Oral ephedrine is useful to wean patients off long term parenteral vasopressors after cervical spinal cord injury

Traumatic spinal cord injury [SCI] in young adults not only increases the risk of mortality but more commonly it complicates with life-long disability. Cervical SCI patients are particularly susceptible and sensitive to phases of cardiovascular instability and respiratory failure directly consequential from their injuries. Furthermore, long term vasopressor requirement is not uncommon though weaning from parenteral vasopressor is a challenge. We document a case of the use of oral ephedrine, which we used to wean our patient from parenteral vasopressors. Oral ephedrine can be an appropriate option to get rid of long term use of infusion of vasopressor

Comparison of spinal anesthesia dosage based on height and weight versus height alone in patients undergoing elective cesarean section / 대한마취과학회지

BACKGROUND: Spinal anesthesia with bupivacaine, typically used for elective and emergency cesarean section, is associated with a significant incidence of hypotension resulting from sympathetic blockade. A variety of dosing regimens have been used to administer spinal anesthesia for cesarean section. The objective of this study was to compare the incidence of hypotension following two different fixed dosing regimens. METHODS: This was a randomized double-blind clinical trial with a two-sided design, 5% significance level and 80% power. After approval of the hospital ethics review committee, 60 patients were divided randomly into two groups. In one group, the local anesthetic dose was adjusted according to height and weight, and in the other, the dose was adjusted according to height only. RESULTS: Sixty women with a singleton pregnancy were included. Of the factors that could affect dose and blood pressure, including age, weight, height, and dose, only height differed between the groups. Mean heart rate was similar between the groups. Hypotension was significantly more frequent with dosage based on height alone than with two-factor dose calculation (56.7% vs. 26.7%; P = 0.018). CONCLUSIONS: Adjusting the dose of isobaric bupivacaine to a patient's height and weight provides adequate anesthesia for elective cesarean section and is associated with a decreased incidence and severity of maternal hypotension and less use of ephedrine.

Atrial myxoma: 14 years experience

Introduction: Cardiac tumors constitute only 0.2% of all tumors. Primary cardiac tumors occur infrequently with an incidence of 0.0017% to 0.19%, estimated on autopsies performed in non-selected populations. Left atrial myxomas are the most prevalent [75% to 80%] and right atrial are less common [10% to 18%]. Surgical excision yields an excellent prognosis and recurrence rate of only 3% with a very low morbidity and mortality

Objective: We aimed to review our experiences with this rare entity and highlight the various aspects of myxoma presentation, diagnosis and outcomes

Methodology: A retrospective chart review done on patients underwent excision of myxoma with histopathological confirmation since January 1991 till December 2015. Standard surgical approach adopted was single atrial, augmented with Biatrial approach where needed

Results: A total 42 cases were identified and 28 cases with complete data were included in the analysis. Mean age was 54.4 [ +/- 17.7] years, with female predominance [58% vs. 42%]. Preoperative comorbidities included hypertension [39.2%], diabetes [28.5%], IHD, dyslipidemia, and COPD [10.7%] that were comparable among gender. The mean dimension of myxoma measured on echocardiography was 4.9x3.5x2.7 cm. Sixty four percent had left sided and 35.7% had right sided myxoma. Most common symptom was dyspnea [71%], constitutional symptoms [39.3%] and stroke in [18%]. Echo being the diagnostic modality of choice. Post-operative complications occurred in 6 patients and mortality occurred in 2 [7.2%]. Mean post-operative follow up was 8.3 months and 10 years telephonic follow up completed in [32%] cases, with 2 late non-cardiac mortalities

Conclusion: Our results showed that the prevalence of cardiac myxoma is comparable with global estimates. Female gender was predominant and age and right atrial myxoma was slightly higher in our sample compare to other published literature. Myxoma can be excised successfully with a low rate of morbidity, mortality and recurrence

Deep hypothermic circulatory arrest - anesthetic considerations

Deep hypothermic circulatory arrest [DHCA] is the best technique that provides the optimal and bloodless operating conditions as well as brain protection. Although hypothermia is the mainstay of cerebral protection, some pharmacological agents, adequate glucose control, appropriate acid-base management and some surgical techniques that provide selective cerebral perfusion, also help in protecting the brain better and for longer periods of time

Postoperative pain assessment using four behavioral scales in Pakistani children undergoing elective surgery

Several measurement tools have been used for assessment of postoperative pain in pediatric patients. Self-report methods have limitations in younger children and parent, nurse or physician assessment can be used as a surrogate measure. These tools should be tested in different cultures as pain can be influenced by sociocultural factors. The objective was to assess the inter-rater agreement on four different behavioral pain assessment scales in our local population. This prospective, descriptive, observational study was conducted in Pakistan. American Society of Anesthesiologists I and II children, 3-7 years of age, undergoing elective surgery were enrolled. Four pain assessment scales were used, Children's Hospital of Eastern Ontario Pain Scale [CHEOPS], Toddler Preschool Postoperative Pain Scale [TPPPS], objective pain scale [OPS], and Face, Legs, Activity, Cry, Consolability [FLACC]. After 15 and 60 min of arrival in the postanesthesia care unit [PACU], each child evaluated his/her postoperative pain by self-reporting and was also independently assessed by the PACU nurse, PACU anesthetist and the parent. The sensitivity and specificity of the responses of the four pain assessment scales were compared to the response of the child. At 15 min, sensitivity and specificity were >60% for doctors and nurses on FLACC, OPS, and CHEOPS scales and for FLACC and CHEOPS scale for the parents. Parents showed poor agreement on OPS and TPPS. At 60 min, sensitivity was poor on the OPS scale by all three observers. Nurses showed a lower specificity on FLACC tool. Parents had poor specificity on CHEOPS and rate of false negatives was high with TPPS. We recommend the use of FLACC scale for assessment by parents, nurses, and doctors in Pakistani children aged between 3 and 7

Anesthetic management of a patient with hypertrophic obstructive cardiomyopathy undergoing modified radical mastectomy

Hypertrophic obstructive cardiomyopathy [HOCM] is a rare genetic disorder characterized by left ventricular outflow tract [LVOT] obstruction. Clinical presentation ranges from absence of symptoms to sudden death. Our 60 year old patient scheduled for left modified radical mastectomy had HOCM since seventeen years with severe LVOT obstruction and mitral regurgitation. An implantable cardioverter defibrillator [ICD] and permanent pacemaker [PPM] was inserted 15 months earlier for ventricular tachycardia. Anesthetic management of these patients presents considerable challenges and requires maintenance of desired hemodynamic parameters and management of specific complications. Factors like tachycardia, hypovolemia, vasodilation and increased cardiac contractility leads to exacerbation of the obstruction. In our patient there was the additional consideration of the ICD which required to be turned off during surgery with full provision for external defibrillation. We managed to successfully maintain the desired hemodynamics throughout the surgery and the patient was discharged home on the seventh postoperative day

Dental fluorosis - an orthodontic adhesive challenge

The purpose of this study, carried out in early 2010, was threefold: Firstly, to assess the frequency of mild to severe type of dental fluorosis in the school children of district Jhang, [Punjab], both males and females with an age range of 6-14 years. The ratio between girls [420] and boys [278] was 1.51:1. Out of a total sample size of 698, 76 girls and 90 boys suffered from dental fluorosis with a total frequency of 23.78%. Secondly, to give a wake up call to those who are responsible for the prevention of this menace from that specific segment of poor and neglected society. Lastly, to get an effective bonding clue for this pretty good quantum of patients who pose a great challenge in orthodontics, in terms of poor sheer bond strength of adhesives due to repeated bond failures while using "standard etching protocol", resulting in a poor treatment outcome. Current orthodontic literature hints that among the various orthodontic adhesive materials, self etching primer has so far played a promising role in these cases, as is evident from various studies

Frequency of ectopic canines - a study

The purpose of this study was to assess the frequency of ectopic canines in patients' reporting to the 28 Military Dental Centre Lahore Cantt, seeking orthodontic treatment during the last twelve months. A total of 173 patients were evaluated. Out of which 41[24%] patients [11 were males and 30 were females] with an approximate male to female ratio of 1:3. Most frequent location was labial, 38 out of 41[93%]

Prevalence of impacted and ectopic teeth in patients seen in a tertiary care centre

The objective of the study was to calculate the prevalence of most frequent impacted and, ectopic teeth in patients reporting to Orthodontic OPD at Armed Forces Institute of Dentistry [AFID] Rawalpindi. Duration of the study was one year from 7 December 04 to 6 December 05. The sample consisted of 388 females and 162 males. Complete record of the patient was taken. 500 patients of both sexes of age 8-25 years were fully analyzed, 124 patients had impacted teeth and 102 patients had ectopic teeth. Most frequently impacted teeth were third molars especially lower right ones. Most frequent ectopic teeth were canines especially upper left canines. Comparing the two jaws, impaction was more common in the mandible 52 [10.4%] than in maxilla 30 [6%], while 42 [8.4%] patients had impacted teeth in both jaws simultaneously. Only one patient had 5 teeth impacted. Most commonly ectopic teeth were maxillary canines which were 102 [60.5%]. Ectopic teeth were more common in females than in males and were more in the upper jaw than in the lower

Prevalence of class III malocclusion in an orthodontically referred Pakistani population

To assess the prevalence of Class III malocclusions in all military and civilian patients seeking orthodontic treatment at Armed Forces Institute of Dentistry, so as to strategize treatment planning on a priority and individualized basis. A total of 1348 patients referred to the department of Orthodontics ..AFID from Oct 1999 through June 2008 were both clinically and cephalometrically screened for this study. Out of a final sample size of 1185, comprising 375 [31.6%] males and 810 [a 4% females, [11.1%] patients exhibited Class III malocclusion. Class III was found in 51 males and 80 females only. Males exhibited a higher frequency 13.6% as compared to females 9.9%. Frequency of Class III malocclusion in our sample is higher than those of Caucasians, Africans and Asians of Middle East. It is however compatible to Turkish and Japanese populations, but lesser than Koreans

frequency of deep bite in orthodontic patients at the armed forces Institute of Dentistry, Rawalpindi

The objective of this study was to evaluate the frequency of deep bite among orthodontic patients who presented at the Department of Orthodontics, AFID, Rawalpindi during a time period of 7 years. The orthodontic treatment records of 1856 patients were evaluated for the presence of anterior deep bite. Patient's study casts and pre-treatment photographs were used for this propose. All the patients included in the study were in the permanent dentition stage. Three hundred sixty eight patients out of 1856 had anterior deep bite with an incisor overlap of more that 3 mm. Of these, 368 patients 238 were females and 130 were males. The patients were divided into two groups. Grade 1 deep bite, having an incisor overlap of more than 3 mm without palatal irritation and Grade 2 deep bite, having an overlap of more than 3 mm with trauma to the palatal mucosa. The occurrence of deep bite among these patients was 19.8% out of which 64.6% were females and 35.4% were males

Aids - an alarming death trap in the dental zone

Acquired immunodeficiency syndrome has been a great challenge both the for medical and dental profession. Early detection is of prime importance. Oral manifestations of AIDS associated lesions, both in children and adults, mostly precedes the systemic signs and symptoms. After acquainting with this current update, an astute Dental professional certainly will probably be the first one to identify and help in diagnosis, and thus minimizing the devastating effects of this crippling and catastrophic syndrome

White enamel lesions associated with fixed orthodontic appliances

Appearance of white demineralized lesions in the vicinity of bonded and banded attachments is a common occurrence during fixed orthodontic treatment. It seems to be a big challenge for every treating orthodontist. The prerequisite of tremendous oral hygiene practice during active fixed orthodontic treatment must be conveyed to the patient and parents apiece. Strict preventive measures are to be reinforced. A wake up call and still more to adapt various ways to prevent this terrible condition from endangering our net orthodontic outcome

Restore a wide radiant smile without dental extractions

Seeking orthodontic treatment is the right of every patient. Its outcome however depends on the clinical judgment of an orthodontist who thoroughly evaluates and customizes a comprehensive treatment planning so as to fulfill the current [needs and wants] of the patient in question. Non extraction philosophy is the main pivot of this article. The logic behind is to maintain a fuller labial profile, concomitant with a wide attractive smile, which in turn expedites easy psychosocial adjustability of the patient in the community around

Complement your teeth through impacted cuspids

A young patient consulted an Oral Surgeon who advised him surgical removal of both of his impacted cuspids. The patient and his father agreed to this treatment, as they were not told of any other conservative options. After seeking some orthodontic information they landed at this clinic where after thorough evaluation, an orthodontic preference was suggested to which they agreed

It took almost 22 months to achieve the set goals. The treatment plan called for replacement of decidous cuspids with the permanent canines, which were impacted. Cuspid guidance was gained. By adding the cuspids in question, a full complement of teeth was restored. He was smartened up with an inspiring and wide radiant smile

Labial estheticsi no more an orthodontic dilemma

The aesthetic destiny of an orthodontic patient is to be paid due attention in terms of avoiding unjustified extraction, which in turn leads to a premature flattening and collapsing of the facial profile

A young profile oriented girl, sought multitude of opinions from different clinics but was confused due to a pool of diversified opinions, she had collected

She finally made her mind. Her [Wants] and [Needs] were given top priority. Keeping in mind the collapsed labial region in particular, prime importance was paid to the key problems in question. After almost two years oftreatment she was blessed with a fuller juvenile labial profile reinforced with a wide radiant smile and complete balanced occlusion

Finally she lost her incisor! A wake up call for orthodontists

The treatment of a young girl with a maxillary ectopic/impacted canine, leading to complete resorption, followed by loss of a neighboring maxillary lateral, is presented. Treatment sequences used to achieve a balanced and functional result are discussed. The patient's parents and/or dental professionals were not aware of this negligence or mishap which led to the loss of her incisor, at such a young age. Thus this part of the chapter is kept tinder a veil while technical part of the subject is addressed and shared in brief