Sas medical case study final (1)

Submitted BY:

Ashish Ranjan

Anirban Ghosh

Ayan Das

Madhumita Ghosh

Somdeep Sen

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

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

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

SBPStatistically difference across groups except the preoperative state

Similar pattern as the HR

DBPStatistically difference across groups except the preoperative state

Similar pattern as SBP & HR

MAPStatistically 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

Parameters(mean) Results

HR


Identical results in group KC & P

Results are relatively similar in Group K, KC & P

Values for group C is relatively lower

SBP


Results are relatively similar in Group K, KC & P

Values for group C is relatively lower

DBP Similar patterns as SBP

MAP


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

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


ST, DBP is different throughout

KC

HR, ST is different throughout

SBP, MAP, DBP, SP02, ETCO2 is stable throughout


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

Groups Analysis

KHR, MAP, SBP, DBP is different throughout

SPO2 is stable throughout

CHR, MAP, SBP, DBP is different throughout


KC

HR, DBP, is different throughout

SBP & SPO2 is stable throughout

Mean MAP is different except 5 & 10 minutes interval

PHR, MAP, SBP, DBP is different throughout


* Parameters are expressed as mean

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

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

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

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

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

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.

Technology

Sas medical case study final (1)