Objective: To assess whether applying betamethasone-gel to an endotracheal tube is more effective than using an unlubricated endotracheal tube in minimizing the occurrence of postoperative sore throat, hoarseness, and cough. Methods: 144 patients of the American Society of anaesthesiologists-physical status (ASA-PS) I and II, aged 18–65 years of either gender planned for elective surgery under general anaesthesia with endotracheal intubation were included. Patients undergoing ENT /oral cavity / oropharyngeal surgeries and upper respiratory tract infections were excluded. Patients were divided into two groups. In group X, patients were intubated with an endotracheal tube lubricated with 0.05% betamethasone-gel. In group Y patients were intubated with the unlubricated endotracheal tube. All patients were evaluated for the frequency of POST, HOV and PEC at 24 h after extubation. Results: Post-operative sore throat was present in 25 (34.7%) patients in group X and 29 (40.3%) patients in group Y. Post-extubation cough was present in 06 (8.3%) patients in group X and 9 (12.5%) patients in group Y. Hoarseness of voice was present in 04 (5.6%) patients in group X and 6 (8.3%) patients in group Y. A comparison of both groups showed a p-value of 0.0001 which is statistically significant. Conclusion: Using betamethasone-gel to lubricate the endotracheal tube markedly diminishes the frequency and intensity of postoperative airway symptoms. Keywords: Endotracheal intubation, betamethasone, sore throat, cough, hoarseness, anesthesia.
Background: During procedures on the upper limbs, the brachial plexus block is usually advised. To increase the length of the block, many medicines have been utilized as adjuvants. The purpose of this study was to compare the effects of dexmedetomidine plus bupivacaine against bupivacaine alone on the onset and duration of the sensory and motor block and the duration of analgesia in the supraclavicular block during upper extremity orthopaedic surgery. Methods: Sixty individuals qualified for orthopaedic operations on the upper extremities, ranging in age from 20 to 60 years, participated in this prospective, randomized investigation. The modified Bromage scale and the pinprick method were used to assess the sensory and motor block. Using a visual analogue pain scale, the postoperative pain was evaluated at 0, 6, 12 and 24 hours after surgery. Results: In patients receiving only bupivacaine, the mean onset time of sensory and motor block was 32.84 minutes and 26.67 minutes respectively; while in those receiving bupivacaine along with dexmedetomidine, it was 23.38 minutes and 14.81 minutes (p<0.005). In the intervention group (bupivacaine and dexmedetomidine), the period between the first request for analgesia and the duration period of sensory and motor block were both longer (p<0.005). The intervention group experienced less postoperative discomfort for 24 hours (p<0.05). Conclusion: Dexmedetomidine added to bupivacaine perineurally prolonged both numbness and immobility while shortening the time it took for sensory and motor blocks to begin. Moreover, dexmedetomidine considerably decreased postoperative pain when combined with bupivacaine for supraclavicular blocks.
Background: Postoperative nausea and vomiting (PONV) are most common and distressing complications after anaesthesia and surgery, leading to various problems. Metoclopramide, a benzamide, used as an anti-emetic, has got various side-effects. Propofol, a short acting induction agent, possesses anti-emetic properties in sub hypnotic doses, without having unwanted side- effects in this low dose. Objectives: To compare the frequency of PONV in patients treated with propofol and metoclopramide. Study Design: Experimental study. Setting: Department of anaesthesia and intensive care, Combined Military Hospital Rawalpindi. Duration: 06 months (01st July to 31st December 2004). Materials and Methods: 182 female patients scheduled for open cholecystectomy were selected for this study. All of them received general anaesthesia without any prophylactic antiemetic. Out of them, 60 patients who complained of PONV in post anaesthesia care unit (PACU) were selected by non probability convenience sampling and were equally divided into two groups. Group ‘A’ received propofol (0.5 mg/kg) while group ‘B’ received metoclopramide (0.2 mg/kg). Recurrence of PONV was recorded 60 min after administration of the study drug. Patients still complaining of PONV 30 min after administration of the study drug received a rescue medication i.e. I/V ondansetron (4mg). Results: In group “A”,18 patients responded to intervention (60%) whereas 26 (86.66%) patients gave a positive response in group “B” (p 0.020). More patients who received propofol needed the rescue medication (40%) than those who received metoclopramide (13.33%) (p 0.020). Conclusion: Metoclopramide is a better option for managing PONV than propofol.
OBJECTIVE: To demonstrate the effective role of Dexmedetomidine as a sedative and analgesic agent in Covid-19 patients when used in conjunction with the established treatment of Acute Respiratory Distress Syndrome. INTRODUCTION: Covid-19 disease is a deadly contagious disease with milder symptoms to a more severe form with acute respiratory failure, septic shock leading to even death. Literature study shows High Flow Nasal Oxygen therapy and prolonged prone position sessions to be beneficial in the treatment of ARDS, however, to facilitate those sessions, a sedative and anxiolytic agent must be added in the treatment. Therefore, this study was conducted to document the beneficial role of dexmedetomidine as a sedative agent. METHODOLOGY: Retrospective observational study which included 150 PCR positive patients admitted in Covid ITC, from 1st February 2021 to 31st July 2021 residing in the premises of PAF Air Base, Mushaf, Sargodha. Data was analyzed using SPSS software. RESULTS: Out of 150 patients, 120 (80%) were treated with High Flow Nasal Oxygen (HFNO), Dexmedetomidine infusion (DEXME) and long periods of prone position (PP) sessions. Among these 120 patients, 88 (73.3%) were discharged while 32 (26.67%) patients died of which 7 (21.875%) died while being on HFNO therapy and 25 (78.125%) patients were intubated. DEXME infusion was found to have a positive outcome (P-value <0.005) in the treatment of moderate to severe ARDS. CONCLUSION: Our findings suggest that DEXME infusion is beneficial in moderate to severe ARDS caused by SARS-CoV2 when given along with HFNO therapy and prolonged PP sessions, thereby, avoiding intubation.
For induction of anaesthesia many agents are administered intravenously, anaphylactic reaction can occur to anyof these agents. Neuromuscular blocking agents are most commonly implicated as the cause of anaphylactic reaction in anaesthesia practice. Amino-steroids, benzylisoquinoliniums and suxamethonium are being commonly used for intubation and perioperative muscle relaxation. We are presenting a case of anaphylactic reaction to benzylisoquinolinium i.e. atracurium in a young patient. The patient was revived with a prompt diagnosis and treatment.
, .
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.
OBJECTIVE: To demonstrate the effective role of plasmapheresis in the treatment of Cytokine Release Syndrome associated with severe Covid 19 pneumonia. INTRODUCTION: Covid-19 disease is a deadly contagious disease with milder symptoms to a more severe form with acute respiratory failure, septic shock leading to even death. Literature study showed that in severe Covid-19 patients, a hyper-inflammatory response to initial infection could accelerate to severe hyper-cytokinaemia that could lead to an underlying endothelial dysfunction and multiple organ dysfunction. Thus, removal of these inflammatory cytokines by Therapeutic Plasma Exchange is considered to be an essential part of the treatment of critically ill patients in order to improve their survival rates. METHODOLOGY: Retrospective observational study which included 150 RT-PCR positive patients admitted in Covid ITC, from the time period of 1st February 2021 to 31st July 2021 –removed for blind review---Data was analyzed using SPSS software version 16. Frequencies were calculated along with mean and standard deviation. Chi square and ANOVA test was applied to the data. P value <0.05 was considered statistically significant. Linear regression study was applied to predict the prognosis. RESULTS: Out of 150 patients, 51 patients (34%) were of severe ARDS category of whom 13 (25.5%) developed Cytokine Release Syndrome. They received plasmapheresis therapy subsequently and 7 out of those 13 (53.8%) patients got improved. P- value was found to be significant ( <0.05). Overall, the mortality rate was low with 120/150 (80%) getting discharged successfully. CONCLUSION: Our findings suggest that Therapeutic plasma exchange is beneficial in Cytokine storm caused by SARS-CoV2 removing the inflammatory cytokines and improving symptoms, thereby, avoiding intubation. KEY WORDS: , Therapeutic plasma exchange, Hypercytokinaemia, Cytokine Release Syndrome
Objective: To compare patient’s response in open versus laparoscopic cholecystectomy in terms of pain perception, scar acceptability, fear of blind scar and full recovery time.
Study Design: Comparative prospective study.
Place and Duration of Study: This study was conducted at department of surgery CMH Kharian and CMH Jhelum, from Mar 2016 to Nov 2018.
Methodology: Sixty patients were enrolled in this study and divided into two groups of 30 each, after informed consent. Visual pain assessment scale was used to measure intensity of pain and scar visual analog scale to measure scar characteristics. Recovery time of the patient was calculated from the day of hospital discharge till they join their routine work/job. Fear of blind scars and satisfaction was evaluated by Likert scale.
Results: In laparoscopic vs open cholecystectomy pain perception was 80% vs 76.67%, acceptability of scar appearance was 90% vs 27%, fear of blind scar was 70% vs 13.3%, and patients satisfaction was 73.3% vs 90% respectively. Majority of patients who underwent laparoscopic cholecystectomy had an earlier recovery time and minimal scarring.
Conclusion: Both the techniques have their own prospects and consequences. There was no difference in pain perception between the two groups. However, patients who had laparoscopic surgery had minimal scarring and a definite edge over open cholecystectomy in terms of scar appearance.
Background: Spinal anaesthesia has its unique place in modern anaesthetic practice. In past, most of the surgeries, irrespective of the site of surgery, were performed in general anaesthesia but now in the modern anaesthetic field, spinal anaesthesia has markedly replaced general anaesthesia, specifically in obstetrics, lower limbs, and abdominal surgeries. Methods: A total of 100 patients fit to undergo lower limb surgery between the ages of 20 to 70 years were included in the study. 50 patients were in 0.5% hyperbaric bupivacaine (Group A) while 50 patients were in the 0.75% hyperbaric bupivacaine group (Group B). Patients with a history of allergies to local anaesthetics, ischemic heart disease and contraindications to spinal anaesthesia were excluded. At the end of the injection, the patient was immediately laid down and tilted to 30 degrees lateral on the operative side for unilateral anaesthesia. Mean arterial pressure at baseline, 15, 30, 45 and 60 minutes was recorded by trainee anaesthesia. A baseline was taken of mean arterial pressure measured 15 minutes before induction of spinal anaesthesia in a lying position. Results: The mean baseline arterial pressure of patients in group A was 88.72±1.71 mmHg and in group B was 88.94±1.95 mmHg. Mean arterial pressure MAP at 15, 30, 45 and 60 minutes in both groups was as follows; 86.22±2.55 vs 81.78±1.52 mmHg, 83.72±3.36 vs 75.84±1.34 mmHg, 80.02±3.40 vs 70.90±0.97 mmHg and 77.14±4.24 vs 66.06±1.62 mmHg respectively (p-value <0.05). Conclusion: This study concluded that the hemodynamic parameters in terms of mean arterial pressure remained more stable by deviating less from the baseline value with the use of a low dose of 0.5% hyperbaric bupivacaine instead of 0.75% hyperbaric bupivacaine in patients undergoing lower limb surgery under unilateral spinal anaesthesia.
'/%3e%3cpath fill='%23fff' d='m8.751-17.959 10.11 11.373L3.997-9.844l13.94-6.1-7.692 13.129z'/%3e%3c/svg%3e)
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)