Article in PDF
How to Cite
Citation Manager
Readers' Comments (0)
Audio Visual Article Statistics
Link
to PUBMED
Print this Article
Send to a Friend
Advertisers
Access Statistics Resources
Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Anaesthetic and Haemodynamic Effects of Dexmedetomidine vs Midazolam used as Premedication in Minor Obstetrics and Gynaecological Procedures- AÂ Prospective Interventional Study
Correspondence Address :
Anita Manoj Kulkarni,
J 201, Queen’s Town, Oposite Chinchwad Railway Station, Udyog Nagar, Chinchwad, Pune, Maharashtra, India.
E-mail: vaishnaviam@rediffmail.com
Introduction: Preoperative anxiety for any surgery is a frequent condition. It may lead to high catecholamine levels which increases blood pressure, heart rate and oxygen consumption. Various agents have been used for anxiolysis and sedation as premedicants.
Aim: To compare the anaesthetic and haemodynamic effects of injection Dexmedetomidine and injection Midazolam used as premedication in minor Obstetrics and Gynaecological procedures.
Materials and Methods: This was a prospective interventional study conducted from July 2016 to September 2017, on total number of 60 patients of American Society of Anaesthesiologist Physical Status (ASA PS I and II) enrolled for the study. They were randomised in two groups: Group A (n=30) for Injection (Inj.) Midazolam 0.04 mg/kg and Group B (n=30) for injection Dexmedetomidine 1mcg /kg injected over a period of 10 minutes prior to General Anaesthesia. After appropriate monitoring like, Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean arterial Pressure (MAP), Peripheral oxygen saturation (SpO2), Respiratory Rate (RR) were noted during the procedure at interval of 5 minutes till 30 minutes and, Ramsay Sedation Score (RSS) and Visual Analogue Scale (VAS) in postoperative period for 1 hour at interval of 15 minutes. The significance between all variables and amongst the two groups was calculated by Chi-square test, Repeated measure Analysis of Variance (ANOVA) test and Independent sample t-test.
Results: It was observed that mean HR, SBP (p<0.05), DBP (p<0.05) and MAP (p<0.05 ) decreased significantly in group B. The RR (p<0.05) was significantly decreased in group B. There was no significant difference in SpO2 (p=0.4) value in both the groups. VAS (p<0.05) of group B patients was significantly reduced in the postoperative period but there was no significant difference in RSS score (p=0.1) at 45 and 60 minutes in both the groups.
Conclusion: Dexmedetomidine is more effective as a sedative agent than injection Midazolam when used in minor gynaecological procedures. Though Dexmedetomidine caused significant reduction in SBP, DBP and HR, it maintained haemodynamic stability well without causing any adverse effects.
Analogue, Anaesthesia, Postoperative, Ramsay sedation, Visual analog scale
Prompt and street fit recovery after a day care surgery has become necessity in modern anaesthesia practice. Preoperative anxiety is a frequent medical condition. Generally it starts two days before the operation and reaches its peak just prior to the induction of anaesthesia (1). Anxiety is more common among younger patients and females. Anxiety, stress and fear that arise just before the operation, may lead to psychological trauma and increase the release of stress hormones resulting in undesirable metabolic responses before anaesthesia (1),(2),(3). High catecholamine levels in blood increase arterial blood pressure, heart rate and oxygen consumption. Comfortable anaesthesia induction and maintenance can be achieved by controlling preoperative anxiety. Various agents such as Phenothiazines, Benzodiazepines, Barbiturates, and Opioids and Antihistamines have traditionally been used to relieve anxiety and provide sedation. Today the most frequently used drugs are Benzodiazepines (4). Midazolam is the medication from this group with rapid onset and short lasting effect. Its sedative effect has been shown in many studies (5),(6),(7).
It has been evident that alpha 2 adrenoceptor agonist may also work in conjunction with anaesthesia (8),(9). Dexmedetomidine is an imidazole derivative. It has sedative, analgesic, sympatholytic and anxiolytic effect that blunt many of the cardiovascular responses in the perioperative period. Dexmedetomidine exerts a sympatholytic effect by activating inhibitory alpha 2 receptors, both in the Central Nervous System (CNS) and peripheral sympathetic nerve endings (9),(10),(11),(12).
Number of minor obstetrics and gynaecological procedures are performed as day care procedures. The objectives of the present study were-
• To compare the anaesthetic and haemodynamic properties of inj. Dexmedetomidine and inj. Midazolam used as a premedication in minor obstetrics and gynaecological procedures.
• To observe any side effects of these drugs.
The present study was a prospective interventional study, conducted from July 2016 to September 2017, on 60 patients who came to Department of Obstetrics and Gynaecology, MIMER Medical College, Talegaon Dabhade, Pune, India, after obtaining approval of the Institutional Ethical Committee (IEC/157). A written informed consent was obtained from all participants after informing about the procedure.
Inclusion criteria: Those patients aged 18-60 years of American Society of Anaesthesiologist Physical Status (ASA PS) grade I and II (13), admitted in Gynaecology Department, planned to undergo a minor obstetrics and gynaecological procedures like Dialatation and Currettage, Medical Termination of Pregnancy (MTP), copper T-insertion etc. under general anaesthesia were included in the study.
Exclusion criteria:b?B Those patients on alpha and beta blockers as antihypertensive, hypertensive patients without any medication (uncontrolled hypertension), patients with psychiatric illness and those on concurrent sedative medications were excluded from the study.
Sample size calculation: With pilot study of 20 patients done earlier and considering power >80%, confidence interval of 95% and alpha error of 5%, the appropriate sample of the present study was calculated to 60 patients.
Hence, a total of 60 patients satisfying the inclusion and exclusion criteria were enrolled in the study and were divided into group A (n=30) and group B (n=30) according to the treatment planned as depicted in the flow diagram (Table/Fig 1).
Study Procedure
The patients were randomly allocated in two groups, group A (n=30) Midazolam group and group B (n=30) Dexmedetomidine group. The group A received Inj. Midazolam 0.4 mg/kg in 100Â mL normal saline and group B received inj. Dexmedetomidine, 1 microgram/kg in 100 mL normal saline over the period of 10 minutes. These agents used for premedication were administered by slow intravenous (i.v.) infusion to provide better haemodynamic control and stop them if needed in case of complication.
The patients were transferred to the preoperative room 40Â minutes prior to anaesthesia induction. Peripheral venous routes were accessed via 20-G catheters and infusion of ringer lactate solution was started. They were reminded about the procedure and about how to mark the VAS (14). Non invasive blood pressure measurement, electrocardiography and peripheral oxygen saturation monitoring was performed. The infusions of the medications were given before induction and completed within 10 minutes. Both groups received injection Fentanyl citrate 1 microgram/kg and injection Glycopyrrolate 0.02 mg/kg before induction. Anaesthesia 21was induced with injection Propofol 2 mg/kg and maintained with Nitrous oxide/Oxygen (70%:30%) by face mask and with top up doses of injection Propofol.
Onset time of sedative infusion was taken as 0 minute and the following parameters were measured at the interval of five minutes. The HR, SBP, DBP, MAP, RR and SpO2 were recorded. After the procedure and recovery from anaesthesia, the patients were observed for one hour. The anxiety threshold was assessed with the VAS, preoperatively as well as postoperatively at 15Â minutes interval.
The patients were asked to self evaluate their feelings of anxiety with the scores of 0-10 with (0=absent and 10=worst). The level of sedation was assessed by using RSS (15), preoperatively as well as postoperatively at 15 minutes interval, RSS, 1=agitated, restless, 2=cooperative, tranquil, 3=responds to verbal commands while sleeping 4=brisk response to glabellar tap or loud voice while sleeping, 5=sluggish response to glabellar tap or loud voice, 6=no response to glabellar tap or loud voice). Drug related side effects like bradycardia (HR<50 beats/minute), hypotension (MAP <60 mm of Hg), nausea, vomiting were recorded and treated accordingly.
Statistical Analysis
Statistical analysis was performed by using Statistical Package for Social Sciences (SPSS) software version 21.0 . Comparison of qualitative data was performed with Chi-square test and expressed in terms of median, frequency and percentage. The statistical analysis of the changes in pulse, mean arterial pressure, SBP, DBP, RR and SpO2 were performed with Repeated measure ANOVA test. Statistical analysis of the VAS and Ramsay score was done over two period of time, from start of study till the time of induction and from recovery till the patient is shifted to the wards, with independent sample t-test. Mean and standard deviation were calculated for quantitative variables. Analysis of variance test was used to compare the parameters with normal distribution between the groups. The p-value <0.05 was considered to be significant.
Total of 60 patients aged 18-60 years were enrolled in the present study. Mean age of 30 patients included in group A was 28.5 years while those of 30 patients in group B was 29.1 years. The demographic data of both the groups was comparable (Table/Fig 2).
Mean HR measured, analysed and compared for all study subjects amongst the two groups are tabulated (Table/Fig 3). It was observed that mean HR differed significantly between Group A and Group B at all time intervals. There was significant reduction in the HR in group B as compared to group A. Further analysis showed that there was significant difference within group A and (p-value=0.01). Mean SBP differed significantly between group A and group B 15 min onwards intra-operatively and at 15 min postoperatively. There was significant reduction in the systolic blood pressure in group B as compared to group A (Table/Fig 3).
The mean DBP differed significantly between Group A and Group B from 15 min onwards intra-operatively, and at all points of time postoperatively. There was significant reduction in the diastolic blood pressure in group B as compared to group A (Table/Fig 3). Mean MAP differed significantly between group A and group B from 15 min onwards intra-operatively and all time points postoperatively. There was significant reduction in the MAP in group B as compared to group A (Table/Fig 3).
Mean RR reduced significantly in Group B as compared to Group A at 5 min, 10 min, 15 min and 30 min during the operation and at 15 min postoperatively. Mean SPO2 differed significantly between Group A and Group B at base line time and at 5 minutes time only. There was no significant difference at other point of intraoperative time. Further analysis showed that there was significant difference within Group A but not in Group B (Table/Fig 3).
Mean VAS differed significantly between Group A and Group B at all time points after the operation. The VAS score was less in Group B as compared to Group A in the post operative period. Ramsay sedation score differed in group A and group B at 15 min and 30 min postoperatively only. Ramsay sedation score is more in Group B as compared to Group A at 15 and 30 minutes postoperatively (Table/Fig 4).
No prevalence of side effects such as nausea, vomiting and hypoxia were observed. Only one patient of group B (Dexmedetomidine group) developed bradycardia (Heart rate <50 beats/minute) which was treated with injection Atropine 0.6 mg i.v.
Preoperative anxiety is a frequent medical condition. It may lead to psychological trauma and increase the release of stress hormones (1),(2). Various agents have been used to relieve the anxiety and provide sedation. Benzodiazepines are most frequently used drugs. Midazolam is the medication from this group having rapid onset and short lasting effect and can be used for sedation (5),(6),(7). Dexmedetomidine which is α-2 adrenoceptor agonist having sedative, anxiolytic and sympatholytic effect and can be used in conjunction with anaesthesia for premedication (8),(9),(12).
In this study we have compared the anaesthetic and haemodynamic effects of Injection Dexmeditomidine and Injection Midazolam used as premedication in short gynaecological procedures. In this study, we enrolled 60 patients of ASA grade one and two with 30 patients in each group.In the present study there was significant reduction in HR, SBP, DBP and MAP in the Dexmedetomidine group (Group B) as compared to Midazolam group (Group A). But this decrease was within limits. Dexmedetomidine induced bradycardia was not found to be clinically challenging and can be treatable. Hypotension and bradycardia caused by Dexmedetomidine could be explained by its agonist action on central α-2 receptors which decreased the release of Noradrenalin from sympathetic nervous system (8),(16). Similar results were found in the study conducted by Eren G et al., where they have done the comparison of Dexmedetomidine and three different doses of Midazolam as preoperative sedation (16). Results of the present study are also comparable to those of study done by Erkola O et al., (10), who compared the effects of Dexmedetomidine and Midazolam in elective abdominal surgery. The similar results were also found in the study conducted by Kumari A et al., (17). Here they have compared the sedative and Propofol sparing effect of Dexmedetomidine and Midazolam as premedicants in minor gynecological surgeries.
When respiratory rate and SpO2 values were evaluated, Dexmedetomidine caused reduction in the respiratory rate as compared to Midazolam but without compromising the SpO2 values in both the groups. Similar results were obtained in the studies done to see the effects of Dexmedetomidine on respiratory parameters like in the study done by Hall JE and colleagues (18). Venn RM et al., studied the respiratory effects of Dexmedetomidine in postoperative intensive care unit patients and found similar results (19).
Sedative and anxiolytic effects of both the drugs were studied with the help of Ramsay sedation score and VAS, respectively. Both Midazolam and Dexmedetomidine caused satisfactory sedation and anxiolysis in the pre and postoperative period as compared to the base line values. But Dexmedetomidine caused more intense sedation and anxiolysis as compared to Midazolam. Similar results were observed in the study conducted by Eren G et al., (16) and also in the study conducted by Anita Kumari and colleagues (17).
Side effects like hypotension and bradycardia were treated accordingly. Only one patient from Dexmedetomidine group developed bradycardia (pulse <50 beats per minute), which was treated by giving injection Atropine 0.6 mg intravenously. None of the patient from both the groups developed apnoea or desaturation. None of the patient had nausea or vomiting either.
Limitation(s)
Study was done for gynaecological procedures only and it can be used for other short procedures.
Dexmedetomidine is more effective as a sedative agent than Midazolam when used for minor gynaecological procedures. Although Dexmedetomidine caused significant reduction in SBP, DBP, MAP and HR, it maintained haemodynamic stability well within limits without causing any adverse effects.
DOI: 10.7860/JCDR/2022/56374.16460
Date of Submission: Mar 15, 2022
Date of Peer Review: Apr 05, 2022
Date of Acceptance: May 09, 2022
Date of Publishing: Jun 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Apr 04, 2022
• Manual Googling: Apr 23, 2022
• iThenticate Software: May 31, 2022 (23%)
ETYMOLOGY: Author Origin
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com