KOPS AWARD ABSTRACTS: CLINICAL PHARMACOLOGY
Year : 2020 | Volume
: 64 | Issue : 13 | Page : 29--34
KOPS Award Abstracts: Clinical Pharmacology
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. KOPS Award Abstracts: Clinical Pharmacology.Indian J Anaesth 2020;64:29-34
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. KOPS Award Abstracts: Clinical Pharmacology. Indian J Anaesth [serial online] 2020 [cited 2020 Aug 12 ];64:29-34
Available from: http://www.ijaweb.org/text.asp?2020/64/13/29/277900
Abstract ID: ISAP209: End-tidal control (TM) reduces sevoflurane consumption in low flow anaesthesia in comparison to manual control.
Shravan Kumar Amaravadi Venkata, Soujanya Shetty, Gundappa Parameswara
Manipal Hospitals, Bangalore
Background & Aims: Et-Control in GE Aisys CS2 workstation is a closed-loop control system for volatile anaesthetic agents. Aladin2 vaporizer enables automated delivery of fresh gases and inhalational agents by employing feedback mechanisms between expiratory and inspiratory circuits of the low-flow circle system. It was reported to reduce the overall consumption of inhalational agents and fresh gases. We aimed to estimate the consumption of sevoflurane with Et-Control and compare with manual delivery of sevoflurane during low-flow anaesthesia.
Methods: After ethical committee approval, 70 patients (American Society of Anaesthesiologists grades I–II, 18–60 years) were randomised into those who underwent general anaesthesia with sevoflurane via Et-Control (ET-C Group,n=35) and those who underwent the same without Et-Control (M-C Group,n=35). Target minimum alveolar concentration (MAC) was set to 1.0 and fresh gas flow at 1 liter/minute. Following parameters were documented: demography, time of Sevoflurane initiation, time to achieve target MAC, total fresh gases and Sevoflurane consumed after extubation. The groups were compared using two-tailed unpaired Student's t-test.
Results: There were no differences in ASA grades and age of patients between the groups. The mean hourly consumption of sevoflurane was lesser in the ET-C Group (7.9±1.1 ml/h) than in M-C Group (8.9 ±1.2 ml/h) (p<0.001). There was no significant difference in the oxygen (1.53±0.49 L/min: ET-C, 1.57±0.61 L/min: M-C; p=0.75) or air (0.499±0.16 L/min- ET-C, 0.508±0.124 L/min- M-C; p=0.66) consumption between the groups.
Conclusion: Sevoflurane consumption was lower and the time to achieve target MAC was shorter in low-flow anaesthesia using Et-Control when compared with manual control.
Lucangelo U, Garufi G, Marras E, Ferluga M, Turchet F, Bernabè F et al. End-tidal versus manually-controlled low-flow anaesthesia. J Clin Monit Comput. 2014 Apr;28(2):117-21. doi: 10.1007/s10877-013-9516-8. Epub 2013 Oct 11.End-tidal Control software for use with Aisys closed circuit anaesthesia systems for automated gas control during general anaesthesia. Available at: https://www.nice.org.uk/advice/mib10/resources/endtidal-control-software-for-use-with-aisysclosed-circuit-anaesthesia-systems-for-automated-gas-control-during-general-anaesthesia-pdf-63498977944261 last accessed 18th Nov 2019.
Abstract ID: ISAP676: “Comparision of manual versus target controlled infusion of propofol in laparoscopic surgeries.”
Brijal N. Patel, Jasmita Kalo, Kalpana S. Vora, Bina Butala
Background and aims: Development of newer infusion system and newer short acting drugs has increased practice of total intravenous anesthesia(TIVA). Target controlled infusion (TCI) provide improved convenience and control during TIVA, as it allows to select blood concentration required for particular effect and control of depth of anesthesia. This study was conducted to evaluate impact of anesthesia via target controlled infusion on drug consumption, intraoperative hemodynamic stability and recovery compared to manual controlled infusion.
Methods: After ethical committee approval and informed consent of patient, 50 patients were enrolled with 25 in each group. In group MCI, induction with inj. Propofol 2 mg/kg followed by infusion 10 ml/kg/hr. In group TCI, brain concentration of 6mcg/ml followed by infusion of 3mcg/ml using schnider model. Heart rate (HR) , mean arterial pressure (MAP), ETCO2 and bispectral index (BIS) were monitored at T0- preoperative,T1- premedication, T2- after administration of Propofol, T3- intubation, T4- 5 min after intubation, T5- pneumoperitoneum, every 15 min after pneumoperitoneum, at extubation and return of spontaneous respiration.
Results: Stable hemodynamic profile with respect to heart rate, mean arterial pressure and ETCO2 seen in both groups, but intubation stress response was successfully blunted in group TCI. Total dosage of Propofol was higher in group MCI compared to group TCI.
Conclusion: Both target controlled infusion and manual controlled infusion were comparable in terms of clinical performance. However target controlled infusion is better than manual controlled infusion as it provides stable plasma concentration and simplifies the complex manual regime
Leslie, K., Clavisi, O., and Hargrove, J. Target-controlled infusion versus manually-controlled infusion of propofol for general anaesthesia or sedation in adults. Cochrane Database Syst Rev. 2008; CD006059Russell, D., Wilkes, M.P., Hunter, S.C., Glen, J.B., Hutton, P., and Kenny, G.N. Manual compared with target-controlled infusion of propofol. Br J Anaesth. 1995; 75: 562–566
Abstract ID: ISAP407: Comparative study of melatonin receptor agonists as oral premedication in oncoanesthesia: A randomized controlled study.
Ravikiran H M, Kavitha Lakshman, Namrata Ranganath,
Department of Anesthesiology and Pain Relief, Kidwai Memorial Institute of Oncology, Bangalore.
Background and aims: Preoperative-anxiety can cause various physiological and psychological responses. Oncosurgical patients are more anxious. Melatonin is found to have anxiolytic property without side-effect. Ramelteon is selective Melatonin-receptor agonist. There is a need for study to compare efficacy of these two drugs. Our primary objectives were to compare the effect on anxiety, sedation and orientation. Secondary objectives were to compare response to intubation and side-effects.
Methods: After ethical-committee clearance, 180 American-Society-of-Anaesthesiologist(ASA) classes I and II patients requiring general anesthesia with endotracheal intubation were randomized into 3 groups: Group-A Ramelteon:8mg, group-B:Melatonin 6mg and group-C:placebo given orally 90min prior to surgery. Visual-analogue-scale:VAS for anxiety, Ramsay-Sedation-Score:RSS, Orientation-log(O-log) score recorded before premedication and 90min later. Heart rate and blood pressure recorded immediately after intubation, 5, 10 and 15min thereafter. Side-effects were noted. Qualitative and quantitative data were represented as frequencies and mean, Chi-square test and ANOVA test used for test of significance respectively. T-test and Wilcoxon-test used to compare before and after drug administration. Post-hoc-Bonferroni test to compare between two groups.
Results: ASA and demographic were comparable in all groups. Significant reduction in mean VAS seen in all group, median RSS was higher in study groups, orientation not affected in study groups, HR and BP was higher in placebo when compared to study groups. No significant difference in HR and BP between Melatonin and Ramelteon. No significant side effect observed.
Conclusion: Premedication with Ramelteon 8mg is similar to Melatonin 6mg in providing adequate anxiolysis with sedation and without causing any disorientation or side effects.
Patel T, Kurdi MS. A comparative study between oral melatonin and oral midazolam on preoperative anxiety, cognitive, and psychomotor functions. Journal of anaesthesiology, clinical pharmacology. 2015 Jan;31(1):37.Mallick S, Mandal US, Halder A, Moulik SG, Hazra SK, Biswas A. Comparison of Ramelteon with Clonidine as an Adjuvant to Anesthesia: A Placebocontrolled, Randomized, Doubleblinded Trial. Karnataka Anaesthesia Journal. 2015;1(2):37-41.
Abstract ID: ISAP409: Effect of premedication with magnesium sulphate on intraoperative sevoflurane requirements during general anaesthesia
Uma, Siva Prasath, Selva Kumar
Madurai Medical College
Background & Aims: In this study we tested the effect of premedication with Magnesium Sulphate on Sevoflurane requirement per hour to maintain a BIS score 50. The secondary outcome was the dosage of muscle relaxant used per hour and quality of recovery
Methods: Randomised placebo controlled double blind study. Adult patients undergoing tracheal intubation and general anaesthesia enrolled in the study were divided into 2 groups .sample sie 20 members. Group P [PLACEBO] & GROUP M [ MAGNESIUM SULPHATE]. Group M given intra venous magnesium sulphate at 40mg/kg 20 minutes prior to induction. Sevoflurane started at 2% for a fresh gas flow of 2 litres. Once BIS 50 reached inspired concentration of sevoflurane reduced to maintain BIS around 50. Total volume of sevoflurane consumed calculated using DEONS equation, and hourly consumption calculated, total dose of Atracurium usage calculated, post operative recovery assessed using Aldrete score
Results: The Mean comsumption of sevoflurane was reduced by 28% in patients premedicated with Magnesium sulphate which was statistically significant. The Atracurium dose was reduced by 15 % and there was no significant differences in quality of recovery Scores
Conclusion: Magnesium sulphate premedication results in reduction of sevoflurane consumption but not atracurium consumption.
Telci L, Esen F, Akcora D, Erden T, Canbolat AT, Akpir K. Evaluation of effects of magnesium sulphate in reducing intraoperative anaesthetic requirements. Br J Anaesth 2002; 89: 594–598.Koinig H, Wallner T, Marhofer P, Andel H, Horauf K, Mayer N: Magnesium sulfate reduces intra- and postoperative analgesic requirements. Anesth Analg 1998; 87:206–10
Abstract ID: ISAP426: Effect of intraoperative dexmedetomidine infusion on isoflurane requirement and blood glucose levels during bis-guided general anaesthesia
Prajna Nanda, S Sanjib Patra
SCB MCH Cuttack, Odisha
Background and aims: Dexmedetomidine as a selective adrenergic alpha-2 receptor agonist is found to blunt the stress response to surgical trauma that causes hyper-glycemia. It can decrease the MAC of volatile anaesthetics. The study was conducted to assess the effect of intravenous Dexmedetomidine on levels of blood glucose, which is one among several stress response markers and Isooflurane requirements in General Anesthesia for patients undergoing neurosurgery.
Methods: This is a prospective, randomized, double blinded study, conducted between august 2018 to august 2019 after ethical committee approval. 40 patients aged 20 -60 years scheduled for neurosurgery under general anaesthesia were divided in to Dexmedetomidine (D)group and Placebo(P) group of 20 each. Group D received a loading dose of inj Dexmedetomidine at 1μg/kg/10min diluted to 20 ml,followed by maintainance with 0.5μg/kg /hr, till the end of surgery .Group P received similar volume of IV normal saline over 10 mins .Anaesthesia was maintained with nitrous oxide in oxygen and Isoflurane keeping BIS between 40 and 60. Hourly estimation of blood glucose and isoflurane consumption based on Dion's formula was done. Hemodynamic parameters and BIS were continuously monitored.
Results: Demographic parameters were comparable. During 1st h of post-operative period blood glucose elevated in group P (136.95 ± 26.21 mg/dL) in compariosion with group D (118.53 ± 16.55 mg/dL) (P = 0.002) which is stastically significant. Mean isoflurane consumption is significantly higher (p<0.05) in group P than group D at end of 1st hour ,2nd hour, and also 3rd hour. There was a clinically and statistically significant reduction in heart rate (HR) in group D throughout intraoperative period compared to group P (P < 0.05). But mean arterial pressure in both groups was comparable.
Conclusion: Dexmedetomidine as a preanesthetic medication and intraoperative infusion was effective in blunting metabolic stress response to major surgeries as indicated by stable blood glucose levels. It also decreased intraoperative anesthetic requirement during BIS guided general anesthesia.
Magalhães E, Govêia CS, Ladeira LC, Espíndola BV. Relationship between Dexmedetomidine continuous infusion and end-tidal Sevoflurane concentration, monitored by bispectral analysis.Rev Bras Anestesiol. 2004;54:303–10. [PubMed: 19471738].Shafiq F, Naqvi HI, Ahmed A. Effects of bispectral index monitoring on isoflurane consumption and recovery profiles for anesthesia in an elderly Asian population. J Anaesthesiol Clin Pharmacol 2012;28:34852.
Abstract ID: ISAP459: Emergence delirium following nasal surgery: A comparison of two different doses of intravenous dexmedetomidine
Chandan N, Rehana Sikora, K. Ramachandra Reddy, Shashikanth Reddy
Manipal Hospitals, Bangalore
Background & Aims: Emergence delirium is common after nasal surgery. We compared the effectiveness of two different doses of intravenous dexmedetomidine in reducing the incidence of emergence delirium after nasal surgery.
Methods: After hospital ethical clearance, a prospective double blinded randomised study was conducted on 72 ASA1 and 2 patients, aged between 18-60 years undergoing nasal surgery of < 90 minutes duration were randomly assigned to group A (0.5mcg/kg) and group B (1.0mcg/kg). Patients with BMI ≥30kg/m2, history of usage of MAO inhibitors/adrenergic blocking drugs/anti psychotics and alcohol abuse were excluded. Conduct of general anaesthesia was standardized for induction and maintenance of anaesthesia. Study drug was infused at induction of anaesthesia over 10 minutes. Incidence of emergence delirium, hemodynamics, duration of emergence, intra operative analgesic requirement, post operative pain and adverse effects were recorded. Student T test and chi-square test were used .
Results: Incidence of emergence delirium was comparable between the two groups [28vs19%, P=0.405]. Group B had lower systolic blood pressure at 15 and 30 min interval after drug administration (P≤0.05). Time of emergence from anaesthesia was shorter in group A compared to group B (P≤0.001). Mean NRS scale for post operative pain was higher in group A than group B (P≤0.001). Intra operative mean heart rate, incidence of bradycardia/hypotension and requirement of intraoperative rescue analgesia were comparable between the two groups.
Conclusion: Administration of low dose of IV dexmedetomidine (0.5mcg/kg) at induction of anaesthesia, as a bolus over 10 minutes is as effective as high dose (1.0mcg/kg) in reducing the incidence of emergence delirium.
Abstract ID- ISAP230: Serum triglyceride level after target controlled infusion of propofol for anaesthesia
Prajna Jayaram, Thamanna Ahmed, Thrivikrama Padur Tantry
Background and Aims: To analyse if medium chain triglyceride- long chain triglyceride( MCT-LCT) propofol is superior to long chain triglyceride( LCT) propofol in causing less derangement of serum triglycerides.
Methods: Fifty patients expected to undergo various elective procedures were randomized into 2 groups; 25 received intravenous propofol infusion with 1% LCT propofol, another 25 received 1% MCT-LCT propofol infusion, both administered through a target controlled infusion(TCI) pump. Blood samples drawn and serum lipid profile was done at various intervals postoperatively for both the groups that is on termination of infusion, after 4 hours of termination of infusion and next day. Parameters studied were pre-induction and post-induction serum triglycerides, awake time, hemodynamic fluctuations. A 'P' value of less than 0.05 is considered statistically significant.
Results: STG levels elevated significantly above the baseline in both the groups but the rise was significantly higher in the LCT group. After 4 hours of stopping infusion, the mean values dropped significantly in MCT group.
Conclusion: We conclude that infusions with LCT (1%) and MCT-LCT propofols (1%) lead to elevated STG levels. However, ratio of rise of STG levels is much less for MCT-LCT propofol than LCT propofol.
James R, Glen JB. Synthesis, biological evaluation, and preliminary structureactivity considerations of a series of alkylphenols as intravenous anesthetic agents. J Med Chem. 1980 Dec;23(12):1350-7Borgeat A, Wilder-Smith OH, Suter PM. The nonhypnotic therapeutic applications of propofol. Anesthesiology. 1994 Mar;80(3):642-56
Abstract ID: ISAP189: To assess the effects of two different doses of intranasal nitroglycerine for attenuation of hemodynamic stress response due to pneumoperitoneum in laparoscopic surgeries
Malarvizhi R, Nethra SS, Swathi N, Sudheesh K
Bangalore Medical College and Research Institute, Bangalore
Background & Aims: Stress response due to pneumoperitoneum can be detrimental in susceptible patients. We investigated two different doses of intranasal nitroglycerine on attenuation of hemodynamic response to pneumoperitoneum in laparoscopic surgeries.
Methods: Following ethical committee clearance, a prospective clinical trial performed on 70 subjects belonging to ASA physical status 1 or 2 posted for elective laparoscopic cholecystectomies under general anaesthesia. After randomisation, Group N4 received 400 mcg of nitroglycerine spray and other group N8 received 800 mcg of nitroglycerine spray intranasally before creation of pneumoperitoneum. Mean arterial pressure (primary outcome), systolic blood pressure, diastolic blood pressure, heart rate and associated side effects were noted intra operatively. Data analysis was done with analysis of variance, student's t test, chi square test or Fisher's exact probability test and final analysis using SPSS version 22.0 (IBM SPSS Statistics, Somers NY, USA). P value less than 0.05 was considered statistically significant.
Results: The demographic variables such as patient characteristics and duration of pneumoperitoneum were comparable between the 2 groups. Heart rate between the groups were comparable throughout but showed highly statistical significance within the groups. Mean arterial pressure was statistically significant between groups. Also, group N8 showed statistical significance only upto 6 minutes of drug administration in intragroup analysis.
Conclusion: Nitroglycerine spray 400 mcg intranasally is sufficient to obtund pneumoperitoneum response compared to 800 mcg and can be beneficial even in high risk patients with coronary heart disease.
Ramsay J, Peatross C; Vasodilators. Pharmacology and Physiology in Anaesthetic Practice. Fifth edition; 2015.511.Kumari I, Naithani U, Pradeep DS, Dadheech VK, Meena K, Verma D. Attenuation of pressor response following intubation: Efficacy of nitroglycerine lingual spray. J Anaesthesiol Clin Pharmacol . 2016 Jan –Mar ;32(1):69-73
Abstract ID: ISAP544: Comparison of hemodynamics and opioid sparing effect of dexmedetomidine nebulization and intravenous dexmedetomidine in laparoscopic surgeries under general anaesthesia: Prospective randomized controlled trial
Kailash P, Shankar K, Rangalakshmi S
Rajarajeswari Medical College and Hospital, Bangalore
Background and aims: Haemodynamic changes are common in laparoscopic surgeries. Intravenous dexmeditomidine prior to induction can exaggerate hypotension and bradycardia caused by propofol. There is also increased demand to a avoid opiods due to various side effects. We compared the effect of Dexmedetomidine nebulization prior to induction of anesthesia with intravenous dexmeditomidine and fentanyl on haemodynamic changes in laparoscopic surgeries under general anesthesia
Methods: After ethical committee clearance and consent, study was performed. 90 ASA I and II patients aged 18-65 years undergoing laparoscopic surgeries under general anaesthesia randomized into 3 groups.
Group N- Nebulised with dexmedetomidine 2mcg/kg volume 3 ml 15minutes before induction and 10ml of normal saline intravenous injection over 10 minutes at the time of induction.
Group I-Nebulised with normal saline (NaCl 0.9%) 3 ml 15 minutes before induction and intravenous dexmedetomidine 1mcg/ kg made upto 10 ml over 10 minutes at the time of induction
Group C- nebulised with normal saline (NaCl 0.9%) 3 ml 15 minutes before induction and intravenous fentanyl 2mcg/ kg made up to 10ml over 10 minutes at the time of induction.
Haemodynamic parameters were recorded throughout the surgery and postoperative period.
Results: Demographics of patient were comparable. Suppression of haemodynamic response during intubation and pneumoperitoneum by nebulised dexmeditomidine was better than Intravenous dexmedetomidine and comparable to Intravenous fentanyl. Haemodynamic stability was better in nebulization dexmedetomidine.
Conclusion: Dexmeditomidine nebulisation can be an acceptable alternative to Intravenous dexmeditomidine with better haemodynamic stability as premedication agent. Haemodynamic stability was better with nebulized Dexmedetomidine at the time of induction.
Vora K, Shah V, Parikh G, Baranda U, Modi M, Butala B. The effects of dexmedetomidine on attenuation of hemodynamic changes and there effects as adjuvant in anesthesia during laparoscopic surgeries. Saudi J Anaesth. 2015;9(4):386Kumar A, Kumari P, Sinha C, Kumar A, Kumar R, Kumar A. Dexmedetomidine nebulization as adjuvant to lignocaine during awake flexible fiberoptic intubation. Saudi J Anaesth 2019;13:152-3.
Abstract ID: ISAP091: Comparison of oral clonidine and moxonidine on sensory and motor characteristics of subarachnoid block
Shreyas S Bhat, Sudheesh K, Nethra SS, Devika Rani
Bangalore Medical College and Research Institute, Bangalore
Background and aims: Moxonidine is a selective alpha 2 adrenergic agonist used in the treatment of hypertension with good proven analgesic property. Moxonidine has also been found to reduce hemodynamic stress response during laparoscopic surgeries. However, its efficacy on blockade characteristics of spinal anaesthesia has not been studied. This study is undertaken to evaluate the efficacy of oral moxinidine premedication over clonidine on sensory and motor characteristics of subarachnoid block with bupivacaine.
Methods: 60 patients undergoing surgeries under subarachnoid block were randomized into 2 equal groups. Group A were premedicated with moxonidine 0.4mg and Group B with clonidine 0.1mg 1 hour prior to subarachnoid block with bupivacaine 0.5%(H.). Time required to attain sensory and motor blockade along with haemodynamic parameters, two segment regression time, duration of sensory block and postoperative analgesia and analgesic requirement over 24 hours were compared between two groups. Statistical tests were applies appropriately.
Result: There was no significant difference between the groups A and B regarding sensory blockade onset and 2 segment regression time ((107.90±20.28 VS 107.10±14.13, P=0.856). Moxonidine provided similar hemodynamic profile and duration of analgesia compared to clonidine.
Conclusion: This study concludes that oral moxonidine is not a superior drug compared to clonidine when given prior to subarachnoid block.
Gupta K, Singh I, Singh VP, Gupta PK, Tiwari V. Preemptive analgesia of oral clonidine during subarachnoid block for laparoscopic gynecological procedures: A prospective study. Anesth Essays Res 2014;8:187-91Bektas N, Nemutlu D, Arslan R. The imidazoline receptors and ligands in pain modulation.Indian J Pharmacol.47(5): 472-478.