ABSTRACT
BACKGROUND: With increasing focus on outpatient care, there has been an increased demand for short-acting spinal anesthetics, facilitating early recovery and mobilization of the patient. AIMS: The aim of the study was to compare 1% chloroprocaine, characterized by short latency and short duration with 0.5% levobupivacaine, which has shown to preserve motor function at low concentrations, with recovery from motor block as the primary objective and recovery from sensory block and hemodynamic stability as secondary objectives. SETTINGS AND DESIGN: A prospective study to evaluate newer isobaric chloroprocaine and levobupivacaine intrathecally in a cohort of patients using randomization and double blinding. MATERIALS AND METHODS: Sixty American Society of Anesthesiologist physical status Classes I and II patients undergoing perianal surgeries were randomly divided into Group C (n = 30) receiving intrathecal 1% chloroprocaine 3 mL and Group L (n = 30) receiving 0.5% levobupivacaine 1.5 mL. Patients were assessed for sensory and motor block characteristics, hemodynamic changes, period of analgesia, time for ambulation, and urination. STATISTICAL ANALYSIS: Qualitative data were analyzed using Chi-square test and quantitative data using Independent t-test. RESULTS: There was no significant difference in highest sensory level, onset of motor block, maximum Bromage scale achieved, and hemodynamic changes between the two groups. There was a significant difference in mean Time for Maximum Bromage scale, Time for Sensory regression (Lumbar-L1), Duration of Motor Block (Group C 50.7 ± 5.7 min and Group L 181 ± 27.8 min), Time for rescue Analgesia, Time for 1st void, and Time for ambulation (Group C 88.3 ± 9.1 min and Group L2 06.7 ± 27.2 min) between chloroprocaine and levobupivacaine group. The above duration was shorter in chloroprocaine group than in levobupivacaine group. CONCLUSION: Thus, chloroprocaine provides good surgical anesthesia and early motor recovery than levobupivacaine and is well suited for day care surgeries.
ABSTRACT
BACKGROUND: Spinal anesthesia is a reliable and safe technique for perianal surgeries; the changing trend of surgical practice from an inpatient to outpatient has urged us to use lower dose of local anesthetic providing segmental block with adjuvants such as opioids. Ropivacaine is a long acting; amide local anesthetic, with greater sensory motor differentiation. Chloroprocaine (CP) is an amino-ester local anesthetic with a very short half-life. This study was designed to compare CP with ropivacaine for spinal anesthesia in an elective ambulatory setting. METHODS: This prospective, randomized, comparative study included 60 adult patients scheduled to undergo perianal surgeries under subarachnoid block with intrathecal 3.0 mL of 1% CP with 12.5 µg fentanyl (Group C) or 1.5 mL of 0.5% ropivacaine with 12.5 µg fentanyl (Group R). STATISTICAL ANALYSIS: Chi-square test used to assess significance for qualitative data, independent t-test for significance of the mean difference between two quantitative variables. RESULTS: Meantime of onset of sensory block at T10 in both the groups were comparable (Group C - 4.7 min, Group R - 4.8 min). Maximum upper level of sensory block was at T8 in both the groups, time for regression of sensory level to L1 was significantly longer with ropivacaine (Group R - 135 min, Group C - 76 min, P < 0.0001), and the duration of motor blockade (Group C - 81 min, Group R - 145 min P < 0.0001) was significantly short in the Group C with early ambulation (160 min). CONCLUSION: CP provides adequate duration and depth of surgical anesthesia for short procedures with the advantages of faster block resolution and earlier hospital discharge compared with spinal ropivacaine.
ABSTRACT
BACKGROUND: The main stay of treatment in organophophosphorous [OP] poisoning is with atropine, oximes and supportive therapy. Despite the therapy, no improvement in mortality and morbidity. Fresh frozen plasma [FFP] a source of serum cholinesterase act as bio-scavenger to neutralise organophosphate toxins to improve the patients out come. METHODS: The prospective study was conducted in 80 patients with acute OP poisoning. Patients with moderate to severe grade of OP poisoning with serum cholinesterase level <1000 IU/L were included in the study. Study group received atropine and oximes along with FFP given as 4 units first day, 3units on 2(nd) day, 2 units on 3(rd) day. Control group was given atropine and oximes only. Serum cholinesterase enzymes level, consumption of atropine per day, number of days on ventilator, length of ICU stay, and need for tracheostomy were assessed. RESULTS: There was a significant increase in the serum cholinesterase levels after FFP infusion in the study group in comparison to the control group. Mean duration of Intensive Care Unit [ICU] stay was 8.35±4.3 in the study group and 12.45±4.13 in the control group. 06 patients in the control group succumbed whereas there were no fatalities in the study group. CONCLUSION: Daily reducing dose of FFP therapy for 3 consecutive days has beneficial effect in acute OP poisoning by increasing serum cholinesterase enzymes in blood with reduction in total dose of atropine consumption per day. It also reduces the ICU stay with zero mortality in OP poisoning.
ABSTRACT
BACKGROUND AND AIMS: Unique post-partum endocrine hormone oxytocin secreted during breastfeeding (BF) has amnestic, sedative properties and down-regulates stress responses. This study was done to assess the effect of BF on consumption of propofol, sevoflurane and haemodynamic stability in women. METHODS: Study was conducted on 120 women aged 20-30 years of American Society of Anesthesiologists I and II physical status scheduled for tubectomy under general anaesthesia who were randomly allocated to three groups 40 of each; BF, withhold feeding (WF), and non-feeding (NF) groups. All received standard premedication. Heart rate (HR), mean arterial pressure (MAP) and state entropy (SE) values were recorded at regular intervals. All patients were induced with intravenous propofol until the SE levels dropped to 45, and dose of propofol recorded. Airway was secured with laryngeal mask airway and anaesthesia was maintained with sevoflurane in 60% N2O and O2. Sevoflurane concentration was adjusted to maintain SE between 40 and 60. End tidal concentration of sevoflurane and consumption of sevoflurane (ml) was recorded by GE Datex-Ohmeda S/5™ System. Results were analysed by analysis of variance and Chi-square test. RESULTS: Demographic parameters were comparable. Dose of propofol and sevoflurane consumption in group BF was significantly reduced by 20% and 35%, respectively (P < 0.05) compared to group NF. Intra-operative HR and MAP were persistently low in group BF and elevated in group WF (P < 0.05). CONCLUSION: BF before induction of anaesthesia decreases the consumption of propofol, sevoflurane and maintains the intra-operative haemodynamic stability, whereas withholding BF increases propofol and sevoflurane consumption with intra-operative higher HR and MAP, compared to control group.
ABSTRACT
A rapid, simple, accurate, and sensitive visible spectrophotometric method for the determination of trace amounts of hydrogen peroxide in acidic buffer medium is reported. The proposed method is based on the oxidative coupling of Ampyrone with dibenzazepin hydrochloride by hydrogen peroxide in the buffer medium of pH 4.0 which is catalyzed by ferrous iron. The blue-colored product formed with maximum absorption at 620 nm was found to be stable for 2 h. Beer's law is obeyed for hydrogen peroxide concentration in the range of 0.03-0.42 µg ml(-1). The optimum reaction conditions and other important optical parameters are reported. The molar absorptive and Sandell's sensitivity are found to be 5.89 × 10(4) mol(-1) cm(-1) and 0.57 g/cm(2), respectively. The interference due to diverse ions and complexing agents was studied. The method is successfully applied to the determination of hydrogen peroxide in green plants satisfactorily.
