RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA

BANGALORE, KARNATAKA

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

|1 |Name of the Candidate and Address (in Block Letters) |Dr. GAYATHRI. G |

| | |W/o Dr. M.P. POORNANANDA |

| | |#320, ANANDA MARGA SIDDARTHANAGARA |

| | |MYSORE. |

|2 |Name of the Institution |J.J.M. MEDICAL COLLEGE |

| | |DAVANGERE – 577 004, KARNATAKA |

|3 |Course of Study and Subject |POSTGRADUATE DEGREE |

| | |M.D. ANAESTHESIOLOGY |

|4 |Date of Admission to Course |1st October 2011 |

|5 |Title of the Topic |“COMPARATIVE STUDY OF ETOMIDATE AND THIOPENTONE SODIUM FOR |

| | |INDUCTION OF |

| | |GENERAL ANAESTHESIA” |

|6 |BRIEF RESUME OF THE INTENDED WORK: |

| |Need for the study: |

| |An Ideal inducing Agent for general Anaesthesia Should have hemodynamic stability, Minimal respiratory side effects and |

| |rapid clearance. |

| |The introduction of thiopental in to clinical practice in 1934 represents one of the most significant advances in the |

| |development of Anaesthesiology. Thiopentone sodium is a derivative of barbituric acid it is the sulphur anologue of |

| |pentobarbitone agent. Thiopentone has been the faster induction agent of anaesthesia because of it’s rapid action. The |

| |main draw back are increased incidence of laryngospasm, bronchospasm allergic reaction, decrease in arterial blood |

| |pressure. Due to it’s cardiorespiratory depressive effects thiopentone is not the drug of choice in shocked patients1. |

| |ETOMIDATE is an imidazole derivative non opiod Intravenous Anaesthetic agent etomidate has been used for both the induction|

| |and maintenance of anaesthesia. The onset of action is in one arm brain circulation. ETOMIDATE is most appropriate in |

| |patients with cardiovascular diseases, reactive airway diseases, intracranial hypertension. The haemodynamic stability of |

| |etomidate is unique among the rapid onset induction agents.The cardiovascular stability and rapid recovery are the features|

| |that commend it’s use as an induction agent in sick and shocked patients1. |

| |This study aims an attempt to compare haemodynomics and other effects of the both the drugs. |

| |Review of Literature |

| |FUCHS T. et al Conducted a study on 60 adult patients allocated them randomly to one of the two groups. Anaesthesia was |

| |induced with alfentanil 10 micro gram/kg followed by thiopentone 5 mg/kg (Goup I) or etomidate 0.3 mg/kg (Group II) both |

| |received rocuronium 0.6 mg/kg. Response to the intubation stimulus was significantly less pronounced in Group II compared |

| |to group I. It was concluded that etomidate as part of an induction regime containing alfentanil and rocuronium, |

| |attenuated the reaction to intubation to a greater extent than thiopentone2. |

| |Scott Jelish W. et al, conducted a study on 66 patients of ASA status II and III, undergoing neuro surgical procedure for |

| |intracranial tumor. Patients were divided into two groups. First control subgroup received low dose etomidate 0.4 to 0.6 |

| |mg/kg, the second control subgroup received thiopentone 3-6 mg/kg. The study group was given high dose etomidate 0.5 to |

| |1.7 mg/kg to an early burst suppression pattern. They concluded that etomidate based anaesthesia induction, titrated to EEG|

| |burst suppression, produced stable haemodynamics during laryngoscopy and intubation as compared with lower dose, more |

| |classic induction with etomidate and thiopentone3. |

| |Boer F et al studied the effect of thiopentone, etomidate and propofol on systemic vascular resistance (SVR) during |

| |cardiopulmonary bypass with constant pump flow in 30 patients undergoing elective coronary artery bypass Surgery. SVR |

| |decreased to 78% of control values after thiopentone 4 mg/kg to 72% of control after etomidate 0.3 mg/kg and to 68% of |

| |control after propofol 2 mg/kg it returned to control values 10 min after administration of thiopentone and propofol and 7 |

| |min after administration of etomidate. Analysis of variance showed that there were no significant differences in the |

| |changes in SVR between the groups4. |

| | |

| |Naresh Dhawan et al conducted study on 30 children with congenital cardiac shunt lesions 15 children having congenital |

| |Right to left group A and 15 children with left to right shunt group B were studied systemic mean arterial pressure and |

| |mean pulmonary arterial pressure and right arterial pressure and pulmonary artery wedge pressure were recorded. He |

| |concluded that the etomidate at 0.3 mg/kg produces very minimal changes in hemodynamic parameters and shunt fraction In |

| |children with congenital shunt lesion5. |

| | |

| |Eames et al conducted a study on 75 patients. Anaesthesia was induced with either 2.5mg/kg Propofol, 0.4 mg/kg etomidate, |

| |or 5mg/kg thiopental. Respiratory resistance was measured at 2 minutes after induction. They concluded that the |

| |respiratory resistance after tracheal intubation is lower after induction with propofol than after with thiopental or after|

| |induction with high dose etomidate6. |

| |Objectives of the Study: |

| |Onset of action |

| |Hemodynamic Changes During |

| |Pre induction |

| |Induction time |

| |Intubation after relaxant |

| |Untoward effects |

| |local irritability at intravenous site of injection |

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|7. |MATERIALS AND METHODS |

| |Source of Data: |

| |This study will be conducted in 60 patients aged between 15-60 yrs undergoing elective surgeries under general anesthesia |

| |in Bapuji Hospital, Chigateri District Hospital and Women and Children Hospital attached to J.J.M. Medical college, |

| |Davangere. |

| | |

| |Method of Collection of Data (Including Sampling Procedure if any) |

| |After institutional ethical committee approval, 60 patients aged between 15-60 years undergoing elective surgeries under |

| |general anaesthesia will be selected. A detailed history, complete physical examination and investigations will be done |

| |for all patients. Informed written consent will be taken. |

| | |

| |The study population will be randomly divided into 2 groups with 30 patients in each group. |

| |Group T Patients will be induced with thiopental 5mg/kg |

| |Group E Patients will be induced with etomidate 0.3mg/kg. |

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| |Method of collection of Data (including sampling procedures if any): |

| |Inclusion criteria: |

| |Age group between 15- 60 years |

| |ASA grade I and II patients |

| |Elective surgeries |

| | |

| |Exclusion criteria: |

| |patients unable to give informed consent |

| |ASA grade III & IV patients |

| |Emergency surgeries |

| |Patient with history of hyper sensitivity to thiopentone and Etomidate |

| |Presence of known primary or secondary adrenal insuffiency or on steroid medication. |

| | |

| |Method: |

| |This study will be conducted on 60 patients. They will be allotted into two groups, comprising of 30 patients in each |

| |group. IV line secured for all patient. All patients. Premeditated with injection fentanyl 2µg/kg and glycopyrollate |

| |0.2mg iv 10min before induction. |

| |Group T patient following premedication receives injection thiopentone 5mg/kg and group E patient following premedication|

| |receives inj. etomidate 0.3mg/kg i.v. for induction of anaesthesia. Required parameters in haemodynamics and side effects |

| |compare with the help of proforma data analysis. |

| | |

| |Does the Study require any investigations or interventions to be conducted on patients or other humans or animals? If so |

| |please describe briefly. |

| |Yes |

| | |

| |Study require: |

| |Blood- HB%, TC, D.C, BT, CT. |

| |Blood urea |

| |Serum creatinine |

| |RBS/FBS |

| |HBSAg, HIV |

| |E.C.G |

| |Urine – albumin, sugar, microscopy. |

| |X-RAY if required. |

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| |Has ethical clearance been obtained from your institution in case of 7.3? |

| |YES |

| |Ethical clearance has been obtained from the institute. |

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|8. |LIST OF REFERENCES: |

| |David Caro, Ron M Walls, Jonathan Grayzel. sedation or induction agents for rapid Sequence intubation In Adults. AMJ |

| |Emergen Medicine May 2011; 17: 141, 19.2. |

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| |Fuchs T, Buder HJ, Sparr and Ziegenfub T. Thopental or Etomidate for Rapid Sequence Induction with Rocuronium. British |

| |Journal of Anaesthesia 1998; 80: 504-506. |

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| |Scott Jellish W, Herve Riche, Francois Salord, Patrick Ravussin, Rene Tempelhoff. Etomidate and thiopental based |

| |Anaesthetic Induction Comparison Between different titrated Levels Electrophysiologic Cortical Depression and response to |

| |laryngoscopy 15th November 1995. |

| | |

| |Boer F, Bovill JG, Ros P, Van Ommen H. Effect of Thiopentone Etomidate And Propofol on Systemic Vascular Rascular |

| |Resistance During Cardio Pulmonary By Pass. British Journal of Anaesthesia 1991; 67(1): 69-72. |

| | |

| |Naresh Dhawan, Sandeep Chauhan, Sunder Kothari, Shambhunath Das. Hemodynamic Response to etomidate In Pediatric Patient |

| |with Congenital Cardia Shunt Lesions Journal of Cardiothoracic and Vascular Anaesthesia October 2010; 24 (Issue 5): 802 – |

| |807. |

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| |Eames Wendell O, Rooke GA, Wu RS, Bishop MJ. Comparison of the effects of etomidate propofol and thiopental on respiratory |

| |resistance after tracheal Intubation. Anaesthesiology June 1996; 84 (Issue 6): 1307-1311. |

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|9. |Signature of the Candidate | |

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|10. |Remarks of the Guide |This study helps to know the least haemodynamic effects after |

| | |giving induction agents. |

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|11. |Name & Designation(in block letters) | |

| |Guide |Dr. Palakshappa K.R. MD.,D.A., |

| | |PROFESSOR |

| | |DEPT OF ANAESTHESIOLOGY, |

| | |J.J.M. MEDICAL COLLEGE, |

| | |DAVANGERE-577004 |

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| |Signature | |

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| |Co-Guide (If any) | |

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| |Signature | |

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| |Head of the Department |Dr MANJUNATH JAJOOR, MD., DA., |

| | |PROFESSOR & HOD |

| | |DEPT OF ANAESTHESIOLOGY, |

| | |J.J.M. MEDICAL COLLEGE, |

| | |DAVANGERE-577004 |

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| |Signature | |

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|12 |Remarks of the Chairman & the | |

| |Principal | |

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| |12.2 Signature | |

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