ABSTRACT
To compare the efficacy and side-effects of 0.5% ropivacaine with that of 0.5% bupivacaine when used for single-shot epidural anaesthesia for orthopaedic surgery. Randomized controlled trial. Department of Anesthesiology, Combined Military Hospital Rawalpindi, over a period of eight months from June 2013 to January 2014. The study was carried out in 60 ASA physical status I, II or III patients undergoing elective lower extremity orthopedic surgery. Two groups of 30 patients each received single-shot epidural anaesthesia either with ropivacaine 0.5% [ropivacaine group] or bupivacaine 0.5% [bupivacaine group]. Onset, time for maximum height and median height of sensory block was assessed as well as time to two segment recession. Modified Bromage scale was used for motor blockade. Total duration of motor block and common side effects were also recorded. The patients in both groups were similar in age, height, weight, gender and ASA status. There was no significant difference in onset of sensory block and time for maximum height of sensory block. The median heighest level of sensory block was T6 [T5-T8] for ropivacaine group and T5 [T4-T7] for bupivacaine group. Time for two segment regression and duration of sensory block were also comparable for both groups. The total duration of motor block was significantly more in bupivacaine group [159 min vs 134.2 min, p< 0.001]. Modified Bromage scale was also significantly higher in bupivacaine group [2.86 vs 1.96 min, p<0.001]. Side effects like hypotension, bradycardia, nausea, vomiting and shivering were similar in both groups. Epidural administration of 0.5% ropivacaine provided effective and good quality anaesthesia. Motor blockade was of less duration as compared to equivalent dose of 0.5% bupivacaine, which may offer potential benefit of early patient mobilization after orthopaedic surgery
ABSTRACT
Background: Endotracheal intubation is routinely practiced in general anaesthesia, with potential hemodynamic effects on patients
Objective: The objective of this study was to compare the efficacy of single bolus intravenous lignocaine with magnesium sulphate to attenuate the haemodynamic response of laryngoscopy and intubation
Material and Methods: Atotal of 178 patients were included, randomly dividing them in two groups, 89 in each group. Group A, received intravenous 1% lignocaine Img/kg and group-B intravenous magnesium sulphate lOmg/kg. The data on heart rate, mean arterial pressure was compared among both groups and with baseline values, for the purpose of comparing efficacy. The data was entered and analyzed in SPSS version 14. Students t test was applied to compare means. A P value of less than 5% was taken as significant. Study design: Double Blind Randomized Clinical Trial. Place and duration of study: Departments of Anesthesiology of CMH Multan, from 1[st] September, 2010 to 1[st] March 2011
Results: There was statistically significant difference between the two groups in terms of efficacy i.e reduction of pressor response to laryngoscopy and intubation. 20% reductions in Mean Arterial Pressure [MAP] from baseline values were observed in 54% of the patients in Group A and 36.69% in group B. Similarly, 25% reduction in heart rate [HR] from baseline values were observed in 11 % of the patients in Group A and 6.23% in Group B. Incidence of > 20% increase in MAP was 4.2 % in Group A versus 20.6 % in group B and > 25% increase in HR 12.35% in group A versus 25.6 % in Group B. Incidence of >20% increase in MAP was 4.2% in group A versus 20.6% in Group B and > 25 % increase in HR 12.35% in group A versus 25.6% in Group B
Conclusion: There is statistically significant difference between two groups that is, lignocaine was more effective and efficacious than magnesium sulphate by preventing the increase in MAP and HR after laryngoscopy and intubation
ABSTRACT
Background: Endotracheal intubation is routinely practiced in general anaesthesia, with potential hemodynamic effects on patients
Objective: The objective of this study was to compare the efficacy of single bolus intravenous lignocaine with magnesium sulphate to attenuate the haemodynamic response of laryngoscopy and intubation
Material and Methods: A total of 178 patients were included, randomly dividing them in two groups, 89 in each group. Group A, received intravenous 1% lignocaine 1mg/kg and group-B intravenous magnesium sulphate 10mg/kg. The data on heart rate, mean arterial pressure was compared among both groups and with baseline values, for the purpose of comparing efficacy. The data was entered and analyzed in SPSS version 14. Students t test was applied to compare means. AP-value of less than 5% was taken as significant. Study design: Double Blind Randomized Clinical Trial. Place and duration of study: Departments of Anesthesiology of CMH Multan, from 1[st] September, 2010 to 1[st] March 2011
Results: There was statistically significant difference between the two groups in terms of efficacy i.e. reduction of press or response to laryngoscopy and intubation. 20% reductions in Mean Arterial Pressure [MAP] from baseline values were observed in 54% of the patients in Group A and 36.69% in group B. Similarly, 25% reduction in heart rate [HR] from baseline values were observed in 11% of the patients in Group A and 6.23% in Group B. Incidence of > 20% increase in MAP was 4.2% in Group A versus 20.6% in group B and > 25% increase in HR 12.35% in group A versus 25.6% in Group B. Incidence of >20% increase in MAP was 4.2% in group A versus 20.6% in Group B and > 25% increase in HR 12.35% in group A versus 25.6% in Group B
Conclusion: There is statistically significant difference between two groups that is, lignocaine was more effective and efficacious than magnesium sulphate by preventing the increase in MAP and HR after laryngoscopy and intubation
ABSTRACT
Thoracic surgeries and aesthesia for lung resection has presented anaesthesiologists with certain unique physiological problems. These include placing [lateral decubitus position] in order to obtain optimal access for most operations on lungs, pleura, esophagus, and great vessels, opening the chest wall [open pneumothorax] and one lung ventilation anaesthesia. One lung ventilation anaesthesia and lateral decubitus position produces decrease in functional residual capacity and an obligatory right to left shunt that ranges from 15% to 40% leading to increase in ventilation perfusion [V/Q] mismatch thus causing hypoxia and or hypoxemia. An optimal level of positive end expiratory pressure of 5cmH O when added to dependent lung is known to improve arterial oxygenation and improve ventilator 2 efficiency. To compare different values of positive end expiratory pressure [PEEP] during one lung ventilation, for its effects on blood arterial oxygenation and carbon dioxide levels. Study Randomized controlled trial [RCT]. Conducted in surgical Unit-III and Department of anaesthesia and Intensive Care, Combined Military Hospital, Rawalpindi. Duration of study with dates: Ten months from 25-12-2008 to 01-10-2009, Additional quantum of Data was collected from 01-01-2011 to 25-01-2011. The patients were divided into two equal groups of 100 patients each, by random allocation of patients to either in-group A [subjected to zero PEEP] or group-B [subjected to PEEP 5cm of water]. At induction and start of two lung ventilation 14 [14.0%] of the patients from group-A and 16 [16.0%] from group-B had normal PaCO. At initiation of one lung ventilation 25 [25.0%] of the patients from group-A and 80 [80.0%] from group-2 B had normal PaO. At initiation of one lung ventilation 26 [26.0%] of the patients from group-A and 80 [80.0%] from group-B had normal PaCO 2 2 with p<0.001. At end of procedure one lung ventilation 30 [30.0%] of the patients from group-A and 90 [90.0%] from group-B had normal PaO. 2 At end of procedure one lung ventilation 32 [32.0%] of the patients from group-A and 91 [91.0%] from group-B had normal PaCO. 2 The execution of one-lung ventilation still constitutes a challenge in clinical and surgical practice
ABSTRACT
To compare the, post op analgesia, vomiting, shivering, length of hospital stay, peri-operative haemodynamic changes and recovery time in patient under going open cholecystectomy under general anaesthesia versus those receiving epidural anaesthesia. Quasi experimental study. Combined Military Hospital Rawalpindi from 15 October 2007 to 15 April 2008. American Society of Anaesthesiology [ASA] physical status [PS] I and ll patient of either gender undergoing un-complicated open cholecystectomy were randomly divided into two groups, group A [n=30] received general anaesthesia [GA] and group B [n=29] received thoracic epidural anaesthesia [EA], Patients of both the groups were assessed for peri-operative haemodynamic changes, recovery time, post op analgesia, vomiting and length of hospital stay. Chi-square test was applied to compare the two groups and obtain P-value. P-value of less than 0.05 was considered significant. 9 out of 30 patients [30%] of group "A" [general anaesthesia] and 4 out of 29 patients [13.79%] in group "B" [epidural anaesthesia] had vomiting. Shivering was seen in 3 out of 30 [10%] in group "A" [general anaesthesia] and 1 out of 29 [3.44%] patient in group "B" [epidural anaesthesia]. Urinary retention was seen in 1 out of 30 [3.33%] in group "A" [general anaesthesia] and B out of 29 [27.5%] in group "B" [epidural anaesthesia]. Urinary retention was relieved by psychotherapy. None of the patient required catheterization. Post operative recovery from surgery was determined by gastrointestinal motility [passage of flatus and start of oral sips]. ln group "A" [general anaesthesia] 6 patients [20%] started oral sips in first post operative day, 16 patients [53.33%] on second post operative day, 8 patients [26.66%] in third post operative day. ln the group "B" [epidural anaesthesia] 13 patients [44.8%] started oral sips on first post operative day, 15 [51.72%] on second post operative day and one patient [3.44%] on third post operative day. Regarding the length of hospital stay 17 patient [56.66%] of group "A" [general anaesthesia] were discharge by third post operative day and 22 patient [75.77] were discharge by third post operative day in group "B" [epidural anaesthesia]. The use of intra-operative epidural anaesthesia combined with postoperative epidural analgesia was found to be associated with reduction in the post operative pain and vomiting in patients undergoing open cholecystectomy.
ABSTRACT
To compare the analgesic effect of commercially available premixed injection of lignocaine 2% and adrenaline in 1:100,000 dilution with that of freshly prepared solution by mixing adrenaline in suitable quantity to 2% plain lignocaine just before the time of injection for tooth extraction in patients of dental caries. Descriptive Interventional Study. Armed Forces Institute of Dentistry [AFID] Rawalpindi from March 2006 to August 2006. Patients and A total of 50 patients of dental caries, who were scheduled for tooth extraction, were divided into 2 groups of 25 each. Group A was provided analgesia with commercially available premixed injection of lignocaine and adrenaline and group B was provided analgesia with freshly prepared solution of plain lignocaine and adrenaline. In group A, good quality analgesia sufficient enough for tooth extraction, was achieved in 19 patients whereas in group B good quality analgesia was achieved in 23 patients. Freshly prepared mixture of plain lignocaine and adrenaline gives better analgesic effect than that of commercially available solution of lignocaine with adrenaline
ABSTRACT
Pain following surgery is a universal phenomenon; it is often underestimated and undertreated. Epidural analgesia is considered to be the best method of pain relief after subcostal cholecystectomy. Epidural is effective technique that offers comparable analgesia and better side effect profile. Quasi Experimental study. Jan2010 to June 2010. Military Hospital Rawalpindi. This is a prospective, randomized control trial. The main objective of this study was to compare the number of rescue doses for postperative pain relief, after subcostal cholecystectomy under epidural anesthesia, in patients receiving continuous epidural infusion of bupivacain 0.125% with those receiving intermittent boluses. Thoracic epidural catheter was placed for post operative pain relief. Patients were divided into two equal groups. Patient receiving continuous epidural anaesthesia were placed in group A and those receiving intermittent doses were included in group B. Purposive [non probability] sampling. Patient who received intermittent boluses [group B] required less rescue doses of nalbuphine as compared to the patients who received continuous infusion of 0.125 bupivacain. Intermittent boluses of 0.125% bupivacain are considered a better method of postoperative pain relief than continuous infusion of 0.125% bupivacain
ABSTRACT
To compare the postoperative pain relief and vomiting and the length of hospital stay in patients undergoing open cholecystectomy under general anaesthesia versus those receiving thoracic epidural anaesthesia. Quasi experimental study. The Combined Military Hospital, Skardu, from February 2009 to July 2010. American Society of Anaesthesiology [ASA] physical status [PS] I and II patients of either gender undergoing un-complicated open cholecystectomy were randomly divided into two groups, group 1 [n=51] received general anaesthesia [GA] and group 2 [n=49] received thoracic epidural anaesthesia [EA]. Patients of both the groups were assessed for postoperative pain, vomiting and length of hospital stay. Chi-square test was applied to compare the two groups and obtain the p-value. P-value of less than 0.05 was considered significant. Thirty six patients of GA group did not require additional analgesics for postoperative pain relief; however, injection Ketorolac had to be administered to 15 patients [29.4%] for pain relief in the postoperative period. Two patients [4.1%] in the EA group required additional analgesic during that period. Eleven patients [21.5%] in the GA group had postoperative vomiting. In the EA group only 1 patient [2%] had postoperative vomiting. Patients in EA group had better postoperative pain relief [p = 0.001] and remained free from vomiting than the GA group [p = 0.003]. Thirty six patients [70.5%] of the GA group and 34 patients [69.4%] in the EA group were discharged within 36 hours postoperatively [p = 0.896]. The use of intra-operative epidural anaesthesia combined with postoperative epidural analgesia was found to be associated with reduction in the postoperative pain and vomiting in patients undergoing open cholecystectomy
ABSTRACT
Negative Pressure Pulmonary Oedema [NPPE] immediately after general anaesthesia is a rare but life threatening complication, caused by an increased fluid in the interstitial spaces and alveoli due to forced inspiratory efforts against tightly closed glottis. Once developed, it impairs gas exchange and causes hypoxemia and if not treated promptly may lead to respiratory failure. Management involves maintaining airway, diuretics and positive pressure ventilation. Affected cases recover completely with appropriate treatment but death may occur if treatment is delayed. We present here three cases that developed post-extubation NPPE after short spells of laryngospasm. All of the three cases recovered completely after management with diuretics and venitlatory support with added PEEP