STUDY OF THE EFFECT OF PROPOFOL & ETOMIDATE AS AN INDUCTION AGENT ON HAEMODYNAMIC CHANGES DURING INDUCTION & ENDOTRACHEAL INTUBATION

Introduction: Laryngoscopy and subsequent tracheal intubation cause a fugitive tachycardia and hypertension as a result of sympathoadrenal stimulation. Careful selection of anestheshetic is thus required, as cardiovascular reserve is decreased in certain patients, so as to avoid undue depressions of cardiac and circulatory function Aims And Objectives: This randomized double blind prospective study had been designed for comparative evaluation of inj propofol 2.5 mg/kg, inj Etomidate 0.3 mg/kg an induction agent on haemodynamic changes such as HR, SBP, DBP, MAP and oxygen saturation during induction and tracheal intubation and also to study the adverse effects the two drugs under study Material And Methods: After approval from medical ethics committee, Dr D Y Patil Medical College and Hospital, Pune, the study was carried out on sixty (60) patients undergoing elective surgeries under standard general anesthesia. ? All patients were premedicated with Ondansetron 0.1mg/kg i.v., inj midazolam 0.02mg/kg and inj fentanyl 2 mcg/kg i.v. ? All patients pre-oxygenated with 100% oxygen for 3 min, all vital parameters recorded (T1) ? Group P received inj. propofol 2.5 mg/kg i.v. and group E received Etomidate 0.3mg/kg i.v. over 30 sec and vital parameters recorded as (T2) ? Inj succinylcholine as muscle relaxant given after administering induction agent, laryngoscopy and tracheal intubation attempted with appropriate sized endotracheal tube. All vital parameters recorded during laryngoscopy(T3), periodic monitoring of vital parameters carried out at 1,2,3,5 and 10 minutes intervals post intubation ? Further the patient was maintained on O2 /N2O / Isoflurane and Vecuronium i.v. top-ups as and when required ? At the end of surgery, patient reversed with inj. Glycopyrrolate 0.008mg/kg i.v. along with inj. Neostigmine 0.05mg/kg intravenously and extubated after gaining consciousness and adequate power ? Patient shifted to recovery room observed for any side effects such as nausea, vomiting, Result: The demographic profile was comparable. There was no statistically considerable difference between the two study groups with respect to baseline parameters of HR, SBP, DBP, MAP and SpO2. There was decrease in mean heart rate seen in group P compared to group E at post induction (T2), after intubation 1 min, 2min, the values were statistically significant with P value <0.05,.and decrease in mean SBP, mean DBP AND MAP in group P compared to group E at post induction (T2), after intubation 1,2 3, 5 min values were statistically significant with p value <0.05 Pain on injection was more in group P 26 out of 30(86.7%) than group E, which was statistically significant with p value <0.05 Incidence of myoclonus was more in group E 23 patients out of 30(76.7%) compared to group P which was statistically significant with p value <0.05. In group P 2 out of 30 patients (6.7%) had vomiting and in group E 3 out of 30 patients (10%) had vomiting, difference was statistically insignificant with p value >0.05 Conclusion: A• Both, Propofol and etomidate are safe induction agents A• Etomidate maintains better haemodynamic stability than propofol as induction agent A• Pain on injection was more with propofol. However, myoclonus was more with etomidate A• Both drugs were associated with no significant side effects/complication.

COVID-19 Vaccines in Pakistan: Efficacy, Adverse Effects and Availability

In this review article, we aim to document the efficacy, adverse effects, mode of action, required doses, and availability of the major vaccines available in Pakistan till 20 May 2021. We reviewed all available literature on COVID-19 vaccines in PubMed and Google scholar. We also reviewed articles from grey literature. Currently, Pfizer–BioNTech and Moderna, Sinopharm (China), Sputnik V (Russia), CoronaVac (popularly known as Sinovac) (China), Cansino, and Vaxzevria vaccines have been authorized for emergency use in several countries. Pakistan has sanctioned the use of all the aforementioned vaccines except Pfizer and Moderna. As per their efficacy, Pfizer and Moderna have been found most effective among all the vaccines with 95% effectiveness, while the Vaxzevria, Sputnik V, Sinopharm, and Cansino have shown 70%, 91.6%, 79.34%, and 90% effectiveness, respectively. All the vaccines have shown milder side effects like headache, fever, and pain on injection sites. To curb the pandemic, more clinical trials are being conducted throughout the world. Importantly public awareness is warranted to achieve the target of vaccinating a large population.

A COMPARATIVE STUDY BETWEEN ETOMIDATE AND PROPOFOL AS AN INDUCTION AGENT DURING INDUCTION, LARYNGOSCOPY AND INTUBATION

Background: The objective of study was to compare Etomidate and Propofol as induction agents and their effect on Pain on injection, time to loss of consciousness and myoclonic movements. Methods: The study was carried out on 100 patients of ASA grade I and II between 18-58yrs of age of either sex enrolled for this prospective randomized double blind study, admitted in K D Medical College, Hospital & Research Center, Mathura (U.P) and scheduled for elective surgical procedures under general anaesthesia and endotracheal intubation. Results: The incidence of pain on injection in propofol group was more as compared to etomidate group (p value <0.05). In propofol group 25(50%) patients while in etomidate group only 2(4%) patients had pain on injection. Etomidate group had significantly more myoclonic movements than propofol group (p value <0.05). In etomidate group 18(36%) patients had myoclonic movements of various severity, while in propofol group no patient had myoclonic movements. Conclusion: Incidence of apnoea on induction was more in propofol group than etomidate group but comparison was not statistically significant. Keywords: Apnea, Propofol, Etomidate.

A comparison of pain on intravenous injection to two formulations of Propofol, one containing medium chain and long chain triglycerides and the other without medium chain and long chain triglycerides

Background: To assess and compare the Visual Analog Scale (VAS) for pain on intravenous injection in patients receiving the two different formulations of Propofol.Methods: Total 170 eligible patients were randomized into Group A receiving Propofol MCT/LCT and Group B receiving Propofol LCT. After standard pre-anaesthetic preparation and baseline values recording, the blinded investigator recorded pain intensity after injection of 1mL study drug propofol, using Visual Analog Scale (0-10). Haemodynamic parameters were recorded every minute for 5 minutes. Calculated Propofol dose was injected in 20 seconds, and signs of pain (hand withdrawal, grimacing) were noted. After patient regained full consciousness, recall of injection pain was asked for.Results: The proportion of patients who experienced pain was similar in both groups (group A: 76/85 =89.41%, group B: 81/85 = 95.29%; statistically not significant (p value=0.247). Patients in group A had longer time for pain onset (11.3 seconds-group A Vs 9.8 seconds-group B; statistically significant, p value =0.008). Pain on injection was higher in Propofol LCT group as compared to Propofol MCT/LCT (VAS scores of group A=3.94±2.0 vs group B = 5.49±1.96; statistically significant; p value = 0.0018). Full dose of Propofol MCT/LCT produced significantly less pain when compared to Propofol LCT (p value = 0.0424). Recall of pain was comparable between the groups. Haemodynamic parameters (Heart rate and Mean Arterial Pressure) remained comparable in both groups.Conclusions: Pain on injection was higher and statistically significant in Propofol LCT group as compared to Propofol MCT/LCT.