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Home > A Randomized Controlled Trial Comparing the Proportion of Hypoxia in Sedated Adults Undergoing Upper Gastrointestinal Endoscopy Using Target Controlled Infusion of Propofol Versus Intermittent Boluses.

A Randomized Controlled Trial Comparing the Proportion of Hypoxia in Sedated Adults Undergoing Upper Gastrointestinal Endoscopy Using Target Controlled Infusion of Propofol Versus Intermittent Boluses.

Thesis Info

Author

Ndosi, Catherine

Department

Anaesthesiology (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2017

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728034313

Similar


Background: A wide variety of sedation techniques are employed to facilitate various invasive diagnostic and therapeutic procedures. Increasingly, propofol is emerging as the preferred sedative agent. Traditionally, it has been administered as intermittent boluses to achieve deep sedation to facilitate gastrointestinal endoscopy. Propofol target controlled infusion can be employed to provide suitably conducive conditions for this purpose. Objective: The primary objective sought to compare the proportion of hypoxia between the study group receiving intermittent boluses of propofol at 0.25mg/kg as needed, and the other receiving target-controlled infusion of propofol at 2.5mcg/ml during upper gastrointestinal endoscopy. The secondary objectives were to compare the occurrence of hypotension, bradycardia, and the time to wake up between the two groups. Primary outcome measure: Decrease in oxygen saturation below 90 percent (SpO2 <90%) Secondary outcome measures: Decrease in systolic blood pressure of more than 20% from baseline; decrease in heart rate to less than 50 beats per minute. Study design: prospective, single centre, randomized controlled trial Study setting: The Aga Khan University Hospital, Nairobi. Sample size: One hundred and seventy-six participants were enrolled; 88 belonging to the intermittent bolus arm and 88, to the target-controlled infusion arm. Study population: Included all ASA I and II patients between the ages of 18 and 65 years scheduled to undergo upper gastrointestinal endoscopy (oesophagogastroduodenoscopy) under sedation. Sedation procedure: One hundred and seventy-six participants were allocated randomly into one of two groups corresponding to the mode of propofol used for sedation (a) Premedication with midazolam 0.05mg/kg added to an initial bolus of propofol 1mg/kg, followed by repeat boluses of 0.25mg/kg as needed (B, n = 88) and (b) Premedication with midazolam 0.05mg/kg added to an initial target effect-site concentration of 4mcg/ml, followed by maintenance target effect-site concentration of 2.5mcg/ml, titrated upward or downward by 0.5mcg/ml from baseline infusion rate as needed (T, n = 88). Oxygenation and haemodynamic parameters were evaluated by determining oxygen saturation, blood pressure and heart rate immediately before administering the sedative and at 2.50, 5.00, 7.50 and 10.00 minutes. Standard care was, in addition to the above, provided. Data collection: A data collection tool was used to record data (refer to appendix V). Patients’ baseline vital signs, including blood pressure, heart rate and oxygen saturation were entered. Any occurrence of oxygen desaturation below 90% in both study groups was also recorded. The sedation starting time, stopping time, waking up time and overall duration of time
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مولانا بشیر احمد کٹھوری

بشیر احمد کٹھوری
صدحیف کہ پچھلے دنوں ہماری بزم انس ومحبت کاایک اوررکن ہم سے بچھڑ گیا۔ یعنی مولانا بشیر احمدصاحب کٹھوری المعروف بہ بھٹہ نے طویل علالت کے بعد وفات پائی۔ مولانا نے اگرچہ علوم عربیہ اوردرس نظامی کی سیوہارہ، امروہہ اور مرادآباد میں باقاعدہ تکمیل کی تھی۔لیکن ان کوکبھی ان علوم کے ساتھ اشتغال یاان کے درس کاموقع نہیں ملا۔اس لیے نتیجہ کے اعتبارسے ان کوباقاعدہ وباضابطہ عالم کہنا بھی مشکل ہے۔لیکن دماغ اورذہن بلا کا رساپایا تھا۔ذہانت اور جودتِ طبع کایہ عالم تھاکہ اگروہ علوم دینیہ واسلامیہ میں مشغول رہتے تومولانا عبیداﷲ سندھی بنتے۔ اور اگر انگریزی تعلیم حاصل کرلیتے تو سرعلی امام یاسر فضل حسین سے کم نہ رہتے۔ بڑے بڑے علما اور انگریزی تعلیم یافتہ حضرات کی مجلسوں میں جب کسی موضوع پرتقریر کرتے تھے تواپنے منطقی استدلال اور برہانی طرزِ بیان سے چھاجاتے تھے اور پھراُن کی تردید کرناآسان نہیں رہتاتھا۔معاش کے لیے انھوں نے کاروبار کاراستہ اختیار کیااور اس میں اپنی ذہانت اورمحنت سے اس درجہ ترقی کی کہ مٹی سے سونا پیدا کرنے لگے۔ اپنی اینٹوں سے سیکڑوں شاندار عمارتیں کارخانے اورفیکٹریاں بنا ڈالیں۔لیکن خودہمیشہ مزدوروں کی طرح کام کرتے رہے اور انھیں کی طرح رہتے رہے۔ خلقِ خداکی خدمت کاان میں بے پناہ جذبہ تھا۔جوشخص بھی ان کے پاس جس کام کے لیے پہنچ جاتاتھا ان کے درسے مایوس نہیں لوٹتا تھا۔ جمعیۃ علمائے ہندکے اعلیٰ طبقہ سے تعلق رکھتے تھے۔اوران کا اس جماعت میں بڑا وقار اور امتیاز تھا۔کانگریس کے بھی بڑے بااثر اورسر گرم کارکن تھے۔تحریک خلافت اورپھر تحریک آزادی کے زمانہ میں کئی بارجیل گئے جس سے ان کی صحت اورکاروبار کوبڑانقصان پہنچا۔لیکن ان کے جوش،سرگرمی اور ولولۂ کار میں کبھی فرق نہ آیا۔قلب ودماغ کی ان خوبیوں کے ساتھ ان میں اخلاقی جرأت بھی کچھ کم نہیں تھی۔ صوبہ اتر پردیش کی کونسل...

Empowering Women through Media in Algerian Non-Governmental Organizations

تعد وسائل الإعلام أداة تستخدمها العديد من المنظمات غير الحكومية في جميع أنحاء العالم. تهدف هذه الدراسة إلى التحقيق في الاستراتيجية التي تستخدمها المنظمات النسائية غير الحكومية في الجزائر لتعزيز ومناصرة المشاكل التي تؤثر على حقوق المرأة وتمكينها. يتم تحقيق ذلك من خلال النظر في كيفية تعبئة المنظمات غير الحكومية لمواردها واستخدام تقنيات محددة لدعم برامج تمكين المرأة. وتنتمي هذه الدراسة إلى البحوث الوصفية التي تختار طريقة مختلطة تجمع بين المقاربات النوعية والكمية. بتعبير أدق، استخدمت استبيانًا منظمًا وزع على 200 مستجيب و16 مقابلة شبه منظمة موجهة إلى مديري المنظمات غير الحكومية من 14 منظمة غير حكومية مختلفة في الجزائر العاصمة. تكشف النتائج أن المنظمات غير الحكومية تختار أدوات وسائل الإعلام اعتمادًا على صلتها بالجماهير والممارسات المستهدفة. في حين أن القنوات الإعلامية التقليدية لم تكن تستخدم بشكل متكرر من قبل المنظمات غير الحكومية وكانت فعالة من حيث الوصول إلى أهدافها الدعائية، كان لوسائل التواصل الاجتماعي تأثير أكثر عمقًا على الناس. ومع ذلك، استخدمته بعض المنظمات غير الحكومية للتأثير على الجمهور من خلال تعزيز النشاط وزيادة الوعي بقضايا المرأة. النظر في ظهور المرأة في أماكن جديدة، مثل وسائل التواصل الاجتماعي، والتحقيق في وظيفة المساحات التي تم تشكيلها حديثًا في عملية التمكين يجب استكشافها وتقييمها بشكل أكبر لمساعدة المنظمات غير الحكومية على القيام بعمل أكثر فعالية في هذا المجال.

Flow and Heat Transfer Analysis of Some Newtonian and Non-Newtonian Fluids

Boundary layer flow in Newtonian and non-Newtonian fluids is encountered in many industrial processes. Particularly boundary layer flow over stretching surface is significant due to their practical applications in processes involving continuous pulling of sheet in textile and paper industries and in the manufacturing of polymer sheets, sheet glass and crystalline materials. Processes like paper production, wire drawing, crystal growth, drawing of plastic films, food processing, metal spinning process, cooling of metallic plate in a cooling bath etc. involves the phenomena of a continuous stretching sheet. In these processes the quality of final product is strongly dependent upon the temperature provided in the process. Therefore to discuss heat transfer characteristics of such boundary layer flows is also important. A literature survey reveals that a large number of research papers are available to discuss flow and heat transfer phenomena due to stretching sheet. This phenomenon is discussed both for two and three-dimensional boundary layer flows. The literature survey indicates that there is room for discussing the three dimensional boundary layer flows over an unsteady stretching surface. Motivated by the practical importance of such boundary layer flows we have discussed three-dimensional flows of viscous, Maxwell and Oldroyd-B fluids due to an unsteady bidirectional stretching sheet in the first half of this thesis. Furthermore, heat transfer analysis for these flows is also considered in the presence of heat source or sink. Some industrial and biological processes involve the flow situations when one fluid is flowing over another fluid having thin layer usually known as a lubrication layer. These have applications in living systems, such as flow pattern of red blood cells in narrow capillaries, liquid flow in the lungs, eye etc. and in the machinery components including fluid bearing and mechanical seals, coating, preparation of thin films and paintings. For the stretching flows with no-slip one has to deal with the nonlinear differential equations with linear boundary conditions. However, for the boundary layer flow over a lubricated surface one needs to solve nonlinear differential equations subject to nonlinear boundary conditions. These nonlinearities in boundary conditions make the system more complicated and analytic solutions are hard with the standard analytical methods. Furthermore, governing equations of non-Newtonian fluids have higher order then the available boundary conditions and in the stretching and stagnation point flows, the coefficient of the leading derivative vanishes at the starting point of the domain. Due to this fact the numerical solutions by a standard integration scheme is not possible. Researchers have adopted different methods to tackle such difficulties. In the second part of this thesis we have discussed the boundary layer flows of second and third grade fluids over a lubricated surface with a power law lubricant. For handling nonlinear boundary conditions we have used the combination of homotopy analysis and shooting methods. The literature is scarce for the flow of non-Newtonian fluids over a lubricated surface. This encourages us to consider flow and heat transfer of non-Newtonian fluids over a lubricated surface. In view of the above mentioned discussion, the thesis is structured as follows. Chapters one covers the literature survey and laws of conservation of mass, momentum and energy. Boundary layer equations of second grade, third grade, Maxwell and Oldroyd-B fluids are also presented. Solution methodology via homotopy analysis method (HAM) and hybrid homotopy analysis method (HHAM) is also given in this chapter. Chapter two addresses the unsteady three-dimensional flow of an incompressible viscous fluid over an unsteady stretching surface in a porous medium. Fluid is electrically conducting and a constant magnetic field is applied in the transverse direction. Heat transfer through constant temperature (CT) and constant heat flux (CH) is also considered. Governing equations are simplified first by applying boundary layer approximations and then by a suitable similarity transformations. Analytical technique (HAM) is used to solve the nonlinear problems subject to linear boundary conditions. A comparison with the existing solutions is also presented for the special case. The leading results of this chapter are published in the journal “Thermal Science”. In chapter three, we have extended the analysis of chapter two for a Maxwell fluid. Boundary layer equations for the three-dimensional flow are used to discuss the flow and heat transfer phenomena. The results are discussed for the influence of pertinent parameters involved in the problem. The contents are accepted for publication in the “Journal of the Brazilian Society of Mechanical Sciences and Engineering”. Chapter four provides the three-dimensional flow and heat transfer of an Oldroyd-B fluid past an unsteady bidirectional stretching surface with constant temperature and constant heat flux. Boundary layer equations are developed for the three-dimensional flow. Similarity solutions are obtained using HAM and convergence of the series is discussed explicitly. The effects of emerging parameters on the velocity and temperature profiles are investigated through graphs and tabular data. Comparison of obtained and previously published work is found in excellent agreement. The results of this chapter are accepted for publication in “Journal of Applied Fluid Mechanics”. Chapter five is prepared to examine the flow and heat transfer analysis of second grade fluid over a lubricated surface. The power law lubricant is assumed to have a thin layer of variable thickness. The interface conditions between second grade fluid and power law lubricant give rise to nonlinear slip condition which is imposed on the boundary. Solutions for this problem are developed using hybrid homotopy analysis method which combines the features of homotopy analysis and shooting methods. Residual errors are computed to validate the obtained solutions. Numerical values of local Nusselt number are examined. The part of the chapter including the flow phenomena is accepted for publication in “European International Journal of Sciences and Technology” while the heat transfer problem is published in “American Journal of Heat and Mass Transfer”. Chapter six extends the flow analysis of chapter five for a third grade fluid. The contents of this chapter are published in “Advances in Mechanical Engineering”. Magnetohydrodynamic Stagnation-point flow and heat transfer analysis of a third grade fluid over a lubricated surface is analyzed in chapter seven. Boundary layer equations for the two dimensional flow are solved subject to a nonlinear slip condition. The corresponding boundary value problems for flow and heat are solved using hybrid homotopy analysis method. Obtained results are validated by plotting residual error curves. The results are discussed for the variations of different parameters appearing in the problem. The work carried out for the flow phenomena is published in “AIP Advances” and the work related to heat transfer analysis is submitted for possible publication in “Journal of Mechanics”.