Background: Shiveringis a common complication following anesthesia. Many drugs have been documented as a prophylaxis of postanesthesia shivering. The aim of this study was to find out a better drug as an antishivering agent. Materials and methods: This comparative study was carried out in the Department of Anesthesiology in Chittagong Medical College Hospital over a period of 6 months starting from November 2015 to April 2016. A total 90 obstetric patients with American Society of Anesthesiology (ASA) physical status I & II underwent cesarean section received placebo (Group-C, n-30), Inj-Ondansetron 8mg (Group-O, n-30) and Inj-Meperidine 0.4mg/kg (Group-M, n-30). These drugs were administered during intraoperative period just after cord clamp. Incidence of shivering, hemodynamic parameters were observed immediate after spinal anesthesia & then 5 min interval for 30 min throughout the intraoperative period. Results: Shivering was observed in 16 patients (53.33%) of group-C, 4 patients (13.33%) of group O and 8 patients (26.66%) of group M. The number of patient with a shivering grade 3 & 4 were very highly significant (p<0.001) in group C compared with other groups at 15 min & 20 min after block & significant (p<0.05) at 25 min & 30 min after block. Conclusion: Ondansetron was found to be more effective and haemodynamically stable drug than Meperidine in prophylaxis of post spinal shivering. JCMCTA 2021 ; 32 (1) : 53-58
Background: Infection with high-risk human papilloma virus (HPV) has been recognised as a causal factor for development of cervical pre-cancerous and cancerous lesions. So far more than 150 types of HPV are identified. Their distribution varies from country to country, also from region to region. Background knowledge about the distribution of HPV genotypes in invasive cervical cancer is crucial to guide the introduction of prophylactic vaccines. Objective: The study was aimed to assess the distribution of type specific human papilloma Virus DNA among cervical cancer patients. Methods: The study was a cross sectional, observational and single centred one. It was carried out in the department of gynaecological oncology, of Bangabandhu Sheikh Mujib Medical University (BSMMU). Purposive sampling was done according to the availability of patients. Results: HPV type 16 was detected in 35 cases (76.1%) followed by type 18 in 4 (8.7%) cases of cervical carcinoma. HPV 39, 56 and 68 were also detected, each was in 1 case (2.2 %). It was to be also found that 1 co-infection (2.2%) with HPV 33+35. HPV 16 was detected in 79.4 % of squamous cell carcinoma and in 70.0% of adenocarcinomas. HPV 18 was detected in 5.9 % of squamous cell carcinoma and 20.0% of adenocarcinomas. HPV 39 was detected in one case of small cell carcinoma (100.0%). One case of HPV 68 (2.9%) and one coinfection with HPV 33+35 (2.9 %) were found in squamous cell carcinoma. One case of HPV 56 (10.0%) was detected in adenocarcinoma of cervix. HPV DNA was not found in 3 cases of squamous cell carcinoma of cervix. Conclusion: The distribution of HPV infection among Bangladesh women is similar to other regions of Asia. However, type specific patterns are different. The study findings will guide the formulation of HPV vaccination policies in Bangladesh, impact of vaccination programmes, to predict the efficacy of cost effective prophylactic vaccine, introduction of newer generation vaccine and finally prevention of cervical carcinoma in the country. Bangladesh Med Res Counc Bull 2022; 48(1): 48-55
Background: The Oculocardiac reflex (OCR) is a well-known complication of ocular surgery involving direct or indirect manipulation of the eye or ocular adnexa. While most commonly associated with eye muscle surgery, with a reported incidence of 40-93%, it is prevalent during traction on the extraocular or eyelid muscles, compression of the globe, intraocular and retro bulbar injection, iris traction, retinal reattachment surgery and enucleation procedures and may manifest as a wide range of arrhythmias including ventricular bigeminy, bradycardia and asystole. Occurrence of the reflex in eye muscle surgery has been documented to increase with hypoxia and decrease with aging and premedication with anticholinergics, namely glycopyrrolate or atropine. Objective: The purpose of our study was to determine the degree of change in heart rate (HR) and systolic blood pressure (SBP) during Enucleation surgery in patients anaesthetized with equipotent concentrations of Isoflurane or Halothane breathing via a laryngeal mask airway (LMA). Methods: The study was designed as a prospective randomizedstudy. Fifty patients, having selected for Enucleation were randomized to Isoflurane (I) or halothane (H) in 66% nitrous oxide at 1.3 minimum alveolar concentration. Patients breathed through a laryngeal mask airway (LMA) and were not pretreated with anticholinergics. Results: The Oculocardiac reflex (OCR), defined as a 20% decrease in heart rate (HR) from baseline, dysrhythmias or sinoatrial arrest concomitant with ocular muscle traction occurred less frequently with Isoflurane than with halothane (I: 37%, H:78%, P = 0.009). The HR during induction was higher with Isoflurane (I: 110 ± 13 bpm, H: 100 ± 15 bpm, P = 0.002). The lowest HR occurred with halothane (I: 94 ± 22 bpm, H: 72 ± 19 bpm, P = 0.001). The incidence of dysrhythmias was higher in the halothane group (I 4%, H: 42%, P = 0.004). Isoflurane may be a more suitable anaesthetic than halothane for operations involving traction on the ocular muscles with controlled respiration in patients because of reduced incidence of OCR with slightly higher airway irritability. Conclusion: Some patients experience a sudden slowing of the heart when the surgeon pulls on the eye muscles during Enucleation operations under anaesthesia. We found that Isoflurane was associated with a lower incidence of the OCR but relatively higher airway irritability compared with halothane. The oculocardiac reflex possesses the potential for significant morbidity and mortality. While some have documented factors affecting the OCR during eye muscle surgery, our data could not prove such a relationship during enucleation. J. Natl. Inst. Ophthalmol. 2022;5(1):21-26
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