Objective: The objective of the study was to assess the occurrence and severity of sore throat following endotracheal anaesthesia and its reduction by beclomethasone inhalation.Study Design: A randomized controlled trial.Place and Duration of Study: This study was carried out at the main operation theatre, Combined Military Hospital Rawalpindi from October 2002 to April 2003.Patients and Methods: Two hundred patients undergoing general anaesthesia for elective surgery were included. Patients were randomly assigned to two groups of 100 patients each. The patients in group A were given one puff inhalation of beclomethasone before intubation while group B was control group. The patients were evaluated for occurrence and severity of postoperative sore throat by direct questions 6, 12, 24 and 48 hours after surgery.Results: In the beclomethasone group, 10 patients had sore throat as compared to 55 in control group (p <0.01). All 10 patients who experienced symptoms in beclomethasone group had mild sore throat while among the patients in the control group 22 had mild, 13 had moderate and 20 had severe sore throat. After 48 hours, no patient had the symptoms in the study group while 9 of the control group still suffered from sore throat. No drug related side effects were observed.Conclusion: Postoperative sore throat after general anaesthesia is common (occurrence rate of 55%). Beclomethasone inhaler is highly effective in the prevention of postoperative sore throat. It reduces both the occurrence and severity of sore throat.
To assess the efficacy of blind nasal intubation technique, in cases of ankylosis of temporomandibular joint (TMJ) without the facility of fiber optic bronchoscope.Analytical study.Maxillofacial Surgery Department, Armed Forces Institute of Dentistry, Rawalpindi, Pakistan, from August 2002 to October 2003.A total of 35 patients of ankylosis of TMJ were included in the study. Blind nasotracheal intubation technique was attempted after induction of anaesthesia and paralyzing the patients. Where blind nasotracheal intubation technique was not successful, one nasotracheal tube was passed into the esophagus and retained. Nasotracheal intubation was attempted through contralateral nares by second tube.Out of 35 patients male to female ratio was 1:1.2. The age of the patients ranged between 5 to 35 years with a mean age of 14.5 years. Blind nasotracheal intubation technique was successful in 23 cases (65.7%), whereas in 12 patients intubation was not successful. The 12 cases of failed blind nasotracheal intubation technique were successfully intubated nasotracheally by prior placement of nasotracheal tube into the esophagus through contralateral nares, which facilitated re-intubation (34.3%).In the selected patients blind nasotracheal intubation was facilitated by prior placement of the endotracheal tube into esophagus. This technique may be helpful in reducing the psychological trauma and complications of tracheostomy in such patients. However, to-date, fiber optic intubation remains the safest and widely accepted intubation technique in such patients.
Objective: To determine the frequency of difficult intubation in obese patients with neck circumference tothyromental distance ratio (NC/TM) ≥5.0.Study Design: Cross sectional study.Place and Duration of Study: Department of Anaesthesia, Forward Treatment Centre, Kel (Azad Kashmir) andCombined Military Hospital (CMH) Malir. Six months, from Jun 2015 to Nov 2015.Material and Methods: A total of 94 patients between the ages of 18 and 50 years with body mass index (BMI)≥27.5 kg/m2 and NC/TM ≥5.0 who received general anesthesia requiring tracheal intubation for elective surgery(Orthopaedic, General Sugery, Urology & Gynaecology) were included in the study. Patients were inducedgeneral anaesthesia and orotracheal intubation was done by anaesthetist with at least 1 year experience. Numberof intubation attempts were recorded in each patient. More than 3 attempts were considered difficult intubation.Results: Eighty two (87.2%) out of 94 obese patients with BMI ≥27.5 kg/m2 and NC/TM ≥5 had difficultintubation.Conclusion: The NC/TM ≥5 was found good predictor for difficult intubation in obese patients.
Background: The key to success in newborn resuscitation is theknowledge about the neonatal physiology and adequate preparation of the staff involved in the resuscitation process.The pulmonary part of the resuscitation can be accomplished with either Endotracheal Tube (ETT) or Face Mask (FM),both of these techniques require expertise and are associated with high rates of failure. Hence a third potential optionhas been suggested to overcome these problems. Objectives: To evaluate the efficacy of Laryngeal Mask Airway(LMA) in neonatal resuscitation and artificial ventilation and to compare it with that of ETT and FM. To evaluate LMA’sefficiency in situation where endotracheal intubation and facemask ventilation is difficult or not possible. Design: A Noninterventional, analytical / comparative study Setting: Combined Military Hospital Rawalpindi. Period: 20 weeks (1stJanuary 2002 to 31 May 2002). Subjects: A group of 75 neonates born with C-Section were selected on the basis ofnon-probability convenience sampling. They were subdivided into three sub gps with 25 neonates in each sub gp.Interventions; 75 neonates born after C-Section, were divided into sub gps i.e. A, B, and C containing a no of 25neonates in each gp. They were ventilated with ETT, FM and LMA respectively. These newborn babies had an Apgarscore < 4. They were resuscitated using a fix protocol. The efficacy of ventilation with either technique was evaluatedin terms of placement and ventilation. Results: The LMA emerged, as a valuable and better option in newbornresuscitation. Moreover, it was a successful tool in situations where endotracheal intubation and facemask ventilationwas difficult or impossible. Conclusion: The LMA is a potential valuable adjunct for the management of neonatalairway.
Objectives: to evaluate the clinical safety, effectiveness, efficacy andpotential side effects of sedation in pediatric patients undergoing computerized tomography by intrarectal thiopentoneand to compare this technique with general anaesthesia for computerized tomography in paediatric patients. StudyDesign: Interventional and analytical / comparative study. Place and duration of study: The study was carried outin Radiology department Combined Military Hospital Rawalpindi over a period of 1 year from Jan 2003 to Jan 2004.Material and Methods: Sixty children below 5 years of age were selected by nonprobability convenience samplingand divided into 2 groups A and B, each comprising of 30 children .Group A was sedated by thiopentone sodium thatwas administered rectally and group B received general anaesthesia with a uniform technique. Results: in group Aquality of sedation was judged to be adequate in 26 out of 30 patients (86.6%). Another 2 were sedated but requiredmild restraint like reposition of the neck leaving 2 with inadequate sedation or an overall failure rate of 6.66%.In groupB the success rate was 100% with no observation of any complication. Conclusion: rectally administered thiopentalis a safe and effective sedative for paediatric patients requiring CT scanning in the presence of anaesthesiologist andthe failure rate is very low. General anaesthesia makes CT scan more successful with minimal adverse events.
Objective: To compare the efficacy of various doses of intrathecal hyperbaric bupivacaine 0.75% for adult anorectal surgery.
Study Design: Randomized control trial.
Place and Duration of Study: The study was conducted at the department of Anaesthesia, Intensive Care and Pain medicine, Combined Military Hospital (CMH) Quetta from November 2008 to October 2009.
Material and Methods: 120 adult patients undergoing anorectal surgery were randomly assigned to three groups. Groups A (n=40) was given the lowest dose of 4.5mg intrathecal hyperbaric bupivacaine 0.75%, while group B (n=40) and group C (n=40) were given 6.0mg and 7.5 mg,respectively. Dural puncture at L4/L5 level for drug administration was done in the sitting position and patient was made to lie down after five minutes and block level assessed.Variables to be assessed were level of sensory block indicated by number of dermatomes with pinprick method and extent of motor block by Modified Bromage Score.
Results: Level of sensory block in groups A,B and C was 5.88 ± 0.94, 8.15± 0.83, 10.10 ± 0.78 dermatomes, respectively (F (2, 117) = 245.976; p<0.0001 ANOVA; p<0.0001 group A vs B, group A vs. C and group B vs. C). Extent of motor block was 4.83 according to the Modified Bromage Scale in group A, compared to 2.25 in group B and 1.48 in group C (H (2) = 92.007; p<0.0001; p<0.0001 group A vs. B, group A vs. C and group B vs. C ).
Conclusion: Efficacy of three doses of intrathecal hyperbaric bupivacaine 0.75% was found to be statistically different although all three doses produced adequate anaesthesia for anorectal surgery. The 4.5 mg dose of spinal hyperbaric bupivacaine is recommended since the doses of 6 mg and 7.5 mg result in extensive motor block.
Objectives: The study was carried out to assess the frequency of pain and withdrawal movements after injection of rocuronium and effects of pre-treatment with lignocaine. Design: It was a double blind study. Place and Duration of Study: This study was of six months duration and was carried out from March 2004 to September 2004 at Combined Military Hospital Kharian. Patients and Methods:One hundred and twenty unpremedicated patients with ASA grade I and II, aged between 18-60 years and of both sexes were enrolled in the study. Patients were randomly divided into two groups of 60 patients each. After induction of anaesthesia with thiopentone, patients in group A, received 3 ml of lignocaine plain while those in group B, received 3 ml of normal saline as pre-treatment before injection of rocuronium. Their effects on pain on injection and withdrawal movements of the arm were studied. Results: Out of total of 120 patients, only 17 patients (14%) developed withdrawal movements of the arm or wrist. In Group A, who received lignocaine plain before rocuronium injection, only 3 out of 60 patients had withdrawal movements while in Group B, who received normal saline as pre-treatment, fourteen out of 60 patients developed withdrawal movements of the arm or wrist. Only one patient belonging to Group B experienced pain. Conclusion: Pre-treatment with lignocaine plain greatly reduces the chances of withdrawal movements and pain on injection of rocuronium.
Objective: To assess the frequency of pain and withdrawal movements after injection of rocuronium and effects of pre-treatment with lignocaine. Study Design: Double blind study. Duration of Study: This study was of six months duration and was carried out from March 2004 to September 2004. Setting: Combined Military Hospital Kharian. Patients and Methods: One hundred and twenty unpremedicated patients with ASA grade I and II, aged between 18-60 years and of both sexes were enrolled in the study. Patients were randomly divided into two groups of 60 patients each. After induction of anaesthesia with thiopentone, patients in group A received 3 ml of lignocaine plain while those in group B, received 3 ml of normal saline as pre-treatment before injection of rocuronium. Their effects on pain on injection and withdrawalmovements of the arm were studied. Results: Out of total of 120 patients, only 17 patients (14%) developed withdrawal movements of the arm or wrist. In Group A, who received lignocaine plain before rocuronium injection, only 3 patients out of 60 patients had withdrawal movements while in Group B, who received normal saline as pre-treatment fourteen out of 60 patients developed withdrawal movements of the arm or wrist. Only one patient belonging to Group B experienced pain. Conclusions: Pretreatment with lignocaine plain greatly reduces the chances of withdrawal movements and pain on injection of rocuronium.
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