ABSTRACT
Background: Patients undergoing major surgical operations continue to experience pain with an overall reported incidence of 29.7% for moderate-to-severe pain and 10.9% for severe pain. Even in developed countries, 86% of patients experience postsurgical pain and 75% of those who reported pain described its severity as moderate-to-severe during the immediate postoperative period Major abdominal surgical operations ideally require the Acute Pain Management Service (APMS) for regular pain assessment and timely management of breakthrough pains and complications in the postoperative period. Aim of the study: To determine the effectiveness of Postoperative Analgesia used for Major Abdominal surgery and its efficacy and safety. Materials and methods: 38 Patients under General Anesthesia and 13 Patients under Regional + General Anesthesia who underwent major Laparotomy procedures were included in the study. Data regarding the type of postoperative Analgesia, Co–Analgesic used (NSAIDS, Paracetamol in oral/suppository form) during both intra and postoperative period were noted. All patients were followed on the first and second postoperative day at 4 PM. Pain severity with VAS score, side effects of Analgesia and Patient satisfaction with Pain management were recorded. Sindhu, Naheed Azhar, Nalini. Observational study to assess the effectiveness of post-operative pain management of patients undergoing major abdominal surgeries in a tertiary care hospital. IAIM, 2019; 6(5): 98-103. Page 99 Results: Use of Epidural Analgesia and Multimodal approach for Postoperative Pain relief greatly improves the patient satisfaction and early recovery of patients undergoing Major Abdominal surgeries. Conclusions: Although there is limited drug availability, regular assessments and appropriate dose adjustments and Use of Epidural and multimodal analgesic practice led to a high level of patient satisfaction
ABSTRACT
Background: Cochlear implantation has been evolved as the management of choice in patients with bilateral severe to profound sensorineural hearing loss in both children and the elderly population. Children who undergo cochlear implantation early in life, followed by appropriate rehabilitation have improved communication and learning skills. Aim of the study: In this study, we review the anesthetic management of seven cases of pediatric cochlear implantation done in our institution in the last one year. Materials and methods: Randomized control study was done at Government Stanley Medical College Hospital, Chennai, Tamil Nadu (January 2018). Intraoperative facial nerve integrity testing was not done for any of our cases. The nasopharyngeal temperature was monitored. To prevent hypothermia, forced air warmer was used. In our institution, stimulation techniques to identify facial nerve were not used for any of the cases. The intraoperative period was uneventful in all cases. Hemodynamics was maintained in all the cases in order to provide a bloodless surgical field. Results: No patients had emergence agitation. Post-operative analgesia was achieved with paracetamol rectal suppositories. No children had postoperative shivering. All children were followed up after discharge for stimulation of electrodes and speech therapy. Presence of mental retardation should be assessed as it may be associated with a retrocochlear hearing loss. Counseling was an important part of the pre-operative period to improve the outcome. Conclusion: Cochlear implantation is a specialized surgery and anesthesiologist’s awareness of the pitfalls and resourcefulness in dealing with communication impaired, pediatric age group makes the task challenging. The procedure itself has no significant anesthetic complications provided a thorough preoperative evaluation and good conduct of anesthesia is done.
ABSTRACT
Background: General anesthesia without supplemental regional anesthesia might result in elevated blood sugar levels secondary to the stress response of anesthesia and surgery. Increased levels of cortisol and catecholamines augment glucose production because of increased hepatic glycogenolysis and gluconeogenesis along with reduced peripheral utilization of glucose. Hence, there exists a high possibility that supplementing dextrose intraoperatively without regular blood sugar estimation might result in hyperglycemic episodes which can lead to osmotic diuresis, impairment of neurological outcome, and risk of hypoxic episodes under anesthesia. Aim: To compare the effect of using Ringer's lactate with or without the addition of 1% dextrose on intra-operative blood sugar levels in the pediatric age group undergoing surgeries. Methods and methods: 44 pediatric age group patients, male patients undergoing circumcision for phimosis under I.V sedation with caudal block were chosen and divided into two groups randomly into Group A and Group B. Group A received 1% dextrose RL and Group B received RL without the addition of dextrose as intra-operative maintenance fluid. Along with basic parameters like heart rate and oxygen saturation, capillary blood glucose was also measured preoperatively just before induction and after the end of procedure postoperatively. Results: Preoperative and post-operative blood sugar values were compared. No significant hypoglycemia was developed in patients who had received only RL. And patients who received 1% Dextrose RL as intra-operative fluid had not developed significant hyperglycemia. Arivuselvan K, Nalani, Naheed Azhar. To study the effect of using ringer’s lactate with or without addition of dextrose on intra-operative blood sugar levels in Pediatric age group undergoing surgeries. IAIM, 2019; 6(5): 87-91. Page 88 Conclusion: Even with patients received only RL without dextrose as intraoperative fluid there is no significant hypoglycemia. So, the addition of dextrose is not mandatory in patients undergoing short surgeries provided their preoperative sugar level is not less than 80 mg/dl.