Comparison of lidocaine vs lidocaine + ketorolac in intravenous regional anaesthesia [bier's block]

To compare the duration of anaesthesia and degree of analgesia during intravenous regional anaesthesia using Lidocaine alone and Lidocaine with Ketorolac. An international quasi experimental study. This study was carried out in Nishtar Hospital Multan from 01/01/2006 to 30/06/2006 [6 Months]. Results: Patients were divided into two groups A and B. In group A injection Lidocaine 0.5% 40ml was given whereas in group B injection Ketorolac 30mg was add to Lidocaine 0.5% 40ml. The degree of anaesthesia and duration of analgesia were compared in both groups. Haemodynamics were also recorded to see any systemic effects of drugs. We conclude that 30mg Ketorolac added to Lidocaine in IVRA increases degree of anaesthesia and also provide prolonged postop analgesia

Difficult ventilation in a patient after Endotracheal intubation: an unusual manufacturing defect in E.T.T. connecter

Airway resistance depends upon the diameter of endotracheal tube [E.T.T] and other respiratory organs. Actually resistance to flow through a tube increases up to sixteen times if diameter is reduced to half of the original size. Disposable E.T.T which are currently used in anaesthesia practice are made up of P.V.0 with a connecter which is fitted on proximal end of endotracheal tube and proximal end of connector is attached with breathing circuit. Usually the internal diameter of connector should be equal to internal diameter of endotracheal tube. In the market, tubes of different manufacturers and of different sizes are available for all age groups. In developing countries like Pakistan, hospital administration usually purchases the endotracheal tubes and other equipments which are relatively cheaper because of lack of funds. Here we present a case where there was a manufacturing defect in E.T.T connector with a very narrow internal diameter that was causing severe respiratory obstruction in a child undergoing laparotomy. We conclude that the anaesthetists must keep in their mind the possibility of E.T.T connector manufacturing defect if they face problem of increased airway resistance in an intubated patient after excluding other possibilities of high airway resistance

Experience of ureteric obstruction following ESWL and its management

One hundred consecutive patients with radiopaque renal stones size ranging between 5 to 35 mm were included. Prior to ESWL treatment double J ureteral stent was inserted in all patients [n=23] who had stone size over 20 mm to prevent risk of ureteric obstruction. Renal ultrasound and x ray KUB were required in every patient at each follow up to assess pulverization, steinstrasse and hydronephrosis. Overall ureteric obstruction due to steinstrasse was noted in 16 patients [16.0%]. The incidence of steinstrasse was 15/77[19.4%] when stone size was 5 to 20mm while it was 1/23 [4.3%] when stone size was above 20mm with double J ureteral stent in place. Adequate pulverization for clearance was 0% at the end of 4 months in the patients with stone size over 20mm. In 3 unstented patients ureteric obstruction was complicated with fever, nausea, vomiting and moderate to severe colic and hydronephrosis and uncomplicated in remaining 13 patients [1 stented and 12 unstented]. Double J ureteral stent was costly and associated with complications like frequency [34.8%], urgency [30.4%], lumber pain [39.1%], bladder pain [34.8%] fever [34.8%], burning micturition [8.7%], difficulty in walking [8.7%]. For complicated ureteric obstruction following ESWL in 5-20 mm size stones PCN and repeat ESWL is recommended in preference to double J stent wich is associated with a high morbidity. ESWL should not be offered to patients with stone size more than 20 mm.

comparative study between isobaric and hyperbaric subarachnoid block for hip surgery

Isobaric bupivacaine or hyperbaric cinchocaine was injected intrathecally in two groups of 30 patients each. Group I received hyperbaric cinchocaine 1.5 ml, group II received isobaric bupivacaine 3.5 ml. These patients were operated upon for hip surgery. The time of onset of analgesia was slightly less in group I than in group II. After subarachnoid analgesia, changes in heart rate, degree of hypotension and respiratory rate were similar. The longer duration of action of bupivacaine was advantageous in the recovery period, resulting in significant reduction in the requirement of post-operative doses of analgesia. Isobaric bupivacainc proved a better local anaesthetic agent for spinal analgesia for hip surgery