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All Journal Indian Journal of Forensic Medicine & Toxicology
Jigisha Mehta
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Observational Study to Compare Transdermal Nitroglycerin and Placebo Patch in Enhancing the Post-Operative analgesic Effect of Intrathecal Clonidine with Bupivacaine in Abdominal Hysterectomies Pooja Shah; Kandarp Vyas; Dinesh K. Chauhan; Jigisha Mehta
Indian Journal of Forensic Medicine & Toxicology Vol. 15 No. 2 (2021): Indian Journal of Forensic Medicine & Toxicology
Publisher : Institute of Medico-legal Publications Pvt Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37506/ijfmt.v15i2.14360

Abstract

Background: Hyperbaric Bupivacaine 0.5% is the most commonly used for spinal anaesthesia.To improve thequality & duration of analgesia many adjuvants have been used.Intrathecal clonidine binds with postsynapticalpha-2 receptors at the dorsal horn of the spinal cord,resulting in anti-nociceptive action.Transdermalnitroglycerin (tNTG) has been found to be converting nitroglycerin to Nitric Oxide(NO),which results inpain modulation in the central and peripheral nervous system by cyclic Guanosine Monophosphate(cGMP)through which the post-operative analgesia effect enhances.Method: Sixty patients Of ASA I/II aged between 20to60 years posted for hysterectomy under spinalanaesthesia were selected.Patients were randomly allotted into 2 equal groups.Group A received:Hyperbaric bupivacaine 0.5% (17.5 mg)+clonidine(50 mcg) + placebo patchGroup B received:hyperbaric bupivacaine0.5% (17.5 mg) + clonidine (50 mcg) + nitroglycerin (tntg)patch(nitroglycerin 25 mg/patch)We have observed onset and duration of sensory.and motor block,two segment regression time, duration ofanalgesia, hemodynamic changes and complication if any.Results: There was no statistically significant difference in demographic data and onset and duration ofmotor and sensory block. Duration of analgesia was significantly prolonged in clonidine with tNTG groupas compared to clonidine group with placebo group.Conclusion: Transdermal Nitroglycerin patch with intrathecal clonidine prolonged duration of analgesiawithout any changes in onset and duration of sensory and motor block.
Pain Relief and Post-Operative Outcome in Patients Receiving Tramadol via Thoracic Epidural versus Intravenous Method in Coronary Artery Bypass Graft Surgery Jigisha Mehta; Dr. Mrugank Bhavsar; Sara Mary Thomas; Pooja Shah; Dinesh Chauhan
Indian Journal of Forensic Medicine & Toxicology Vol. 15 No. 2 (2021): Indian Journal of Forensic Medicine & Toxicology
Publisher : Institute of Medico-legal Publications Pvt Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37506/ijfmt.v15i2.14767

Abstract

Background & Objectives:Acute pain is common after cardiac surgery and can keep patients fromparticipating in activities that prevent postoperative complications especially respiratory complications.Accurate assessment and understanding of pain are vital for providing satisfactory pain control andoptimizing recovery.Our aim of the study was to compare pain relief and post-operative outcome in patients receiving Tramadolvia Thoracic epidural versus intravenous method in coronary artery bypass graft surgery.Methodology: Sixty patients aging 40-65 years posted for off pump coronary artery bypass graft surgerywere selected. They were randomly assigned into two groups.Group IVA (n = 30) received Inj. Tramadol(1 mg/kgiv)and Group TEA (n = 30) received Tramadol 0.5 mg/kgepidurallyhalf an hour before shiftingin cardiac recovery room. Hemodynamic parameters like Heart rate, systolic and diastolic blood pressure,pulmonary artery pressure were recorder for 72 hours postoperatively. We have compared extubation timein both the groups. Pain was assessed by visual analogue scale (VAS). Any patients with the VAS more than4 were treated with rescue analgesic. Duration of analgesia and total no. of rescue analgesia were recorded.Duration of stay in cardiac recovery room and in hospital was also recorded.Observation & Results: We have observed statistically significant difference in hemodynamic parametersbetween two groups with better stability in TEA group from shifting till next 72 hours. Extubation time wasalso earlier in TEA group. Mean duration of analgesia and VAS score was also better TEA group. All theseled to shorter length of cardiac recovery stay and earlier discharge from the hospital with less complication.Conclusion: Thoracic epidural analgesia is better than intravenous technique in terms of earlyextubation,maintaining hemodynamic stability and better postoperative analgesia with reduced length ofcardiac recovery and hospital stay.
An Observational Study to Compare the Effects of Esmolol and Diltiazem in Attenuating the Haemodynamic Response to Laryngoscopy and Endotracheal Intubation Dinesh Chauhan; Avani Vayeda; Jigisha Mehta
Indian Journal of Forensic Medicine & Toxicology Vol. 15 No. 3 (2021): Indian Journal of Forensic Medicine & Toxicology
Publisher : Institute of Medico-legal Publications Pvt Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37506/ijfmt.v15i3.15301

Abstract

Background - Laryngoscopy and endotracheal intubation are two most essential part of anaesthetic management. They help in control of airway during general anaesthesia and produce transient marked sympathetic response which manifest as an increase in heart rate, blood pressure, intraocular and intracranial pressure. Esmolol is a selective beta adrenergic receptor antagonist and diltiazem is a calcium channel blocker. The drugs were compared towards reducing the haemodynamic stress response.Methods –This study included 50 patients of both gender, with ASA grade I to IV, aged between 18 to 60 years, scheduled for surgery under general anaesthesia. Among these 25 patients were given inj. esmolol with dose of 1mg/kg i.v.bolus and 25 patients were given inj. diltiazem with dose of 0.2mg/kg i.v.bolus . The haemodynamic parameters were recorded at baseline , just after premedication , after injecting the drug under study, after intubation at 1 , 3 , 5 and 10 minutes. Conclusion –Patients who received inj. esmolol in dose 1mg/kg i.v. showed marked attenuation in both heart rate as well as systolic and diastolic blood pressure whereas inj. diltiazem with dose of 0.2mg/kg only showed attenuation in systolic and diastolic blood pressure but failed to achieve any control over heart rate.
Co-Authors Avani Vayeda Dinesh Chauhan Dinesh K. Chauhan Dr. Mrugank Bhavsar Kandarp Vyas Pooja Shah Sara Mary Thomas