ABSTRACT
Even after the recent advances and new technologies, prevalence of malnutrition has remained unchanged over the last two decades in India. Both overfeeding and underfeeding affect the outcome of critically ill patients. Hence the assessment of nutritional status becomes the important aspect in critically ill patients and with prolonged ICU stay. The objective of the study was to assess the nutritional status of critically ill patients with prolonged ICU stay before intervening with enteral feeds and parenteral feeds. MethodsThis prospective, observational study was conducted in the Neurosurgical Intensive Care Unit of a tertiary care rural hospital in central India over a period of 6 months after the institutional ethical committee approval. The study included adult patients admitted for more than 72 hours in the Intensive Care Unit who were initiated on Ryles tube feeding. ResutlsAmong 60 patients, 27 patients come under class A of the Subjective Global Assessment (SGA) Scale, 24 patients come under the class B. 9 patients came under class C. ConclusionsIncidence of malnutrition was found to be 60 % as per the of the Subjective Global Assessment (SGA) scale. Of these, 40 % of patients were categorized under class B (mildly malnourished), 15 % of patients were categorized under class C (moderate malnutrition).
ABSTRACT
One of the commonest non-obstetric problem that will require surgical intervention during pregnancy is acute appendicitis. Laparoscopic appendectomy in parturient has many challenges to anesthesiologists like preterm labour, foetal morbidity, and maternal morbidity. Providing safe anaesthesia is such cases is challenging and necessary. The anaesthesiologist has to ensure maintenance of maternal oxygenation, perfusion, and homeostasis, with the least extensive anaesthetic for the best outcome for the foetus.Laparoscopy in pregnancy is challenging both for the surgeon and anaesthesiologist. Challenges faced by the anaesthesiologist includes laryngoscopy and tracheal intubation associated pressor responses haemodynamic changes associated with gravid uterus causing aortocaval compression and increased in intraabdominal pressures due to pneumoperitoneum, maternal CO2 monitoring to avoid maternal and foetal acidosis, considerations of avoiding foetal exposure to unnecessary medications & foetal heart rate monitoring. Whenever practically feasible regional anaesthesia is usually preferred over general anaesthesia in pregnancy whenever it is practically feasible. Regional anaesthesia in this case involves discomfort to the patient, need to take a higher level for surgical anaesthesia, hemodynamic changes associated after induction, risk of uterus manipulation by surgeons all of which can predispose to preterm labour. In our case we have opted for general anaesthesia over regional anesthesia due to fore mentioned reasons.
ABSTRACT
Propofol is one of the safest drugs for induction of general anaesthesia. Routinely available preparation in the market being propofol LCT (long chain triglycerides) has the disadvantage of pain on injection. This pain is very discomforting for the patient and also to the anaesthesiologist. So, they are coming up with a new preparation propofol MCT (medium chain triglycerides) which causes less pain on injection. We wanted to compare the occurrence of pain on injection of Propofol MCT with Propofol LCT.METHODSAfter obtaining institutional ethical committee approval, 150 patients undergoing various elective surgeries under general anaesthesia where propofol was used as an induction agent, aged between 18 and 65 years of ASA I & II were enrolled in the study. The study patients were divided into two groups. Group M, who received Propofol MCT and group L, who received Propofol LCT as an induction drug. The intensity of pain was evaluated by using Visual Analogue Score (VAS). Similarly change of triglyceride levels after single induction dose of Propofol MCT and Propofol LCT were observed.RESULTSGroup M showed reduced pain score (4.15±1.90) after injection along with less incidence of pain compared to Group L (6.37±2.49). Serum triglyceride levels had no significant difference in preoperative and postoperative values.CONCLUSIONSPain on injection with Propofol MCT (4.15 ± 1.90) is less compared to Propofol LCT (6.37± 2.49) & no evidence of change of triglyceride levels was seen after a single induction dose in the study.
ABSTRACT
Epidural analgesia has been the gold standard, preferred technique for providing postoperative analgesia in lower abdominal, lower limb, pelvic and vascular surgeries. Combination of local anaesthetic agents when used along with opioids, as an adjuvant in epidural analgesia, was found to be effective and synergistic. Ropivacaine is associated with less central nervous system toxicity and cardiotoxicity, and produces less motor blockade. Nalbuphine is an opioid with mixed kappa (κ) agonist and mu (µ) antagonistic properties, when mixed with other opioids, attenuates the µ opioid effect and enhances the κ opioid effect. We wanted to compare the post-surgical analgesic efficacy of epidural nalbuphine (10 mg) when added as an adjuvant to epidural ropivacaine (0.2%-9 ml) in patients undergoing lower abdominal surgeries. Primary objective was to compare the duration of postoperative analgesia and number of rescue analgesics required in 24 hours. Secondary objectives were to compare postoperative haemodynamic variation, quality of analgesia, Visual Analogue Score and side effects if any in both the groups.METHODSIt was prospective observational study conducted after obtaining ethical committee clearance. Sixty patients of ASA class I & II, fulfilling inclusion criteria posted for elective lower abdominal surgeries preferably abdominal hysterectomies divided into two groups, each comprising of 30 patients; group R- Ropivacaine- 0.2% - 9 ml with 1 ml normal saline and group R+N - 0.2%- 9 ml with nalbuphine 1 ml - 10 mg, under spinal anaesthesia with epidural catheter insertion. Parameters like duration of analgesia, number of rescue analgesia, quality of analgesia by patient rated quality of pain management, haemodynamic variation was assessed. Assessment of pain was done by VAS scale, side effects like sedation was assessed by modified Ramsay sedation scale.RESULTSNo demographic variation was found in any group. Mean duration of analgesia was found more in group R+N. Number of rescue analgesia was reduced in group R+N with improved quality of analgesia which was statistically significant. Mean HR was significant in group R+N. No change was noted in SBP, RR, SpO2 in either group. DBP and MAP showed statistically significant difference at 30, 60 min and 15, 30, 60 min respectively. None of the patients in either group had sedation; one episode of vomiting was noted in group R+N with statistically non-significant results.