Journal of the Indian Medical Association
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Randomized Controlled Trial Comparative Study
Comparative clinical study of effect of neostigmine and ketamine for postoperative analgesia.
The purpose of the study was to evaluate and compare the role of neostigmine and ketamine as an additive to epidural bupivacaine to prolong the duration of postoperative analgesia. A double-blind randomised study was done on 60 adult patients, of both sexes, between 18 and 50 years, belonging to ASA grades I and II, undergoing below umbilical surgeries under epidural anaesthesia. All the patients were divided into three groups of 20 each to receive 20 ml of 0.5% bupivacaine with either 1 ml of normal saline, 100 mg of neostigmine or 50 mg of ketamine (both diluted with 1 ml normal saline). ⋯ Both neostigmine and ketamine demonstrated better haemodynamic stability with less incidence of hypotension. There was no increased incidence of nausea and vomiting or any other side-effects. In conclusion, it can be said neostigmine is a good adjuvant to epidural block to produce adequate pain relief without increased incidence of adverse effects.
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Randomized Controlled Trial
Efficacy of prophylactic intramuscular ephedrine in prevention of hypotension during caesarean section under spinal anaesthesia: a comparative study.
Hypotension during caesarean section under spinal anaesthesia is a common complication. Several measures are used to reduce the incidence of hypotension but no method is fully effective. Prophylactic intramuscular ephedrine may be effective in reducing the incidence of hypotension in addition to conventional measures. ⋯ Mean arterial pressure and heart rate were significantly more in group E10 compared to group C. No significant increase in the incidence of hypertension and tachycardia in any group were observed. The findings of this study indicate that prophylactic IM ephedrine 0.5 mg/kg given 10 minutes before spinal anaesthesia gives better haemodynamic stability during intra-operative period without any significant increase in the incidence of adverse effects.
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Randomized Controlled Trial Comparative Study
Comparison of palanosetron, granisetron and ondansetron as anti-emetics for prevention of postoperative nausea and vomiting in patients undergoing middle ear surgery.
The objective of the study was to compare the efficacy of palanosetron (0.25 mg), granisetron (3.0 mg) and ondansetron (8.0 mg) used as anti-emetics for the prevention of postoperative nausea/vomiting in patients undergoing middle ear surgery. The study was done among 75 adult patients (age group 30-45 years) of which 50 were males and rest (25) females, all of ASA I and ASA II. The patients were randomly allocated into 3 equal groups: Group I (n = 25) received injection palanosetron (0.25 mg) IV, group II (n = 25) received injection granisetron (3 mg) IV and group III (n = 25) received injection ondansetron (8.0 mg) IV at the end of the surgical procedure. ⋯ The incidence of emesis-free patients during the 0-6 hours period was 100% for group I; 72% for group II and 56% for group III. During the 6-24 hours period incidence of emesis-free patients were 96% for group I; 56% for group II and 32% for group III. So to conclude, a single dose of palanosetron (0.25 mg) is a superior anti-emetic to granisetron (3.0 mg) or ondansetron (8.0 mg) in complete prevention of postoperative nausea and vomiting after middle ear surgery during the first 24 hours period.
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Red cell distribution width (RDW) is an automated laboratory determination of red cell anisocytosis. The aim of the study was to analyse the role of RDW in differentiating iron deficiency anaemia (IDA) from thalassaemia trait. There were 500 patients who were screened for the study. ⋯ Evaluation of RDW as screening test to detect microcytic anaemia had sensitivity of 71.42% and specificity of 40%, Evaluation of RDW as a screening test for IDA had sensitivity of 67.9% and specificity 25%. It was found uniform increase in RDW in all cases of microcytosis. It is concluded that RDW adds useful but limited information in classifying microcytic anaemia.
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Joubert syndrome is a very rare disorder characterised by respiratory irregularities, saccadic eye movements, hypotonia, ataxia, developmental retardation with abnormalities of cerebellum and brainstem. Epilepsy is rarely associated with this syndrome. Herein such a case with associated epilepsy is presented. ⋯ Pregnancy and prenatal period was uneventful. There was history of one of his siblings having the disorders of respiratory irregularities, saccadic eye movements, ataxia, hypotonia, etc (same as the child) and died at 3 1/2 years of age. MRI brain showed features of Joubert syndrome.