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Goyal, Ritu
- A Pilot Study of the Efficacy of Intrathecal Neostigmine for Postoperative Analgesia in Lower Abdominal and Lower Limb Surgery at SIMS, Ghaziabad, Uttar Pradesh
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Authors
Affiliations
1 Department of Anaesthesia, Sarswathi Institute of Medical Sciences, NH-24 Anwarpur, Hapur, Ghaziabad 245304, IN
1 Department of Anaesthesia, Sarswathi Institute of Medical Sciences, NH-24 Anwarpur, Hapur, Ghaziabad 245304, IN
Source
Indian Journal of Public Health Research & Development, Vol 3, No 1 (2012), Pagination: 136-138Abstract
Intrathecal neostigmine had been used in various doses to produce analgesia without neurotoxicity in both animal and human studies. The present study was conducted using 50μg intrathecal neostigmine methylsulphate with 12.5mg bupivacaine (0.5% heavy) for optimum duration of post-operative analgesia with minimal side effects. In this study 100 patients belonging to ASA physical status I and II, age 20-70 years of either sex scheduled for elective lower abdominal and lower limb surgeries under spinal anaesthesia were included. Patients were randomly allocated in two groups: group I (n=50, control) received 2.5ml bupivacaine + 0.5ml of normal saline and group II (n=50, test) received 2.5ml bupivacaine +0.5ml of neostigmine (50μg). Time of onset of sensory and motor block, highest level of block, duration of analgesia and side effects like hypotension, bradycardia, nausea, vomiting, etc were recorded. Onset time of sensory and motor block was much faster In bupivacaine and neostigmine group as compared to bupivacaine group. Patients were pain free for average 6-7 hours with bupivacaine and neostigmine as compared to 3-4 hours with bupivacaine. It was concluded that intrathecal neostigmine in the dose of 50μg provide post-operative analgesia for a period of 6-8 hours with lesser incidence of side effects of nausea and vomiting.Keywords
Anaesthesia, Spinal Anaesthesia, Drugs, Bupivacaine, Neostigmine
References
- Hood DD, Eisenach JC, Tuttle R. Phase I safety assessment of intrathecal neostigmine methylsulfate in humans. Anaesthesiology 1995:82:331-343.
- Yaksh TL, Dirksen R, Harty GJ. Antinociceptive effects of intrathecally injected cholinomimetic drugs in the rat and cat. Eur J Pharmacol 1985 117: 81-8.
- Krukowski JA, Hood DD, Eisenach JC and et al. intrathecal neostigmine for post caesarean section analgesia: Dose response. Anesth Analg 1997; 84: 1269-75.
- Eisenach JC, Detweiler DJ, Tong Cy and et al. Cerebrospinal fluid norepinephrine and acetylcholine concentrations during acute pain. Anesth Analg 1996; 82: 621-6.
- Hood D.D., Eisenach J.C., Tong C., Tommasi E., Yaksh T.L.Cardio respiratory and spinal cord blood flows effects of intrathecal neostigmine methy1sulphate, clonidine and their combination in sheep. Anesthesiology 1995; 82: 428-435.
- Chung CJ, Kim JS, Park HS, Chin YJ. The efficacy of intrathecal neostigmine, intrathecal morphine and their combination for post cesarean section analgesia. Anesth Analg 1998; 87: 341-6.
- Mainvsky J.M., Renaud G., Le Corre P.Intrathecal bupivacaine in humans: effects of volume and baricity on spinal effects. Anesthesiology 1999; 91:1260-1266.
- Krukowski J.A., Hood D.D., Eisenach J.C. and et al. Intrathecal neostigmine for post cesarean section analgesia; dose response. Anesth Analg. 1997; 84: 1269-1275.
- Batra YK, Rajeev S, Panda NB and et al. Intrathecal neostigmine With bupivacaine for infants undergoing lower abdominal and urogenital Procedures dose response.Acta Anaesthesiol Scand 2009;Apr,53(4);470-5
- Tan PH, Kuo JH, Liu K, Hung CC. Efficacy of intrathecal neostigmine for the relief of post inguinal herniorrhaphy pain. Acta Anaesthesiol Scand 2000; 44:1056-60.
- Liu SS, Hodgson PS, Moore JM, Trautman WJ. Dose response effects of spinal neostigmine added to bupivacaine spinal anesthesia in volunteers. Anesthesiology 199; 90: 710-7.
- Saini S, Sethi S, Malhotra N Evaluation of Intrathecal Neostigmine for postoperative Analgesia J Anaesth Clin Pharmacol 2006; 22(1) : 35-40
- Gupta S.Postoperative Analgesia With Intrathecal Neostigmine; Two Different doses Of 75 µgms And 50 µgms With Heavy Bupivacaine. The Internet journal of Anaesthesiology ISSN 1092-406X
- Lauretti GR, Hood DD, Eisenach JC. A multicenter study of intrathecal neostigmine for analgesia following vaginal hysterectomy. Anesthesiology 1998; 89: 913-8.
- Klamt JG, Slullitel A, Garcia IV, Prado WA. Postoperative analgesic effect of Intrathecal neostigmine and its influence on spinal anaesthesia. Anaesthesia s1997; 52: 547-51.
- A Pilot Study Comparing Propofol-Thiopentone Admixture with Propofol-Ketamine Admixture for Ambulatory Anaesthesia at SIMS, Ghaziabad, Uttar Pradesh
Abstract Views :412 |
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Authors
Affiliations
1 Department of Anaesthesia, Saraswathi Institute of Medical Sciences, N. H.- 24 Anwarpur, Hapur, Ghaziabad, U.P.245304, IN
2 Department of Surgery, Saraswathi Institute of Medical Sciences, N. H.- 24 Anwarpur, Hapur, Ghaziabad, U.P.245304, IN
1 Department of Anaesthesia, Saraswathi Institute of Medical Sciences, N. H.- 24 Anwarpur, Hapur, Ghaziabad, U.P.245304, IN
2 Department of Surgery, Saraswathi Institute of Medical Sciences, N. H.- 24 Anwarpur, Hapur, Ghaziabad, U.P.245304, IN
Source
Indian Journal of Public Health Research & Development, Vol 3, No 2 (2012), Pagination: 147-150Abstract
In the present study, we aimed to compare the efficacy, tolerability, cardiovascular stability and recovery profile of propofol-thiopentone admixture with propofolketamine admixture in patient undergoing short surgical procedures. Sixty ASA grade I and II patients, age group 20-50 years of either sex scheduled for elective ambulatory surgical procedures were included. Patients were randomly allocated in two groups. Patients in group PT(n=30) were induced with admixture containing 10 ml of 1% propofol and 10 ml of 2.5% thiopentone and in group PK(n=30) were induced with admixture containing 10 ml of 1% propofol and 10 ml of 0.5% ketamine till loss of verbal response. Top up doses for maintenance were given as 2ml aliquots of the study drug. Induction dose and total maintenance dose of the drug, pain on injection, episode of apnoea, incidence of laryngospasm, bronchospasm, cough, hiccup and emergence phenomenon were recorded. Patients were monitored for pulse rate, non-invasive systolic and diastolic blood pressure through out the procedure. Recovery and discharge time was recorded. Induction and total maintenance dose of propofol was significantly high in group PT as compare to group PK. Patients in group PK have more stable haemodynamic profile as compare to patients of group PT. Incidence of side effects like apnoea and pain on injection were more in patients of group PT. The recovery and discharge time of the patients of both groups were comparable so it was concluded that combination of propofol and ketamine gives better efficacy and tolerability in terms of dose requirement, cardiovascular stability, less frequent side effects without affecting discharge profile as compare to propofol and thiopentone admixture.Keywords
Anaesthetics, Intravenous, Propofol, Thiopentone, Ketamine, Ambulatory anaesthesiaReferences
- M. Naguib, A Sari Kouzel. Thiopentone-propofol hypnotic synergism in patients. Br.J. Anaesth 1991; 67: 4-6.
- T.W. Hui, T G Short, W Hong, m T Suen,T Gin, J Plummer. Additive interactions between proprofol and ketamine when used for anaesthesia induction in female patients.Anesthesiology 1995; 82 : 641-647.
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- Miller RD, Cucchiara RFand Miller ED. Chapter 65, Page no.2213- 2214, Anaesthesia. 5th edition. Churchill sssLivingstone, 2000.
- Chernin EL, Stewart JT, Smiler B. Stability of thiopentone sodium and propofol on polypropylene syringes at 23 and 24ºc. Am J Health Syst Pharm 1996; 53: 1576-9.
- Prankerd RJ, Jones RD. Physiochemical compatibility of propofol with thiopentone sodium. Am J Health Syst Pharm 1996; 53: 2606-10.
- Lazar ER, Jolly DT, Tam YK, Hrazdil J, Tawfik SR, Clanachan AS. Propofol and thiopentone in a 1:1 volume mixture is chemically stable. Anesth Analg 1998; 86: 422-6.
- Crowther J, Hrazdil J, Jolly DT, Galbraith JC, Greacen M, Grace M. Growth of micro organism in propofol, thiopental and a 1:1 mixture of propofol and thiopental. Anesth Analg 1996;82:475-8.
- Jones D, Prankerd R, Lang C, Chilvers M, Bignell S, Short T. Propofol – thiopentone admixture – Hypnotic dose, pain on injection and effect on blood pressure. Anaesth Intensive Care 1999;27:346-56.
- Chilvers M, Jones D, Rushmer J, Bignell S, Boots R, Prankerd R. Propofol-thiopentone admixture: recovery characteristics. Anaesth Intensive Care 1999 ; 27: 601 - 609.
- Wong WH, Lim TA & Lim KY. Isobolographic Analysis of the Hypnotic Interaction Between Propofol and Thiopental. Malaysian Journal of Medicine and Health Sciences Vol. 6(1)
- Bowdle TA, Radant AD, Cowley DS, et al. Psychedelic effects of ketamine in healthy volunteers: relationship to steady-state plasma concentrations. Anesthesiology 1998;88:82–8.
- Krystal JH, Karper LP, Seibyl JP, et al. Subanesthetic effects of the noncompetitive NMDA antagonist, ketamine, in humans: psychotomimetic, perceptual, cognitive, and neuroendocrine responses. Arch Gen Psychiatry 1994;51:199–214.
- Guit JBM, Koning HM, Coster ML, et al. Ketamine as analgesic for total intravenous anaesthesia with propofol. Anaesthesia 1990;46:24–7.
- Idvall J, Ahlgren I, Aronson KF, et al. Ketamine infusions: pharmacokinetics and clinical effects. Br J Anaesth 1979;51:1167–72.
- Kaushik Saha, M Saigopal, Rajini Sundar, M palaniappan, Anil C Mathew. Comparative evaluation of propofol- ketamine and propofl-fentanyl in minor surgery. Ind. J. Anaesth 2001;45(2): 100-103.
- Tan CH, Onsiong MK, Kua SW. The effect of ketamine pre treatment on propofol injection pain in 100 women. Anaesthesia 1998; 53: 302-305.
- A Comparison of Post Operative Analgesia and Adverse Effects Produced by Neostigmine and Morphine when Given Intrathecally
Abstract Views :287 |
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Authors
Affiliations
1 Department of Anaesthesia, Saraswathi Institute of Medical Sciences, Hapur, Ghaziabad 245304, IN
1 Department of Anaesthesia, Saraswathi Institute of Medical Sciences, Hapur, Ghaziabad 245304, IN
Source
Indian Journal of Public Health Research & Development, Vol 3, No 2 (2012), Pagination: 154-157Abstract
Various modalities had been tried for optimum duration of post operative analgesia with minimal side effects. The present study was undertaken to evaluate the duration and quality of post operative analgesia by intrathecal bupivacaine alone, intrathecal bupivacaine12.5mg (0.5% heavy) with neostigmine (50μg) or intrathecal bupivacaine12.5mg (0.5% heavy) with morphine (100μg) in spinal block. 150 patients of ASA physical status 1&2, age 20-70 years of either sex, body weight 50- 100Kg were randomally assigned in three study groups. Group I - 0.5% bupivacaine (2.5ml bupivacaine+0.5ml normal saline), group II - 0.5% bupivacaine with 50μg neostigmine (2.5ml bupivacaine+0.5ml neostigmine) and group III - 0.5% bupivacaine with morphine100μg (2.5 ml bupivacaine+0.5 ml morphine). Onset of sensory and motor block of intrathecal neostigmine and intrathecal morphine group was much faster as compare to control group. Duration of post operative analgesia was also more in intrathecal neostigmine and intrathecal morphine group as compare to control group. Intrathecal neostigmine and intrathecal morphine groups were comparable in terms of onset of sensory and motor block and level of highest block. Nausea, vomiting and bradycardia were more in neostigmine group as compare to intrathecal morphine and control group. Patients in intrathecal morphine group had more incidence of pruritus. We concluded that intrathecal morphine 100μg is a better choice than intrathecal neostigmine during spinal block.Keywords
Anaesthesia, Spinal Anaesthesia, Drugs, Bupivacaine, Neostigmine, MorphineReferences
- Hood DD, Eisenach JC, Tuttle R. Phase I safety assessment of intrathecal neostigmine methylsulfate in humans. Anaesthesiology 1995:82:331-343.2.
- Mc Neely JK, Farber NE, Rusy LM,:Epidural analgesia improves outcome following paediatric fundoplication. Reg. Anesth. 1997, 22: (16).
- Dahl JB, Jeppesen IS, Jørgensen H, et al. Intraoperative and postoperative analgesic efficacy and adverse effects of intrathecal opioids in patients undergoing cesarean section with spinal anesthesia. Anesthesiology 1991;91:1919 –27.
- Rathmell JP, Pino CA, Taylor R, et al. Intrathecal morphine for postoperative analgesia: a randomized, controlled, doseranging study after hip and knee arthroplasty. Anesth Analg 2003;97:1452–7.
- Urban MK, Jules-Elysee K, Urquhart B, et al. Reduction in postoperative pain after spinal fusion with instrumentation using intrathecal morphine. Spine 2002;27:535–7.
- Casey WF, Wynands JE, Ralley FE. The role of intrathecal morphine in the anesthetic management of patients undergoing coronary bypass surgery. J Cardiothorac Anesth 1987;1:510–6.
- Hamber EA, Viscomi CM. Intratheal lipophilic opioids as adjuncts to surgical spinal anesthesia. Reg Anesth Pain Med 1999;24:255– 63.
- Murphy PM, Stack D, Kinirons B, and et al. Optimizing the Dose of Intrathecal Morphine in Older Patients Undergoing Hip Arthroplasty Anesth Analg 2003;97:1709 –15.
- Almeida RA, Lauretti GR, Mattos AL. Antinociceptive Effect of Low-dose Intrathecal Neostigmine Combined with Intrathecal Morphine following Gynecologic Surgery. Anesthesiology: 2003;(2);495-498.
- Motamed C, Bouaziz H, Franco Dand et al. Analgesic effect of low-dose intrathecal morphine and bupivacaine in laparoscopic cholecystectomy. Association of Anaesthetists of Great Britain & Ireland 2000;55:118-124.
- Krukowski JA, Hood DD, Eisenach JC and et al. intrathecal neostigmine for post caesarean section analgesia: Dose response. Anesth Analg 1997; 84: 1269-75.
- Eisenach JC, Detweiler DJ, Tong Cy and et al. Cerebrospinal fluid norepinephrine and acetylcholine concentrations during acute pain. Anesth Analg 1996; 82: 621-6.
- Chung CJ, Kim JS, Park HS and et al. The efficacy of Intrathecal neostigmine, intrathecal morphine and their combination for post cesarean section analgesia. Anesth Analg 1998; 87: 341-6.
- Mainvsky J.M., Renaud G., Le Corre P. Intrathecal bupivacaine in humans: effects of volume and baricity on spinal effects. Anesthesiology 1999; 91:1260-1266.
- Eisenach JC, Hood DD, Curry R. Phase I human safety assessment of intrathecal neostigmine containing methyl- and propylparabens. Anesth Analg 1997; 85:842–6.
- Lauretti GR, Hood DD, Eisenach JC. A multicenter study of intrathecal neostigmine for analgesia following vaginal hysterectomy. Anesthesiology 1998; 89: 913-8.
- Tan PH, Chia YY, Lo Y and et al: Intrathecal bupivacaine with Morphine or neostigmine for postoperative analgesia after total Knee replacement surgery. Can J Anaesth, 2001; 48: 6: 551–618.
- Ishaque M, Siddique R, Hashmi SN, Naseem A and et al;A study of post operative analgesia and adverse effects produced by intrathecal neostigmine, morphine and their combination in patients undergoing elective caessarian section under spinal anaesthesia. Pakistan Armed Force Medical Journal : 2005,(2).
- Klamt, J. G, Garcia, L. V, Prado W A. Analgesic and adverse effects of a low dose of intrathecally administered hyperbaric neostigmine alone or combined with morphine in patients submitted to spinal anesthesia: pilot studies. Anesth 1999; 54(1): 27-31.
- Network Marketing the Concept, the Challenges and the Success Mantras
Abstract Views :367 |
PDF Views:204
Authors
K. C. Mittal
1,
Ritu Goyal
1
Affiliations
1 Punjab School of Management Studies, Punjabi University, Patiala, IN
1 Punjab School of Management Studies, Punjabi University, Patiala, IN
Source
Review of Professional Management- A Journal of New Delhi Institute of Management, Vol 4, No 2 (2006), Pagination: 47-57Abstract
Network Marketing, called the wave of the future is one of the most touchy and the most misunderstood concepts today. The naive and insincere players have caused this system to be looked at with a suspicious eye. The concept involves common men and women and their success as Leaders. There are number of challenges for a common man to make it big in this concept but the success of many from diverse backgrounds suggests that anyone can be successful in Network Marketing if the person has a dream and he/she understands and follows the success mantra's.Keywords
Downlines, Sponsoring, Customer-Distributor, Network, Free Enterprise System, Levels, Pyramids.Full Text
- A Microbiological Study of the Hygiene Maintained in Day Care Centres of Chandigarh with Special Reference to Contamination with E. coli
Abstract Views :281 |
PDF Views:0
Authors
Ritu Goyal
1,
Madhu Kaul
1
Affiliations
1 Department of Microbiology, Govt. Home Science College, Sector-10, Chandigarh, IN
1 Department of Microbiology, Govt. Home Science College, Sector-10, Chandigarh, IN
Source
The Indian Journal of Nutrition and Dietetics, Vol 35, No 12 (1998), Pagination: 339-343Abstract
The use of non parental day care for children has increased over the past several decades and mirrors changes in the social and economic fabric of our country. The infants and pre school children are intermingled in child care facilities which often lack adequate toilet and hand washing facilities and are frequently staffed by individuals with little or no training in the area of infection control.- Social Security Provisions in Practice:Evidence from Prerogative of Indian Workforce
Abstract Views :257 |
PDF Views:0
Authors
Ritu Goyal
1,
Sonu Madan
1
Affiliations
1 Department of Economics, Indira Gandhi University, Meerpur, Rewari, Haryana, IN
1 Department of Economics, Indira Gandhi University, Meerpur, Rewari, Haryana, IN
Source
Research Journal of Humanities and Social Sciences, Vol 10, No 2 (2019), Pagination: 653-660Abstract
Social security not only protects people from various shocks across the life cycle, but also plays a crucial role in boosting domestic demand and productivity, supporting the structural transformation of national economies, and promoting a culture of decent work. In this concern, the paper intends to analyze the association of prerogative of the workforce for social security provisions with various factors related to the quality of workforce and status of employment, using unit level data extracted from the 68th round of NSS survey on employment and unemployment with the help of chi-square test statistics. The paper wraps up with the conclusion that social security provisions are still at a milestone as the majority of the workforce is out of social security net. Qualitative attributes of workforce help in getting better job opportunities in the formal sector and thus opens a route of entitlement for social security provisions. Herein, the status of employment has emerged as an important factor in this concern. Herein, regular and contractual workers in government and large enterprises/organisations, formal private limited companies and cooperative societies etc. are entitled for social security provisions. Casual workers, domestic servants, self-employed and informal workers without any job contract have remained out of the social security net. Hereby, a special policy of the government is required to broaden the umbrella for social security provisions. There is a dire need of special provisions for self-employed to provide strength to entrepreneurs to come up as job providers under the safety net to fight against the uncertain and undesirable phase of a lifetime.Keywords
Social Security Provisions, The Prerogative of Workforce, Qualitative Attributes of the Workforce, The Status of Employment.References
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