Comparison of emergence time after total intravenous anaesthesia versus inhalational anaesthesia in gynaecological procedures

To compare emergence time after Total Intra-venous Anesthesia [TIVA] using Propofol and Inhalational Anesthesia using Sevoflurane in minor gynecological and obstetric procedures. Randomized controlled study. Department of Anesthesiology, Intensive Care and Pain Management, Combined Military Hospital, Peshawar. Six months from 15[th] March 2010 to 14[th] September 2010. A total of 200 gynecological patients of ASA-I and II were included in this study. Patients were divided randomly in 2 groups of 100 each using random numbers table. Group A patients were administered TIVA- Propofol and group B patients were given inhalational anaesthesia using Sevoflurane. A stopwatch was started when the anesthetic drug was discontinued at the end of surgery and was stopped as soon as the patient opened her eyes spontaneously to record the emergence time. All the data was entered in a patient performa. It was observed that group A patients who were administered Propofol had a faster emergence time as compared to group B patients who were administered Sevoflurane. The mean emergence time of TIVA- Propofol group was 6.24 minutes [SD=0.726] while that of inhalational- Sevoflurane group was 8.52 minutes [SD=1.218]. The shorter emergence time of Propofol group was highly significant when compared with the Sevoflurane group [p<0.001]. The study concluded that Propofol provides rapid emergence than Sevoflurane

Cervical lymph node metastases in squamous cell carcinoma of tongue and floor of mouth

Oral squamous cell carcinoma has high chances of cervical lymph node metastasis. This case series describes the distribution of cervical lymph nodes in 50 cases of squamous cell carcinoma of tongue and floor of mouth. The mean age was 47.28 +/- 10.5 years. Thirty positive metastatic lymph nodes were found; 90% occurring at level l-ll mostly in T4 size but also in T1 and T2 cases. The distribution of involved lymph nodes in oral cancer affects the neck dissection extent and is, therefore, an important pre-operative feature

Comparison of haemodynamic changes after laryngeal mask airway insertion with propofol versus sevoflurane

To compare haemodynamic changes on Laryngeal Mask Airway [LMA] insertion using tidal volume induction technique with sevoflurane at high concentration versus an intravenous induction with propofol. Randomized Controlled Trial [RCT]. Place and Duration of study: The study was carried out at Department of Anaesthesiology, Intensive Care and Pain Management, Military Hospital Rawalpindi from May 2006 to April 2007. One hundred patients were enrolled after written informed consent. Patients were divided in two groups. Group A received propofol and group B received sevoflurane for induction of general anaesthesia. Heart rate and mean arterial pressure [MAP] were recorded one minute before induction of anaesthesia and three minutes after induction and LMA placement. Independent sample "t-test" was applied to compare means for MAP and mean heart rate in both the groups and p value was inferred to judge the significance. In group A 20 males and 30 females were enrolled for the study while in group B there were 16 males and 34 females. The mean age of the patients in group A was 30.5 +/- 4.8 years while in group B was 28.4 +/- 5.2 years. Mean weight was 60.5 +/- 5.8 and 62.2 +/- 4.7 kilograms respectively in both groups. Twenty two patients were ASA I and 28 were classified as ASA II in group A while 27 were ASA I and 23 were ASA II in group B. In the group A, MAP was recorded to be 90 +/- 5.3 mmHg before induction and 79.9 +/- 7.5 mmHg after LMA placement following propofol induction. Whereas MAP in Group B before induction of anaesthesia and after LMA placement were 90 +/- 4.8 and 84.2 +/- 7.03 mmHg respectively. The fall in MAP was found to be significant in Group A when compared to Group B after induction and insertion of LMA [p value < .005]. In group A, mean HR was recorded to be 79.1 +/- 4.3 before induction and 82.2 +/- 8 per minute after LMA placement following propofol induction. While mean HR in Group B was 78.1 +/- 7.8 before induction and 83.3 +/- 8.0 per minute after LMA placement following sevoflurane induction. Hence, we found no significant difference in terms of change in mean HR between the two groups [p value > 0.4] before and after LMA insertion. Considering more fall in the MAP following propofol induction in group A and as there was no significant change in MAP and heart rate before and after sevoflurane induction, we conclude that sevoflurane provided better haemodynamic stability than propofol for LMA insertion

Evaluation of the analgesic and adverse effects of tramadol in combination with low dose bupivacaine for painless epidural delivery

To evaluate the analgesic and adverse effects of Tramadol in combination with low dose Bupivacaine for painless epidural delivery. Quasi-experimental study. Place and Duration of Study: The study was carried out at department of anaesthesiology Military Hospital Rawalpindi from August 2004-July 2007. Material and Fifty ASA-I uncomplicated full term primiparous were selected. Epidural analgesia was given with 15ml of 0.1% Bupivacaine plus 0.5% Tramadol when labour was established and was repeated on patient's demand. Pain was assessed by using verbal analogue scale 0-10 in first stage as well as in second stage of labour. Adverse effects on mother and baby were noted. Overall satisfaction about the procedure was also assessed. Forty two [84%] rated first stage of labour pain free [VAS-0] and Eight patients [16%] rated it as good pain relief [VAS-3]. Thirty four [68%] patients in second stage of labour rated it pain free while sixteen [32%] patients rated it as good pain relief [VAS-3]. One patient developed hypotension. Two patients complained of nausea. No patient complained of vomiting and none of them developed sedation. Three [6%] newborns had Apgar score nine and forty seven [94%] had ten after five minutes of delivery. Forty four patients described the experience as excellent; five described it as good and one as satisfactory. Tramadol used in epidural painless delivery in combination with low dose Bupivacaine is very effective analgesic with less adverse effects on mother and baby and can be used as an alternative to fentanyl/pethedine

new supraclavicular approach to subclavian venous catheterization

Supraclavicular approach to access the right subclavian vein is easier and associated with fewer complications as compared to infraclavicular approach. Needle is directed at an angle of 10° medially from the sagittal plane and 35° posteriorly from the coronal plane, just at the clavisternomastoid angle, to locate the subclavian vein