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Background and Aims: Post-discharge nausea and vomiting (PDNV) is a pertinent problem in patients undergoing ambulatory surgery. The objective of this study was to assess the efficacy of the novel drug olanzapine, which has proved its efficiency in patients undergoing highly emetogenic chemotherapy for PDNV prevention. Methods: This randomised controlled trial recruited 106 adult patients (18-65 years) undergoing highly emetogenic daycare surgeries with propofol-based general anaesthesia (GA). Group O received preoperative oral olanzapine 10 mg, and Group C, acting as a control, received 8 mg of intravenous dexamethasone and 4 mg of ondansetron intraoperatively. The primary outcome was nausea (numeric rating scale >3) and/or vomiting 24 h after discharge. Secondary outcomes included nausea and vomiting in the post-anaesthesia care unit (PACU), severe nausea, vomiting and side effects. Normality was assessed using the Shapiro-Wilk test, and the independent samples t-test or the Mann-Whitney U test was used to compare continuous variables. Fisher's exact test was used to assess any non-random associations between the categorical variables. Results: The incidence and severity of postoperative nausea and vomiting were similar in both groups within PACU (four patients experienced nausea and vomiting, three had severe symptoms in Group O, P = 0.057) and in the post-discharge period (three patients in Group O had nausea and vomiting compared to five patients in Group C, of which four were severe, P = 0.484). The side effects (sedation, dizziness, and light-headedness) were comparable between the two groups. Conclusion: A single preoperative oral olanzapine can be an effective alternative to standard antiemetic prophylaxis involving dexamethasone and ondansetron for preventing PDNV in highly emetogenic daycare surgeries with propofol-based GA.
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Brain ischemia modulates endogenous opioids production and the expression of opioid receptors. The present investigations aim to determine the neuroprotective effect of Spiradoline and Naloxone, administered intraperitoneally, against carotid artery occlusion induced cerebral ischemia in adult male Wistar rats. The ischemic assessment was carried out by evaluation of behavioral (cognitive and sensorimotor), and biochemical (antioxidants, acetylcholinesterase, brain swelling and hemispheric water content) parameters. The groups included sham-operated control, vehicle control, spiradoline-treated and naloxone-treated rats. Carotid artery occlusion induced behavioral impairment as per 8-arm radial maze, elevated plus maze, sensorimotor deficits, free radical production and biochemical changes. The results revealed that spiradoline significantly (p<0.05) antagonized the cognitive and sensorimotor deficits, indicated by reduced working memory errors, increased transfer latency time, and neurologic scores on 24 h and day 7 after ischemia, while naloxone produced transient improvement. The drugs significantly (p<0.05) restored the levels of antioxidants, and acetylcholinesterase on day 7. The brain edema development was significantly antagonized by spiradoline while naloxone showed lesser improvement. The results implied that the opioid agonist spiradoline has better efficacy than opioid antagonist naloxone for brain stroke therapy at tested doses, and spiradoline may be used in future combination therapies as a neuroprotective drug.
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The objective of the study was to develop UPLC method for the determination of purity of Cefditoren Pivoxil in API and its validation. UPLC is a better technique than HPLC in terms of performance and speed, so it was selected. The method was developed using Acetonitrile and Ammonium Acetate buffer (pH 6.7) and Kromacil column C18 (50×2.1mm, 3.5μ) as a stationary phase at a flow rate of 0.25ml/min. Validation was done by linearity, precision, and robustness studies. The precision was found to be within the limits. The linearity studies indicated the drug obeys Beer’s law and revealed the specified range of linearity for drug was between 80μg/ml and 120μg/ml. The robustness was observed from the insignificant variation in the analysis by changes in flow rate, mobile phase ratio, wavelength, column oven temperature and pH. Forced Degradation study revealed the drug degraded initially by the influence of acid, alkali, and peroxide. Solution stability study showed the drug was not stable for more than 2 h at 25˚C but stable at 5˚C. It can be concluded that the proposed method was simple, precise, and robust and can be useful for determination of purity of Cefditoren Pivoxil in API by using UPLC.