comparison between drugs in prevention of post anesthetic shivering
DESCRIPTION
To compare HR, SBP, DBP, MAP, SPO2 & ETCO2 across groups -In intra-op & Post-op stages at different time intervals -From the base line (Pre-op: for Intra-op & EOC: for Post-op) To study (across groups) Adverse events (Tachycardia, Brady-cardia, Hypertension, Hypo-tension & Nausea Vomiting) Shivering and sedationTRANSCRIPT
PRESENTED BY: SOMDEEP SEN
Business Analyst: Trimax Analytics
e-mail: [email protected](p): 09748229123LinkedIn: http://linkd.in/1ifqs3x
Objectives:
• To compare HR, SBP, DBP, MAP, SPO2 & ETCO2 across groups
-In intra-op & Post-op stages at different time intervals
-From the base line (Pre-op: for Intra-op & EOC: for Post-op)
• To study (across groups)
- Adverse events (Tachycardia, Bradycardia, Hypertension, Hypotension & Nausea Vomiting)
- Shivering and sedation
Total: 120 Patients
Group K=30
Intravenous ketamine
Group C=30Group KC=30
Group P=30
Normal saline
Intravenous clonidine
Intravenous ketamine &
clonidine
Copyright: Somdeep Sen
Differences in age, height, weight, DOS and sex across groups: statistically insignificant
K C KC P
39.80 42.70 40.07 43.27
161.47 163.07 163.37 161.70
64.70 61.47 64.10 64.7076.63 74.27 77.23 73.93
Me
an
Groups
Demographic Details
AGE HEIGHT WEIGHT DOS
Copyright: Somdeep Sen
Parameters(mean) Results
Heart Rate
Statistically difference across groups except the preoperative state
Patterns are same for group K, KC and P
Mean heart rate of group C is relatively lower
SBP Statistically difference across groups except the preoperative state
Similar pattern as the HR
DBP Statistically difference across groups except the preoperative state
Similar pattern as SBP & HR
MAP Statistically difference across groups except the preoperative state
Similar pattern as SBP , HR & MAP
SPO2 Statistically insignificant difference across groups
ETCO2 Similar pattern as SP02
ST Similar pattern as SP02 & ETCO2
CT
Statistically significant difference across groups at all stages
Results are similar for group K, C & KC
No fluctuations in results (36.53) for group C at all stages
Copyright: Somdeep Sen
Parameters(mean) Results
HR
Statistically significant difference across groups at all stages
Identical results in group KC & P
Results are relatively similar in Group K, KC & P
Values for group C is relatively lower
SBP
Statistically significant difference across groups at all stages
Results are relatively similar in Group K, KC & P
Values for group C is relatively lower
DBP Similar patterns as SBP
MAP
Statistically significant difference across groups at all stages
Results are relatively similar in Group K, C & KC
Values for group P is relatively lower
SPO2 Statistically insignificant difference across groups at all stages
Copyright: Somdeep Sen
Groups Results
K
HR, MAP, ST, DBP is different throughout
ETCO2, SPO2 is stable throughout
Mean SBP is stable except intubation and end of surgery
CT is different across all time intervals except the first 5 minutes
C
HR, SBP is different throughout except IND
SP02, ETCO2 is same throughout
CT is different across all time intervals except the first 5 minutes
ST, DBP is different throughout
KC
HR, ST is different throughout
SBP, MAP, DBP, SP02, ETCO2 is stable throughout
CT is different across all time intervals except the first 5 minutes
P
MAP, DBP, SPO2, ETCO2, CT is stable throughout
Mean Heart is same throughout except IND
Mean SBP is stable except EOS
ST is different across all time intervals
* Parameters are expressed as mean
Copyright: Somdeep Sen
Groups Analysis
K HR, MAP, SBP, DBP is different throughout
SPO2 is stable throughout
C HR, MAP, SBP, DBP is different throughout
SPO2 is stable throughout
KC
HR, DBP, is different throughout
SBP & SPO2 is stable throughout
Mean MAP is different except 5 & 10 minutes interval
P HR, MAP, SBP, DBP is different throughout
SPO2 is stable throughout
* Parameters are expressed as meanCopyright: Somdeep Sen
0
2
4
6
8
10
12
14
16
Bradycardia Tachycardia Hypertension Hypotension Nausea and Vomiting
2.5
15
13.33
0.83
12.5
2.5
0.83
13.33
6.67
3.33
5 5
4.17
1.67
4.17
8.33
11.67
4.17
3.33
Adverse Effect(%)
K C KC P
Statistically significant difference in the occurrence of adverse events across all the groups
Copyright: Somdeep Sen
Events Analysis
Bradycardia 27% :out of 120
50 %: out of 30 in group C
Relatively low in the other groups
Tachycardia 30.83% : out of 120
60 % : out of 30 in group K
Relatively low in other groups
Hypotension 21.67% : Out of 120
53.3% : Out of 30 in group C
None group K has
Relatively low in KC and P
Nausea & Vomiting Only 12.5% : 120
26% : out of 30 in Group C
Relatively low in all the groups.
Hypertension 30.83% : out of 120
53 % : out of 30 in group K; 47% of the people (out of 30) in group P
Relatively low in group C & KC
Copyright: Somdeep Sen
• Statistically significant difference among in the sedation scores across groups
• All the patients had sedation across groups
• None belonging to group K, KC and P had extreme sedation(>=3)
• 23.3%: out of 30 in group C had extreme sedation
>3 >=3
100
76.67
23.33
100 100
Sedation Score: Within Groups
K C KC P
Copyright: Somdeep Sen
• Statistically significant difference in the occurrence of shivering across group
• 75.9% of people: out of 120 ; 27.5% of people had extreme shivering(>=3)
• 66.67% people out of 30 in group P had experienced extreme shivering
• Moderate or No Shivering: 86.67% in group KC; 76.67% in Group K and 93.3% in group C
• Intravenous clonidine: Most useful in prevention of post anesthetic shivering as compared to other drugs
• Placebo seems to be the least effective in the prevention of shivering in comparison to others
0 <3 >=3
10.0
66.67
23.33
33.3
60.00
6.67
50.0
36.67
13.33
3.3
30.00
66.67
Shivering Score(%): With in GroupsK C KC P
Copyright: Somdeep Sen
Terms Abbreviation
HR Heart Rate
SBP Systolic Blood Pressure
DBP Diastolic Blood Pressure
MAP Mean Arterial Pressure
SPO2 Peripheral oxygen saturation
ETCO2 Capnography
CT Core Temperature
ST Surface Temperature
DOS Duration of SurgeryAdverse events:
•Tachycardia happens when intra-operative Heart Rate rises above 100
•Bradycardia happens when intra-operative Heart Rate falls below 60
•Hypertension happens when the Intra-operative MAP rises 20% or more from Baseline level
•Hypotension happens when the Intra-operative MAP falls 20% or more from Baseline level
Copyright: Somdeep Sen
Score Shivering Sedation
0 None -
1 peripheral vasoconstriction but no visible
shivering fully awake and oriented
2 Muscular activity in only one muscle
group Drowsy
3 Muscular activity in more than one
muscle group but not generalized Eye closed but responds to commands
4 Shivering all over the body Eye closed but responds to mild physical stimulation.
5 - Eye closed and not responding to mild physical stimulation.
Copyright: Somdeep Sen
Copyright: Somdeep Sen
Detailed document available at: http://bit.ly/1nvZxBn