Intra-operative hypotension; induction of anesthesia in patients continuing their routine dose of angiotensin system inhibitor therapy before surgery

To determine the frequency of intra-operative hypotension following induction of Anesthesia in patients continuing their routine dose of angiotensin system inhibitor therapy before surgery. Cross-sectional study. Department of Anaesthesiology, Combined Military Hospital, Quetta. One year from 20-08-2010 to 19-08-2011. Total 92 hypertensive patients were included in this study. Diagnostic criteria for patients was those cases receiving ACEI/ARA therapy for at least 3 months with admission preoperative arterial blood pressure of >150/90mmHg. Mean age of the patients was 47.70 +/- 8.47 years. Out of 92 patients, 38 patients [41.3%] were male while remaining 54 patients [58.7%] were female. Distribution of cases by hypotension after induction of anesthesia shows, hypotension at 30 minute in 55 patients [59.8%] and hypotension at 60 minute in 37 patients [40.2%]. Out of 55 hypotensive patients [at 30 minute] 17 patients [30.9%] had mild hypotension, 32 patients [58.2%] had moderate hypotension and 6 patients [10.9%] had severe hypotension. Out of 37 hypotensive patients [at 60 minute] 8 patients [21.6%] had mild hypotension, 25 patients [67.6%] had moderate hypotension and 4 patients [10.8%] had severe hypotension. Hypertensive patients continuing their routine angiotensin system inhibitors therapy [<10 hr preoperative] have a variable risk of developing moderate hypotension within 30 minutes after induction. This moderate hypotension proved to be of little clinical significance as it responded to conventional therapy

Comparison of hemodynamic responses to use of laryngeal mask airway versus endotracheal tube in hypertensive patients

To compare hemodynamic responses to use of laryngeal mask airway [LMA] versus endotracheal tube [ETT] in hypertensive patients. A quasi-experimental study. Department of Anaesthesiology and Intensive Care, Combined Military Hospital Rawalpindi and Kharian from January 2008 to December 2008. Seventy hypertensive patients selected by non-probability convenience sampling technique were equally distributed in two groups ETT and LMA using alternate patient technique [n=35 each]. Patients in both groups were anaesthetised using common anaesthetic technique. Patients in ETT group underwent laryngoscopy and ETT intubation, whereas patients in LMA group received LMA without laryngoscopy for their airway maintenance. Hemodynamic variables, [pulse, systolic, diastolic and mean arterial pressures] were measured using non-invasive monitoring technique at various intervals before and after intubation or LMA placement, before and after extubation or LMA removal. In ETT group after intubation there was an increase both in, pulse from 69 +/- 9 to 75 +/- 8, and mean arterial pressure [MAP] from 89 +/- 10 to 104 +/- 4mm Hg, when compared to LMA group, in which pulse increased from 67 +/- 7 to 68 +/- 5 and MAP from 89 +/- 11 to 94 +/- 8 mm Hg. Before extubation pulse in LMA group patients was 73 +/- 10 and MAP was 93 +/- 9 whereas in ETT group mean pulse was 76 +/- 9 and MAP was 107 +/- 9 mm Hg. On ETT extubation pulse increased from 76 +/- 9 to 77 +/- 8 and MAP from 107 +/- 9 to 108 +/- 8 mm Hg, whereas in LMA group pulse changed from 73 +/- 10 to 69 +/- 7 and MAP from 93 +/- 9 to 95 +/- 9. All the hempdynamic responses were significantly lower in LMA group than in ETT group [p<0.05]. Use of LMA in hypertensive patients for control of ventilation showed significantly lower hemodynamic responses when compared to ETT at both intubation and extubation.

Intubating conditions 60 seconds after giving muscle relaxant for rapid sequence induction comparison between succinylcholine and rocuronium

To compare efficacy of succinylcholine with rocuronium for rapid sequence induction. Randomized control trial. The study was done in Anaesthesia department, Combined Military Hospital Kharian from 17th march 2007 to 16th march 2008 a total of 100 cases of elective surgery for haemorrhoids were taken and patients were randomly assigned in two equal groups using random number table. American Society of Anesthesiologist [ASA] status was assessed. Informed consent and approval of ethical committee was obtained. Patients were divided into group A and B. In both groups there were 25 males and 25 females of 20-40 years. In group A, patients were preoxygenated for 3 min then propofol was given followed by succinylcholine. After 60 seconds of giving muscle relaxant intubating conditions were assessed by vocal cords movements on laryngoscopy, apnea and abdominal jerky movements on intubation. In group B, rocuronium was given instead of succinylcholine. In group A one [2%] patient was having movement of vocal cords at the time of laryngoscopy while in group B nine [18%] patients had vocal cord movement [p=0.016]. As far as apnea is concerned, in group A one [2%] patient was not having apnea after 60 seconds but in group B eight [16%] patients were not having apnea [p=0.031]. At the time of intubation in group A three [6%] patients showed jerky movements of abdomen while in group B that movement was present in eleven [22%] patients [p=0.041]. Intubating conditions with rocuronium were not superior to those with succinylcholine

Epidural analgesia; effect on the duration of labour

The influence of epidural analgesia on the length of labour remains a source of controversy in literature. To see the effect of epidural analgesia on the duration of active first stage and second stage of labour. Obstetric Department of CMH Kharian. From 1[st] January 2005 to 31[st] March 2006. One hundred pregnant full term, women were included in the study. Fifty primiparous reporting at full term, half were given epidural analgesia the other half were control. Another fifty multiparous reporting at full term, twenty five women were given epidural the other twenty five were control. The mean duration of active first stage of labour in primiparous women after 3-4 centimeter cervical dilatation was 5.10 hrs in the epidural group while it was 6.65 hrs in the control group [p less than 0.001]. In the multiparous women the mean duration of active first stage of labour after 3-4 centimeter cervical dilatation was 2.40 hrs in the epidural group while it was 3.43 hrs in the control group [p less than 0.001]. In the primiparous women the mean second stage was 23.76 minutes in the epidural group, and 37.33 minutes in the control group [p less than 0.001]. In the multiparous group, the mean second stage was 17.58 minutes in the epidural group, and 22.00 minutes in the control group [p less than 0.001]. Epidural analgesia decreases the duration of active first stage and second stage of labour

Post spinal headache; comparing needles of 25 and 27 gauges for incidence of post spinal headache

The main objective of the study was to give emphasis for use of smaller caliber spinal needles with the bevel placed sagitally to get the best results and reduce the incidence of PDPH in the patients getting spinal anesthesia. The study on PDPH was conducted as comparative and prospective. Study comparing the two different spinal needles of 25 G and 27 G [different calibers for incidence of Post dural puncture headache]. This study was conducted in Anaesthesiology department CMH Lahore. For this study the literature from different books/magazines/journals and internet was consulted to make the study comparable. The study design contained the patients selection through randomization technique. Proper criteria for selection of the patients were opted and in it only A.S.A.1 Patients were studied. Similarly certain specific age group [young patients] were kept for this study to get accurate results, proper caparison and patients and already got spinal anaesthesia were not tested too. Quincke Babcock spinal needles of 25G and 27G were easily available in the market. This clinical trial contained eighty patients divided in two groups. After taking all precautionary measures they were given spinal anaesthesia and after it they were observed for spinal headache [study performa annexed]. Epidural blood patches were also given in those patients who were given spinal anaesthesia with 25G needle, where required. The results of the study were tested by use of Chi's square test with 1 of freedom. The results confirmed the hypothesis that smaller caliber needle [27G] caused no PDPH while bigger caliber needle [25G] caused headache in percentage of patients. In the end the references from the concerned literature were cited and results were found comparable as given in the literature. The role of smaller caliber needles was well evaluated in this study