Comparison of ondansetron and metoclopramide in the prevention of nausea and vomiting after laparoscopic cholecystectomy under general anaesthesia

To evaluate and compare the antiemetic efficiency of ondansetron with metoclopramide when administered prophylactically for the prevention of post operative nausea and vomiting after laparoscopic cholecystectomy. Prospective, Randomised, Comparative study. The study was conducted at the department of Anaesthesia Fauji Foundation Hospital, Rawalpindi from Sep 2010 to may 2011. Total 90 ASA grade-I and ASA grade-II patients, sex female, and age 35 - 70 years undergoing elective laparoscopic cholecystectomy were included in the study. Patients were randomly divided into three groups, 30 in each group. Group-I received 4 mg intravenous ondansetron, group-II received 10 mg, Intravenous nietoclopramide and group-III received intravenous 0.9% normal saline 2 minutes prior to induction of anaesthesia. They received standard General Anaesthesia for surgery. Post operative analgesia was provided with intravenous ketorelac 30 mg. There was no difference among the groups in patient charactertics and risk factors for PONV. Patients were observed for 24 hours after operation for occurrence of nausea and vomiting and requirement of rescue antiemetic. Efficiency of the drug was evaluated as [a] complete response- no nausea and no vomiting. [b] Mild response Nausea with no vomiting [c] Moderate response - 1-2 vomiting episodes I moderate nausea [d] Severe response - > 3 vomiting episodes Isevere nausea. During 1St 24 hours after operation incidence of nausea and vomiting was 77% in patients in placebo group, was 33% in patients in the ondansetron group and 53% in patients in the metoclopramide group. The incidence of PONV was significantly lower in patients who received ondansetron [P < 0.05] as compared to metoclopramide or placebo. Complete response with no nausea and vomiting was higher in patients who received ondansetron [66%] than in patients who received metoclopramide [46%] or placebo [23%]. The incidence of nausea with vomiting [moderate to severe response] was significantly lower with ondansetron [20%] as compared to metoclopramide [34%] and placebo [60%]. There was no need for another rescue antiemetic in [80%] patients, with ondansetron [67%] with metoclopramide, [40%] with placebo. Single intravenous dose of 4 mg ondansetron when administered prophylactically is more effective than 10 mg intravenous metoclopramide in the prevention of PONV after laparoscopic cholecystectomy. Single 4 mg IV dose of ondansetron reduces the incidence and severity of PONV and also requirement of rescue antiemetic in the Post operative period

effects of CO2 pneumoperitoneum on end tidal CO[2] [ETCO[2]], arterial blood pressure and heart rate during laparoscopic cholecystectomy under general anaesthesia

To analyze the effects of CO2 pneumoperitoneum at 13 to 15 mmHg infra-abdominal pressure on end tidal CO2 [ETCO2], arterial blood pressure and heart rate during laparoscopic cholecystectomy under general anaesthesia with controlled mechanical ventilation. Prospective Descriptive Study. The study was conducted at the department of anaesthesia Fauji Foundation Hospital Rawalpindi from August 2005 to September 2006. Fifty consecutive ASA grade-1 patients, 47 females, 3 males and aged 35-65 years undergoing laparoscopic cholecystectomy were included in the study. All patients received a standardized balanced anaesthetic in which 0.7 - 1% isoflurane was used during maintenance. Ventilation was controlled and minute volume was kept at 100 ml/kg/min. Pneumoperitoneum was created with CO2 at a flow rate of 10 liter/min and 13 to 15 mmHg infra abdominal pressure was maintained during the operation. End tidal CO2 [ETCO2], heart rate and non invasive systolic, diastolic and mean arterial blood pressure was recorded immediately before infra abdominal C02 insufflation and then after 5 minutes interval during the period of CO2 pneumoperitoneum. Study period started immediately before infra-abdominal CO2 insufflation till about 60 minutes of surgical procedure. The end tidal CO2 [ETCO2] levels progressively increased to reach a plateau 36mmHg 20 minutes after the beginning of infra abdominal CO2 insufflation. The end tidal CO2 [ETCO2] levels increased to 21% of base line [from 30 to 36 mmHg] during CO2 pneumoperitoneum for laparoscopic cholecystectomy under controlled mechanical ventilation at minute volume 100 ml/kg/min. The systolic, diastolic and mean arterial blood pressure increased to 12% to 17% of the baseline during CO2 pneumoperitoneum at 13-15 mmHg infra abdominal pressure. There was no significant change in heart rate. CO2 pneumoperitoneum produces rise in end tidal CO2 [ETCO2] levels and hemodynamic alterations proportional to the increased infra abdominal pressure during laparoscopic surgery under general anaesthesia with controlled mechanical ventilation

Complications of thyroid surgery

To determine the percentage of complications in thyroid surgery and compare these complications with the other national and international studies, Study Design: A descriptive study, The study was conducted in the department of Surgery, Foundation University Medical College and Fauji Foundation Hospital Rawalpindi from 1 [st] January 2009 to 31[st] December 2009. Patients and Methods: 192 patients above the age of 14 who consented were included in the study. General physical ansd loco regional examination was done in OPD. Thyroid function tests [T3, T4, and TSH] were done in all the patients besides other routine investigations. FNAC and thyroid scan was done in only selected patients. Anemia, hypertension and other comorbid condition, if present, were corrected and assessed by anesthetist in the pre admission clinic. Only euthyroid patients, both clinically and biochemically and fit for general anesthesia were admitted for operation. Subsequently all the patients were subjected for surgery and the specimens were sent for histopathology after visual examination. Pre as well as per operative findings were recorded on a specially designed proforma. The data were then entered in the computer for analysis and conclusions were drawn. Total of 192 patients operated for benign thyroid disease in year 2009. Age ranges between 14 to 80 with 120 patients below the age of 40. Out of 192 patients, only 6 were males.90 patients were operated for pressure symptoms, 78 for cosmetic reasons and 24 for toxic symptoms. Subtotal thyroidectomy was done in 132 patients while 24 patients ended up with near total and 36 were candidates for lobectomy. 6 patients had symptoms of RLN damage while 24 develop parathyroid insufficiency post operatively. All these patients managed conservatively and discharge on 2[nd] or 3[rd] post op day. They regain normal voice and normal serum calcium levels by the end of 3 months. Subtotal thyroidectomy is one of the commonest procedure done by the surgeons of Rawalpindi Islamabad region. Maximum effort should be done to optimize the patients preoperatively. If patients are euthyroid and assessed carefully for anesthesia fitness before operation, chances of per or post- operative complications are negligible

Efficacy of esophageal detector device in verification of endotracheal tube placement

To assess accuracy of esophageal detector device [EED] for detection of endotracheal tube placement and to compare its performance with that of capnography. A prospective study in which 400 patients were divided into two groups. In group-I the patients were intubated as per routine, then the EDD and capnograph were again used to check both the tubes. The result showed 100% sensitivity, 100% specificity and 100% predictive value for EDD. The EDD was found to be very effective device in differentiating esophageal from tracheal intubation

Plasma vitamin A, carotene, serm total protein and albumin levels in the school age children and young adults of Multan city

Purpose of this study was to estimate the severity and extent of vitamin A deficiency and to find whether it constitutes a significant public health problem. This study included 446 school children aged 5-17 years and 210 young adults aged 18-22 years of Deeni Madaras. All students were male, normal and apparently healthy. The schools and students of Multan city were selected randomly. It was observed that majority of the children belonged to poor socioeconomic class. In these subjects dietary intake of milk, meat and eggs per week was very low and in many cases the consumption of these commodities was once per month. Intake of other dairy products like butter and butter oil was also not found in many cases. However, consumption of leafy vegetables was common to some extent. Clinical examination showed that none of the children had visual or skin disturbances. To assess the malnutrition, serum total protein and serum albumin were measured in all subjects. Low levels of serum total proteins were found in 52.4% children of age 5-11 years, in 26.6% children of age 12-17 years and in 21.0% young adults of age 18-22 years. Low levels of serum albumin were found in 28% children of age 5-11 years, 37% children of age 12-17 years and in 35% young adults of age 17-22 years. Low or subclinical plasma vitamin A levels were noticed in 81.5% children of age 5-11 years, in 6% children of age 12-17 years and in 12.5% young adults of age 18-22 years. Low or subclinical plasma carotene levels were observed in 64% children of age 5-11 years, in 16% children of age 12-17 years and in 20% young adults of age 18-22 years. This study has shown that clinical features of vitamin A deficiency are not visible in our children, however subclinical deficiency is present which must be corrected for adequate growth and development