Role of preoperative zinc, magnesium and budesonide gargles in Postoperative Sore Throat (POST) - a randomised control trial.

BACKGROUND: Post-operative sore throat (POST) has an incidence ranging from 21 to 80%. To prevent the development of POST, several pharmacological measures have been tried. Aim of this study was to compare the efficacy of preoperative zinc, magnesium and budesonide gargles in reducing the incidence and severity of POST in patients who underwent endotracheal intubation for elective surgeries. METHODS: We conducted a prospective, randomized, double-blind, controlled equivalence trial in 180 patients admitted for elective surgical procedures under general anaesthesia. Patients were randomised into three groups; group Z received 40 mg Zinc, group M received 250 mg Magnesium Sulphate and group B received 200 µg Budesonide in the form of 30 ml tasteless and colourless gargle solutions. Sore throat assessment and haemodynamic recording was done postoperatively at immediate recovery (0 h) and 2, 4, 6, 8, 12 and 24 h post-operatively. POST was graded on a four-point scale (0-3). RESULTS: POST score was comparable at all recorded time points i.e. 0,2,4,6,8,12 and 24 h. Maximum incidence was seen at 8 h in group B (33.3%) and the minimum incidence was at 24 h in group Z (10%) (p > 0.05). It was found that the incidence of POST was more in the surgeries lasting longer than 2 h in all groups. This difference was found to be statistically significant in Groups M and B. The incidence of POST was found to be comparable between laparoscopic and open procedures. CONCLUSION: Magnesium, zinc and budesonide have an equivocal effect in the prevention of POST at different time points. The incidence of sore throat increases significantly in surgeries lasting more than two hours if magnesium or budesonide have been used as premedicant. Duration of surgery is an independent predictor for POST. TRIAL REGISTRATION: CTRI/2021/05/033741 Date-24/05/2021(Clinical Trial Registry of India).

Comparison of nebulized ropivacaine (0.75%) with nebulized dexmedetomidine on the hemodynamic response on intubation in patients undergoing surgery under general anesthesia: A comparative randomized double-blind placebo-controlled study.

Background: Laryngoscopy and tracheal intubation lead to sympathetic stimulation resulting in hemodynamic fluctuations. We compared local anesthetic ropivacaine 0.75% with alpha agonist dexmedetomidine through ultrasonic nebulization for direct local action of the drug in the airway. Methods: In our randomized study, 180 patients were prospectively assigned to three groups of 60 each: group R (0.75%), group D (1 microgram/kg), and group C (control). The primary objective was to determine whether nebulized ropivacaine or nebulized dexmedetomidine can cause a reduction in stress response to laryngoscopy and intubation. The secondary objectives were to compare the hemodynamic parameters at extubation, cough response at extubation, and postoperative sore throat. Results: A total of 165 patients were analyzed. Demographically, all the groups were similar. Group R and group D were found to significantly attenuate the heart rate (HR) at intubation and extubation when compared to group C (P < 0.05). A significant reduction in mean arterial pressure (MAP) was seen (P < 0.05; group D: 90 ± 18.4 mmHg, group C: 99.5 ± 15.9 mmHg, group R: 92.4 ± 16.1 mmHg). There was a significant reduction in cough response in both groups in comparison with group C at 0 minutes (P value; group C vs group D: <.0001; group C vs group R:.01) and 5 minutes (P value; group C vs group D: <.0001; group C vs group R: <.0001). Conclusion: Preinduction topical use of ropivacaine or dexmedetomidine, through the nebulization route, effectively attenuated the pressor responses when compared to placebo.

Clinical Utility of the Behavioral Pain Assessment Tool in Patients Admitted in the Intensive Care Unit.

INTRODUCTION: Unnoticed and unrelieved pain is one of the main sources of psychological and physiological stress for intensive care unit (ICU) patients. The eight-item behavior pain assessment tool (BPAT) is a multicountry validated tool to assess pain in ICU patients. However, its feasibility and clinical utility for ICU patients in India need further research. AIMS AND OBJECTIVES: The Aims and objectives of the study were to assess pain using BPAT and its clinical utility in pain assessment and management in ICU patients. MATERIALS AND METHODS: Following ethical approval, 400 consecutive adult patients admitted in the ICUs in a tertiary care teaching hospital were assessed for pain severity using BPAT at intake, baseline pain and procedural pain. Patients <18 years and in deep coma on the Glasgow coma scale were excluded from the study. The patients with BPAT score ≥4 were given opioid analgesic, and their pain was reassessed after 2-3 hours. A feedback regarding feasibility and clinical utility was filled by the doctors. RESULTS: High interrater agreement for BPAT was observed with excellent kappa coefficients (>0.85) for each item. The BPAT significantly guided the pain management (p < 0.0001). More than 90% of doctors found BPAT easy to understand and use. In most of the cases (95.5%), doctors agreed that BPAT can improve the clinical management of ICU patients. CONCLUSION: The BPAT is a reliable, brief, and an easy-to-use pain assessment tool, which clinicians can use for guiding pain assessment and management in the ICU setting on a routine basis. CLINICAL SIGNIFICANCE: We recommend implementing BPAT in the clinical practice for better pain assessment and control in ICU patients. HOW TO CITE THIS ARTICLE: Mitra S, Jain K, Singh J, Saxena P, Nyima T, Selvam SR, et al. Clinical Utility of the Behavioral Pain Assessment Tool in Patients Admitted in the Intensive Care Unit. Indian J Crit Care Med 2020;24(8):695-700.

Does an acute pain service improve the perception of postoperative pain management in patients undergoing lower limb surgery? A prospective controlled non-randomized study.

BACKGROUND AND AIM: An acute pain service (APS) has been running in our institute since April 2013 and is managed by the Department of Anesthesia and Intensive Care. However, it is not clear to what extent the patients feel benefited from the APS. The aim of the study was to compare the perception of postoperative pain management in patients receiving care under APS with those receiving routine postoperative pain relief following lower limb surgery. MATERIAL AND METHODS: This was a prospective, hospital-based, controlled non-randomized study. American Society of Anesthesiologists (ASA) grades I-III patients with age 18-75 years undergoing lower limb orthopedic surgery were prospectively recruited into APS (index group) or routine postoperative care (control group) (n = 55 each). Postoperatively, American Pain Society Patient Outcome Questionnaire-Revised (APS-POQ-R) and Short Form (SF-12) were used to evaluate the outcome of postoperative pain management at 24 h and health-related quality of life after 4 weeks respectively. RESULTS: Both groups were comparable in terms of demographic data. Patients in the index group had statistically significant better perception of care than the control group. Index group scored significantly higher than control group on median patient satisfaction score (9; interquartile range [IQR] [7-10] vs. 5 [3-6]; P < 0.001). In index group, there was significant reduction of worst pain in first 24 h along with decreased frequency of severe pain. CONCLUSION: Implementation of acute pain service plays an important role in improving the quality of postoperative pain relief, perception of care, and patient satisfaction.

Fabrication and field emission study of novel rod-shaped diamond-like carbon nanostructures.

Novel sp(3) rich diamond-like carbon nanorod films were fabricated by a hot filament chemical vapour deposition technique. The results are indicative of a bottom-up synthesis process, which results in a hierarchical structure that consists of microscale papillae comprising numerous nanorods. The papillae have diameters ranging from 2 to 4 microm and the nanorods have diameters in the 35-45 nm range. A growth mechanism based on the vapour-liquid-solid mechanism is proposed that accounts for the morphological aspects at the microscale and nanoscale. Investigation of field emission properties of fabricated nanorods reveals a low turn-on field of about 4.9 V microm( - 1) at 1 nA and a high field-enhancement factor.

A selective membrane electrode for lanthanum(III) ion based on a hexaaza macrocycle derivative as ionophore.

We have developed a highly La(III)-selective PVC membrane electrode based on a hexaaza macrocycle, 8,16-dimethyl-6,14-diphenyl-2,3,4:10,11,12-dipyridine-1,3,5,9,11,13-hexaazacyclohexadeca-3,5,8,11,13,16-hexaene [Bzo2Me2Pyo2(16)-hexaeneN6] (I) as membrane carrier, dibutylbutyl phosphonate (DBBP) as solvent mediator and sodium tetraphenylborate (NaTPB) as lipophilic additive. The best performance was given by the membrane of macrocycle I having a composition 10:260:5:120 (I:DBBP:NaTPB:PVC). The electrode exhibits a Nernstian response to La(III) ion in the concentration range 1.0x10(-1)-7.94x10(-7) M with a slope of 19.8+/-0.2 mV/decade of concentration and a detection limit of 5.62x10(-7) M. The response time of the sensor is 12 s and it can be used over a period of 4 months with good reproducibility. The electrode works well over a pH range of 2.5-10.0 and in partially non-aqueous medium with up to 30% organic content. The sensor was also used as an indicator electrode in potentiometric titration of La(III) ions with EDTA and for determining La(III) concentration in real samples.

Cobalt(II)-selective membrane sensor based on a [Me2(13)dieneN4] macrocyclic cobalt complex.

A new poly(vinyl chloride)-based membrane was fabricated with the cobalt(II) complex of 2,4-dimethyl-1,5,8,11-tetraazacyclotrideca-1,4-diene [Me2(13)dieneN4] as an ion carrier. The membrane composition was Co2+ complex/PVC/NaTPB/DBP 15:50:15:20 (w/w). The sensor exhibited a Nernstian response for Co2+ ions over a wide concentration range (7.94x10(-6)-1.0x10(-1) M) at pH 2.5-7.0, a response time of 10 s, and it could be used for 3 months without any significant divergence in potential. The proposed membrane sensor exhibited good selectivity for Co2+ over a wide variety of other metal ions and in mixtures containing up to 25% (v/v) non-aqueous content. The sensor was successfully used as an indicator electrode in the potentiometric titration of Co2+ with EDTA and the direct determination of Co2+ in real samples.

Silver(I)-selective electrode based on [Bz2Oxo4(18)dieneS4] tetrathia macrocyclic carrier.

A polystyrene-based membrane of 7,8:16,17-dibenzo-6,9,15,18-tetraoxo-1,5,10,14-tetrathiacyclooctadeca-7,16-diene [Bz2Oxo4(18)dieneS4] was fabricated using sodium tetraphenylborate (NaTPB) and dioctyl phthalate (DOP) as anion excluder and plasticizing agent. The best performance was obtained from the membrane with the composition ionophore [Bz2Oxo4(18)dieneS4]:polystyrene:DOP:NaTPB, 5:100:150:10 (w/w). The response of the electrode was linear over a wide range of concentration, 1.26 x 10(-6)-1.00 x 10(-1) mol L(-1) for silver ion with a Nernstian slope of 58.4 +/- 0.1 mV per decade and a detection limit of 1.0 x 10(-6) mol L(-1). The electrode was found to be chemically inert and of adequate stability with a response time of 10 s and could be used for a period of 3 months without change of potential. It worked satisfactorily in mixtures containing up to 35% (v/v) non-aqueous content. The proposed membrane sensor had good selectivity for Ag+ over a wide variety of metal ions in the pH range 2.2-8.5. It was successfully used as an indicator electrode in potentiometric titration of silver ion. The electrode was also useful for determination of Ag+ in waste from photographic films.

Strontium(II)-selective electrode based on a macrocyclic tetraamide.

A new PVC membrane electrode based on 5,7,12,14-dibenzo-2,3,9,10-tetraoxa-1,4,8,11-tetraazacyclotetradecane (I) as an ion carrier, o-nitrophenyloctyl ether (o-NPOE) as solvent mediator and sodium tetraphenylborate (NaTPB) as lipophilic additive was fabricated and investigated as Sr(2+)-selective electrode. The best performance was exhibited by the membrane having composition 8:200:4:120 (I:o-NPOE:NaTPB:PVC). The electrode exhibited a Nernstian response for strontium ion over a wide concentration range 3.98 x 10(-6) to 1.0 x 10(-1)M with a slope of 29.0+/-0.1 mV/decade of concentration and a detection limit of 2.82 x 10(-6)M. It showed a response time of less than 10s and could be used for at least 3 months without any divergence in potential. The proposed electrode showed a good discriminating ability towards strontium(II) ion over a wide variety of other metal ions including alkali, alkaline earth, transition, and heavy metal ions. The electrode can be used in the pH range of 2.5-10.5 and in mixtures containing up to 35% (v/v) non-aqueous content. It was used as an indicator electrode in potentiometric titration of strontium ion against EDTA.

A bromide selective polymeric membrane electrode based on Zn(II) macrocyclic complex.

A novel bromide ion-selective PVC membrane sensor based on 2,3,10,11-tetraphenyl-1,4,9,12-tetraazacyclohexadeca-1,3,9,11-tetraene zinc(II)complex (I) as carrier has been developed. The electrode exhibited wide working concentration range 2.2 x 10(-6) to 1.0 x 10(-1)M and a limit of detection as 1.4 x 10(-6)M with a Nernstian slope of 59.2+/-0.5 mV per decade. The response time of electrode was 20s over entire concentration range. The electrode possesses the advantages of low resistance, fast response and good selectivities for bromide over a variety of other anions and could be used in a pH range of 3.5-9.5. It was successfully used as an indicator electrode in the potentiometric titration of bromide ions with silver ion and also in the determination of bromide in real samples.

New cadmium(II)-selective electrode based on a tetraazacyclohexadeca macrocyclic ionophore.

A poly(vinyl chloride)-based membrane of 3,4:11,12-dibenzo-1,6,9,14-tetraazacyclohexadecane with sodium tetraphenyl borate (NaTPB) as an anion excluder and dibutylphthalate (DBP), dibutyl(butyl)phosphonate (DBBP), tris(2-ethylhexyl)phosphate (TEHP) and tributyl phosphate (TBP) as a plasticizing solvent mediator was prepared and investigated as a Cd2+-selective electrode. The best performance was observed with the membrane having a ligand-PVC-DBP-NaTPB composition of 2:25:60:1, which worked well over a wide concentration range (1.6 x 10(-6) - 1.0 x 10(-1) M) with a Nernstian slope of 29.5 mV per decade of activity between pH 2.0 - 6.0. This electrode showed a fast response time of 13 s and was used over a period of 4 months with good reproducibility (S = 0.4 mV). The selectivity coefficient for mono-, di- and trivalent cations indicated excellent selectivity for Cd2+ ions over a large number of cations. Anions such as NO3- and SO4(2-) , did not interfere. The membrane sensor has been successfully used to determine Cd2+ in real samples.

A highly selective thallium(I) electrode based on a thia substituted macrocyclic ionophore.

A new highly Tl(I)-selective PVC membrane electrode based on tetrathia macrocycle 6,7: 14,15-dibenzo-5,8,13,16-tetraoxo-1,4,9,12-tetrathiacyclohexadecane [Bz(2)O(4)(16)aneS(4)] (I) as membrane carrier, o-nitrophenyloctyl ether (o-NPOE) as solvent mediator and potassium tetrakis(p-chlorophenyl)borate (KTpClPB) as lipophilic additive has been developed. The best performance was given by the membrane of macrocycle (I) with composition 3:120:1.5:50 (I:o-NPOE:KTpClPB:PVC). This electrode exhibits a Nernstian response to Tl(I) ions in the concentration range 1.0x10(-1)-2.23x10(-6)M with a slope of 58.2mV/decade of concentration and a detection limit of 1.58x10(-6)M. The response time of the sensor is 12s and can be used over a period of 4 months with good reproducibility. The proposed electrode revealed good selectivity over a wide variety of other cations including alkali, alkaline earth, heavy and transition metals. The electrode works well over a pH range of 3.2-11.5 and in partially non-aqueous medium with up to 30% organic content. The sensor was also used as an indicator electrode in potentiometric titration of Tl(I) ions with KI solution.