ABSTRACT
Objective: To compare the mean duration of atracurium induced neuromuscular blockade in minutes when dosed according to real body weight [RBW] or ideal body weight [IBW] to obese patients undergoing abdominal surgeries under general anesthesia
Study Design: Randomized controlled trial
Place and Duration of Study: Department of Anesthesiology, National hospital defense Lahore, From March 2015 to March 2016
Material and Methods: One hundred and fifty [150] patients were selected for this study and divided in to two equal groups [75 patients in each group], group-I [experimental group] and group-II [control group]. Sample size was calculated with 80% power of test, 95% confidence interval taking mean and standard deviation of duration of atracurium induced neuromuscular blockade in minutes in both groups i.e. 74.6 +/- 37.56 in real body weight group versus 40.02 +/- 22.5 in ideal body weight group. Non probability consecutive sampling technique was used. SPSS version 16 was used for data analysis. Frequency and percentages were used to present categorical data and mean +/- standard deviation for numerical data. Independent sample t-test was applied to compare the significance of outcome variables. A p-value of <0.05 was considered statistically significant
Results: There was a prolong duration of action in experimental group [real body weight group] 69.64 +/- 3.11 minute versus 46.33 +/- 2.77 minute in control group [ideal body weight group] which suggests that dose of atracurium should be calculated and given on basis of ideal body weight in obese
Conclusion: It was observed in our clinical trial that body weight calculation and dosage of atracurium accordingly has altered duration for recovery from blockade, the results of the study showed that atracurium when used according to ideal body weight as compared to total body weight has reduced duration of action. So atracurium dose should be calculated according to ideal body weight rather than total body weight in obese patients
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