Non-invasive positive pressure ventilation facilitates early extubation in post operative cardiac patients

To assess the use of NIPPV [non-invasive positive pressure ventilation] during weaning from mechanical ventilation in post-op patients in an ICU and compared this procedure with intermittent mandatory ventilation [IMV] by analyzing cardiac and respiratory parameters and complications. A randomized clinical trial was conducted from June 2009 to July 2010 on Post-operative surgical patients that were on IMV for more than 48 hours, who failed at 30 minutes of spontaneous breathing T-piece trial [SBT]. If failure occurred before the 30th minute, he/she was included in the group previously defined by random assignment. Patients in the experimental group were extubated and placed on NIPPV, whereas other patients [the control group] returned to IMV. Daily SBT was carried out thereafter in order to evaluate the possibility of extubation in control group. Of 60 patients who failed T-piece trials, 30 patients were placed on NIPPV and 30 on [IMV]. The ages of patients in the NIPPV and IMV groups were 45.7 +/- 18.11 and 47.10 +/- 18.45 years respectively. In both groups, ventilation time before T-piece trial was 2-3 days. Patients of the NIPPV group had a shorter stay in the ICU and in the hospital i.e., 2.93 +/- 0.785 days versus 7.4+1.11 days for IMV group. No serious complications were observed in both groups. The results of this study suggest that the combination of early extubation and NIPPV is a good alternative

Aplasia cutis congenita scalp: management options

To document the management of aplasia cutis congenita scalp. This descriptive study was conducted in the Department of Plastic and Reconstructive Surgery, Hayatabad Medical Complex, Peshawar from February 2000 to September 2007. Eleven patients with aplasia cutis congenita scalp were referred to our unit. A split thickness skin graft from adjacent healthy scalp or thigh was used for coverage of the scalp wound. Among these eleven patients, seven were males and four females. Two patients were observed with associated congenital anomalies. The ages ranged from 05 days to 04 weeks. Mean age was 12.5 days. Split thickness skin grafts were used in all these patients. About 10% graft loss was observed in one patient. One patient developed CSF leakage after wound healing. This patient expired after 03 weeks. Early surgical intervention in the form of split thickness skin graft for wound coverage is the most favorable treatment for Aplasia cutis congenita

Comparison of epidural steroid injections with conservative management in patients with lumbar radiculopathy

To determine the difference in short- and long-term pain improvement between lumbar Epidural Steroid Injections [ESIs] and conservative management in patients with lumbar radiculopathy. Quasi-experimental study. The Postgraduate Medical Institute of Hayatabad Medical Complex, Peshawar, from April 2005 to March 2007. Fifty elective patients fulfilling the inclusion criteria were randomly divided into two groups. Patients in the steroid group were treated with 80 mg of methylprednisolone injected in combination with 3 ml of 2% plain xylocaine and 3 ml of normal saline in the lumbar epidural space, while patients in the conservative group were treated with bed rest, non-steroidal anti-inflammatory agents, muscle relaxants, and opioids. All the 50 patients in the two groups were regularly assessed at 2 weeks, 1 month, 3 months and 6 months of periods for pain score by the Visual Analogue Scale [VAS], patients satisfaction score and any unwanted side effects. A marked improvement of the pain score and patients satisfaction score were noticed in the steroid group. Less significant improvement was seen in the conservative group during the initial period i.e 2 weeks and 1 month [p <0.05]. The difference in Visual Analogue Scale [VAS] and patients satisfaction score was non-significant in chronic stages of treatment in both groups [p > 0.05]. Epidural steroid injections in acute symptoms of sciatica are considered to be a better option compared to conservative treatment

Comparison of caudal bupivacaine and bupivacaine-tramadol for postoperative analgesia in children undergoing hypospadias surgery

To compare the effectiveness of caudal bupivacaine and bupivacaine-tramadol for postoperative analgesia in children undergoing hypospadias surgery. Quasi experimental study. The Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar, from February 2006 to August 2007. The study was conducted on 60 male children undergoing elective hypospadias surgery at the study centre. Patients were divided into two groups of 30 each. Patients in group 'B' [bupivacaine] were given 0.5 ml/kg of 0.25% plain bupivacaine, while patients in group 'BT' [bupivacaine and tramadol] were given 0.5 ml/kg of 0.25% bupivacaine in combination with 1 mg/kg of tramadol in caudal epidural space just after induction of anaesthesia. ASA status, duration of anaesthesia,duration of surgery, type of anaesthesia and maintenance of anaesthesia were similar for both groups. In the recovery room, patients were compared for pain scores, sedation score, need for rescue analgesia and any unwanted side effects for 24 hours postoperatively. All patients were assessed haemodynamically at regular intervals intraoperatively in both groups. A t-test was used to compare the mean values of the group with significance at p < 0.05. Mean age of the children was 4.2 +/- 2.35 and 5.5 +/- 1.51 years in group B and BT respectively. Their weight ranged from 10-30 kg. A lower pain score was observed in the bupivacaine-tramadol group during the first 24 hours in the recovery room, as well as in the postoperative ward. The mean duration of analgesia was significantly prolonged and the requirement for rescue analgesics were significantly less in the bupivacaine-tramadol group [p < 0.0001] postoperatively. Demographic data, haemodynamic variables, sedation score, and minor complications were not significantly different in the two groups. Caudal tramadol with bupivacaine provides prolonged and good quality postoperative analgesia compared to plain bupivacaine in children undergoing hypospadias surgery

Midazolam with bupivacaine for improving analgesia quality in brachial plexus block for upper limb surgeries

To compare the onset, duration and postoperative pain scores of supraclavicular block with bupivacaine alone and bupivacaine-midazolam combination. Randomized controlled clinical trial. The Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar, from April 2005 to June 2007. A randomized controlled clinical trial was conducted on 50 ASA-I or II adult patients undergoing upper limb surgeries under supraclavicular brachial plexus block. Patients were randomly allocated into two groups of 25 each. Patients in group A were administered 30 ml of 0.5% bupivacaine and those in group B were given 30 ml of 0.5% bupivacaine with midazolam 50 micro g.kg-1. Hemodynamic variables [heart rate, noninvasive blood pressure, oxygen saturation], pain scores, rescue analgesic requirements and sedation score were recorded for 24 hours postoperatively, and compared using ANOVA with significance at p <0.05. The onset and duration of sensory and motor block was significantly faster and longer in group B compared to group A [p < 0.001]. Pain scores were significantly lower in group B for 24 hours postoperatively [p < 0.001]. Demand for rescue analgesic were significantly less in group B. Hemodynamics and sedation scores did not differ between the groups in the studied period. Bupivacaine [0.5%] in combination with Midazolam [50 micro gúkg-1] quickened the onset as well as prolonged the duration of sensory and motor blockade of the brachial plexus for upper limb surgery. It improved postoperative analgesia without producing any adverse events compared to plain bupivacaine [0.5%] in equal volume

Induction and emergence characteristics of propofol in two different concentrations in day case eye surgery in children

To compare the induction characteristics of two different concentrations of propofol i.e. 1% and 2% in children undergoing eye surgeries. Material and In this cross-sectional comparative study 100 consecutive patients of ASA status 1 and II coming for elective eye surgeries were divided into two groups of 50 each. Group A were given propofol 1% while patients in Group B were given propofol 2% for induction of anaesthesia and were maintained with 1% isoflurane and 60% nitrous oxide in oxygen. Induction characteristics i.e. loss of consciousness or onset time of anaesthesia, pain on injection, spontaneous or purposeless movements, spasm just after intubation and conditions of intubation were assessed and compared in two groups. Student't test and chi- square test were applied. Loss of consciousness was more rapid with propofol 2% compared with propofol 1% [40s Vs 48s; P = 0.02]. Pain on injection occurred in 5[10%] and 10 [20%] patients [P = 0.09] after propofol 1% and 2% respectively. Spontaneous movements during induction occurred in 8 [16%] and 12 [24%] patients [P=0.18]; satisfactory intubation was done in 40 [80%] and 45 [90%] patients [P=0.19], while spasm just after intubation was noticed in 1 [2%] and 3 patients [6%], receiving propofol 1% and 2% respectively. Haemodynamic changes were not different in the two groups. Propofol 1% and propofol 2% are equally effective and safe for induction of anaesthesia in children undergoing eye surgeries

frequency of postdural puncture headache in different age groups

To compare the frequency of postdural puncture headache [PDPH] in younger and older age groups i.e. 30-50 years and 51-75 years in patients undergoing spinal anaesthesia. Cross-sectional comparative study. Anesthesia Department of Hayatabad Medical Complex, Peshawar, from June to December 2002. Two hundred patients, fulfilling the American Society of Anesthesiologist [ASA] I and II criteria, were included in the study and the results of PDPH in both age groups were compared and Chi-square test was applied. The level of significance was significant, if the p-value was less than 0.05. The occurrence of PDPH was more in young patients i.e. 30 patients [30%] in group A, as compared to 5 patients [5%] in group B [p< 0.05] Female patients had higher frequency of PDPH in both groups. In group A, 20 female patients [40%] had PDPH as compared to 10 male patients [20%], while in group B, 4 female patients [8%] had PDPH as compared to 1 male patient [2%]. The frequency of postdural puncture headache [PDPH] was less in older age group than younger age group and more frequent in females than males

Prevention of postoperative nausea and vamiting by ondansetron, In children undergoing strabismus surgery

To evaluate the antiemetic effect of ondansetron in controlling postoperative nausea and vomiting in children undergoing strabismus surgery. It was a randomized placebo controlled, double blind study of 100 children between 5-15 years of age with American Society of Anaesthesiologists [ASA] status I and II undergoing strabismus surgery under general anaesthesia.. Patients were divided into two groups of 50 each. One group was given normal saline while the other received 75ug/kg1 of ondansetron pre operatively. Children were monitored for the number of emetic episodes, and the need for a rescue antiemetic. There was significantly high P< 0.05 frequency of vomiting 30 patients 60% in group receiving normal saline when compared to ondansetron group 15 patients 30%. The incidence of early vomiting [0-4 hour] and the need for rescue antiemetic were also very low in patients receiving ondansetron when compared with the saline group. Ondansetron was found to an effective drug in preventing nausea and vomiting postoperatively in children undergoing strabismus surgery