ABSTRACT
Objectives: Hoarseness of voice, cough and sore throat are well known complications of endotracheal intubation. Many pharmacological strategies are used to reduce the incidence of these complications post surgery. We conducted this study to see the effectiveness of local application of diclofenac sodium gel, lidocaine gel or the effect of these two drugs when applied in combination on tracheal tube during intubation, regarding hemodynamic response and the incidence of postoperative sore throat, hoarseness of voice and cough
Methodology: In this prospective, randomized single blind trial, 150 patients undergoing coronary artery bypass graft [CABG] surgery at Chaudhry Pervaiz Elahi Institute of Cardiology from January 2016 to March 2016, were selected. The patients were divided into three groups; Group X [control Group] in which endotracheal tube [ETT] was lubricated with 2% lignocaine gel. Group D: ETT was lubricated with diclofenac sodium gel [2%]. And Group XD: where a mixture of lignocaine and diclofenac sodium gels was used to lubricate ETT before insertion. Data were analyzed in SPSS V16. One way ANOVA and chi-square test was used for analysis of quantitative and qualitative variables respectively taking p-value < 0.05 to be significant
Results: There was no difference in the age and gender of patients between groups. Post intubation HR increased more in Group D [108.94 +/- 7.40 beats/min.], and least in Group XD 96.62 +/- 3.84 beats/min and 100.72 +/- 6.98 beats/min in group X [p < 0.0001]. HR returned back to baseline value in group X and Group XD within five minutes after intubation but remained higher in diclofenac group [p < 0.0001]. The rise in blood pressure after intubation was highest in Group D [162.46 +/- 5.05 mmHg], then 157.34 +/- 5.43 mmHg in Group X, and least in Group XD [154.12 +/- 6.07 mmHg] [p < 0.0001]. Similarly blood pressure after five minutes of intubation was still high in Group D and was least in Group XD [p < 0.0001]. The time of return of HR and systolic blood pressure to baseline value was 9.00 +/- 1.33 min in Group D, 4.59 +/- 1.03 min in Group X and 3.43 +/- 0.81 min in group XD [p < 0.0001]. Incidence of sore throat, hoarseness of voice and cough was highest in Group X and less in Group D and was least in Group XD [p-values 0.039, 0.025 and 0.002 respectively]
Conclusion: Local application of a combination of lignocaine and diclofenac sodium gels over the endotracheal tube before intubation is associated with better hemodynamic control and significantly lower incidence of postoperative sore throat, hoarseness of voice and cough
ABSTRACT
Objective: Pulmonary dysfunction is considered to be the most important complication after open heart surgery. Different maneuvers like intermittent or continuous positive pressure ventilation, low tidal volume ventilation and different vital capacity maneuvers have been used for reducing the incidence of pulmonary dysfunction after cardiac surgery. In this study we evaluated the effects of low tidal volume ventilation versus no-ventilation during cardiopulmonary bypass [CPB] in patients undergoing conventional CABG surgery
Methodology: This randomized clinical trial was conducted in a tertiary care cardiac hospital. One hundred patients who were planned to undergo conventional CABG surgery were divided into two groups by using draw randomization procedure. In Group A patients [ventilation group] ventilation was continued at low tidal volume of 3 ml/kg, respiration rate of 12 breaths/min and PEEP of 5 cmH[2]O. In Group B patients [non-ventilation group] ventilation was arrested during CPB. For data analysis Statistical Package for Social Sciences [SPSS] V17 was used. Parametric variables were compared using unpaired t-test and non-parametric variables were compared using o[2]-test
Results: The mean patient's age in this study was 57.70 +/- 8.57 years in ventilated group and 54.5 +/- 8.33 years in non-ventilated group. PaO[2]/FiO[2] ratio and alveolar-arterial oxygen tension gradient immediately after intubation was same in groups. But PaO[2]/FiO[2] was significantly high in ventilated group after one hours of CPB and even after four hours of CPB [p < 0.001 and 0.002 respectively]. Alveolar arterial oxygen tension [A-a O[2]] gradient after 1 hour and four hours of CPB was significantly low in Ventilated group [p < 0.001 and 0.001 respectively]. Total Mechanical ventilation time was also significantly shorter in ventilated group 5.19 +/- 1.96 hours versus 6.42 +/- 2.60 hours in non-ventilated group [p 0.009]. On 4th post-operative day, incidence of atelectasis was significantly low 20% in ventilated group versus 38% in non-ventilated group [p = 0.04]
Conclusion: Continuous low tidal volume ventilation is associated with better oxygenation after surgery and reduced risk of post-op pulmonary complications during cardiopulmonary bypass in patients undergoing conventional coronary artery bypass graft surgery
ABSTRACT
To compare the quality, onset and duration of intravenous regional anaesthesia [IVRA] with 0.5% lignocaine plus tramadol and 0.5% lignocaine alone. A comparative, double blind, randomized, prospective study. Orthopaedic operating rooms, Nishtar Medical Institution, Multan, Pakistan, from June 2005 to June 2006. In our of 60 adult ASA class I and II patients undergoing upper limb surgeries in patients were divided in two groups having 30 patients in each. We used tramadol, a weak opioid as a component of IVRA with lignocaine to suppress intra-operative pain and enhance postoperative analgesia. Patients received IVRA with 40ml of 0.5% lignocaine to which either 100mg tramadol or saline was added. The onset of anaesthesia and recovery was compared by loss and regain of sensations. Tramadol with lignocaine was found to be significantly better for rapid onset and quality of anaesthesia compared to lignocaine alone and devoid of opioid related side effects. We conclude that tramadol as a component of IVRA is significantly better adjunct to lignocaine