ABSTRACT
Background: Central venous cannulation is a commonly performed procedure in neurosurgical patients to maintain the hemodynamic stability in the intraoperative period. It is used for infusion of intravenous fluids, vasopressors central venous pressure monitoring and detection of air embolism. Subclavian vein is commonly performed as there are minimal effects of positioning on it. Supraclavicular approach to subclavian vein cannulation is not as frequently employed as the infraclavicular approach. The purpose of this study was to compare the supraclavicular approach versus the infraclavicular approach in terms of number of attempts, success rate of catheterization and complications associated with the procedure.Methods: About 150 patients undergoing various neurosurgical procedures were enrolled in the study. They were divided into two groups. 75 patients underwent right supraclavicular catheterization of subclavian vein while as 75 patients underwent right infraclavicular catheterisation of the subclavian vein. The number of attempts for cannulation, success or failure of catheterization and any complications associated with the procedure or in the postoperative period were noted in each group. The data was compared between the two groups by using Chi-square test and Student’s Independent Samples T-test.Results: The right supraclavicular vein was successfully cannulated in 90.66% while as the right infraclaviclar vein was successfully cannulated in 96% of the patients (p >0.05). Malpositioning of catheter (threaded in contralateral subclavian) was noted in 4 patients in Group S and ipsilateral internal jugular vein in 2 patients. Pneumothorax was encountered in 1 patient in the group S undergoing supraclavicular subclavian vein cannulations while as subclavian arterial puncture was seen in 4 patients who underwent infraclavicular arterial puncture.Conclusions: There was no difference in successive cannulations between right the supraclavicular and right infraclaviclar veins. The rate of complications between the two approaches was comparable.
ABSTRACT
Background: Laryngoscopy is associated with a sympathetic response that results in a rapid increase in blood pressure and heart rate in these patients. The mechanisms underlying these hemodynamic changes are incompletely understood. They may be caused by a reflex sympathetic discharge due to stimulation of the upper respiratory tract. It has been observed that hemodynamic responses to tracheal intubation are associated with an increase in plasma catecholamine concentrations and are attenuated by β-adrenergic blockade. These hemodynamic changes may be undesirable particularly in neurosurgical patients. Aim of the study is the present study was prospective, randomized, double-blind conducted to evaluate the efficacy of dexmdetomidine and fentanyl in attenuation of pressor responses to laryngoscopy and intubation in neurosurgical patients undergoing lumbar spine surgeries.Methods: A total of 60 patients of 18–65 years, American Society of Anaesthesiologists Class I/II of undergoing elective neurosurgical procedures were included in the study. The patients were divided into two groups of 30 patients each. Group D received dexmedetomidine and Group F received Fentanyl. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MAP) were recorded preoperatively (baseline), at 5 and 8 minutes after infusion of study drug, before induction, 1 minute after induction, 2 minute after intubation, 5 minute after intubation, 10 minute after intubation and 15 minute after intubation.Results: There was a better control of Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure in Group D when compared to Group F during laryngoscopy and after intubation.Conclusions: The present study shows that dexmedetomidine suppresses hemodynamic responses effectively than fentanyl.
ABSTRACT
Background: Infertility is one of the most common conditions confronting Gynecologists and tubal factor is one of the most common causes of infertility. Hysterosalpingography and laparoscopy are used as methods for diagnosis of tubal patency in infertility. HSG is an OPD procedure and, for many years has been used as an invaluable procedure for diagnosis of tubal patency and intrauterine pathology in infertility. Laparoscopy is an invasive procedure and is used for evaluation of tuboperitoneal factors. Aims and objectives: To evaluate the diagnostic accuracy of hysterosalpingography in the diagnosis of tubal pathology in infertility in comparison to laparoscopy Methods: 60 patients of infertility were evaluated in the department of Gynecology and obstetrics, Government Lalla Ded Hospital ,Srinagar from April 2013 to August 2014. A prospective cross sectional study was performed. HSG was performed in the pre-ovulatory phase .Laparoscopy was performed under general anesthesia at least three months after HSG in the premenstrual phase. Diagnostic laparoscopy was considered as the reference standard in detecting tubal blockade and findings of hysterosalpingography were compared with laparoscopy. Results: All the patients in the study group were complaining of infertility. The total number of patients in this study was 60 in which 41 were in primary infertility group and 19 were in secondary infertility group. The age of patients was between 21 and 39 years. The average duration of primary infertility was 4.08 years and secondary infertility was 5.15 years. The sensitivity of HSG was 90.91% (95%CI: 76.43-96.86) and specificity was 77.78% (95%CI 59.24-89.39) with positive predictive value of 83.33% (95%CI 68.11-92.13) and negative predictive value of 87.50% (95%CI 69.0- 95.66),when tubal pathology was defined as any form of tubal occlusion detected at laparoscopy, either one sided or two sided. The further advantage of laparoscopy is the possibility of visualization of some other pelvic abnormalities which may be the cause of infertility. In our study, in patients with tubal block, adnexal adhesions were found in 15 (45%), endometriosis in 8(25%) and suspected intratubal block in 10(30%). Conclusion: HSG is the first step diagnostic test for assessment of fallopian tubes. Although laparoscopy is more invasive than HSG, laparoscopy with chromotubation is the gold standard for diagnosis of tubal block, and for identifying periadnexal adhesions and endometriosis and thus to guide appropriate therapy.