Multiple Research Trials Research Articles

Low Dose Ketamine in Prevention of Propofol Injection Pain

Background: Propofol is the most widely used intravenous anesthetic agent for induction and maintenance of anesthesia as well as for sedation inside and outside operation theatre. Propofol is almost an ideal intravenous (IV) anesthetic agent, but pain on its injection still remain a problem. Pain may not be a serious complication, but most patients remember it as one of the unpleasant encounters with anesthetists. In one survey pain on propofol injection stands seventh most important problem in the current practice of clinical anesthesia. Ketamine is (NMDA) receptor antagonist agent and a dissociative anesthetic with neurostimulatory side effect, multiple research trials suggest ketamine as a strong analgesic agent in sub anesthetic IV doses. Objective: The aim of the current study was to prove the effectiveness of low dose ketamine in preventing propofol injection pain. Methodology: Two groups each included 60 patients (middle age females who performed ovum pick up surgery: Ketamine group 60 patient received ketamine 0.2 mg/kg with propofol. Saline group 60 patient received normal saline 10 ml with propofol. Results: In the current study pain and hemodynamic changes (BP, pulse) were observed. Regarding pain: The incidence of propofol injection pain in the current study was reduced from 93.2% in saline group to 55% in ketamine group, the incidence of severe pain was completely abolished with ketamine. Regarding hemodynamics: There was no statistical significance between both groups regarding heart rate, regarding BP the degree of drop in BP in ketamine group was to less extent than in saline group that proves the role of ketamine in hemodynamic stability. Conclusion: Finally ketamine in low dose was effective in reduction of propofol injection pain.

Abstract TP4: Current Practices and Discharge Outcome of Endovascular Coiling and Clipping Amongst Hemorrhagic Stroke Patients

Background: 20% of strokes are hemorrhagic (HS), with subarachnoid hemorrhage (SAH) and intracerebral hemorrhage each accounting for 10%. Most SAHs are caused by ruptured saccular aneurysms. Therapeutic advances like endovascular coiling (EvC) and clipping have added to the armamentarium for treating this malignant process. Methods: Data from Nationwide Inpatient Sample (NIS) (years 2003-2013) was analyzed to identify HS (aSAH and ICH) hospitalization using ICD-9-CM codes. EvC and clipping patients were identified from the cohort. A retrospective analysis with multivariate survey logistic regression was done to evaluate the predictors of utilizations of EvC and clipping. Results: From years 2003 to 2013, total 1,004,736 patients with HS were hospitalized. Out of them, 47,999 (4.7%) patients had EvC and 55,900 (5.6%) patients had clipping. Predictors of higher EvC utilization were young 35-50 years patients (aOR: 1.20; 95%CI: 1.04-1.38), large hospitals (>100 beds) (aOR: 4.53; 95%CI: 3.54-5.81), and urban teaching hospitals (aOR: 4.66; 95%CI: 3.63-5.97). Clipping utilization was higher among age 65-80 years patients (aOR: 2.02; 95%CI: 1.73-2.37) and age >80 years (aOR: 5.15; 95%CI: 4.25-6.23), male (aOR: 2.02; 95%CI: 1.89-2.15), emergency admissions (aOR: 1.73; 95%CI: 1.52-1.97), and pre-existing co-morbidities like renal failure, solid tumor, hypertension, and diabetes. Utilization of EvC was associated with lower frequencies of in poor discharge disposition: transferred to short-term hospital/skilled nursing facility/intermediate care/long term care facility (45.86% vs. 49.75%; p<0.001) in comparison to clipping. Discussion: Historically, coiling was reserved for the treatment of high-grade subarachnoid bleed, has found to be not only safe but also favourable with better discharge disposition. The recent AHA guideline and multiple research trials have shown the same result.

Role of ketamine for analgesia in adults and children.

Ketamine an N-methyl-D-aspartate (NMDA) receptor blocking agent and a dissociative anesthetic with neurostimulatory side effects. In recent years, multiple research trials as well as systematic reviews and meta-analyses suggest the usefulness of ketamine as a strong analgesic used in subanesthetic intravenous doses, and also as a sedative. In addition, ketamine was noted to possess properties of anti-tolerance, anti-hyperalgesia and anti-allodynia most likely secondary to inhibition of the NMDA receptors. Tolerance, hyperalgesia and allodynia phenomena are the main components of opioid resistance, and pathological pain is often seen in the clinical conditions involving neuropathic pain, opioid-induced hyperalgesia, and central sensitization with allodynia or hyperalgesia. All these conditions are challenging to treat. In low doses, ketamine does not have major adverse dysphoric effects and also has the favorable effects of reduced incidence of opioid-induced nausea and vomiting. Therefore, ketamine can be a useful adjunct for pain control after surgery. Additional studies are required to determine the role of ketamine in the immediate postoperative period after surgical interventions known to produce severe pain and in the prevention and treatment of chronic pain.

Using Estrus-Detection Patches to Vary Time of Insemination Improves Pregnancy Rates Compared with One Single Timed Insemination

Timed artificial insemination (TAI) of beef cows at a predetermined time is a management tool that reduces labor costs associated with conventional heat detection before insemination. Multiple research trials have examined timing of the individual components of the developed protocols associated with TAI. The 7-day CO-Synch + progesterone insert (controlled internal drug release; CIDR) protocol has been shown to initiate ovulation effectively in cycling and noncycling suckled beef cows, often producing pregnancy rates greater than 50% in beef cows. In the current research, we examined using two targeted insemination intervals depending on the occurrence of estrus. We hypothesized that by more closely synchronizing estrus and insemination that pregnancy rates would be increased. We further hypothesized that cows that do not demonstrate estrus and are subjected to a TAI protocol might benefit from an increased interval to insemination.

Variation in timed artificial insemination pregnancy rates in specific groups of suckled beef cows (2014)

Insemination of beef cows at a predetermined time is a management tool to reduce labor costs associated with conventional heat detection available to cattle producers. Multiple research trials have examined the timing of the administration of the individual components of the developed protocols associated with timed artificial insemination (TAI). In the current research, we examined various classifications of postpartum beef cows and analyzed their reproductive performance when submitted to TAI protocols. The 7-day CO-Synch + controlled internal drug release (CIDR) insert protocol and the 5-day CO-Synch + CIDR protocol have been shown to effectively initiate ovulation in cycling and non-cycling suckled beef cows, producing pregnancy rates at or greater than 50% in beef cows. We hypothesized that uniformly selected groups of cows based on their progesterone status at CIDR insertion, days postpartum, body condition score, and/or parity would demonstrate improved reproductive performance compared with non-grouped cows.

Spontaneous Intracerebral Hemorrhage

Spontaneous intracerebral hemorrhage (sICH) is defined as bleeding within the brain parenchyma, and occurs twice as commonly as subarachnoid hemorrhage, but is equally as deadly. Risk factors for sICH include hypertension, advanced age, leukoaraiosis, prior ICH, renal failure, use of anticoagulant drugs, and cerebral amyloid angiopathy. When a patient is clinically suspected of having sICH, head computed tomography scan is the standard diagnostic tool. However, newer magnetic resonance neuroimaging techniques may aid in determining the underlying pathology and aid in prognosis. Supportive care and blood pressure management are important in the care of patients with sICH. Ongoing research is aimed at determining a safe blood pressure goal that may also prevent expansion of hemorrhage. Hemostatic medications and neuroprotectants have thus far not shown clinical improvement. Although several neurosurgical trials have failed to demonstrate benefit for surgical evacuation of sICH, multiple research trials are ongoing investigating acute blood pressure control, deep or basal ganglionic hemorrhage evacuation via minimally invasive approach (MISTIE; http://mistietrial.com/default.aspx), lobar ICH evacuation (STICH; II http://research.ncl.ac.uk/stich/), and intraventricular thrombolysis with tissue plasminogen activator (tPA) (CLEAR III; http://biosgroup-johnshopkinsmedicine.health.officelive.com/default.aspx).