ABSTRACT
Background: General anesthesia and selective ventilation has long been the traditional anesthetic approach for video-assisted thoracoscopic surgery [VATS]. However it may not always be necessary or feasible in a certain variety of patients. VATS under locoregional anesthesia and sedation has proved to be a safer and more efficacious alternative to general anesthesia, especially in cases deemed unfit for the latter
Methodology: We retrospectively reviewed medical records of patients who underwent VATS under regional anesthesia/nerve blocks with sedation in three private hospitals from April 2014 to November 2015. VATS are conducted in these hospitals by the same anesthesia team and operated by a single surgeon. Eighteen patients included in the case-series were either considered high-risk for general anesthesia or required minor to intermediate surgery. None of the patients required endotracheal intubation or conversion to thoracotomy during the procedure
Results: Eighteen patients underwent successful VATS under locoregional anesthesia with sedation at our set-up from April 2014 to November 2015. The procedures included pleural biopsies, pleurodesis, empyema drainage, biopsies for mediastinal masses, lung tumors and apical infiltrates, all performed under video-assistance. There was no perioperative mortality or unanticipated ICU admission
Conclusion: VATS under locoregional anesthesia and sedation is a valuable, efficacious and safe alternative to general anesthesia that needs to be incorporated more frequently in the modern anesthesia practice
ABSTRACT
Objective: to compare the mean postoperative opioid consumption in patients with and without use of perioperative intravenous lidocaine undergoing laparoscopic surgery
Methods: this Randomized controlled trial was conducted in Department of Anesthesiology, Lahore General Hospital. A total of 100 cases undergoing laparoscopic surgery were included through Non-probability, Purposive sampling. Informed consent and demographic information were obtained. Patients were randomly divided in two equal groups by using lottery method. In group A, patients were given intravenous 1.5mg/kg bolus of lidocaine followed by 2mg/kg/hr infusion of lidocaine till end of procedure and in group B, normal saline was given in same volume to the patients. All surgeries were performed by the same surgical team and most of the procedures were completed within 60 mins. The infusion was continued for one hour to those patients whose surgery was completed earlier than an hour. Postoperative opioid consumption was noted till 24 hours. All the information was recorded on a preform. Data was entered and analyzed through SPSS 16. Both groups were compared for mean consumption of postoperative opioid by using t-test taking P-value<0.05 as significant
Results: in this study, the mean age of patients was 49.34+/-10.30 years. Out of 100 patients, there were 20 [20%] male and 80 [80%] females. In lidocaine group, the total mean opioid consumption during 24 hours after surgery was 81.80+/-17.01 mg whereas with Normal Saline was 89.35+/-17. 74 mg. There was significant difference found between both groups [p-value=0.032] for total opioid consumption where patients in lidocaine group has less consumption of opioids
Conclusion: it was concluded from results of the study that total opioid consumption is less when lidocaine infusion was used during surgery
ABSTRACT
Objective: to evaluate the reasons for cancellation of elective surgical operation of the patients who presents for pre-Anesthesia evaluation one day before surgery or on the day of surgery in a 235 bedded public sector hospital in Lahore
Methods: the medical records of all the patients, from 1st June 2014 to 30th May 2015, who had their operations cancelled one day before surgery or on the day of surgery in all gynecology and obstetrics units of the hospital, were audited prospectively. The number of operation cancelled and reasons for cancellation were documented in detail
Results: 2160 patients were scheduled for elective surgical procedures during the study period of one year; 204 [9.4 %] of these were cancelled one day before surgery during pre-Anesthesia fitness or on the day of surgery. The most common cause of cancellation was inadequate patient preparation. 59 [28.92%] patients were cancelled as they were not adequately prepared for surgery as per anesthetist advice [incomplete NPO, Investigations or referrals required]. The second most common cause of cancellation was the optimized medical status of the patients53 [25.98%]. 36[17.65%] cancellations were because of equipment failure/Electricity shutdown; 17 [8.33%] cancellations due to lack of operation theater time; 16 [7.85%] were cancelled due to patient's refusal/patient left against medical advice; 12 [5.88%] were cancelled by the surgeon due to a change in the surgical plan and 11 [5.39% ]patients were cancelled due to non-availability of surgeon
Conclusions: most causes of cancellations of operations are preventable
ABSTRACT
Pregnancy is associated with both anatomical and physiological changes in the body, especially in cardiovascular and respiratory systems. Patients with anterior and middle mediastinal masses are recognized to be at risk for cardiorespiratory compromise. Likewise, pregnancy has a widely known constellation of potential complications that confront the anaesthesiologist. The combination of both [pregnancy and mediastinal mass] in a single patient presents an unusual anaesthetic challenge. Caesarean sections are usually the mode of delivery, therefore, the cardio-respiratory stability is very important. The following is the report of a 31 weeks pregnant patient with a large, symptomatic anterior and middle mediastinal mass, who required anaesthesia for emergency caesarean section. The anaesthetic management entailed Combined Spinal and Epidural [CSE] technique with safe feto-maternal outcome
ABSTRACT
Objective: to compare conventional Macintosh laryngoscope with Airtraq for elective tracheal Intubation
Material and Methods: a in this randomized control trial conducted during Jan-June 2013. 50 ASA I andII patients without predicted difficult airway included in each group. Main outcomes were intubation time and intubation success rate, number of attempts, airway injury, and number of optimization maneuvers, glottic view and failure of intubation
Results: airtraq has significantly less intubation time, number of optimization maneuvers required and better glottic view [p<0.005] as compared to Macintosh laryngoscope
Conclusion: during elective intubation, Airtraq has better laryngoscopic view and shorter intubation time as compared to Macintosh laryngoscope
ABSTRACT
Introduction: Post-operative nausea and vomiting [PONV] is one of the important complications after laparoscopic surgery resulting in patient dissatisfaction and consumption of healthcare resources
Objectives: We compared the efficacy of dexamethasone and ondansetron in preventing post operative nausea and vomiting in gynaecological laparoscopic surgeries
Methods: After approval from ethical committee and informed consent, the patients were randomly assigned to receive dexamethasone 8 mg or ondansetron 4 mg i.v. at induction. Postoperative PONV scores, pain scores, morphine consumption and Richmond Agitation sedation scores were compared one hourly for 6 hours and at 12 and 24 hours
Results: Both patient groups were similar in age, weight, height, duration of surgery and ASA distribution. No difference was observed in PONV scores at 1 hour [p=0.33], 2-3 hours [p=0.27], 4-6 hours [p=0.13] and 7-12 hours [test p=0.48]; first episode of vomiting [4.87 sd +/- 2.29 vs. 4.29 sd +/- 1.32 hours, p=0.59]; maximum pain scores at 1 hour [p=0.61], between 2-3 hours [p=0.32], 4-6 [p=0.47], 7-12 [p=0.57] and 13-24 hours [p=0.79]; and post-operative Richmond Agitation Sedation scores [p =0.33; 0.48, and 0.50 at 1-3, 4-6, and 7-12 hours]. Mean morphine consumption was similar in two groups at 1-3 hours [2.44 +/- 2.18 vs. 3.0 +/- 2.0 mg; p=0.24], 4-6 [3.73 +/- 2.85 vs. 4.41 +/- 2.72 mg; p=0.31], 7-12 [3.81 +/- 2.91 vs. 4.75 +/- 2.96 mg; p=0.18] and 13-24 hours intervals [3.94 +/- 2.97 vs. 4.80 +/- 2.97 mg; p=0.23]. The time to first occurrence of nausea was significantly delayed in dexamethasone group, [3.85 +/- 2.24 vs. 2.25 +/- 1.38 hours; p=0.02]
Conclusion: The efficacy of dexamethasone and ondansetron in preventing post-operative nausea and vomiting in gynaecological laparoscopic procedures is comparable; onset of nausea is significantly delayed in dexamethasone group
ABSTRACT
Background: Intravenous regional anesthesia, is easy to administer, reliable method for short procedures, however, adjuncts are needed to improve its efficacy
Objective: To compare the effects of adding tramodol and ketorolac as adjunct to the lignocaine in intravenous regional anesthesia [IVRA], on intra-operative and postoperative pain
Material and Method: A prospective, randomized study was carried out on total of 90 patients who were undergoing upper limb surgery. The patients were divided into three groups as follows: group A received lignocaine 0.5% with tramodol 50 mg, group B was administered lignocaine 0.5% with Ketorolac 30mg, while group C received lignocaine 0.5% only as control. Intra-operatively and post operatively the patient's pain score was evaluated using visual analogue scale [VAS]. All the patients were compared for the time to first analgesic. The groups were also compared for the total number of analgesics required in the first twenty-four hours
Results: A total of 90 patients were included in this study. The mean age of patients in group A [Lignocaine 0.5% 40ml + Tramadol] was 52 +/- 7 years while in group B [Lignocaine 0.5% 40ml + Ketorolac], it was 53 +/- 6 years and in Group C [Lignocaine 0.5% 40ml], 50 +/- 5 years.Tramadol in lignocaine was found to be significantly better [p<0.05] compared to ketorolac in lignocaine and lignocaine alone for intra operative and post operative pain. The patients in tramadol group required significantly less number of analgesics in the first twenty four hours as compared to the other two groups
Conclusion: We conclude that as adjunct tramadol is significantly better as compared to ketorolac and lignocaine alone for intravenous regional anesthesia, with respect to operative, post operative analgesia, time to first analgesic and total analgesics in twenty-four hours