component here, gabapentin and pregabalin may be effective in these patients and may reduce postoperative opioid consumption. The purpose of this systematic review was to find out efficacy of gabapentin and pregabalin in acute postoperative pain after cardiac surgery. Methods: Published prospective human randomized clinical trials, which compared preoperative and/or postoperative gabapentin/pregabalin with placebo or no treatment for postoperative pain management after cardiac surgery has been included in this review. Results: Four RCTs each for gabapentin and pregabalin have been included in this systematic review. Three gabapentin and two pregabalin studies reported decrease in opioid consumption in cardiac surgical patients while one gabapentin and two pregabalin studies did not. Three RCTs each for gabapentin and pregabalin reported lower pain scores both during activity and rest. The drugs are not associated with any significant complications. Conclusion: Despite lower pain scores in the postoperative period, there is insufficient evidence to recommend routine use of gabapentin and pregabalin to reduce opioid consumption in the cardiac surgical patients.

Resumo Objetivos: A esternotomia para cirurgias cardíacas causa dor intensa no pós-operatório e quando não tratada adequadamente pode causar morbidade grave. Como nesse caso a dor neuropática é uma componente importante, gabapentina e pregabalina podem ser eficazes nesses pacientes e podem reduzir o consumo de opioides no pós-operatório. O objetivo desta revisão sistemática foi avaliar a eficácia de gabapentina e pregabalina na dor aguda após cirurgia cardíaca. Métodos: Foram incluídos nesta revisão estudos clínicos prospectivos e randômicos com humanos, que compararam o uso de gabapentina/pregabalina nos períodos pré- e/ou pós-operatório com placebo ou nenhum tratamento para o controle da dor no pós-operatório de cirurgia cardíaca. Resultados: Quatro ECRs de gabapentina e pregabalina foram incluídos nesta revisão sistemática. Três estudos de gabapentina e dois de pregabalina relataram diminuição do consumo de opioides em pacientes cirúrgicos cardíacos; um estudo de gabapentina e dois de pregabalina não relataram. Três ECRs de gabapentina e pregabalina relataram escores menores de dor, durante a atividade e o repouso. Os medicamentos não estão associados a complicações significativas. Conclusão: Embora os escores de dor tenham sido menores no pós-operatório, não há evidências suficientes para recomendar o uso rotineiro de gabapentina e pregabalina para reduzir o consumo de opioides em pacientes cirúrgicos cardíacos.

[Perioperative gabapentin and pregabalin in cardiac surgery: a systematic review and meta-analysis]. / Gabapentina e pregabalina no período perioperatório em cirurgia cardíaca: uma revisão sistemática e metanálise.

OBJECTIVES: Sternotomy for cardiac surgeries causes significant postoperative pain and when not properly managed may cause significant morbidity. As neuropathic pain is a significant component here, gabapentin and pregabalin may be effective in these patients and may reduce postoperative opioid consumption. The purpose of this systematic review was to find out efficacy of gabapentin and pregabalin in acute postoperative pain after cardiac surgery. METHODS: Published prospective human randomized clinical trials, which compared preoperative and/or postoperative gabapentin/pregabalin with placebo or no treatment for postoperative pain management after cardiac surgery has been included in this review. RESULTS: Four RCTs each for gabapentin and pregabalin have been included in this systematic review. Three gabapentin and two pregabalin studies reported decrease in opioid consumption in cardiac surgical patients while one gabapentin and two pregabalin studies did not. Three RCTs each for gabapentin and pregabalin reported lower pain scores both during activity and rest. The drugs are not associated with any significant complications. CONCLUSION: Despite lower pain scores in the postoperative period, there is insufficient evidence to recommend routine use of gabapentin and pregabalin to reduce opioid consumption in the cardiac surgical patients.

Goal directed fluid therapy decreases postoperative morbidity but not mortality in major non-cardiac surgery: a meta-analysis and trial sequential analysis of randomized controlled trials.

BACKGROUND AND AIMS: Optimum perioperative fluid administration may improve postoperative outcome after major surgery. This meta-analysis and systematic review has been aimed to determine the effect of dynamic goal directed fluid therapy (GDFT) on postoperative morbidity and mortality in non-cardiac surgical patients. MATERIAL AND METHODS: Meta-analysis of published prospective randomized controlled trials where GDFT based on non-invasive flow based hemodynamic measurement has been compared with a standard care. Data from 41 prospective randomized trials have been included in this study. RESULTS: Use of GDFT in major surgical patients does not decrease postoperative hospital/30-day mortality (OR 0.70, 95 % CI 0.46-1.08, p = 0.11) length of post-operative hospital stay (SMD -0.14; 95 % CI -0.28, 0.00; p = 0.05) and length of ICU stay (SMD -0.12; 95 % CI -0.28, 0.04; p = 0.14). However, number of patients having at least one postoperative complication is significantly lower with use of GDFT (OR 0.57; 95 % CI 0.43, 0.75; p < 0.0001). Abdominal complications (p = 0.008), wound infection (p = 0.002) and postoperative hypotension (p = 0.04) are also decreased with used of GDFT as opposed to a standard care. Though patients who received GDFT were infused more colloid (p < 0.0001), there is no increased risk of heart failure or pulmonary edema and renal failure. CONCLUSION: GDFT in major non- cardiac surgical patients has questionable benefit over a standard care in terms of postoperative mortality, length of hospital stay and length of ICU stay. However, incidence of all complications including wound infection, abdominal complications and postoperative hypotension is reduced.

Confined Metastable 2-Line Ferrihydrite for Affordable Point-of-Use Arsenic-Free Drinking Water.

Arsenic-free drinking water, independent of electrical power and piped water supply, is possible only through advanced and affordable materials with large uptake capacities. Confined metastable 2-line ferrihydrite, stable at ambient temperature, shows continuous arsenic uptake in the presence of other complex species in natural drinking water and an affordable water-purification device is made using the same.

Prophylactic amiodarone vs dronedarone for prevention of perioperative arrhythmias in offpump coronary artery bypass grafting: A pilot randomized controlled trial.

The aim of this study was to compare the effects of prophylactic dronedarone and amiodarone in prevention of arrhythmias during and following off-pump coronary artery bypass grafting (OPCAB). This randomized, controlled, double-blinded, parallel-group study was carried out on 36 adult male patients aged 30-70 years, with modified Parsonnet score 0-10 undergoing offpump coronary artery bypass grafting. After obtaining approval from the institutional ethics committee and informed consent, the patients were randomly allocated to two equal groups (n=18). In one group, patients were given inj. amiodarone 3mg/kg in 100ml of normal saline prior to skin incision intravenously over 20 minutes. In the second group patients received tablet dronedarone 400mg orally twice daily, commencing three days prior to the date of surgery. Patients in the amiodarone group received placebo tablet while patients in the dronedarone group received placebo infusion for the sake of blinding. The frequency and profile of arrhythmias intraoperatively and 24 hours postoperatively were studied. Intraoperative arrhythmias occurred in 50% of patients receiving amiodarone and 16.67% of patients receiving dronedarone. Maximum ventricular rate during atrial fibrillation was significantly lower in the dronedarone group (121 beats per min) than in the amiodarone group (168 beats per min). The study concludes that dronedarone appears to be at least as effective as amiodarone in prophylaxis of intraoperative and postoperative arrhythmias in patients undergoing OPCAB, with a better control of ventricular response.

Combination of 5-HT3 Antagonist and Dexamethasone Is Superior to 5-HT3 Antagonist Alone for PONV Prophylaxis After Laparoscopic Surgeries: A Meta-analysis.

INTRODUCTION: 5-Hydroxytryptamine type 3 (5-HT3) receptor antagonists are the most commonly used drugs for postoperative nausea vomiting (PONV) prophylaxis. Dexamethasone is another antiemetic with proven efficacy in reducing PONV. The aim of this study was to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the combination of dexamethasone and 5-HT3 antagonist versus a 5-HT3 antagonist alone as prophylaxis of PONV in laparoscopic surgical patients. METHODS: PubMed, PubMed Central, and CENTRAL databases were searched to identify those randomized trials that compared a 5-HT3 antagonist with the 5-HT3 antagonist and dexamethasone combination for PONV prophylaxis after laparoscopic surgeries. RESULTS: Data from 17 RCTs that evaluated 1402 patients were included. Results from our meta-analysis show that the combination of dexamethasone and a 5-HT3 receptor antagonist is more effective in preventing PONV than the 5-HT3 antagonist alone (odds ratio 0.38, 95% confidence interval [CI] 0.27-0.54; number needed to treat = 6.6), with no statistical heterogeneity (I = 0) among studies. The need for rescue antiemetic is also decreased in patients receiving the combination (odds ratio 0.21, 99% CI 0.10-0.46; number needed to treat = 6), although data are insufficient to detect any significant difference in incidence of adverse effects. In addition, patients in the combination group complained of less pain after 24 hours (Weighted Mean Difference -0.67, 99% CI -1.27 to -0.08). CONCLUSION: Combination of a 5-HT3 receptor antagonist and dexamethasone is significantly more effective than 5-HT3 antagonist alone in preventing PONV after laparoscopic surgeries, with possible improvement in postoperative analgesia.