Predictors of postoperative mechanical ventilation time, length of ICU stay and hospitalization period after cardiac surgery in adults

Objectives: To study the effect of perioperative factors on patients' recovery after cardiac surgery in adults

Methods: This is a prospective observational analysis of 101 adult patients [age range 19-78 years] who had undergone coronary artery grafting, heart valve[s] replacement / repair or combined [coronary and valve] surgeries, was conducted at Queen Alia Heart Institute. The influence of 22 perioperative parameters [age, gender, co-morbidities, body mass index, type of surgical procedure, left ventricular function, cardiopulmonary bypass time [CPB], inotropic support, analgesia, postoperative blood losses,...] on recovery variables [time of extubation, ICU and hospital discharge] was studied. European system for cardiac operative risk evaluation [EUROSORE] has been calculated. Univariate and multivariate analysis of results was performed

Results: Mean time of mechanical ventilation was 11 +/- 8.5 hours. Delay in extubation was noticed in patients with left ventricular impairment, chronic respiratory disease, morbid obesity, urgent surgery, age above 61 years, patients who had reopening for control of bleeding and lower temperatures during deliberate hypothermic cardiopulmonary bypass. The mean length of ICU stay was 1.8 +/- 1.2 days. The average length of hospitalization was 5.1 +/- 1.2 days. There was a correlation between Length of intensive care unit stay and CPB [p-value=0.02], and between Length of intensive care unit stay and aortic cross clamp time [p-value=0.006]. Prolonged operative time [OT] was associated with increased length of hospitalization [p-value=0.008]. Average EUROSCORE value was 1.4 [ranged between 0.5 -5.3]

Conclusion: Left ventricular dysfunction, urgent surgery, inotropic support, considerable postoperative bleeding, morbid obesity, longer cardiopulmonary bypass and aortic clamp times, are main risk factors of delayed [or prolonged] extubation, and ICU/ hospital discharge

Isolated hydatid cyst of breast: a case report

Hydatid disease involving the breast is Very infrequent. The breast can be either a primary site of the disease or part of a disseminated hydatidosis. This disease should be included in the differential diagnosis of breast lumps especially in endemic areas. Pre-operative diagnosis can be made by tine needle aspiration cytology. The breast hydatid disease also can be diagnosed by radiological or serologic means but neither of them is definitive. Surgery is the treatment of choice. We report a case of isolated hydatid cyst of breast in a 40-year-old woman, from Afghanistan who presented La our field hospital with a right breast painless lump of one year duration, which was diagnosed incidentally during surgery from it 5 gloss appearance which mimics that of a liver hydatid cyst, normally common in this endemic area

Intraperitone versus wound infiltration with bupivacaine after laparoscopic operations

This study included 120 patients class l,ll,ll according to the American society of anesthesiologists [ASA] aged 25-60 years, who were scheduled for different kinds of laparoscopic procedures in prince rashed ben-al hassan hospital during the period from 15 january to 30 november 1997. the patients were divided randomly into four equal groups in a double blind study. Bupivacaine 20 ml, 0.5%, was given intraperitoneally to group A in the head down position, and to group B in the supine position. Group C received 20 ml normal saline intraperitoneally as control. Group D received 20 ml of plain Bupivacaine 0.5% infiltrated around the wounds. All injections were given at the end of surgery. We assessed the patients on awakening and then after 30 minutes, 1 hour, 3 hour, and for 24 hours, using pain scores of 1-5 pain scores on awakening, after 30 minutes and three hour were significantly lower in group D than in group A. no differences between B and C group. Infiltration aroud the wound with bupivacaine is very useful analgesis method, and is ideal for laparoscopic procedures up to 5 hours

Study of the effects of opioid abnalgesics [fentanyl] on propofol requirements in day case surgery

We studied one hundred women undergoing day- case surgery, allocated randomly into two groups. Group a received fentanyl 1.5 microgram/kg intravenously before induction. Group B received no analgesic drugs. Anaesthesia was induced with propofol intravenously and maintained using 60% nitrous oxide in oxygen with propofol infusion. In group A induction time and dose were significantly less. The mean assessment of quality of anaesthesia were similar in both groups. It is concluded that the use of fentanyl for short gynaecological procedures allows reduction of the propofol dose range, decrease induction time, prevents the pain at the site of propofol injection and does not alter recovery significantly