Orchio-Septopexy: A new technique to cover and fix detorsed testis undergoing fasciotomy of tunica albuginea

ABSTRACT Purpose Compartment Syndrome (CS) has been recognized as a potential factor that worsens testicular viability after detorsion, especially in borderline cases of prolonged ischemia. Fasciotomy of the testicular tunica albuginea to relieve the pressure associated with CS has been proposed to accommodate edema after detorsion, embracing the raw fasciotomy area with tunica vaginalis flap (TVF) or graft. Fashioning the TVF can be tedious in cases of severe scrotal edema. Herein we present a technique that facilitates and expedites the procedure, maintaining the fasciotomy area decompressed. Materials and Methods In testicular torsion, where the testis remains with dark coloration and questionable viability after detorsion a longitudinal releasing incision is made in the tunica albuginea (fasciotomy) to decrease compartmental pressure. If signs of parenchymal recovery (bleeding points, better color) are seen an orchio-septopexy is performed, suturing the incised albuginea's edges to the septum with a running suture, avoiding CS as well as re-torsion. Results Orchio-septopexy was performed in 11 cases with a mean age of 11.9 years (3-17). All cases had clinic follow-up and testicular Doppler US with a mean of 9.5 months (6-24). 6/11 cases (54%) were salvaged, with good vascularity in the Doppler US and maintained more than 50% testicular volume compared to the contralateral side. Conclusion Orchio-septopexy after testicular fasciotomy is a simple and fast technique that can be utilized in cases of prolonged testicular ischemia and questionable viability. More than half of the testes recovered, encouraging us to propose its utilization as well as its validation by other surgeons.

Efficacy of nalbuphine in preventing hemodynamic response to laryngoscopy and intubation

To determine the efficacy of nalbuphine in preventing increase in heart rate and mean arterial pressure in response to laryngoscopy and tracheal intubation. This double blind randomized controlled trial was conducted on 100 ASA [American Society of Anesthesiologists] grade I-II patients scheduled for general anesthesia. Patients were randomly allocated to receive either saline [group I, control group, n=50] or nalbuphine 0.2 mg kg-1 [group II, study group, n=50] as a bolus dose 5 minutes before laryngoscopy. Anaesthesia was then induced with propofol [2mg kg-1] and atracurium [0.6mg kg-1] and or tracheal intubation was then performed within 30 seconds. Heart rate [HR] and mean arterial pressures[MAP] were recorded before the administration of the study drug, baseline value [T-0], 3 minutes after study drug administration [T-1], immediately after tracheal intubation [T-2] and then after every 1 minute up to 5 minutes [T3-7] and then after 10 minutes of intubation [T-8]. The Nalbuphine group showed significantly lesser rise in HR compared to control group after laryngoscopy and or tracheal intubation that continued till 10 minutes after intubation [p-value from ?0.0001-0.0297]. The Nalbuphine group also showed significantly lesser rise in MAP compared to control group after laryngoscopy and or tracheal intubation that continued till 5 minutes after intubation [p-value from ?0.0001-0.0152]. At 10 minutes post intubation though the rise in MAP was still lesser in Nalbuphine group than control group but it was not significant [p-value=0.0540]. Nalbuphine 0.2 mg kg-1 prevents a marked rise in heart rate and mean arterial pressure associated with laryngoscopy and or tracheal intubation

Cardiovascular responses to scalp infiltration, using adrenaline, with or without lignocaine, during craniotomy

To find out changes in the heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure after infiltrating scalp with adrenaline with or without Lignocaine in craniotomies. This comparative study was carried out at AIMS international hospital Hayatabad, Peshawar from January to June 2009. Cardiovascular response to scalp infiltration with adrenaline was noted in 100 unpremedicated patients undergoing craniotomy. They were divided into 2 groups of 50 patients each. Group A received lignocaine 2% with adrenaline 1:200, 000 and Group B received normal saline with adrenaline 1:200, 000. Episodes of tachycardia occurred more frequently in group B. Systolic blood pressure, diastolic blood pressure and mean arterial pressure were significantly increased in group B. Significant decrease in diastolic blood pressure and mean arterial pressure occurred in group A. In neurosurgical patients undergoing craniotomy, infiltration of the scalp with solution containing adrenaline alone causes significant hypertension. The addition of lignocaine attenuates the hypertensive response but causes decrease in blood pressure

effects of intravenous lignocaine on pain during injection of medium and long-chain triglyceride propofol emulsions

To determine if propofol-MCT/LCT premixed with lignocaine as well as given alone is effective in reducing pain on injection. Three hundred American Society of Anesthesiologists I-II patients listed for different elective procedures were randomized to three groups of 100 patients each. Group A received Diprivan a long-chain triglyceride preparation [LCT-propofol] premixed with lignocaine [i.e., 2 ml of 1% lignocaine in 20 ml of propofol]. Group B received Propofol-Lipuro [MCT/LCT-propofol] premixed with 2 ml normal saline, and group C received Propofol-Lipuro [MCT/LCT-propofol] premixed with lignocaine [2 ml of 1% lignocaine in 20 ml of propofol]. Anaesthesia was standardized in all the three groups. Undiluted Diprivan [LCT-propofol] and Propofol-Lipuro [MCT/LCT-propofol] were used for induction of anaesthesia and subjects were questioned about discomfort until contact was lost. Discomfort was recorded as none, mild, moderate or severe. Frequency of pain was 26% in group A [16% mild, 06% moderate and 04% severe pain,]. In group B frequency of pain was 28% [22% mild, 06% moderate and none severe pain], and in group C only 05% patients felt mild pain. None of them had moderate or severe pain. The p-value was 0.000007 in group C Vs A, 0.000027 in group C Vs B and 0.436782 in group B Vs A. The addition of lignocaine to MCT/LCT propofol significantly reduced the incidence of pain on injection compared to LCT-propofol with lignocaine p-value 0.000027 and MCT/LCT-propofol alone. Propofol MCT/LCT alone does not provide any advantage to reduce pain on injection in comparison to propofol MCT/LCT premixed with lignocaine

Incidence of pain on propofol injection and efficacy of addition of lignocaine or selecting big vein or both combined in reducing it a randomized control trial

To find out the frequency of pain due to propofol injection and to assess the efficacy of addition of lignocaine to propofol, selecting big vein in antecubital fossa or both combined in reducing pain. Incidence of injection pain with propofol was noted in 200 unpremedicated patients undergoing tonsillectomy. They were divided into 4 groups of 50 patients each. The patients were randomly allocated by card method to one of the four groups. Group A received plain propofol in a small vein on the dorsum of hand. Group B received 10 mg lignocaine added to propofol before administration into a vein on the dorsum of hand. Group C received propofol in a vein in the antecubital fossa and group D received lignocaine 10 mg added to propofol prior to administration in vein in the antecubital fossa. Incidence of pain was 58% with plain propofol injected in small vein, 10% when lignocaine was added prior to injection, 8% when injected in large vein and 6% when lignocaine was added before injecting propofol in large vein. Addition of lignocaine to propofol before injection into a small vein and administration of plain propofol into a large vein were equally and significantly effective [P value < 0.001] in reducing the incidence of pain. Addition of lignocaine to propofol into a large vein further reduced the incidence as compared to plain propofol but this was not statistically significant [P value >0.05]