Online ISSN: 2515-8260

Keywords : induction


A COMPARISON OF PROPOFOL VERSUS KETOFOL PLUS FENTANYL AS INDUCTION AGENTS ON HEMODYNAMIC PARAMETERS IN PATIENTS UNDERGOING ELECTIVE SURGICAL PROCEDURES UNDER GENERAL ANESTHESIA

Krishna Reddy Pingili, Raghuveer Chinnapaka, Nandaraj Dubbaka, M. Sindhura

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2407-2417

Background: Propofol has gained a lot of popularity and is very commonly used in elective surgeries due to its solubility, rapid induction, quick recovery time along with its amnestic and antiepileptic properties make a potent anesthetic agent. Exclusive uses of propofol to provide LMA might be associated with some undesirable effects which are dose-dependent are like hypotension, respiratory depression, coughing, hiccups, laryngospasm, and movements. Forgoing studies reveled that a combination of ketamine and propofol decreased patients' use of propofol and opioids and improved hemodynamic and respiratory stability. The prime objective of our study is to substantiate the earlier results regarding whether the efficacy of the ketamine-Propofol-Fentanyl combination has more favorable hemodynamics than the gold standard prototypic induction drug (Propofol) in a cohort of healthy patients and to compare the additional post-operative analgesia requirements between the two groups.
Materials and Methods: The clinical prospective observational study was done on 240 individuals which were divided in to 2 equal groups (120 each group), the, Group A (Propofol) received 2.5 mg/kg Propofol for induction and the Group B (Ketamine-Fentanyl-Propofol) of 120 subjects, provided with 0.8mg/kg of ketamine + 0.2mg/kg fentanyl + 1mg/kg of Propofol. Patients in both - groups were maintained with O2, N2O, Sevoflurane and measurement of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) was done before induction and 10 minutes after induction before the surgical stimulus. Additional analgesia (0.2 mg/kg ketamine, 0.1mg/kg fentanyl and 0.3 mg/kg propofol, for a total of 1mg/kg ketamine, 0.3 mg/kg fentanyl and 1.3 mg/kg propofol) was supplied to all patients with a VAS > 3 who reported pain. Independent samples t-test and paired t-test were employed for analysis of the collected data.
Results: In Group B (KP), the systolic, diastolic, mean arterial blood pressure, and heart rate changes following LMA implantation were considerably greater than in Group A (P). Group B had longer recovery durations, lower VAS scores immediately following surgery, and less analgesic needs. There was no incidence of apnea, hypoventilation, or emerging responses.
Conclusion: Ketofol (0.8mg/kg ketamine and 1 mg/kg propofol) + 0.2mg/kg fentanyl has multiple advantages than relaying propofol (2.5mg/kg) alone Hemodynamic stability, absence of respiratory depression, rapid recovery, and potent postoperative analgesia. We thus advocate intravenous ketofol as an induction drug, particularly for patients undergoing short surgical operations.

Clinical study of fetomaternal outcome of postdated pregnancy in a tertiary care center

Dr. Chaitali R Pandav, Dr. Varsha L Deshmukh, Dr.Shrinivas Gadappa, Dr.PratikshaKandalkar .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 1741-1748

Background: Postdated pregnancy is one of the commonest obstetric condition. The pregnancy beyond 40 weeks of gestation is called as post dated pregnancy. Post dated pregnancy increases risk to mother and fetus. In mother there is increased risk of induced labour, instrumental delivery and LSCS and associated morbidities. The risks to the fetus also increases inpostdated pregnancy mainly due to increasing fetal weight, decline in placental function, oligohydramnios which increase chances of cord compression, and meconium aspiration.
Methods: This cross sectional observational study of feto-maternal outcome in post dated pregnancy (Women beyond 40 weeks of gestation) was carried out in the department of obstetrics and gynaecology in tertiary care centre from October 2019 to September 2021, willing to participate and fulfilling the inclusion and exclusion criteria in the study period. Results:  Out of total 300 patients,118 patients (60.82%) went into spontaneous labour and delivered vaginally, whereas 102(34%) patients required caesarean section. Induction of labour was done  in 76(39.17%) patients.Conclusions: The present study, we conclude that, the post dated pregnancy can be considered as a high risk factor as there is more fetal morbidity.

EVALUATION OF EFFICACY AND SAFETY OF MISOPROSTOL FOR CERVICALRIPENINGANDINDUCTIONOFLABOURBYTWODIFFERENTROUTES

Dr. Kavita Chhabra, Dr.Divya Saraswat

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 1866-1869

BACKGROUND: Cervical ripening is one of the methods employed for induction of labour.
Cervicalripening involves the usage of pharmacological agents or other means to soften, efface or
dilate thecervix to increase the likelihood of a vaginal delivery. Induction of labour (IOL) is the
process
ofinitiatingcontractionsinpregnantpersonswhoarecurrentlynotinlabour,tohelpthemachievevaginaldel
ivery within 24 to 48 hours. OBJECTIVE OF THE STUDY: The objective of the study is
tocompare the efficacy and safety of two different routes of regimen of misoprostol for cervical
ripeningand induction of labour. MATERIALS &METHODS: This prospective comparative
study, wasconducted in the Department of Obstetrics and Gynaecology at Adesh Medical College,
for a periodfrom may January 2021 to June 2021. We enrolled 100 patients in our study. We
divided the
patientsintotwogroupsrandomlyintoGroupAandGroupB.GroupAweadministeredmisoprostolvaginal
lyandGroupBsublingually.Thedoseusedforboththegroupswas25μg.RESULTS&CONCLUSIONS:
In our study, we found that there were no statistically significant differences indemographis,
Bishops Score after induction, number of doses required, complications (foetal distress,meconium
stained liquor and hyper stimulation), maternal side effects and neonatal Apgar
Scoresbetweenthetwogroups.Therewerestatisticallyhighlysignificantdifferencesintheneedforoxytoci
naugmentation between the two groups. Oxytocin augmentation was more in group B in patients
ascomparedto patients in group A.

A Comparison of Ketamine-Propofol Versus Propofol as Induction Agents on Hemodynamic Parameters in Patients Undergoing Elective Surgical Procedures Under General Anesthesia

Prathap Sidda, Jhansi Gurram

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 5016-5028

Background:Propofol produces quick induction and recovery, depresses airway
reflexes, and is used for sedation and anaesthesia; nevertheless, it is associated with
dose-dependent hypotension and respiratory depression.It can produce coughing,
hiccups, laryngospasm, and movements when used as a sole agent to provide LMA.In
addition to its amnesic and analgesic effects, ketamine raises heart rate and blood
pressure through stimulating the sympathetic nervous system.It was shown that a
combination of ketamine and propofol decreased patients' use of propofol and opioids
and improved their hemodynamic and respiratory stability. Objectives:1. Determine
whether the ketamine-Propofol combination has more favourable hemodynamics than
the gold standard prototypic induction drug (Propofol) in a cohort of healthy patients.2.
To compare the additional post-operative analgesia requirements between the two
groups.
Materials and Methods: Group KP, the Ketamine-Propofol Group, provided 0.75mg/kg
of ketamine and 1.5mg/kg of Propofol to 60 patients with ASA status I who were
randomly divided into two groups. Group P – Propofol Group received 2 mg/kg
Propofol for induction. The airway is secured with LMA, and patients in both groups
were maintained with O2, N2O, and Sevoflurane. For the next 15 minutes, every three
minutes, the baseline hemodynamics, heart rate, NIBP, Spo2, and respiratory rate were
recorded. Pain scores were measured for each subject post-operatively. Additional
analgesia was supplied to all patients with a VAS > 3 who reported pain.
Results: In Group KP, the systolic, diastolic, mean arterial blood pressure, and heart
rate changes following LMA implantation were considerably greater than in Group P.
Group KP had longer recovery durations, lower VAS scores immediately following
surgery, and less analgesic needs. In neither group was there an occurrence of apnea,
hypoventilation, or emerging responses.
Conclusion: Ketofol is a mixture of ketamine and Propofol that has multiple
advantages.Hemodynamic stability, absence of respiratory depression, rapid recovery,
and potent postoperative analgesia. We thus advocate intravenous ketofol as an
induction drug, particularly for patients undergoing short surgical operations.

About Research Of Spectra Of Own Oscillations Thin-Wall Plates In Magnetic Fields

Safarov Ismail Ibrahimovich; Esanov Nuriddin Kurbonovich; Almuratov Shavkat Narpulatovich; Safarov Ismail Ibragimovich; Esanov Nuriddin Qurbanovich

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 7, Pages 1109-1116

The paper considers the problems of natural vibrations of viscoelastic plates with different boundary conditions in magnetic fields.
The aim of the work is to study the oscillations of thin-walled structural elements in a magnetic field: to calculate the spectra of natural frequencies and vibration damping coefficients of rectangular viscoelastic plates with different conditions for fixing the edges, as well as to study the effect of the transverse and longitudinal magnetic field induction on the values of natural frequencies and damping coefficients, as well as their distribution. The validity and reliability of the results of the work is ensured by the correct statement of the problems, the use of applied mathematics metathemes, modern software and the comparison of the results with the results given in scientific publications. For calculations, mathematical packages MATLAB, software environment MAPLE-18 are used.
The paper first obtained analytical solutions for calculating the complex vibration frequencies of viscoelastic plates with a different combination of boundary conditions. A numerical analysis of the oscillations of rectangular viscoelastic plates with different conditions for fixing the edges is carried out, the influence of the transverse and longitudinal magnetic fields on the spectrum of complex frequencies is studied. New effects that the magnetic field exerts on the distribution of natural frequencies and the damping coefficient of the plate element structures are found.

NFLUENCE OF INDUCTION AND INHIBITION OF THE MONOOXYGENASE SYSTEM OF THE LIVER ON THE THYROID STATUS OF THE RAT'S BODY

Abzalova Sh. R.; Yuldashev N. M.; Rasulova M. T.

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 3, Pages 3235-3246

In order to assess the dependence of the thyroid status of the organism on the functional state of the monooxygenase system of the endoplasmic reticulum of hepatocytes in sexually mature male rats, induction and inhibition of the monooxygenase system of the liver by its inductors and inhibitors was caused. As inducers, we used known induction drugs - benzonal (benzobarbital) and zixorin (flumecinol), and as inhibitors a chemical compound - cobalt chloride and a blocker of histamine H2-receptors - cimetidine. Benzonal was administered orally at a dose of 50 mg / kg body weight for 3 days, and zixorin was administered at a dose of 40 mg / kg body weight for 4 days. Cobalt chloride was administered once intraperitoneally at a dose of 30 mg / kg of body weight, and cimetidine was administered orally at a dose of 100 mg / kg for 10 days. It was revealed that during the induction of the monooxygenase system of the liver by its inductors - benzonal and zixorin, there is an increase in the content of thyroid hormones - triiodothyronine and thyroxine in the blood against the background of no change in the level of thyroid-stimulating hormone. When the monooxygenase system of the liver is inhibited by its inhibitors - cobalt chloride and cimetidine, an increase in the content of thyroid hormones - triiodothyronine and thyroxine in the blood is also observed, but against the background of a statistically significant decrease in the content of thyroid stimulating hormone. It is concluded that there is an indirect relationship between the functional state of the monooxygenase system of the liver and the thyroid status of the body.