Effect of inhalational and continuous epidural anesthesia on the haemostatic mechanism in geriatric patients undergoing major orthopaedic surgery

The speciality of geriatrics has become increasingly important in recent years. Major surgery in elderly patients is associated with higher incidence of postoperative deep vein thrombosis. This work aimed to study the changes in some hemostatic parameters following general and epidural anesthesia in geriatric patients undergoing major hip surgery. The study was carried out on 30 geriatric patients. Patients were allocated to two groups: General anesthesia group which included 15 patients and epidural anesthesia group which included 15 patients. The following measurements were carried out: Platelet count, prothrombin time, partial thromboplastin time, fibrinogen level, fibrin degradation products screening, fibrinopeptide A level and plasminogen estimation. All these investigations were measured in the preoperative period, immediate postoperative period and one week after the operation. There were changes in all parameters after operations indicating the occurrence of postoperative hypercoagulable state in old patients especially among those who received general anesthesia. In this study, it was found that fibrinopeptide A is an early indication for the activity of the hemostatic process. Fibrinopeptide A increased significantly in the general anesthesia group than the epidural one. The incidence of deep vein thrombosis in geriatric patients undergoing major orthopedic surgery was less under continuous epidural anesthesia than those receiving general anesthesia

Evaluation of the anxiolytic effect of oral midazolam on pre-operative anxiety: Comparative study with diazepam and promethazine

The anxiolytic effect of oral midazolam [15 mg], diazepam [10 mg] and promethazine [50 mg], on preoperative anxiety was studied double blindly in three groups; each of 50 adult patients of both sexes, who had undergone moderate and major orthopaedic surgery. All the patients included in the study were selected with panic anxiety according to Taylor's scale [greater than 30] and psychogalvanic reflex wave amplitude [greater than 2.9 mv]. The study showed that three drugs did reduce the preoperative anxiety. Midazolam showed the most striking effect on reducing the degree of preoperative anxiety. This was evident by the significant reduction in the mean Taylor's score [20.5 +/- 1.9] and the mean psychogalvanic reflex wave amplitude [1.1 +/- 0.28 mv] 60 minutes after receiving the drug. This reduction was highly significant when compared with diazepam and promethazine. The three drugs showed significant reduction in the mean values of respiratory rate, pulse rate and systolic blood pressure. The decrease in respiratory rate was more with midazolam but was of no clinical importance. The decrease in blood pressure was marked with promethazine

Assessment of anaesthesia and recovery of propofol Diprivan as a main intravenous anaesthetic agent in minor surgical procedures

Thirty adult patients of both sexes [ASA-1], scheduled for minor surgical procedures were premedicated with atropine only. Anesthesia induced by propofol using a titration method and maintained by increments of 20-30 mg together with inhalation of 50% N2O in O2. The mean induction dose was 2.05 +/- 0.12 mg/kg and mean induction time was 38.5 +/- 6.7 seconds. The quality of induction was good in all patients. Immediately after induction there was significant increase in respiratory and heart rates together with significant reduction in systolic and diastolic arterial pressures which gradually returned to the pre-induction values. Pain at site of injection was noticed in 36.4% of the patients when the veins in the dorsum of the hand were used. Apnea occurred in 20% of patients and its duration was not more than 20 seconds. During anesthesia with propofol 6.6% of the patients showed spontaneous movements, 6.6% showed twitches and one patient showed mild laryngeal spasm. The recovery times after propofol anesthesia were markedly short. The mean time to sit after the end of anesthesia was 6.1 +/- 2.6 minutes and the mean time to stand up unaided was 8.1 +/- 3.1 minutes. The study showed a significant association between total induction dose, total dose of propofol given and duration of anesthesia with the time to sit and time to stand up. All patients had maximum recovery room score after 15 minutes from the end of anesthesia. The study suggests that propofol is the most suitable intravenous anesthetic agent for day case surgery for its smooth induction, uneventful and uncomplicated recovery

Neurological complications as a sequence of Hypophosphatemia in patients receiving total parenteral Hyperalimentation

Within 7 to 10 days after initiation of total parentral hyperalimentation with solutions lacking inorganic phosphates 8 out of 12 patients were found to be significantly hypophosphatemic [serum inorganic phosphate less than 1 mg/100 ml]. Slight nervous manifistations were observed in all of the 8 patients, one of them developed severe nervous manifistations which resulted into coma and respiratory failure. His serum inorganic phosphate was very low [0.35 mg/100 ml]. Intravenous potassium phosphate supplements returned serum phosphate levels to normal with reversal of the neurological manifistations. No hypophosphatemia was detected in the group of patients receiving fat emulsions

Inter-relation between water, electrolytes, and acid-base disturbances in acute intestinal obstruction

The inter-relation between water, electrolytes and acid-base disturbances was studied in 30 patients subjected to elective surgery on the gastrointestinal tract served as a control, 30 patients with early intestinal obstruction and 30 patients with late intestinal obstruction. The alterations in water, electrolytes and acid-base status were not significant in early cases of intestinal obstruction, but were significant in late cases specially when the obstruction was high. Late upper intestinal obstruction cases showed severe losses of water and electrolytes specially potassium, producing metabolic alkalosis compensated by respiratory acidosis. The lower intestinal obstruction cases were associated with metabolic acidosis compensated by respiratory alkalosis and significant loss in water and electrolytes. The existance of hypokalaemia with metabolic acidosis or alkalosis was found

Effect of age on hypoxaemia in the pre-and post-operative periods

The effect of age on the degree of arterial hypoxaemia in the pre- and post-operative period was studied in forty patients who underwent a variety of surgical procedures under general anaesthesia. The study showed that arterial oxygen tension declines, whereas alveolar-arterial oxygen gradient and venous admixture increase with age in the pre-operative period. These changes can be exaggerated post-operatively

Post-operative arterial hypoxemia: determination by calculation of venous admixture

Determination of the degree of arterial hypoxemia during anesthesia and in the post-operative period by measuring the arterial oxygen tension, alveolar-arterial oxygen gradient and venous admixture was carried on 40 adult healthy patients. Depending on the type of surgery adopted, patients were divided into thoracic, abdominal and non abdominal groups. All parameters of hypoxemia showed significant changes in the thoracic group only during anesthesia and in the three groups in the post-operative period. The changes were more severe in the thoracic group than in the abdominal group and were least in the non-abdominal group. These changes were mainly attributed to disturbances in pulmonary gas exchanges [either true shunt, ventilation/perfusion mismatching or both]. Venous admixture proved to be a specific parameter for assessment of such disturbances. The relative value of other parameters of oxygenation-namely [P[A-a]O2 and PaO2 - was explained

Potassium nitrogen ratio as a guide parameter for post-operative intra venous alimentation

Thirty consecutive patient operated upon for cancer oesophagus and stomach were chosen at random for this study. A control group of 10 patients were not treated by intravenous alimentation, while the remaining 20 patients received intravenous alimentation. The K:N ratio was used as a guide parameter for the metabolic changes in each group. The K:N ratio and the N-balance can indicate the metabolic state and the ratio is an earlier indicator and useful guide parameter m such cases