Efficacy of nalbuphine in preventing hemodynamic response to laryngoscopy and intubation

To determine the efficacy of nalbuphine in preventing increase in heart rate and mean arterial pressure in response to laryngoscopy and tracheal intubation. This double blind randomized controlled trial was conducted on 100 ASA [American Society of Anesthesiologists] grade I-II patients scheduled for general anesthesia. Patients were randomly allocated to receive either saline [group I, control group, n=50] or nalbuphine 0.2 mg kg-1 [group II, study group, n=50] as a bolus dose 5 minutes before laryngoscopy. Anaesthesia was then induced with propofol [2mg kg-1] and atracurium [0.6mg kg-1] and or tracheal intubation was then performed within 30 seconds. Heart rate [HR] and mean arterial pressures[MAP] were recorded before the administration of the study drug, baseline value [T-0], 3 minutes after study drug administration [T-1], immediately after tracheal intubation [T-2] and then after every 1 minute up to 5 minutes [T3-7] and then after 10 minutes of intubation [T-8]. The Nalbuphine group showed significantly lesser rise in HR compared to control group after laryngoscopy and or tracheal intubation that continued till 10 minutes after intubation [p-value from ?0.0001-0.0297]. The Nalbuphine group also showed significantly lesser rise in MAP compared to control group after laryngoscopy and or tracheal intubation that continued till 5 minutes after intubation [p-value from ?0.0001-0.0152]. At 10 minutes post intubation though the rise in MAP was still lesser in Nalbuphine group than control group but it was not significant [p-value=0.0540]. Nalbuphine 0.2 mg kg-1 prevents a marked rise in heart rate and mean arterial pressure associated with laryngoscopy and or tracheal intubation

Comparative study of pulmonary functions and oxidative stress in smokers and non–smokers.

Chronic Obstructive Pulmonary Disorder (COPD) is projected to rank third leading cause of deaths by 2030 as per WHO. COPD is a multietiological disease. The airflow dysfunction is usually progressive, associated with an abnormal inflammatory response of the lungs to noxious particles or gasses. As the lung is exposed to high levels of oxygen, it is more susceptible to oxidants mediated injury. Gender based differences are identifiable risk factors. Smoking is found to be a major risk factor in the causation of COPD resulting in oxidative stress . The aim of the present study is to evaluate the oxidant antioxidant imbalance in healthy non smoker controls and smokers with COPD. A total of 60 control (healthy non smokers) and 121 smokers having COPD were studied. The mean age is more in smoker group as compared to healthy controls, which identifies advancing age as a risk factor for COPD. The mean BMI and weight of smoker group is reduced as compared to control group. GOLD 2008 criteria was used to assess lung functions. Lung functions namely FEV1, FVC, FEV1/FVC% and FEV1% Predicted showed significant reduction in smoker group as compared to healthy non smoker controls. MDA in control and smoker group (1.09±0.09 and 1.41±0.23 nmol/ml respectively) showed significant changes (P<0.001). Our results also demonstrate significant reduction in anti oxidant enzymes namely SOD (units/mg of serum protein), Catalase (units/mg of serum protein) and GPX (nmol of NADPH oxidized/ min/mg of serum protein) in smoker group as compared to healthy controls. On the basis of study it is concluded that smoking, gender and oxidant antioxidant imbalance are identifiable risk factors in COPD.

effects of intravenous lignocaine on pain during injection of medium and long-chain triglyceride propofol emulsions

To determine if propofol-MCT/LCT premixed with lignocaine as well as given alone is effective in reducing pain on injection. Three hundred American Society of Anesthesiologists I-II patients listed for different elective procedures were randomized to three groups of 100 patients each. Group A received Diprivan a long-chain triglyceride preparation [LCT-propofol] premixed with lignocaine [i.e., 2 ml of 1% lignocaine in 20 ml of propofol]. Group B received Propofol-Lipuro [MCT/LCT-propofol] premixed with 2 ml normal saline, and group C received Propofol-Lipuro [MCT/LCT-propofol] premixed with lignocaine [2 ml of 1% lignocaine in 20 ml of propofol]. Anaesthesia was standardized in all the three groups. Undiluted Diprivan [LCT-propofol] and Propofol-Lipuro [MCT/LCT-propofol] were used for induction of anaesthesia and subjects were questioned about discomfort until contact was lost. Discomfort was recorded as none, mild, moderate or severe. Frequency of pain was 26% in group A [16% mild, 06% moderate and 04% severe pain,]. In group B frequency of pain was 28% [22% mild, 06% moderate and none severe pain], and in group C only 05% patients felt mild pain. None of them had moderate or severe pain. The p-value was 0.000007 in group C Vs A, 0.000027 in group C Vs B and 0.436782 in group B Vs A. The addition of lignocaine to MCT/LCT propofol significantly reduced the incidence of pain on injection compared to LCT-propofol with lignocaine p-value 0.000027 and MCT/LCT-propofol alone. Propofol MCT/LCT alone does not provide any advantage to reduce pain on injection in comparison to propofol MCT/LCT premixed with lignocaine

Cardiovascular responses to scalp infiltration, using adrenaline, with or without lignocaine, during craniotomy

To find out changes in the heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure after infiltrating scalp with adrenaline with or without Lignocaine in craniotomies. This comparative study was carried out at AIMS international hospital Hayatabad, Peshawar from January to June 2009. Cardiovascular response to scalp infiltration with adrenaline was noted in 100 unpremedicated patients undergoing craniotomy. They were divided into 2 groups of 50 patients each. Group A received lignocaine 2% with adrenaline 1:200, 000 and Group B received normal saline with adrenaline 1:200, 000. Episodes of tachycardia occurred more frequently in group B. Systolic blood pressure, diastolic blood pressure and mean arterial pressure were significantly increased in group B. Significant decrease in diastolic blood pressure and mean arterial pressure occurred in group A. In neurosurgical patients undergoing craniotomy, infiltration of the scalp with solution containing adrenaline alone causes significant hypertension. The addition of lignocaine attenuates the hypertensive response but causes decrease in blood pressure

Estimation of soluble L- selectin and plasma fibronectin in patients with rheumatoid arthritis

This study was done to detect the serum level of soluble L-selectin [sL-selectin] and plasma level of fibronectin [pFN] in patients with rheumatoid arthritis [RA] and compare these levels to normal healthy controls. The aim extends to determine the relation of these levels to clinical parameters of disease activity. Fifty patients with RA as well as twenty healthy persons- as a control group- were included into this study. All patients were subjected to full clinical assessment and laboratory investigations. sL-selectin and pFN were measured in patients and controls using the enzyme-linked immunosorbent assay technique, and their correlations with disease activity parameters were studied. Serum levels of sL-selectin and pFN were highly significantly increased in RA patients as compared to healthy controls [p<0.001]. These levels also showed a highly statistically significant correlation with some parameters of RA disease activity [p<0.001]. This rise was more evident in patients with severe disease activity sL-selectin and pFN levels are elevated in RA patients especially in those with a severely active disease. The might reflect their role in the pathogenesis of RA. The correlation of sL-selectin and pFN with clinical parameters of RA patients may help in evaluation of progression or remission of the disease

Neodymium: YAG laser treatment for dense premacular subhyaloid hemorrhage

Objective: To assess the efficacy of Neodymium: YAG laser membranotomy and posterior hyaloidotomy in achieving rapid intravitreal drainage of dense premacular hemorrhage and rapid visual rehabilitation

Methods: Eight eyes of eight patients had Nd: YAG laser treatment to release trapped hemorrhage overlying the macula. Two to five laser membranotomies were performed. Colored fundus photographs were taken. Patient with diabetes had panretinal photocoagulation prior to YAG laser treatment

Results: The premacular hemorrhage originated from proliferative diabetic retinopathy in four eyes, from a retinal macroaneurysm in two eyes, from leukemic retinopathy one eye and from valsalva retinopathy in one eye. Complete intravitreal dispersion was achieved in all eyes within one week with marked improvement of vision. One diabetic eye showed less improvement in vision due to diffuse dispersion of hemorrhage in the vitreous

Conclusion: Nd: YAG laser membranotomy seems helpful in rapid clearing of premacular hemorrhage and improvement of vision in certain eyes

Role of intraoperative 360 retinal endophotocoagulation in the management of giant retinal tears

To determine the effectiveness of intraoperative 360 degree retinal photocoagulation in the management of giant retinal tears [GRTs]. Departments of Vitreoretina, Al Shifa Trust Eye Hospital, Rawalpindi. From 2000 to 2004. Sixteen eyes of 16 consecutive patients with GRTs were operated at Al Shifa trust eye hospital. Eyes included in this study underwent pars plana vitrectomy, perfluorocarbon liquid injection, 360 degree retinal photocoagulation and silicone oil exchange. Retinopexy was applied to the edges of the tear through endolaser photocoagulation and extended over 360 degree to the peripheral attached retina. No scieral bijckle was placed in any of these cases. The extent of the GRT was 180 degree or greater in four eyes and 90 degree to 180 degree in twelve eyes. The lower edge of the GRT was located in the inferior quadrant in fourteen eyes. PVR was grade A in five eyes, grade B in eight eyes and grade C in three eyes. In 12 [75%] of the 16 eyes, the retina was successfully reattached after surgery and 360 degree laser photocoagulation. The silicone oil was removed after a mean period of twelve weeks. Two of the four eyes were successfully reoperated by performing relaxing retinotomies. At the end of the follow up, the retinal was reattached in 14 [87.5%] of the 16 eyes. The mean follow up period was 14 months [range 5-23 months]. The success rate of management of GRTs with pars plana vitrectomy, internal temponade and 360 photocoagulation of the retina without scleral buckle is high

Incidence of pain on propofol injection and efficacy of addition of lignocaine or selecting big vein or both combined in reducing it a randomized control trial

To find out the frequency of pain due to propofol injection and to assess the efficacy of addition of lignocaine to propofol, selecting big vein in antecubital fossa or both combined in reducing pain. Incidence of injection pain with propofol was noted in 200 unpremedicated patients undergoing tonsillectomy. They were divided into 4 groups of 50 patients each. The patients were randomly allocated by card method to one of the four groups. Group A received plain propofol in a small vein on the dorsum of hand. Group B received 10 mg lignocaine added to propofol before administration into a vein on the dorsum of hand. Group C received propofol in a vein in the antecubital fossa and group D received lignocaine 10 mg added to propofol prior to administration in vein in the antecubital fossa. Incidence of pain was 58% with plain propofol injected in small vein, 10% when lignocaine was added prior to injection, 8% when injected in large vein and 6% when lignocaine was added before injecting propofol in large vein. Addition of lignocaine to propofol before injection into a small vein and administration of plain propofol into a large vein were equally and significantly effective [P value < 0.001] in reducing the incidence of pain. Addition of lignocaine to propofol into a large vein further reduced the incidence as compared to plain propofol but this was not statistically significant [P value >0.05]