Oxidative stress associated with altered activity of glutathione peroxidase and superoxide dismutase enzymes with IDA during pregnancy

Iron deficiency anemia [IDA] during pregnancy, although associated with disturbances of hematological parameters, is now also considered as a source of oxidative stress [OS]. Present study aims to detect any alteration in superoxide dismutase [SOD] and glutathione peroxidase [GSH-Px] enzymes activity in pregnant women with IDA. Levels of GSH-Px and SOD were measured in 156 anemic, pregnant women and compared with similar levels in 20 non anemic, pregnant women. Activity of SOD was found to be reduced in the anemic group when compared with the control group. We found a non- significant increase in GSH-Px activities in the anemic group. These findings could be explained in terms of OS under hypoxic condition which preserves the activity of GSH-Px with a decrease activity of SOD. A positive association was seen between IDA during pregnancy and OS with results suggesting that, apart from the deficiency of iron, some other factors are also associated for the increased OS seen during pregnancy

Advantages of carotid endarterectomy under local anaesthesia with minimal cerebral monitoring: an experience of 45 cases

To evaluate the benefits, efficacy and safety of local cervical plexus block in the performance of carotid endarterectomy, in the absence of sophisticated cerebral perfusion monitoring. This study was carried out at Combined Military Hospital [CMH] Lahore, Pakistan from January 2012 to May 2013. Quasi-experimental study. A total of 45 cases of ASA II and ASA III physical status were operated for carotid endarterectomy under local block of cervical plexus. After thorough preanaesthetic assessment, the patients physical conditions were optimized before surgery. Premedication was given with midazolam and sedated during operation with small doses of propofol. Local anaesthesia [LA] was completed by injecting bupivacaine in cervical plexuses C2, C3 and C4 areas. During operation vital signs and adequacy of cerebral perfusion were monitored by keeping the patient awake and making clinical neurological observations. Verbal contact was maintained with the patient. Breathing patterns and motor power were assessed in contralateral upper and lower limbs. Postoperatively patients were interviewed and analgesia during operation was assessed with visual analogue scale. Surgeon's satisfaction regarding intraoperative analgesia was also noted. Patients who required added sedation or local anesthetic agent were also noted. Average duration of surgery time was two hours and average stay of the patients in hospital was five days. Out of 45 patients, 37 patients [82%] had smooth and comfortable anaesthesia and analgesia. In only 1 patient [2.2%] LA had to be converted into general anaesthesia [GA]. In 3 cases [7%] LA was supplemented. One patient [2.2%] developed hoarseness and difficulty in breathing and 1 patient [2.2%] developed hemiparesis intra-operatively; while 1 patient [2.2%] developed hypotension in the immediate postoperative period. One patient [2.2%] developed haematoma at infiltration site. Surgeon satisfaction was excellent in 40 [89%] cases. Surgery of carotid endarterectomy can be performed adequately and comfortably under LA. In centers where sophisticated facilities for intraoperative cerebral blood flow measurements are not available, clinical intraoperative assessment of cerebral functions is of immense benefit, which is only possible under LA

Effect of general anaesthesia versus spinal anaesthesia on apgar score in elective caesarean section

To compare the effects of general versus spinal anaesthesia on Apgar score of neonates in elective Caesarean section. Randomized control trial. The Department of Anaesthesia and Intensive care CMH Lahore over duration of six month from 20-02-07 to 19-08-07. A total of 100 pregnant patients undergoing elective Caesarean section were divided into two groups: Group-A [General anaesthesia], Group-B [spinal anaesthesia]. In both the groups the patients were randomly divided using random number table and were blind to the technique of anaesthesia used. Mean Apgar score at one minute in group-A was 6.4 +/- 1.1 and in group-B was 8.4 +/- 1.1. The difference between two groups was statistically significant [p< 0.001]. Mean Apgar score at 5 minute was observed 9.4 +/- 0.7 in group-A and 9.5 +/- 0.6 in group-B. The difference between these two groups was not statistically significant [p=0.202]. Apgar score of neonates whose mothers received spinal anaesthesia was better at 1 minute than neonates whose mothers received general anaesthesia but there was no significant difference in Apgar score after 5 minutes in both techniques

Comparison of effectiveness of thoracic epidural and paravertebral block for post thoracotomy pain relief

To compare the effects of thoracic epidural and thoracic paravertebral block in post thoracotomy pain relief and early ambulation. Randomized control trial [RCT]. Combined Military Hospital Rawalpindi a tertiary care health facility, from Jan 2007 to Dec 2007. Thoracic epidural block was given in group-A while thoracic paravertebral block was given in group-B patients post operatively. Pain scores were assessed at 30 min intervals after the dose of 0.25% Bupivacaine using visual analogue scale [VAS]. There was no significant difference for pain scores in first 24 hours after surgery between paravertebral block [PVB] and thoracic epidural group measured at 30 min interval. But complication like hypotension occurred less with PVB. Paravertebral block is a safe and effective technique and can to be used more widely for unilateral post thoracotomy pain relief

Comparison of median and paramedian techniques of spinal anaesthesia

To compare median and paramedian technique of spinal anaesthesia in terms of success rate, number of attempts, paresthesia, bloody tap and length of needle. Comparative cross-sectional study. Department of Anaesthesia and Intensive care PNS Shifa Karachi over duration of one year from March 2007 to Feb 2008. This was a comparative cross-sectional study and 100 patients undergoing spinal anaesthesia for lower abdominal and lower limb surgeries were included. Hundred patients were divided into two separate groups. Group I was given spinal anaesthesia with median approach and Group II was given spinal anaesthesia with paramedian approach. In both the groups the patients were divided using non probability convenience sampling and patients were blind to the choice of technique of spinal anaesthesia used, however consent was obtained from every patient to be included in study. The success rate of median approach was found to be 84%, with the first attempt success rate of 48%. Paresthesia was felt by 38% of patients and incidence of bloody tap was 6%. Length of needle required most of the time was between 4-6 cms. The success rate of paramedian approach was found to be 96%, with first attempt success rate of 70%. Paresthesia was felt by 20% of patients and incidence of bloody tap was 12%. Most of the time length of needle required was between 6-8 cms. Paramedian approach is associated with higher success rate with lesser number of attempts and decreased incidence of paresthesia

Congenital fibre type disproportion: an unusual presentation of respiratory failure

A 38-year-old lady, with a weeklong history of flu-like illness, presented acutely with type-2 respiratory failure needing mechanical ventilation. She had a known history of a rare subtype of congenital myopathy called congenital fibre type disproportion myopathy [CFTDM]. This condition most commonly presents as hypotonia in neonates and is characteristically non-progressive. It may present in children as generalised weakness, delayed milestones and skeletal deformities such as scoliosis and myopathic facies. To the best of our knowledge this is the first reported case of CFTDM contributing to respiratory failure in an adult patient. She made good recovery in four weeks and was discharged home on intermittent non-invasive ventilatory support

Bilateral lung collapse due to aspirated nasal packing

An aspirated foreign body continues to present serious challenge of airway management to anesthesiologists perioperatively. These patients usually present with respiratory distress and require a high index of suspicion; need prompt assessment and recognition of the potential cause, and emergency management to obtain the best possible outcome. Nasal packing after ENT surgery has been previously reported to result in complications. A nasal pack obstructing left bronchus completely and right bronchus partially, resulting in post obstructive pulmonary edema is reported. This patient had aspirated the nasal pack in recovery room after tracheal extubation. The case highlights the need for close postoperative monitoring in patients with nasal packs, the diagnostic role of fibroptic bronchoscope and therapeutic role of rigid bronchoscope in airway obstruction

Acute organophosphorus poisoning - an experience

To determine various modes of acute poisoning due to pesticides with respect to gender, age, time period, mechanical ventilation, hospital stay and outcome. Prospective observational study. Department of medicine, Combined Military Hospital Pano Aqil Sindh, from April 2003 to November 2004. All indoor patients poisoned by pesticides, of either sex, age more than 12 years were included in the study. Data collected on proforma, contained categories of age, gender, mode of poisoning, time duration, clinical presentation, mechanical ventilation, hospital stay and final outcome. Out of 24 poisoned patients, 18 were males [75%] and 6 were females [25%]. Mean age was 23 years [range 13 years to 47 years]. About 79% of the victims were in the age range of 16-25 years. Suicidal, occupational and accidental incidences were 70.83%, 20.83% and 8.33% respectively. Only 10 patients [42%] needed mechanical ventilation due to acute respiratory failure and other 14 patients [58%] managed conservatively. Mean hospital stay was 4.5 days [range 01 to 15 days]. A total of 3 deaths with death rate of 12.5% were observed and all the deaths were among the suicidal victims. Pesticides are the major chemical agents which pose a health threat, particularly to young people, depressed females and farm workers, in rural set up. Since respiratory failure is the major reason for mortality, its early recognition, prompt endotracheal intubation and mechanical ventilation are life saving measures in severe organophosphorus [OP] poisoning

Pre - operative hematological profile: current practice

The use of pre-operative laboratory tests became a part of clinical practice in the later half of the 20th century as the clinicians acknowledged identification of pre-operative assessment of prospective postoperative morbidity and mortality. It was, however, argued that routine pre-operative hematological investigations were not cost-effective. Less than 3% of the abnormalities noted were previously unknown, and the number of patients whose surgery was delayed or altered as a result of the abnormal hematological tests ranged from none to 0.5%. In fact, overuse of the laboratory has a detrimental effect on the quality of care because clinicians were over-loaded with irrelevant information. Reference ranges are defined as the central 95% distribution of healthy subjects, and therefore, the probability [p] of an abnormal value occurring in a perfectly healthy patient increases with the number of tests [n] performed [p=1-[.95] n]. Thus, if 12 tests are performed, the probability of at least one test being abnormal is 46% and if 20 tests are performed, at least one will be abnormal in 65% of healthy subjects. Additionally, an abnormal value in an asymptomatic patient is far more likely to be false-positive than in a symptomatic patient, which may result in further unnecessary workup and delay in surgery. The objective of this communication was to analyze current practice in pre-operative hematologic profile evaluation